Spiraling about med school debt

[deleted1216916]

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More of a vent than an actual question because I have no one I can speak to about this I guess. I grew up in a family where inheritance took on the form of generational trauma for poverty. Like, not flushing until after taking the piss 2-3 times to keep our utility bills down poor.
Flash forward, I somehow made it through undergrad thanks to generous financial aid and am now facing medical school after getting one acceptance by the skin of my teeth (I had high stats but lousy ECs, mostly in the form of low volunteering, partly because I was working throughout college and partly because I make poor decisions). But the one school I got an acceptance to doesn’t offer grants, only loans. So after a lifetime of saving like my life depends on it, I’m now looking at about $400k in tuition total, more if you count interest. To add to the cosmic joke, the powers that be have decided that this year is the time to pull the plug on federal loans.
I know that this is my ticket out of this life and the only way I can climb the social ladder. I am aware that this is an opportunity that many people never get, and I am extremely grateful to be in this position. However, at the risk of sounding bitter, petulant, self-pitying, and ungrateful, I can’t help but beat myself up that I should have done better, done more to get a good merit scholarship or into a more well-endowed school that offers need-based grants, like many of my peers did.
Apologies for this abomination, I just need to get it out of my system because I probably won’t have time to panic over this once school starts. I’ll get therapy once I can spare anything from my paycheck after paying off loans.

 

[Mr.Smile12]

More of a vent than an actual question because I have no one I can speak to about this I guess. I grew up in a family where inheritance took on the form of generational trauma for poverty. Like, not flushing until after taking the piss 2-3 times to keep our utility bills down poor.
Flash forward, I somehow made it through undergrad thanks to generous financial aid and am now facing medical school after getting one acceptance by the skin of my teeth (I had high stats but lousy ECs, mostly in the form of low volunteering, partly because I was working throughout college and partly because I make poor decisions). But the one school I got an acceptance to doesn’t offer grants, only loans. So after a lifetime of saving like my life depends on it, I’m now looking at about $400k in tuition total, more if you count interest. To add to the cosmic joke, the powers that be have decided that this year is the time to pull the plug on federal loans.
I know that this is my ticket out of this life and the only way I can climb the social ladder. I am aware that this is an opportunity that many people never get, and I am extremely grateful to be in this position. However, at the risk of sounding bitter, petulant, self-pitying, and ungrateful, I can’t help but beat myself up that I should have done better, done more to get a good merit scholarship or into a more well-endowed school that offers need-based grants, like many of my peers did.
Apologies for this abomination, I just need to get it out of my system because I probably won’t have time to panic over this once school starts. I’ll get therapy once I can spare anything from my paycheck after paying off loans.

Did you fill out our Spring 2026 Applicant Experience Survey? We have been trying to document how applicants and incoming students' attitudes have changed with the changes in the financial aid landscape. If you didn't, it's a shame that your feelings aren't part of our analysis that we cannot advocate for you better. We can't hear your voice if you don't speak out early.

We have pushed out articles and videos over the year about these challenges for current and incoming students. At some point, you have to take a practical approach. And you have to vote.

 

[Moko]

More of a vent than an actual question because I have no one I can speak to about this I guess. I grew up in a family where inheritance took on the form of generational trauma for poverty. Like, not flushing until after taking the piss 2-3 times to keep our utility bills down poor.
Flash forward, I somehow made it through undergrad thanks to generous financial aid and am now facing medical school after getting one acceptance by the skin of my teeth (I had high stats but lousy ECs, mostly in the form of low volunteering, partly because I was working throughout college and partly because I make poor decisions). But the one school I got an acceptance to doesn’t offer grants, only loans. So after a lifetime of saving like my life depends on it, I’m now looking at about $400k in tuition total, more if you count interest. To add to the cosmic joke, the powers that be have decided that this year is the time to pull the plug on federal loans.
I know that this is my ticket out of this life and the only way I can climb the social ladder. I am aware that this is an opportunity that many people never get, and I am extremely grateful to be in this position. However, at the risk of sounding bitter, petulant, self-pitying, and ungrateful, I can’t help but beat myself up that I should have done better, done more to get a good merit scholarship or into a more well-endowed school that offers need-based grants, like many of my peers did.
Apologies for this abomination, I just need to get it out of my system because I probably won’t have time to panic over this once school starts. I’ll get therapy once I can spare anything from my paycheck after paying off loans.

First off, congratulations on your acceptance! The cost of medical education is certainly daunting, but as a physician, you will be able to pay it off if you live frugally as an attending. Even in internal medicine working in academia (double whammy in terms of pay) where I was "only" making ~$200k, I was still able to put $100k towards a combo of savings and loan repayments every year. The vast majority of physicians make significantly more (the median pay even in internal medicine, for example, is closer to $300k).

Depending on your interest rate and time horizon, it may require some sacrifices such as pursuing a non-academic career (typically more patients), performing more moonlighting, and/or practicing in a less desirable (typically rural) region especially early on. But debt can be managed even in lower paying specialties. Hope this helps alleviate some concerns.

Edit: there's also PSLF, though with the current political environment, it's unclear what will happen to this in the future. Joining the military will allow you to graduate debt free, but this typically does not make sense financially long term and going this route will also place many restrictions (e.g. specialty, location/lifestyle, etc.).

 

[Med Ed]

Congrats on getting in! Don't beat yourself up over not getting any scholarships. Those are by far the exception. Medical school is generally paid for the old fashioned way: loans or parents.

Play your cards right and 10 years after finishing residency you can be a debt-free millionaire. A few tips that can help you after you graduate and start practicing:

1. Don't be hellbent on living somewhere where the COL is utterly insane.
2. Don't buy the big house (yet). This also means you will not have to furnish the big house.
3. Don't buy the nice car (yet). Unless you're in a 1957 Jaguar XKSS, vehicles are depreciating assets.
4. Don't get divorced. By this I mean don't do anything that will get you divorced.
5. Don't act like an ATM for your family.
6. (Most important) Invest early and consistently. One of the phrases you may hear is "pay yourself first." This means on payday you shunt funds into your savings/retirement account(s) before tackling any expenses. In addition to building up your portfolio, this move helps to mitigate lifestyle creep (see points 1-3).

 

[Med Ed]

One more thing. I did not fully wrap my head around the power of compounding interest until far too late in my own game. If you are trying to build wealth your biggest asset is time.

For example, if someone dropped $1,000 in the S&P 500 in 1980 and then forgot about it, it would currently be worth ~$206,000.

 

[deleted1216916]

Thank you to everyone for kindly indulging me and for the great tips, I’ll commit your advice to heart.
I’m desperately hoping to overcome these feelings before classes start so that it doesn’t affect my performance in school. The more rational part of me recognizes that this debt probably won’t shape my entire life trajectory, but I guess at the moment it’s distressing for me to accept that I’ll need to spend more money than I have in my entire life before I get the chance to earn anything. Shortsighted, I know, but I can’t fathom the idea that it’s possible to earn enough money to pay this off.
On the bright side, being able to invest and buy a house and car of my own sounds like a dream! I’ll try my best to keep that vision in mind and invest wisely in the future.

 

[Mr.Smile12]

Also, many schools have scholarship funds to appropriate after you have a record of academic performance. In other words, have a laser focus on doing well, and make sure your accountability group of peers has your interests in mind (and reciprocally). Read the threads here about succeeding as a medical student. Keep checking in with financial aid, and look out for your local options (near your hometown/family/identity group).

I see many professional groups focused on supporting physicians who identify within their own identity group. The amount of money may vary, but every small amount helps.

 

[eyeeye_captain]

Two resources that should be helpful are your school’s financial aid office (you’re helping pay those folks’ salaries after all) and White Coat Investor. WCI tends to run pretty conservative/debt averse which sounds like your speed.

A 1:1 debt to income ratio is generally quite doable, and it’s definitely not impossible to find a $400k job. Aggressive repayment can usually be 2-3 years. I think I was 20 months with a 1:1 and was so aggressive I actually got a refund check after my last payment. A 2:1 probably works out to 5 years.

Granted, nobody knows the the future of the loan market, so those timeframes may not work depending on the terms of your loans, but still doable as long as you don’t start getting big lifestyle creep.

 

[Mr.Smile12]

Pay attention the AAMC FIRST team as well. Here's their latest webinar.

Also, use the MLOC. Your financial aid team should give you a primer on this when time comes.

 

[WildWing]

You may be able to get this for free; I think some schools get copies that are handed out. Your med school career center/library may have a copy as well:

Amazon.com

(SDN affiliate link to White Coat Investor book)

 

[Tenk]

I was very poor growing up. I have found, as an attending, the people who grew up poor are usually the most cautious with their money. I paid off over $400,000 in debt in less than 4 years as EM. I also bought an house and a truck and went on plenty of vacations during that time. If you just live on 50% of your income and hit loans with the other 50% they will be paid off rather quickly. You don’t have to “live like a resident,” but you also don’t get to live like a baller either. Just try to spend as little now and work your ass off. It’ll work out.

 

[deleted1216916]

I really can’t express how grateful I am for all the encouragement and advice everyone has given. I didn’t expect much of a response at all, or to be met with dismissiveness or contempt if anything.
Given how notoriously rigorous and long medical training is, it’s currently difficult for me to look beyond the immediate horizon and be confident that someday my circumstances will change and I will be a physician like many of you, but I will do my best to remember the experiences that you all have shared and pursue these resources. I think it won’t be difficult not to let the money get to my head because like Tenk said, I have ingrained frugality to the point that spending any amount of money aside from keeping a roof over my head leads to feelings of intense guilt. But it seems that this will serve me well in the future, so onward it is. Do well in school, meet with financial aid, read the White Coat Investor, vote, and invest in the S&P 500.

 

[anon2]

I was very poor growing up. I have found, as an attending, the people who grew up poor are usually the most cautious with their money. I paid off over $400,000 in debt in less than 4 years as EM. I also bought an house and a truck and went on plenty of vacations during that time. If you just live on 50% of your income and hit loans with the other 50% they will be paid off rather quickly. You don’t have to “live like a resident,” but you also don’t get to live like a baller either. Just try to spend as little now and work your ass off. It’ll work out.

50% is a good guideline I tell everyone, since any attending can trivially live off of that portion of their (post-tax) income, which is 90%ile lifestyle - relative to the US no less.

Think bigger than just paying off debt (congrats on 4 years) - if you maintain the 50% savings rate, you'll be retired (FI/not need to work for money) in 20 years.

I had a 70% savings rate (upper middle lifestyle), and that was 10 years to retirement.

 

[Mr.Smile12]

Read

The OB3 Effect: How Loan Caps Hit Health Students

What is the OB3 effect on future doctors, dentists and vets? HPSA survey data reveals funding gaps and who is hit hardest.

www.studentdoctor.net