Should I Ultimately Decide Based on Cost?

[anon172]

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[Cyberdyne 101]

I don't think SDN is going to help much with this 11th hour decision. What schools are you referring to anyway?

 

[anon172]

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[Cyberdyne 101]

Yeah I know but I figured it was worth a shot..
SUNY Upstate and Quinnipiac

45k is certainly not an excessive price to pay for a better fit imo. In fact, you indicated that it was significantly better. Why not go with Quinnipiac?

 

[Mansamusa]

Yeah I know but I figured it was worth a shot..
SUNY Upstate and Quinnipiac

What are your goals? Is Upstate the cheaper school? Because, personally, that is the one I would choose.

Whether or not the debt is worth, imo, is based on which specialties you are considering (ie. $45K extra to go into primary care can be quite a burden in the end). And I would definitely take into consideration the fact that Upstate has a good match list, with a wide variety of subspecialty placement, and an academic center. But if you think the fit of Quinni will enhance your performance, then maybe it is worth the extra money.

 

[Mansamusa]

@gonnif In regards to the last line of OP post, because I don't want OP to accidentally get their acceptances withdrawn: Is it too late for OP to ask Quinni's financial aid office for money? Do all decisions need to be dropped by Monday or does OP still have Monday to work things out?

I also don't know what OP means by forfeiting both deposits because that would mean withdrawing all acceptances...

 

[anon172]

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[DrBowtie]

Do not base this decision on cost. Take it out of the equation and make your decision on that. I know for someone right out of the college, the numbers of savings seems enormous as does the cost and debt overall, but I will tell you, it will not matter nor even seem important 10-20 years now. Just take money out the consideration.

By the same token, the soft reasons for choosing between schools will not matter nor seem important 10-20 years from now either, so I'll take a new car.

 

[anon172]

@gonnif I followed my heart and not my wallet 😉

 

[mw18]

@gonnif I think it's refreshing that you suggest to take money out of the consideration. So many people on SDN tell prospective students to make their decision based purely on the money. I know you say if it's less than $100k then don't let it affect you. How far would you personally recommend to let it go, money-wise? Is $1ook near the limit? I'm asking as someone who went with love over money last year, so I agree with you. But I am curious as to what you think.

 

[DrBowtie]

I think that most premeds look at a single factor for a single absolute answer or metric, such as GPA and MCAT scores, and do not look at things in a nuanced way to make an informed and intelligent overall judgement including all factors. Cost, loans and debt for medical school are no different in this regard, perhaps even more because few premeds/acceptees have experience in how they work, what the impact will be over time, and generally overwhelmed by the sheer size of the numbers. So let me explain my very crude rule of thumb and how every acceptee can do this for their own proposed loans in 5 minutes.

Each year you get a new loan, and from the day the school disperses the money until deferment period end (6 months after graduation) you get simple daily interest applied. That is just amount of yearly interest broken down in daily amounts and added up. At the end of the 6 month deferment the interest is capitalized into a new principal (ie becomes the new total loan amount as you essentially borrowed the interest money you now owe). You will have multiple loan sources (stafford, gradplus, direct/private) and may have a few equations per year but I will give you an example with private with $25,000 ($25K) and 6% interest rate as this will represent the difference in loans. But you can use you the full loans amounts for an estimate if you want. This assumes dispersing in September year 1 and you graduate June year 4 starting repayment September year 4. Hence I have 12 month loan increments (this is a 3 month deferment you can go to 6 months, just easier for this example calculation)

Example: $25,000 tuition difference per year borrowed at 6%
year 1 $25,000 + $6,000 (48 months interest) = $31,000 capitalized
year 2 $25,000 + $4,500 (36 months interest) = $29,500 capitalized
year 3 $25,000 + $3,000 (24 months interest) = $28,000 capitalized
year 4 $25,000 + $1,500 (12 months interest) = $26,500 capitalized

Total loans capitalization 3 months after graduation is $115,000
So total difference of the tuition would mean $115,000 when you graduate

But what does this mean? If you dont estimate or model what the conditions will be for paying it back, it just be an enormous number.
Lets assume conservatively that you are in primary care which has an current average salary of $195,000. Also remember that your salary will increase as your career goes on but the cost of what you borrowed remains the same. In essence, the cost of borrowing becomes a decreasing percentage of your income and thus becomes "cheaper" to payback as you move forward in time.


Just to give example of what this would cost to pay back over 25 years at 6% interest (see below) would be $740.95 a month or just under $8,900 a year or 4,5% of a current primary care average salary. I think under $10,000 a year in payback cost is nominal in the grand scheme of things, and interests rates are going up (I think this year is around 7%), payback lengths can vary, etc. I use $100,000 difference in 4 years tuition as my rule of thumb in using money as a major factor in deciding on which acceptance to take. I think location, living style, cost of living, needing a car, curriculum style, facilities, etc are all much more important in making your decision


http://www.finaid.org/calculators/scripts/loanpayments.cgi
Loan Balance: $115,000.00
Adjusted Loan Balance: $115,000.00
Loan Interest Rate: 6.00%
Loan Fees: 0.00%
Loan Term: 25 years
Minimum Payment: $50.00
Monthly Loan Payment: $740.95
Number of Payments: 300
Cumulative Payments: $222,282.65
Total Interest Paid: $107,282.65

Obviously its a personal decision, but I disagree STRONGLY. You are putting a price tag on soft "feels" like location, diversity, curriculum. That price tag is 222k or equivalent in your example to over a whole years salary. Your bolding of the lower monthly payment is purposefully minimizing the situation. This is all MARGINAL cost between two options when both have roughly the same result, an MD.

I'm shaking my head that anyone would recommend prolonged 25 year payment of a 6% debt. Remember, you'd still have an MD from the cheaper school. Many of the don't worry, you'll pay it off proponents are older physicians that had interest rates in the 2-3% range with much smaller principal amounts.

I think applicants actually view these large numbers with little concern rather than overwhelming feelings. When the base cheapest school is going to run ~150k, often that becomes the starting point and an extra 25k, 50k, 100k are not viewed with as serious consequence. They aren't viewed as a % of their base for the cheapest school. For example if school A is 150k and school B is 250k, School B better be 40% better to justify the expense. There are few schools that can objectively deliver that. If you have an absolute need to be in a certain location due to family or spousal restrictions then this might be worth the cost.

As I'm nearing the end of my residency, I can't think of a single time my residency classmates brought up how awesome their ______ was at their medical school, but its daily to weekly that people are talking about their debt, moonlighting opportunities to pay their debt etc.

 

[DrBowtie]

The original question on this thread "Should I Ultimately Decide Based on Cost?" And my answer to that is no. It should be a factor in consideration. Yes, any school you go to will provide an MD and residency. But you are also going to have to live, breathe, and work there for 4 years. They are not factors that should be overlooked. I simply use a rule of thumb that acceptees can consider and easily digest in the myriad of factors that comes down to a single decision. As you pointed out at the end of residency when you have had almost nothing but accumulating and service debt looks nothing but overwhelming. That is why I go thru a rational derivation so these emotionally overwhelming issue can be seen in realistic content purposely at 6% and 25 years. It is in a sense a most difficult case scenario. Where will this debt be in 10 years when your are an attending in a full practice? What percent of your salary will it be? Everything has to be estimated/modeled in some fashion and this one I have set up is reasonable.

Your opposite view that almost ONLY cost should be considered seems extreme and simplistic. Yes either case will make you an MD. But there is more to life than simply focus on costs.

I'm just pointing out that the stuff that people think differentiates schools become less and less important. That $740 payment you're still making 20 years from now so you could avoid PBL curriculum isn't going to be worth it.

 

[caffeinemia]

To answer your question - I don't think that cost -- at your differential -- should really matter. However, there is one thing that is more concerning about your more expensive school: the fact that it is brand new. My experiences with new schools has been that they are disorganized, have poor advising, and underwhelming matches. I can't speak for all schools, but I have enough friends in "new" medical schools and have "worked" with enough graduates from new schools to know. In a place like New York and the Northeast, I'd argue that your better bet would be Upstate.

I'm sure there will be people who will disagree with me, so take what you will from this.

 

[akwho]

46k is a "moderate" amount of money. It's not 100k, where you should definitely go to the cheaper school, and its not 20k where it's kind of a wash.

The most important question you need to ask yourself is where will YOU be most successful. To be successful you need to first and foremost be happy, then second you need institutional support & resources. I would argue that SUNY Upstate will have more institutional support & resources and is "moderately" cheaper. Therefore you should go to SUNY Upstate, unless you feel you will be significantly happier Quinnipac.


Also whatever you were sold on interview day... curriculum does NOT matter. You will self-study anyways for 90%+ of the material. Do not include curriculum structure in your algorithm for choosing a school, unless for some bizzare reason they aren't P/F for the preclinical years.