Student Loan Repayments--Fact or Fiction?

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MedSchoolFool

Shake Zula
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For those of you nearing the end of residency..how many employment offers have you had that included student loan repayments (SLR)? It would be great to know the details of the offers (how much per year? How much time do you owe in exchange? Are taxes paid on your behalf for the loan repayment portion of your salary?)

I'd just like to know if SLR is becoming a more common (or less common..:scared:) part of the compensation package. Also any opinions on how to go about negotiating this. Just now finishing PGY-1 year, so I'm a ways off from this....but SLR just doesn't seem to be talked about much where I'm at.

Bonus: It would be particularly great to hear about SLR offers for those going into CAP.

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I'm interviewing now and loan repayment offers seem to be more the exception than a trend. Lots of places that qualify for NHSC loan repayment also have their own programs- generally less attractive both in terms of amount and taxation- but jobs in/near metropolitan areas, not so much. NHSC repayment is really attractive because the money that's paid doesn't count as income, so $30,000 of tax free loan repayment is worth more like $40,000 of taxed repayment assistance. Some states have their own versions of the NHSC program, but many of those don't include psychiatry under primary care. Beware, the NHSC applies the same terms to the loan repayment as to the scholarship: they give the money at the beginning of service and if you quit early (minimum 2 year initial contract) you owe back triple the remainder, plus interest. Lots of rural sites would be happy to have a child and adolescent psychiatrist but don't have dedicated positions (i.e. you've got to treat all ages) and I haven't noticed any difference in the compensation offered for jobs that are purely child and adolescent versus mixed. On the bright side, the payments on consolidated loans are entirely manageable and because of the 30 year term, the payments aren't much worse for me than they were on my 10 year undergrad loans.
 
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I'm graduating this year and I will be starting at a hospital that is offering Loan Forgiveness. The location didn't qualify for NHSC, but a couple of places I interviewed at did. I have to pay the taxes on this, but it's a good deal and it's going to cover me as long as I stay at this place which is unique. Most places that I looked at offered me 3 years or something like that. The more remote the location the better the offer. My Salary offers for inpatient were all about 200,000 with Loan forgiveness and that didn't include incentives and additional pay for call, so my salary offers were in the 200s. Stay away from the cities like NYC or Boston and you'll do well. Negotiate too and you'll be surprised what you can get in regards to PTO, CME, call, etc.
 
Another factor is will the place of employment match retirement contributions? Several places will match up to 10% of what you put into retirement. For those of you who don't know how this works, I could put say 10% of my yearly salary into retirement and the employer could match it. You're doubling your retirement savings right there. That money is then put into an investment fund, and it could be tax free until you pull it out when retired.

Employers usually have strings attached such as you have to work at the place a certain number of years, and/or they'll match only up to a certain dollar amount.

Another beauty of this is that you're retired when you pull your money out, you're now in the bottom tax bracket. So instead of being in the top tax bracket when this money is taxed, you save more money there.

Look into this in addition to things such as loan forgiveness.

One more--some places will pay you lifetime benefits if you work for them a certain number of years. Several states and faculty positions are such that you work X number of years, you get lifetime health insurance among other benefits.
 
what r starting salaries like in nyc for someone coming out of residency, either inpatient or consult...150s-160s? In general, are inpatient jobs easier to find for new grads than pure consult jobs? seems like a lot of ppl go for inpatient at first.
 
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good question clement, but maybe for a new thread on salaries??
 
I've been out of the NYC area for some time but I've heard it pays lower and NYC has a higher cost of living and taxes vs. most parts of the country. I heard it's this way because NYC doesn't suffer the lack of psychiatrists most parts of the country have.

Someone in that area feel free to update and/or correct me.
 
Bump to any NYC or Boston interviewees with salary information. Less than 150K?
 
I'm just an MS4 here, but I do keep an eye out on the APA's job bank among others which has been a great way for me to (begin to) understand psychiatrists' compensation.

My findings are obvious, but I'll share them anyway in the hopes that other people are as clueless I was :)

Be really skeptical of the best paying jobs. I emailed two of the hospitals that had ridiculous starting salaries (over 250k), and it sounded like an awful setup: you would be the only full-time psychiatrist on an inpatient unit! They did not volunteer that information either. Ok so they weren't huge places, but still.

Rural jobs tend to have better compensation to include SLR, and all the gov't affiliated jobs seemed to always have it. The NHSC offers SLR as standard and provide $30k/yr in SLR if you work at a high need site, otherwise it's $20k/yr. Some of these jobs can pay awful though (~95k/yr) so I really doubt the SLR makes the NHSC a good decision from a purely financial perspective.

Interesting (and I don't see this mentioned that often on SDN), some hospitals offer really interesting perks such as helping you buy a house. A job in the mid-west pays $5k for the down payment. That's pretty clever if you think about it as it's a great way to keep a physician around.
 
Thanks for the responses. Hoped there would be more loan repayment offers out there, though.
 
My last year of residency, a buddy of mine from medschool I lost contact with but reestablished because I met him while interviewing for fellowship.

A year later, while in fellowship, he told me he was working as an attending in NYC and he couldn't stand it. His salary wasn't great, due to several regulations in NYC laws regarding this and that he was dealing with bureaucracy he couldn't stand, and he knew that there were greener pastures.

He left and got a job at the hospital where I did residency in Atlantic City.

In NJ, the state hospital system pays 200K+ and 250K a year is realistic for 40 hours a week. Work there 25 years and you get a pension worth half your salary. Some doctors intentionally work more during their last few years to spike up this value. (E.g. work 50 hours a week instead of 40).

The problem here is the NJ state hospitals are dungeons where attacks on attendings, staff members not doing anything they're ordered to do are common, or at least was common while I was a resident Attendings at the hospital I worked at who make about $165K a year told me even for 250K they wouldn't work at the state hospital.

If you're an attending in an underserved area, you'll make much more money but there'll be hardly any referral services. So if you got a nightmare train-wreck patient that you believe needs IOP or case management, welcome to Hell buddy, there might not be those things and now you're stuck with this patient. Then add to stress that if you're the only psychiatrist in the practice you're going to be on 24-hour duty/7 days a week with this patient.
 
what r starting salaries like in nyc for someone coming out of residency, either inpatient or consult...150s-160s? In general, are inpatient jobs easier to find for new grads than pure consult jobs? seems like a lot of ppl go for inpatient at first.

The money is in the 140-160 k range in NYC. I am happy I left NYC.
 
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