Resident Debt

[jmillski]

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hey residents- hope this thread doesnt get moved- it deals with residency issues.

im curious as to how you all feel about your debts now that you are facing them. do any of you regret your previous choice of medical school even if it was a great experience? how are the debts effecting you emotionally and financially?

(i am trying to decide between school i love with fair amount of debt and one im not excited about with a little debt)

thank you!

 

[dragonfly99]

No I don't regret becoming a doctor.
I am pretty sure I would have gone to a cheaper school, rather than the expensive private one I attended, if I had it to do over. I would have had about 50k less debt at the cheaper school...that become >>50k when you count all the interest you have to repay.

What is the cost difference between the two schools, and what is their general quality (your assessment)? Is there any clear advantage to going to the more expensive school, in terms of your career? Are you sure you'd be happier at the more expensive school? Is there something about the cheaper school that gives you a really bad feeling, or is just that the expensive school wowed you a little more on your interview day and you have a nebulous feeling it will be "more fun" or "better". In general, fun is not a word I would use to describe med school and wherever you go, you are going to spend a ton of time holed up studying and sometimes feel ground down. Also, keep in mind that med school teaching is rather standardized so despite what the schools say, they end up teaching you very similar things and often in similar ways.

You can tell I'm a little biased, and it's your choice to go to a really expensive school vs. other one, but if you don't think your debt will have an effect on your future lifestyle and general stress level, I don't think you are right (particularly if you are talking about 120-150k or less debt vs. debt of 200k or more).

 

[John Deere Gree]

I don't regret becoming a doctor either.

I had the choice between in-state and out-of-state and choose my in-state school because I didn't need any more debt than necessary. At the end of four years you are going to be a doctor, regardless of what school you choose to attend.

As far as emotionally and financially...

Emotionally it hasn't been an issue. I do feel sorry that my wife married into a boat load of debt (just med school debt).

Financially I own a nice house minus the house. The debt is there, it will get paid off eventually. When that occurs, I dunno yet since I'm not out of residency and don't know exactly what I'll make. I feel that even with the boatload of debt, and with my continued fiscal responsibility, I'll be able to support my family and myself and live comfotably for rest of my life. Will I own a $20 million mansion? No, but I'm completely ok with that.

 

[ohai647]

There is a new loan repayment program called Income based repayment (IBR) which make the process of repayment a lot easier to handle. Plus, if you work in an academic or non-profit hospital (501c3) you can have your loan forgiven after 10 years of payments.

http://www.ibrinfo.org/

 

[dynx]

There is a new loan repayment program called Income based repayment (IBR) which make the process of repayment a lot easier to handle. Plus, if you work in an academic or non-profit hospital (501c3) you can have your loan forgiven after 10 years of payments.

http://www.ibrinfo.org/

1. How did trusting the rules to remain the same work out for people planning on defering thier loans during residency? It didn't, these laws can be changed at any time, expecially since the hard start date is clearly known (10 years) and the clear cost of this program will be apparent.

2. What do i do if I'm smart and on the board at a medical school? Jack up tuition. Don't worry, uncle sam will pay for that! Or will he? You're going to see tuition rise because of this...period. Whats more, these medical schools are affiliated with university hospitals...what will they do?...

3. What do I do if Im smart and run a non-profit/academic hospital (when my affiliated medical school is done raping you that is)? Sign you on with a contract that expires a year before your elegibility is up. You had a 4 year residency 2 year fellowship. Here's your 3 year contract. Now try to renegotiate...I'll offer you a 10 year contract low-balled salary with a non-compete clause. Don't like my terms? Go get a public sector job and pay that debt that's been accruing interest, and while you're at it move you and your family out of the area. And good luck getting a better job at a non-profit...they can read you know. They know they have your ass up against a wall too.


You didn't think they were just going to let you have all that money did you? There are lawyers and accountants working this law into the business models of hospitals/medical schools etc. as we speak.

Oh yeah, this is going to make it a lot easier to pay down your debt. All you'll have to do is pay higher tuition and make a lower salary! YAY us.

 

[ohai647]

1. How did trusting the rules to remain the same work out for people planning on defering thier loans during residency? It didn't, these laws can be changed at any time, expecially since the hard start date is clearly known (10 years) and the clear cost of this program will be apparent.

2. What do i do if I'm smart and on the board at a medical school? Jack up tuition. Don't worry, uncle sam will pay for that! Or will he? You're going to see tuition rise because of this...period. Whats more, these medical schools are affiliated with university hospitals...what will they do?...

3. What do I do if Im smart and run a non-profit/academic hospital (when my affiliated medical school is done raping you that is)? Sign you on with a contract that expires a year before your elegibility is up. You had a 4 year residency 2 year fellowship. Here's your 3 year contract. Now try to renegotiate...I'll offer you a 10 year contract low-balled salary with a non-compete clause. Don't like my terms? Go get a public sector job and pay that debt that's been accruing interest, and while you're at it move you and your family out of the area. And good luck getting a better job at a non-profit...they can read you know. They know they have your ass up against a wall too.


You didn't think they were just going to let you have all that money did you? There are lawyers and accountants working this law into the business models of hospitals/medical schools etc. as we speak.

Oh yeah, this is going to make it a lot easier to pay down your debt. All you'll have to do is pay higher tuition and make a lower salary! YAY us.

Well I was simply trying to make the point that its probably the best option rather than forbearance in which your interest will continue to accrue, and rather than making standard payments which are too costly for us during residency. I didnt say it was the greatest thing or that anyone is giving me money...just that out of all options its doable for many of us.

But I guess I should speak for myself since my post obviously ticked you off...

And btw dynx, lawyers are going to continue to be parasites- that will never change, especially with Obama and the dems in power. So if you want to change the economic reality for the medical community you should advocate with the AMA and other organizations instead of taking out your frustrations on posters of SDN.

 

[drsarah82]

There is a new loan repayment program called Income based repayment (IBR) which make the process of repayment a lot easier to handle. Plus, if you work in an academic or non-profit hospital (501c3) you can have your loan forgiven after 10 years of payments.

http://www.ibrinfo.org/

I've heard of this and think it would be a great program, if it actually works out. Thanks for the website, I signed up for the webinate to get more info.

 

[listeriaismfb]

I for one am not counting on a federal program which may or may not exist by the time I need it to help me with my debt. I'll keep it in mind & it would be nice but I'm not holding my breath.

I went to my state school for undergrad & med school. My education debt is six figures and the first digit is a 1. I REFUSED to go into deferrment during residency. I did not want to borrow an additional red cent towards my education; deferrment is the equivalent of borrowing more money because interest accrues/capitalizes on the unsubsidized portion of your loans. We paid interest only for four years and I just received the 1% break on my rate.

I feel that my debt is managable, and I do not generally regret becoming a doctor. I have my moments where I fantasize about saying "f-this" but the fact is I generally like what I do and I can't imagine doing anything else. The daily doses of BS are why they call it a "work" and not "super happy fun time".

 

[dragonfly99]

I for one am not counting on a federal program which may or may not exist by the time I need it to help me with my debt. I'll keep it in mind & it would be nice but I'm not holding my breath.

I went to my state school for undergrad & med school. My education debt is six figures and the first digit is a 1. I REFUSED to go into deferrment during residency. I did not want to borrow an additional red cent towards my education; deferrment is the equivalent of borrowing more money because interest accrues/capitalizes on the unsubsidized portion of your loans. We paid interest only for four years and I just received the 1% break on my rate.

I feel that my debt is managable, and I do not generally regret becoming a doctor. I have my moments where I fantasize about saying "f-this" but the fact is I generally like what I do and I can't imagine doing anything else. The daily doses of BS are why they call it a "work" and not "super happy fun time".

This is a great post. I agree.

I kind of agree with dynx too, although what he/she posted came across a bit harsh.

 

[yaah]

With only one month left to go until I finish fellowship and start my real job, the biggest pieces of advice I would give any future med student are 1) make sure you really want to by a physician (and you aren't doing it because you're "supposed to" or you can't think of anything else you want to do more or you think it will compensate you the best); and 2) Minimize your debt as much as possible. Do not take out more debt to go to a "better" school, because "better" is essentially arbitrary and does not impact your training. Even if it does, it is far less important than your own performance and motivation, which will likely be improved if you have less debt.

I get queasy to this day when I hear people turning down a good state school, or a good private place with lots of scholarship money, to go to their "Dream" school or the "more prestigious" school for reasons which they cannot really describe, which are at best stretching the truth and at worst farcical abstractions. In the end, med school is like high school, it's a few years of your life which is part of a transition towards your real life. Your purpose should not be to make those four years of your life the greatest, your purpose should be to use those four years to make the remainder of your life as fulfilling as possible. You can do this by 1) studying hard; 2) minimizing your debt; and 3) leaving both your ego and your insecurities at the door when you enter med school.

 

[listeriaismfb]

I really liked the high school analogy Yaah used; I found it very fitting.

Once you become a resident, where you went to medical school becomes much less important. As a resident, for the most part no one is going to care where you graduated from as long as you do your job and do it well.

 

[anesthesiadoc]

I found myself in a similar situation. A physician who I was doing research for at the time advised me to choose the school that had the better academic ranking, and not to let money make the decision for me. I'm very glad I did.

For certain, some specialties and residency positions are easier than others to match into, but for the most part, the match is no picnic. The more competitive an applicant you can make yourself, the better. Whichever medical school you attend, the amount of effort you put into both the preclinical studies and your clinical years will be paramount, affecting your letters of recommendation, your boards preparation, etc.

Whether the actual clinical education is better at one school versus another has any correlation to the US News rankings, probably not. However, applicants from that list of upper tier medical schools do have an easier time getting interviews at the more competitive residencies. I didn't want the added pressure (perceived or actual) of having to be at or the top of my medical school class, or need a USMLE Step 1 >230 in order to be considered for interviews at the programs I was interested in.

So here I sit, with a couple of letters sitting on my desk in my tiny studio apartment. The first is yet another monthly reminder of my $200,000+ debt, reminding me to resubmit the forbearance paperwork to defer through another year of indentured servitude, all the while watching interest accrue. I'm okay with that. Because the second is the invite to interview at my top choice for a very competitive fellowship.

Do you need to go to an academic Mecca to have things work out and get the job and residency you want? No. Might it help? Yes.

 

[dragonfly99]

I agree with yaah.
Unless you are going for and MD/PhD and/or want to be a bench researcher, I don't think it is worth the $$ to go to one of the expensive private schools, even if it has a higher ranking than another, cheaper school that you were accepted to. Of course, everything is relative. If you get accepted to Harvard and it's going to cost you $5k/more per year, vs. another school that you got into that is somehow bottom of the barrel (terrible neighborhood, on probation from the powers-that-be, etc.) then yes, pay the 20k extra to go to Harvard. But most cases are not like that. Most cases where students are making this choice are something like, "Should I got to my state school, or should I pay $20k/more or 25k/more per year to go to this mid-tier private school that served better bagels on the interview day and seemed to have 'cooler' extracurricular activities?" And I would honestly question whether it IS worth that amount of extra money to attend somewhere like Georgetown/GWU/BU/Mt Sinai/insert other private school.

I also think that people forget that it may be harder to be AOA, or at least in the top 25-30% of the class, at a very competitive medical school vs. a lower tier one. A student who is AOA at a mid or lower tier school is likely to do just as well, or better, in the match as a student buried in the middle of his/her class at somewhere like Johns Hopkins or Washington U. I think there is no absolute right or wrong answer that we can offer up to every potential med student about which type of school to attend. Anyone with multiple med school admissions offers is definitely fortunate. I do think that depending on one's level of debt and perhaps personality type, the debt load is something that can affect performance in med school and residency, though...the stress of knowing one has this huge debt load hanging there, and/or of trying to pinch pennies on little things like shopping for clothes, etc. can add up over time.

 

[VMSmith]

I went to my state school and have about $150k in debt, which I am comfortable with. If I had gotten into a top 20 or 30 school I probably would've gone, even if it had cost more. I also was advised to go to the best school I got into without regard to cost.

With the benefit of hindsight, I'm glad I didn't have the option, because things have worked out well for me so far and I have far less debt. But when you don't yet know what's going to happen, I think there's something to be said for the peace of mind knowing that you've kept every door open. I do believe that students from upper tier schools do have a slight advantage in getting interviews at certain residency programs. However slight that advantage might be, an advantage is an advantage.

If I had to do it all over again, and could've gone to any school, the only way I would be willing to go into >$200k in debt (remember, you need to factor in living expenses as well) would be to go to a top 10 school.

For the OP, I think your decision is not an easy one, and you need to ask yourself a few questions. Why do you love one school and not the other? If your love is based on factors like "atmosphere" or the students you met on your interview day/second look, or the preclinical curriculum, I'd suggest that you might want to rethink that...I think it takes several months before you really know what a school is like, and the preclinical curriculum doesn't really matter all that much. If you feel that the more expensive school is highly regarded enough that it will help you in the residency application process (and I think the list of schools that do provide an advantage is a pretty short list, and also depends on geography) then it may be worth it.

Edit: Apparently I've replied to one of your posts before haha. Again, if it were me, I'd go to UNC in a heartbeat and see that you've made the same decision. And your friend who turned down a full ride at UMich to pay full tuition at Vandy made me want to bang my head against a wall...

 

[listeriaismfb]

There are opportunity costs here. If the $$$ is going to student loans it is not going to something you might be more interested in. Real life example. I have 100k in student loans. I'm in a job I don't like, and a better offer out of state came along. Since I currently live in a state that is 5th in the nation in foreclosures if I take the new job I will likely be holding the note for my house for a long time. I can take the new job, buy a new house, and hold the note on my old house indefinitely because my student loans are not prohibitive. I'm not so sure I would be able to pull all of this off if I was sitting on 300k in medical school debt - debt could effectively lock me into my current job. Can you say trapped rat?

Will the big name school help you land residency interviews, sure, but how much it will help you in the grand scheme is the question. Wherever you go, work hard & do well. Your goals in medical school should be to learn for your patients' sake, be the finest medical student you can be, and land the best residency you can get into. You will be judged by what you've done most recently, and if medical school was to be the end of the line for you I would say that it does matter quite a bit. But it's not going to be the end of your training, you'll have residency & possibly fellowship too.

I believe that in exchange for prestige I bought long term flexibility. You need to decide what matters more to you.

 

[dragonfly99]

Having big student loans can affect other things down the line as well, like being able to get a loan to buy a house, etc. I only have about 120k left and it's still kind of a problem. I don't think it should deter anyone from going to medical school, but your level of debt is definitely going to affect your future lifestyle and some of the choices you have about where and how to live.

 

[Ashers]

I turned down my state school to go to a more expensive private school. The main reasons was that I knew I'd be miserable there after my interview (due to the location and curriculum). I hoped I'd get rejected, and I got accepted.

I do not regret going to the more expensive school. Sure I've got more debt, but unlike people, I have very little undergrad debt. (I went to the cheapest school, and I was miserable for 3/4 years -- I didn't want to repeat that).

Affecting me financially... have to talk to my financial adviser to see how to deal with it, but I think I generally live within my means; I may have to cut back on a few things though.