The Cost of Caribbean Medical School

[20000Leagues]

From my calculations, a school like SGU would cost roughly $350,000 over 4 years. This includes food, flight, accommodations etc. If you start at age 22 and choose family medicine (being realistic here) you would be able to practice at about age 30.

During residency you are only paid somewhere between $40,000 and $50,000 per year. So I doubt you would be able to do more than pay down the interest that is accumulating. This means you probably still have $350,000 in debt when you begin practicing.

What follows is based on some quick research. I am not sure if this information is correct, which is why I wanted to bring the discussion to this forum.

From searching online, the average family physician makes $175,000 per year in the US. After overhead (25-30%) and taxes (30%) I am guessing you would take home $100,000.

Several factors will influence how fast you are able to pay off your loan at this point. These include: Where you are living, if you are married and if you have kids.

I figure you can count on contributing at LEAST $30,000 / year to repaying your loan ($2500 per month). However at this rate it would take you 14 years to pay off your loan.

So my questions are:

Does my math make sense?
Is this a manageable financial situation?
Are there any ways to speed up loan repayment? (ex. loan forgiveness for working in an under serviced area)

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[Skip Intro]

From my calculations, a school like SGU would cost roughly $350,000 over 4 years.

Your math is way off.

Total tuition for the entire program (yes, it's expensive) is $236,807.

To get to $350k, you'd have to spend an additional $28,300 per year to cover everything else. If you are spending that much money in medical school (even living in NYC for clinicals for two years), then you are doing something wrong.

My total out of pocket cost, including my solo apartment in Queens when I was in NYC for my clinicals, was about $16k over 2 years. I didn't pay nearly that much when I was living in Dominica. I know Grenada is more expensive, but not THAT much. And, it's not as expensive to fly back and forth to the Caribbean as people think... unless you are doing it every other weekend or something.


-Skip

 

[Skip Intro]

Incidentally, for comparison the total tuition for the program at Ross is $204,680.

Let me also add...

Your individual cost in addition to tuition will depend greatly on what kind of lifestyle you expect while in school, if you have kids, what you expect as far as eating out, etc. You can easily spend a lot of cash unnecessarily (in my opinion) on b.s. stuff. But, you can also live fairly thrifty and not have to spend $28k/yr to support yourself. It all depends on the individual. Some of my classmates, for example, shared apartments in Queens and got even a better deal than I did living solo. (And, I mean that I spent about $16k/per year on extraneous expenses including rent, utilities, food, Metro card, etc. when in NYC.)

-Skip

 

[bedevilled ben]

Yes, it's expensive, but no, it's not that expensive.

Skip is right on. After interest I'm on track for about $260k total for loans, and that includes a few thousand from undergrad as well. While this is a lot, it's not unusual for a medical school. That averages about $65k a year. Compare that to US schools:

https://services.aamc.org/tsfreports/report.cfm?select_control=PUB&year_of_study=2013

It's on the higher end of the spectrum, but not unreasonable. There are government loan repayment options as well as forgiveness programs. I have a couple of friends who negotiated lower starting salaries post-residency with a % repayment incentive from their employers. I get tons of emails (even as a MS2) for underserved rural areas in the midwest that will pay big bucks for FP doctors. There are always options for those savvy enough to look for them.

 

[hmania]

good post OP. I needed to know about this too!

 

[20000Leagues]

Your number for the tuition is correct, but you have to add cost of living. That $28,300 per year is not unreasonable. Two semesters of living cost (on campus) at SGU is $9000. It is $11,000 in second year (extra two months). Flights (4 per year) is another $3200. Add on another couple thousand per year for food. Add another $1500 per year for books and online services like Uworld. Then there are the incidentals of life - clothes, bedsheets, backpack, phone bill etc. I think this brings you pretty close to that $350,000 mark, or at least above $300,000.

Regardless, I am wondering if someone can check my math on the second part of the equation - repaying the loan. Let's assume the debt is in fact $350,000.

So the questions I am wondering are:
Do family physicians really make an average of $175,000 per year in the US?
Can you expect to take home $100,000 per year after overhead and taxes?
Is $30,000 a reasonable amount per year for loan repayment?
Does 14 years sound about right?
Do you consider this to be a financially sound investment?

Thanks for mentioning the loan repayment programs bedevilled ben. I am wondering if anyone else has stories about these? I hear a lot about them, but I'm uncertain if they live up to the hype. I wouldn't mind living in a rural community for 5 years if it meant I could pay off my loan faster, but it would depend on how much faster we're talking about.

 

[bedevilled ben]

Can't speak for the other universities, but you definitely don't have to spend an extra 28k a year extra at SGU, but that's neither here nor there I suppose.

So the questions I am wondering are:
Do family physicians really make an average of $175,000 per year in the US?

Yes, but an average is a pretty poor measure of a complicated statistic like "salary". Medscape does a nice job of analyzing physician pay.
http://www.medscape.com/features/slideshow/compensation/2013/familymedicine

Can you expect to take home $100,000 per year after overhead and taxes?

This is going to vary a lot based on how and where you practice. If you're in solo practice, you're probably going to have huge overhead and high malpractice. If you're on service as a hospitalist, you should have considerably less overhead. If you're in a huge practice, you might have significantly lower insurance rates, etc.

Is $30,000 a reasonable amount per year for loan repayment?
Does 14 years sound about right?

Yeah, that sounds about right to me, maybe a bit more but again this is going to vary immensely based on your income, which is going to vary as I said above.

Do you consider this to be a financially sound investment?

For me? Absolutely. I spent 5 years in a career that I didn't like before switching to medicine. The opportunity cost for unhappiness is incalculable. However, if you're just going into medicine to make money, there are so many better options.

Have you looked through AAMC's website on student loans? There is a ton of information on loan forgiveness programs, income-based repayment forgiveness, military stipends, etc.
https://services.aamc.org/30/first/home/calculatorinput

 

[ronathan]

So the questions I am wondering are:
Do family physicians really make an average of $175,000 per year in the US?
Can you expect to take home $100,000 per year after overhead and taxes?
Is $30,000 a reasonable amount per year for loan repayment?
Does 14 years sound about right?
Do you consider this to be a financially sound investment?

Just to add another monkey wrench to your planning,20,000 Leagues, you should be aware that there are also ways that you can get your student loans reduced or maybe even eliminated. One way is, as ben mentioned above, military stipends that come from giving a couple of years of service to one or another branch of the armed forces. The US Naval Reserve, for example, has a lot of these kinds of programs for residents, and I would take a moment to peruse their website if that is something that you're interested in. Another thing to consider, especially if you want to do either Family Practice or some other primary care, is that a lot of states have loan forgiveness programs where they will pay for at least part (if not all) of your loans if you, again, do a couple of years of service in their state after or during residency. I know for a fact that Oregon and Texas both have such programs for General Practice and Family Med. I believe Washington state also has a program like that for Family Med, and I'm sure they are many more. So the take home message is that there are ways to reduce your debt burden post-residency, especially if you want to do Family Med.

 

[20000Leagues]

So according to that medscape survey the $175,000 average is right on. On page 8 it says that only 28% of family docs would choose family medicine again. Thats horribly unsettling. Even if this does make financial sense, theres a 72% chance that I will hate my job? I wonder what the main reason for this is? Lower income than other specialties? Too much red tape these days? I'm honestly curious, does anyone have some insight?

I was able to find a list of loan repayment programs here:
https://services.aamc.org/fed_loan_pub/index.cfm?fuseaction=public.welcome&CFID=7563505

Some of them seem pretty good..

 

[20000Leagues]

I may have found the answer to my own question on another medscape survey...

"Despite the frustration over reporting requirements, malpractice risks, EHRs, and other new aspects of medical practice, more than half of physicians would choose to become doctors again. While that's just slightly down from 54% in 2012, it's still a huge decline from the 2011 report in which a whopping 69% said they'd choose medicine again.
The specialties most apt to choose their own specialty again are dermatology (74%), ophthalmology (61%), and urology (60%). Least likely to choose their own specialty again are internists (19%), family physicians (28%), and obstetricians/gynecologists (37%). The dissatisfaction with their specialty, among primary care physicians, is palpable."

It says overall, 42% would choose the same specialty. I wonder if this statistic could be improved if medical students were given earlier exposure to the different specialties instead of just 3rd and 4th year, thus giving them more time to make a decision.

 

[bedevilled ben]

If you had to articulate your concern in one sentence, what would it be? I'm not really clear on what information you're fishing for here. Medicine as an industry is hugely complicated and people go into it for various reasons. Are you afraid that you won't be able to pay off your debt if you go into FP? Do you want to go into a different subspeciality but are afraid all you'll get is FP if you go Caribbean? Is FP your "fallback" residency? There is tons of uncertainty in medicine right now, but be wary of statistical data when it comes to making your decision. Nobody is coming from the same background as you are, and keep in mind that Medscape data is self-reported, so it's not precisely representative of what's going on in contemporary medicine. The data should inform your decision, but it shouldn't dictate your future.

Edit:

I wonder if this statistic could be improved if medical students were given earlier exposure to the different specialties instead of just 3rd and 4th year, thus giving them more time to make a decision.

Yeah, in my experience this is a common but inaccurate thought that I struggle with daily. There is a baseline level of knowledge you need to have before you can start experiencing different specialities. You're going to think you know better than your profs and your attending physicians at various points in your education, and you'll be wrong just like countless generations of previous doctors-in-training have thought. There's really no way that I can think of to illustrate this point, but you're just going to have to trust me that their approach is the correct one (at least currently). You need perspective to choose a speciality, and you need experience to gain perspective. There is no substitute for it. There is no substitute for just slogging your way through the muck and mire, making the same mistakes that previous generations have made. I know it sounds trite and dismissive, but it's true. You just have to get through it to understand. There really is a method to the madness, you just can't see it yet.

 

[20000Leagues]

Yes, my main concern is the debt. 14 years is a long time but add a mortgage on top of that and now we're talking a REALLY long time. How realistic will it be for me to buy a house, get married, and start a family when I finish residency?

I think I like Family Practice. But then there's always the possibility that I would find out I like something else more, or even hate FP when I go into 3rd and 4th year. So now you've spent $150,000+ and you find out you don't like FP, but it's the only residency you can get. It seems like such a gamble. And yet I love medicine, and can't imagine doing anything else with my life. I'm not in this for the money, but I don't want to be chained to my debt until I'm 60 years old.

That is my dilemma, and I would imagine its not an uncommon one for medical students these days, whether they go to the caribbean or not.

Am I blowing this out of proportion? Or is this a valid concern?

 

[bedevilled ben]

Am I blowing this out of proportion? Or is this a valid concern?

No, not at all. It's a really big decision, and you're not wrong. It's a lot of money. Medicine is a long expensive journey, and if you end up unable to practice at the end your income will be severely limited. I think it's important to know what you're getting into and have a long-term plan.

So, a couple of things. First of all, have you exhausted every resource you have trying to get into a US school? Have you gone through at least two application cycles, applied to the newly-opened medical schools, applied widely? If your MCAT score is holding you back, have you tried to retake it? Have you considered doing a post-bacc program? Have you considered going the DO route with grade replacement? All of these things are better options than coming down here, and I would strongly encourage you to explore them.

That being said, if you're convinced that coming down here to the Caribbean is your best shot, you still have options. SGU and Ross (probably Saba and AUC as well, but I don't have first-hand experience w/ them) post their residency placements online. If you look through them you will see that we are not restricted to only FP or IM. We have EM, obs/gyn, peds, neuro, psych, surg, etc. This past year, we had our first ortho resident. So there are only a few specialities that I would say we are unofficially "locked out" of. That being said, competition is stiff and you need to be able to outperform US student averages by 10-25 points to get some of those spots. But it can be done.

Secondly, the Big 4 schools graduate about 2,000 doctors a year, most of which return to the US for residency/practice. That's a lot of doctors. If they were unable to pay back their government-funded student loans, you'd be hearing about it. Maintaining low default rates is a requirement for accreditation.

One last thing just because it's not widely known and I didn't mention it before. If you work for a not-for-profit institution (like public hospitals, hint hint) for 10 years and make the minimum payments on your student loans, the government will forgive the remainder. It's called Public Service Loan Forgiveness - you can read more about it here.

 

[Skip Intro]

20000Leagues,

Not gonna split hairs with you... Mine is just one man's opinion, and you have obviously thought a lot about this, which I respect immensely.

Suffice it to say that most of the "surveys" on physician salaries are currently, in my opinion and observation, on the low side. I'm not precisely sure why this is, but I make far more than the "average" for an anesthesiologist on many of these surveys. My first job out of residency I was offered more than "average" and I've been in practice for four years now. So, I'm not always certain where they get their numbers (especially the AAMC one which, again in my opinion, seems way off).

Secondly, it all depends on what type of practice you want to build. I can tell you that for a busy family practice doctor, $175k is very low. However, if your goals is to work basically a 9-to-5 job in some big healthcare system's clinic where it doesn't matter the number of patients you see and the NP's handle all the calls (most of a FP's "problems" at night can be handled by a phone call or a referral to the ER), then you can expect to be on the lower end.

You should be and are right to be concerned about the debt you're going to be in. Set aside the fact that a significant number of people who embark on this journey fail and are straddled with a lot of debt, the tuition is outrageous at many of these schools. Can't and won't sugarcoat that. The fact is that the tuition at the Carib and the DO schools, for that matter, has risen disproportionately to their costs. They are profit centers that will deliver your dream... for a price.

And, I'm not sure that - overall - the reimbursements for the work that you will eventually do as a doctor are going to be there 5 years from now to justify this. Without getting on my soapbox too much, failing to address this (and tort reform) in my opinion is among the biggest failures of the ACA. There are ways, however, to minimize your tuition costs. You just have to be creative.

Whatever you choose, good luck. You are asking the right questions and thinking about the right things before you jump into this crazy realm of "becoming a doctor".

-Skip

 

[bedevilled ben]

Suffice it to say that most of the "surveys" on physician salaries are currently, in my opinion and observation, on the low side. I'm not precisely sure why this is, but I make far more than the "average" for an anesthesiologist on many of these surveys. My first job out of residency I was offered more than "average" and I've been in practice for four years now. So, I'm not always certain where they get their numbers (especially the AAMC one which, again in my opinion, seems way off).

I'm glad you mentioned this, Skip. I had that same thought when I was looking through those surveys, but I assumed I was just wrong. Do you know of anybody that's really had trouble paying off their loans? I'm about 8 years older than most of my classmates so I worry about being able to pay off my debt faster. I lived pretty modestly before going to med school and I don't really see that changing, but I don't want to be still paying off my loans into my 50's if I can help it...

 

[Dr Dazzle]

Doesn't seem worth it if you take $350k in debt and only make a family practice salary while paying $4500 or more in loans per month. You will literally be living on 4k per month. That's how much anyone with a college degree can make usually. It's also a risk if you don't match anywhere....more likely to happen for Caribbean grads since residencies are just enough for US grads in coming years.

 

[didymus]

Someone may have already pointed this out, but as a resident, at most programs, you can moonlight throughout residency and make serious $$ on top of your PG-salary. Working weekends in rural ED's can get you $100 per hour or more. 3 years of weekend moonlighting will put a major dent in that student loan debt.

 

[Dr Dazzle]

Someone may have already pointed this out, but as a resident, at most programs, you can moonlight throughout residency and make serious $$ on top of your PG-salary. Working weekends in rural ED's can get you $100 per hour or more. 3 years of weekend moonlighting will put a major dent in that student loan debt.

Not everyone is in a rural area or gets permission to do moonlighting from their program. It's the exception rather than the rule.

 

[didymus]

Not everyone is in a rural area or gets permission to do moonlighting from their program. It's the exception rather than the rule.

I think it still qualifies as a reasonable option worth considering.

 

[bedevilled ben]

Doesn't seem worth it if you take $350k in debt and only make a family practice salary while paying $4500 or more in loans per month. You will literally be living on 4k per month. That's how much anyone with a college degree can make usually. It's also a risk if you don't match anywhere....more likely to happen for Caribbean grads since residencies are just enough for US grads in coming years.

I guess it's all relative, but I can assure you that before career-switching to medicine, I wasn't making near 4k gross per month, and thats with a relatively competitive engineering degree in biomedical engineering. After picking the Caribbean offering, I'm also not going to be anywhere near $350k in debt, so I'm not really clear on what your take-home message is. Medicine is expensive, but it isn't life-crippling debt like you're implying here, at least not in my experience. I'm not counting on moonlighting to supplement my salary, either way. While you shouldn't expect a free ride, you shouldn't expect the Caribbean route to cripple your income for the rest of your life, either. Family practice isn't exactly chump-change.

 

[Leforte]

Doesn't seem worth it if you take $350k in debt and only make a family practice salary while paying $4500 or more in loans per month

Your estimation of loan repayment is a bit high. I have 180k in student loans and pay around $800 per month. Even if you doubled that to 1600 per month, if it allows me the opportunity to make $150k per year (not unreasonable for FP,) you are still ahead ~130k per year and are doing something that makes a difference.

 

[enlightenedbb]

Your estimation of loan repayment is a bit high. I have 180k in student loans and pay around $800 per month. Even if you doubled that to 1600 per month, if it allows me the opportunity to make $150k per year (not unreasonable for FP,) you are still ahead ~130k per year and are doing something that makes a difference.

Um, 150k post tax is like 95k. 95k - 19.2k = 75k after tax, still a decent amount of money, just not 130k.

 

[BestDoctorEver]

20000Leagues,

Not gonna split hairs with you... Mine is just one man's opinion, and you have obviously thought a lot about this, which I respect immensely.

Suffice it to say that most of the "surveys" on physician salaries are currently, in my opinion and observation, on the low side. I'm not precisely sure why this is, but I make far more than the "average" for an anesthesiologist on many of these surveys. My first job out of residency I was offered more than "average" and I've been in practice for four years now. So, I'm not always certain where they get their numbers (especially the AAMC one which, again in my opinion, seems way off).

Secondly, it all depends on what type of practice you want to build. I can tell you that for a busy family practice doctor, $175k is very low. However, if your goals is to work basically a 9-to-5 job in some big healthcare system's clinic where it doesn't matter the number of patients you see and the NP's handle all the calls (most of a FP's "problems" at night can be handled by a phone call or a referral to the ER), then you can expect to be on the lower end.

You should be and are right to be concerned about the debt you're going to be in. Set aside the fact that a significant number of people who embark on this journey fail and are straddled with a lot of debt, the tuition is outrageous at many of these schools. Can't and won't sugarcoat that. The fact is that the tuition at the Carib and the DO schools, for that matter, has risen disproportionately to their costs. They are profit centers that will deliver your dream... for a price.

And, I'm not sure that - overall - the reimbursements for the work that you will eventually do as a doctor are going to be there 5 years from now to justify this. Without getting on my soapbox too much, failing to address this (and tort reform) in my opinion is among the biggest failures of the ACA. There are ways, however, to minimize your tuition costs. You just have to be creative.

Whatever you choose, good luck. You are asking the right questions and thinking about the right things before you jump into this crazy realm of "becoming a doctor".

-Skip

How much money one should expect to pay back monthly in loan repayment for a 10-year plan if you are 300k in the red? Can you tell me how much you are paying back and how much were you in the red? I am looking at 300k in loan if I got accepted into a US school and that scares the bejesus out of me... PM me if you don't want to discuss that on a public forum...

 

[Zagaza]

if you owe 300k at the end of medical and you want to pay back in 10 years given a 5.41%-8.5% interest every month you are looking between 3k-4k monthly pauments.I use that range because you will have to borrow multiple loans with different interest rates.Which is usually the case.Here is a (Loan Calculator) link you can use to input loan amounts and play around with the numbers http://www.bankrate.com/calculators/mortgages/loan-calculator.aspx
And that is usually the case for most people.if you miss a payment, now that will depend on your loan servicers, but expect for the money to grow like a flame to a blaze.Check out mu signature and PM if you have any questions.No affliation, just a happy customer so far.

 

[whizplusdum]

Your math is way off.

Total tuition for the entire program (yes, it's expensive) is $236,807.

To get to $350k, you'd have to spend an additional $28,300 per year to cover everything else. If you are spending that much money in medical school (even living in NYC for clinicals for two years), then you are doing something wrong.

My total out of pocket cost, including my solo apartment in Queens when I was in NYC for my clinicals, was about $16k over 2 years. I didn't pay nearly that much when I was living in Dominica. I know Grenada is more expensive, but not THAT much. And, it's not as expensive to fly back and forth to the Caribbean as people think... unless you are doing it every other weekend or something.


-Skip

Hey Skip,
I have seen your post all over SDN however I have yet to find a forum about your success. I am currently applying to SGU for the August term of 2014, but the more I read, the more worried I become. If I do get in, assuming everything goes well I will be done at the end of 2018. I am worried that I will not find a residency, I will be unable to pay back my loans, and unable to practice medicine.
I know you have been very successful in your medical career, and I would love your 2cent. My first choice is general surgery, then internal medicine, and finally family practice.
I have read a lot of forums about this, and all of the current med students and pre-meds have indicated that in the past Caribbean students were okay in finding a residency and now they are not okay. I know that this is not true, because the stigma has always been there since the start. But I am wondering why haven't any successful doctors from the Caribbeans argue against these claims?

 

[Skip Intro]

My first choice is general surgery, then internal medicine, and finally family practice

General surgery is going to be the most difficult of those three to land. I wouldn't want to discourage you from pursuing your dream, but those three fields are all vastly different with nearly completely different lifestyles and technical skills required.

It is often easier for candidates to land a preliminary surgery spot, and then fight for a categorical spot afterwards. The intern year is completely cutthroat at programs that allow this. Some programs will not even offer a prelim surgery spot unless you already have a PGY-2 spot lined up (meaning you are already committed to go somewhere else after your first year and are doing the prelim surgery year to satisfy your internship requirement). Others will simply offer you spots on a year-to-year basis with no guarantee that they will train you completely. The second option is a categorical spot, which means that you are fully admitted to the surgical training program but does not guarantee you will finish it. Surgery training is quite rigorous.

The other two, FP and IM, are totally different tracks as well. In FP, you will spend a lot of time in the clinic learning how to be an outpatient doctor. In IM, you will spend a lot of time in the hospital learning how to be an inpatient doctor. Both are three years long, but IM will open far more doors down the road for fellowship and subspecialization (cardiology, gastroenterology, infectious diseases, etc.).

Don't limit yourself, though. You might find that you like something completely different when you start rotating on the wards. Of course, you have to get through the toughest part of medical training, the first two years, before you will have that opportunity.

... all of the current med students and pre-meds have indicated that in the past Caribbean students were okay in finding a residency and now they are not okay. I know that this is not true, because the stigma has always been there since the start. But I am wondering why haven't any successful doctors from the Caribbeans argue against these claims?

It is hard to say exactly what will happen in the future. The well-established Caribbean schools pride themselves in the fact that the vast majority of those they train go into primary care, which is helping to fill a huge gap in the U.S. healthcare system. This year, there were 900 more spots in the Match over last year. Caribbean students fared about as well as they did last year.

Will this be the same in 4 years? Hard to tell. There are more graduating seniors in U.S. MD schools. Same holds true for D.O. schools. Time will tell. And, if this forum is still here, I probably will be too either eating crow or saying "I told you so."

🙂

-Skip

 

[Skip Intro]

How much money one should expect to pay back monthly in loan repayment for a 10-year plan if you are 300k in the red? Can you tell me how much you are paying back and how much were you in the red? I am looking at 300k in loan if I got accepted into a US school and that scares the bejesus out of me... PM me if you don't want to discuss that on a public forum...

There are tons of financial calculators out there. But, the short answer is how long the payback period is and how it amortizes over the length of the loan.

I will say that I am amazed at how much more expensive it's gotten since I attended. I initially didn't believe that it now costs as much as it does, but the ten required semesters at Ross, just tuition alone, you will rack-up between of $204,680 to $209,940 (depending on how old you are when you start because of personal health insurance). To track for $300k of total debt, that leaves you only $22,515 per year to live off of, which ain't much when you factor in rent, food, and other personal expenses. And, that is if you totally stay on track.

https://www.rossu.edu/medical-school/admissions/Tuition-and-Fees.cfm

Now, factor in that many of the primary care jobs are going to pay you a pittance when you get out. In many of them, you will work for a healthcare organization that is going to pay you a salary and, especially in primary care, that salary may be eaten up in large part by your loan payments.

You know, I gotta tell you guys that, at the current rates, I would seriously, seriously, seriously try to look at ways to defray these costs. I don't want to diminish anyone's dream, but the cost of this education just in the dozen years since I was there has skyrocketed. And, I'm not sure it's justified.

-Skip

 

[Skip Intro]

Here's a breakdown of $300k of loan debt at an average of 5.8% APR over thirty years, which is pretty standard:

• Monthly payment: $1,760.26
• Total amount of interest paid over 30 years: $333,692.70
• Total amount you actually pay over the life of the loan: $633,692.70

https://www.dinkytown.net/java/SimpleLoan.html

The good news is that, while you're in residency and paying this back, you can claim a tax credit on the interest paid (if you make under $75k/yr) and perhaps get some loan forbearance (but, check carefully before you do that maneuver because it has credit implications).

Good luck. This is a HUGE financial decision, as you can see. You cannot possibly fathom that amount of debt right now (most of you). If you choose to do this, success is the only option.

-Skip

 

[Heresthedoc]

Here's a breakdown of $300k of loan debt at an average of 5.8% APR over thirty years, which is pretty standard:

• Monthly payment: $1,760.26
• Total amount of interest paid over 30 years: $333,692.70
• Total amount you actually pay over the life of the loan: $633,692.70

https://www.dinkytown.net/java/SimpleLoan.html

The good news is that, while you're in residency and paying this back, you can claim a tax credit on the interest paid (if you make under $75k/yr) and perhaps get some loan forbearance (but, check carefully before you do that maneuver because it has credit implications).

Good luck. This is a HUGE financial decision, as you can see. You cannot possibly fathom that amount of debt right now (most of you). If you choose to do this, success is the only option.

-Skip

Your posts are always so helpful, Skip. Thank you very much for everything you've said, in multiple threads.

 

[whizplusdum]

General surgery is going to be the most difficult of those three to land. I wouldn't want to discourage you from pursuing your dream, but those three fields are all vastly different with nearly completely different lifestyles and technical skills required.

It is often easier for candidates to land a preliminary surgery spot, and then fight for a categorical spot afterwards. The intern year is completely cutthroat at programs that allow this. Some programs will not even offer a prelim surgery spot unless you already have a PGY-2 spot lined up (meaning you are already committed to go somewhere else after your first year and are doing the prelim surgery year to satisfy your internship requirement). Others will simply offer you spots on a year-to-year basis with no guarantee that they will train you completely. The second option is a categorical spot, which means that you are fully admitted to the surgical training program but does not guarantee you will finish it. Surgery training is quite rigorous.

The other two, FP and IM, are totally different tracks as well. In FP, you will spend a lot of time in the clinic learning how to be an outpatient doctor. In IM, you will spend a lot of time in the hospital learning how to be an inpatient doctor. Both are three years long, but IM will open far more doors down the road for fellowship and subspecialization (cardiology, gastroenterology, infectious diseases, etc.).

Don't limit yourself, though. You might find that you like something completely different when you start rotating on the wards. Of course, you have to get through the toughest part of medical training, the first two years, before you will have that opportunity.



It is hard to say exactly what will happen in the future. The well-established Caribbean schools pride themselves in the fact that the vast majority of those they train go into primary care, which is helping to fill a huge gap in the U.S. healthcare system. This year, there were 900 more spots in the Match over last year. Caribbean students fared about as well as they did last year.

Will this be the same in 4 years? Hard to tell. There are more graduating seniors in U.S. MD schools. Same holds true for D.O. schools. Time will tell. And, if this forum is still here, I probably will be too either eating crow or saying "I told you so."

🙂

-Skip

Hey Skip,
I want to thank you again for answering my concerns. I do understand that all 3 fields are different. I believe that I will just be happy as a doctor, I have always dreamed of becoming one and at this point, I will be happy with any of the 3 fields.

Also Skip, can you please clarify how applying for residencies work? From what I can gather, people just apply for spots at a specific hospital and what they would like as their residency at that hospital. My question is, do you only have three picks or there are more? Because I find it hard to believe that people on SOAP failed to match into a non-competitive residency. Is it because they just apply for competitive and failed?

As always, you are extremely helpful. I really do appreciate your advice, and I am willing to deal with the loans that I will be dealt with.

 

[Skip Intro]

About residency (briefly)...

Going Caribbean, you will have to be ECFMG certified. There is a process the school you choose (and the friends you'll make) will help you start. You need this to register and sit for the USMLE exam. That's first.

When it comes time at the end of third year, you will apply for residency through the Match (http://www.nrmp.org/). This will be coordinated through the ECFMG. You will need passwords, certification numbers, (etc.) for both.

You can apply, literally, to as many programs as you want. Over a certain limit, though, you have to pay more. You will be offered interviews in those programs interested in your application, based on your numbers, letters of recommendation, and board scores up to that point. The next thing is the cost/time of going on selected interviews. This is all done through the Match/ECFMG websites.

It's a good idea to apply broadly, as you will not get invited to every program. I think, if I remember correctly, I applied to like 35-40 anesthesia programs, got invited to 14 or 15 interviews, went on 13, and ranked 12 programs. I matched at #2. Of course, this was 2004-05. Look at the programs on your school's website that have historically Matched former graduates. Include them for sure. Then, go on your interview and rock out.

Right before the Match, you will be required to submit your rank order list. This will be from the programs you liked best (#1, #2, #3, etc.) all the way down to the bottom, how many ever you interviewed at and want to rank.

Then, Match day comes and you find out.

SOAP happens only if you don't Match. And, I've heard it's still a terrible process despite the fact that they've tried to make it better in recent years. Fortunately, I got my spot in the main Match and everything worked out for me.

But, there is a long arduous road before you get to this point. Right now, you should focus on the best program for you and start thinking about how you're going to kill Step 1 the first day on campus.

Good luck!

-Skip

 

[BestDoctorEver]

Your estimation of loan repayment is a bit high. I have 180k in student loans and pay around $800 per month. Even if you doubled that to 1600 per month, if it allows me the opportunity to make $150k per year (not unreasonable for FP,) you are still ahead ~130k per year and are doing something that makes a difference.

Do you have a 30-year repayment plan?