Student Loans

[Mitch Connor]

OMS3 about to move into OMS4 and thinking about student loans. When I graduate I will have a maximum of 280K (haven't accepted my final loan yet) and a minimum of 230K. There is a state scholarship program I am interested in that offers 200K tax free that recipients can use as the wish in exchange for service in a rural area in primary care; IM/FM/peds for 4-6 years. Length of time is determined by the shortage in the area. So the more rural you go the less time you owe back. The idea of graduating with less that 100K of debt is super attractive, but I would be committing to a location several years in advance.

I am applying to IM and FM with the hope that I can stay here at the hospital I have been training at since they have an IM program now.

What I am trying to figure out is how tough it would be to get a job offer in IM (primary care in general) that can front that kind of bonus?

Would it be more foolish to commit to a rural area now for that tax free assistance or to carry the debt in hopes of finding an entry level package with that kind of sign on bonus?

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[gutonc]

You're unlikely to ever find a practice with a $200K signing bonus in any medicine specialty. The problem with programs like these is that you never know what you're going to want to do in the future.

So if you're definitely going into rural PC, no matter what else happens, then this may be a good option for you (and you should probably pursue FM over IM) in that case). If you're not 150% set on that life, then I wouldn't take this.

 

[CatFactorial]

Are these federal loans? If so, consider consolidating them and enrolling in a PSLF compatible repayment plan.

 

[HemeOncHopeful19]

What are your life goals? Why are you applying IM and FM with the goal of marching at a single institution?

What happens if you take the money and end up backing out?

 

[dozitgetchahi]

What are your life goals? Why are you applying IM and FM with the goal of marching at a single institution?

What happens if you take the money and end up backing out?

Yeah, I’m confused.

Sounds like someone putting the cart before the horse. Plans change, things happen, and it’s not uncommon that someone wants nothing to do with the location that has been so carefully planned ahead of time.

There are $200k signon bonuses out there, but I’ve only ever seen that for neurosurgeons and the like. Not IM/FM docs.

 

[thumbz]

Hospitalist here - one shop in our (semi) rural area was offering a $100k sign on bonus with a 5 year pro-rated commitment (leave early and you're expected to pay back the proportion you haven't "earned" yet). This was specifically $100k that needed to get put towards student loans. They also gave $20k sign on an $15k in relocation (without need of proof of expenses for reimbursement). So that's the biggest I've ever heard of. Keeping in mind it's for a 5 year commitment, but it can wipe out half your loans.

They also do the $100k as a "loan" so it's tax free up front. Then each year you "earn" $20k of it so taxes are with held on that amount. So it was a legit check for $100k.

They've since been bought by a bigger entity and I'm unsure if they still offer it. But the take home is that you can find something similar allowing you to still shop around salary wise, and not geographically limiting yourself early on. I've had several residents take their home states up on this offer and uniformly regret it in their PGY2/3 year when they see the offers their colleagues are getting.

 

[Splenda88]

@thumbz

One hospital (rural) that is not far from where I am gives 100k for 3 yrs (or 33k/yr). I don't remember how much they give for sign on and relocation. I have a couple of friends who work there.

My group (small city) gives 20k/yr if you agree to sign a 3 yr contract. They also give 20 sign on and 10k relocation. You might be able to negotiate 30k sign on without the relocation.

 

[chessknt]

Fun fact--you lose ~1/3 of that 100k to federal taxes + more to state taxes.

 

[Mitch Connor]

Thank you everyone for the input, I appreciate your insight. I honestly think I would be happy with either FM or IM and am dual applying because you still have to play the game to ensure you match. It really comes down to a question of where I want to live, which is right where I am (IM program), but the programs I will apply to are ones that are a fit for the myself and family. I really like the idea of Direct Primary Care so while I like inpatient I suppose I lean towards outpatient long term. This is really my 3rd career so I am more sure of where I am heading at this point than not. The loan program I mentioned is actually tax free so uncle sam doesn't steal any of it, but you do have to commit to a rural area for 3-5 years based on population. The smaller the population the less time you owe and your time is mobile if you have to move to a different rural area. Is rural med what I want to do the rest of my career? Maybe not. Is the cart before the horse? Might be, but that's a trade I'm willing to make for the first few years to get rid of my loans.