Hey guys....first an admission. I am not a premed anymore. I am fully board certified and practicing medicine. I am concerned that some of you may not fully realize the financial implications of your choice to go to medical school.....
So I am posting most of this thread from SERMO.com (kind of like Facebook, but for licensed physicians only). This discussion was prompted by a Forbes magazine journalist. You can see his initial question and the responses.
Here is the final article passed about 6 months ago:
http://www.forbes.com/forbes/2009/0202/060a.html
The fact is, medical school debt has skyrocketed....$155K average for 2008.
The government just voted out your ability to defer payments during residency:
http://www.med.unc.edu/ama/news/20-220-to-be-maintained-until-july-1-2009
This means you will be forced to start paying off your loans as soon as you graduate, when you are making about $35K/year as an overworked intern/resident. Think about it.
Think about what you are about to spend. Think about what you might make in salary when you are done and how long it will take you to pay off your debts. Read the comments and decide for yourself if medicine is right for you. But most of all be informed. Debts of these size are crushing and unforgiving.
Here is the thread - apologies for the length.
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From the media: Medical school debt vs. income
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From the media: I am a reporter from Forbes Magazine working on a story about rising student debt. Are you a physician that has a debt load that is two or three times your income? What measures are you taking to manage/pay-off this debt? Would you be willing to be quoted on this topic in a national magazine? If so, please share a few details about your individual circumstance and whether or not you are available to speak tomorrow morning (Friday, January 9.) in more detail.
Tags
debt, medical school, income
Category: General Interest
Posting ID: 31413
[Author] Posted on January 08, 2009 by a Sermo Client
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Comments (102)
102
DocESP Radiology
Posted Jan 08, 2009 at 5:50 PM
Don't forget about other sources of debt that most medschool grads have--loans from undergraduate college, auto loans, perhaps a mortgage if they're lucky enough not to be renting. During their 4 years of medschool, those debts have been accruing interest, while their nonmedical peers have been earning salaries and making monthly payments.
PamCobb Family Medicine
Posted Jan 08, 2009 at 5:54 PM
I am one of the lucky ones. I went to a moderately priced liberal arts college, and then returned to my home state (1974) for medical school at the state's university. This was in my home city, I lived at home several years, and graduated owing $5000. At that time, average debt was about $20,000.
I worked recently with a woman who returned to school to become a physician. She was the chief resident in family medicine. She owes almost $200,000 and, although working in an underserved area, has no loan repayment. She constantly lives "on the edge" financially. She does not spend extravagantly. She was a flutist before entering medicine, and sometimes performs in order to supplement her income.
This situation is a travesty; thank you for considering us physicians. I look forward to reading your article.
rameses75 Neurology
Posted Jan 08, 2009 at 6:34 PM
My current amount of educational debt is slightly less than my annual income. It will likely take me another 5-7 years to pay off my loans. It is ONLY 5-7 years because I usually make two payments per month to reduce the amount of capitalized interest and make a bigger dent in the principal. My car is paid off. My housing expenses are minimal compared to my medical school loan repayment burden every month--this IS my primary monthly expense. I would be glad to speak with you more about this.
wuerfel1 Family Medicine
Posted Jan 08, 2009 at 7:03 PM
as a family doc, out of residency 1 year, my debt is still more than I could make in 1-2 years. (Currently 125,000 and I have paid off 15,000 already). I have no debt from undergrad and no other outstanding debt and still struggle to balance our budget. Like PamCobb above, no extravagances. I pay more per month on my student loans than I do my mortgage and it will take me the same amount of time to pay off both of them. And, about the time I finish paying for my school, I might be able to start saving or paying for my kids' college tuition.
So, when I compare what I am making (once I subtract my student loans) to what my peers are making-- I'm definitely not on the top rung. Add that to the fact that I wasn't able to start making any money until 8 years after those that graduated with a bachelors degree (for example an engineer or other business person), I'm way behind the eight ball in savings, retirement planning, etc.
Like rameses75 I would be glad to speak with you further.
Echopeds Pediatrics
Edited Jan 08, 2009 at 7:06 PM
I love being a pediatrician. If timing of things in my life were different I would have loved to have done a three year fellowship in nephrology. I could not afford to do that given my need to support my family.
During medical school I was pushed at one point by the director of a radiology residency to apply for a slot. When I look at the pay I would make as a radiologist. The same thing during a dermatology rotation.
Likely both of those people were blowing smoke my way. Who knows. I sometimes wonder if my family would have been better off if I chose one of those lines of training.
I love being a pediatrician when I am in the room with a child. I really love being at the bedside of an ill child in the middle of the night. When I look long term at how I am going to support my family I am not so enthralled.
I would be willing to send you an email with more details of my personal financial problems but I do not want to post them here in such a public place. If you send me an email via the sermo system I would be willing to provide you with my thoughts.
If you are going to want to talk/quote numbers(how much I earn/owe) I would be willing to let you do so but not with my name.
loreman Pulmonology
Posted Jan 08, 2009 at 9:15 PM
I am amazed that the general public is willing to pay more to their plumber, stockbroker etc than to see their physician. The incredible amount of time and debt that it takes to learn medicine and help save lives is definately not worth the rewards. I am actively encouraging my children to chose another career. I love what i do but when i think of all the years of debt incurred and nights of studying to have patients complain over a co-pay and state that healthcare should be free why they themselves earn way more than me is disheartening
imsahagun Pediatrics
Posted Jan 08, 2009 at 9:16 PM
I am very lucky to have NO debt... thanks to scholarships and hard-working parents who deprived us of every luxury known to a kid!
TomSabDO Osteopathy
Posted Jan 08, 2009 at 9:40 PM
My debt is higher than my yearly income. I will be done paying my college and med school loans when I am 63 (I re-consolidated at 33).
JRooney Allergy and Immunology
Posted Jan 08, 2009 at 9:56 PM
My wife and I finished medical training in our 30's with $250,000 in combined debt. My spouse cannot work due to illness. My income, after 15 years in practice, is $125,000 before taxes. We're fortunate to have a mortgage of $2700/month in a working class community in New York.
DocLMG Family Medicine
Posted Jan 08, 2009 at 9:57 PM
I finished medical school with $150,00- of educational debt. It is now paid off but it was a struggle starting out as a new physician. There is no way we would have been able to open a new practice with that debt.
chinita Pediatrics
Edited Jan 08, 2009 at 10:01 PM
Thank goodness for California public universities. My undergrad loans are paid off and I have a very small amount left for my medical school loans. (About 1/4 of my annual salary).
Now if only the situation is similarly sunny on my home... (Lost >20% equity since purchase and now a member of the negative equity homeowners).
shawshank Psychiatry
Posted Jan 08, 2009 at 10:04 PM
My debt is >200k, and I make about 60-70% of that per year.
One of my biggest complaints with our debt is that we can NOT tax deduct the interest we pay on our student loans if our combined family income is >150k. This is ridiculous!!! I devote 12 years of my life AFTER college to training, have a significant opportunity cost in doing this, finally get to make over 100k with a job, but can't deduct any interest I pay on 250k in loans? Absurd.
My spouse has 150k in loans also and only makes 50% of that amount. So, together, we have what amounts to an extra mortgage. And again, what really kills me is that we can't deduct any interest we pay on these loans. Put that in your story. And, sure, I'd love to talk more about it.
JohnGalt Family Medicine
Edited Jan 08, 2009 at 10:28 PM
I was fortunate enough to have moonlighting opportunities during my first 4 years out of residency that allowed me to completely pay off my med school debt. I worked my ***** off during those 4 years; was exhausted all the time. Working 100+hrs per week (both regular clinic and moonlighting). Not everybody gets that chance. Debt is one of several reasons that primary care physicians are a dying breed.
auelocks Family Medicine
Posted Jan 08, 2009 at 11:14 PM
I'm in my first year out of residency, making 135K a year. My educational debt is 260K+. It hasn't taken long for my eyes to be opened to the struggles to pay this debt. Other doctors used to say, "don't worry about borrowing money, you'll be making plenty to pay your debt and still live a good life." Not so true nowadays.
So, now I moonlight for a few extra dollars. I'm a single mom or would be working more than I do now. I've gotten pretty good at making a budget over the years. At least for the first year, my employer is paying $1000 of my debt, but that's about 1/3 of my total payments. I'm not so sure this incentive will continue. I'm applying for a loan repayment program, but don't know how realistic my chances of being chosen.
I love my profession, caring for patients, but am already discouraged with being a doctor. This definitely isn't what I thought I was signing up for.
Sp1ndoctor Oncology, Hematology/Oncology
Edited Jan 09, 2009 at 12:30 AM
I was fortunate to have a lot of help from my parents, and fortunate to NOT have been smart enough, or connected enough, to get into any of the Ivy League schools I applied to ...
;-)
... so I had to "settle" for a decent private undergrad university, (which is often ranked as one of the "best deals" in the national rankings) and a top ranked state med school, and if that turn of events were my "first choice", I couldn't have been any happier ... so things turned out all right, after all ...
I have to say that the advice I hear, here on Sermo is true, that one does not ~need~ to attend Private or Ivy league schools for most careers, and I suspect that is true, even if you can be President with a "C" from the Ivy leagues ..
However, I also did lots of "work" from summer jobs, to "scribing for hire" to other odds and ends and always lived and played within my means, so I graduated Med School with modest debt, under $100,000 and was fortunate to pay it off within 5-6 years of finishing residency.
I probably can't offer my stories for your article, but even though it is not the prime focus, I hope your article at least covers the issue of doctor's income during post-graduate training.
I sometimes see articles about the professional schools - Usually Law vs Business vs Doctor -comparing the "starting salaries" .... but starting MBAs and starting lawyers don't graduate only to do another 3-10 years more (known as the "residency") for "on the job" training for a pittance.
Where they enter the workforce, doctors are still "in training" albeit on a token salary --- when I graduated med school, in the 90's, resident salaries ranged from 30 to 50K. I am sure they are a little better now, but I bet not by much.
Most doctors cannot afford to pay their loans during this time, but you can usually defer. My student loans were all eligible for interest deferral, (and did not accumulate) but some of my friends who needed more assistance took on "worse" quality loans and while their interest was eligible for "forbearance" it did accumulate and this can be a big reason doctors may graduate with such heavy debt burdens ...
Debdoc Pathology
Posted Jan 09, 2009 at 2:45 AM
I also had a lot of educational debt, about $180,00 after finishing my training. While I only took out about $35K, I made between $29K and 42K during my 7 years of post graduate training and could not afford to pay off student loans during this time. Consequently the interest rate was capitalized ( and I had the misfortune to be in med school when the interest rates were about 9% for student loans) and my debt grew.
During my internship and residency I was working an average of 120 hours a week, so you can see that the salary was more akin to minimum wage.
I finally paid off the loans about 13 years after finishing med school and largely because I switched from an academic position to a more highly paid private/commerical operation. Student loan debt definitely shapes career choices.
I also found that when I finally made enough to pay the loans off, I couldn't deduct the interest. I would be in favor of a quasi socialized medical system where medical school is free or subsidized and all students are required to do paid national medical service, for a year or 2 as they do in many European and South American countries. This would take care of underserved areas and alleviate the debt situation.
Echopeds Pediatrics
Edited Jan 09, 2009 at 6:34 AM
sp1n last I heard that 20/220 pathway was going away this summer so residents/fellows will not be able to ask for interest deferment any more.
As of last fall this was still an active issue - I have not heard if congress ever acted to restore this rule.
www.ama-assn.org
www.aafp.org
steven Internal Medicine
Posted Jan 09, 2009 at 6:40 AM
My son is at Temple Medical school, tuition 42k/year PLUS living expenses, about 6/yr. He had to take a loan of 20k this year. His roommate is taking loans for 42k/year. they will both come out with mortgage like loans. It is truly ridiculous to think they will not enter a lucrative specialty, not primary care in order to repay those sums.
docnag1 Family Medicine
Posted Jan 09, 2009 at 8:00 AM
My debt is old. I think I was one of the first physicians in such a horrible upside down financial situation. I came out of school with $97,000 debt at a time when interest was 17-19.5% capitalized and compounded daily. My first year in practice I had to go out and borrow $10,000 to pay taxes on the educational loan payments as the tax laws changed to make the interest not deductible. I used the forbearance route for a very short time and the balance very quickly grew even greater. Only in the past couple of years has my income finally exceeded my debt yet my income is right about the same as a tenured teacher in NYS school system.....except I don't get their premo health insurance coverage. I have to pay for my own. The only people making enough money to service current educational debt load in medicine are those who have been forced to sell their souls. Medicine was a dream of mine since I was a very young child. My father was a laborer with eight children and my family tried to convince me that medicine was not the way to go but I didn't listen. I sat at my medical admission interview and answered their questions about loans. I had worked and done my own taxes since I was 16yo. I had even had an IRS audit already. In those days you paid interest on educational financial investment or you paid taxes on money you didn't pay for education. The year I got out, they very simply changed the rules. The only way any poor kid can go to medical school now is in exchange for their life.
Sp1ndoctor Oncology, Hematology/Oncology
Posted Jan 09, 2009 at 8:45 AM
echo -I read that here on Sermo last yer --- I didn't know it had passed, but wouldn't be surprised ..
PamCobb Family Medicine
Posted Jan 09, 2009 at 10:38 AM
To the Forbes correspondent: I think it is starting to become clear from the responses above that 1) a significant number of physicians, starting in the 1980's, accumulated a tremendous amount of debt relative to their education, and are struggling to pay it off and 2) because of the economic climate, many of us are discouraging our children from entering the practice of medicine, and 3) very few people can afford to enter the general fields of pediatrics, family med, and internal medicine---this has CLEAR repercussions for the American public, and public health, in the future.
DebDoc alludes to a potential "fix" which I would support and has been mentioned before; that is, waive the cost of medical school for qualified applicants that are willing to serve the underserved for X number of years (my suggestion would be a minimum of five years) This would do much to stimulate renewed interest in the fields of primary care. At the end of five years, the hope would be that the applicant would continue to serve in some capacity that area; however, they could choose to enter specialty training, or relocate, or become an academician (which also should be financially supported, in some way.) [email protected]
Bohnstedt07 Neurosurgery
Posted Jan 09, 2009 at 11:09 AM
From Medical school I accrued over $140,000 in debt at an instate medical school and was on the lower end of medical school class for debt when graduating in 2007. Thus, I can only second all of the statements above. It is interesting to me that our society easily dismisses these factors of escalating debt and complains that physicians are paid too much. It is my fear that if the debt issue is not addressed (either by above mentioned ideas or otherwise) and the issue of decreasing compensation that the bright individuals in our society will shy away from medicine much as many of the above have expressed encouraging their children to do. One should not go into medicine for financial gain; however, penalizing them for going into by delaying their ability to earn a supporting income and starting their lives out with $200,000 + in educational debt seems a bit impractical.
DeLaughterDO Emergency Medicine
Posted Jan 09, 2009 at 11:33 AM
Echopeds is correct - as of this year (2008-2009), deferral is no longer available. I am now paying essentially twice my normal rent (rent + loan payment) every month. I went to a state-sponsored institution and fortunately came out with only about 150K in loans (all my undergrad loans were paid off before entering med school), and will likely be paying on my loans for about a dozen or more years, depending on the income I get when I'm done with residency (currenlty making about 48K in residency with 18 months to go).
jsmall0210 Emergency Medicine
Posted Jan 09, 2009 at 11:52 AM
I have about 114k left, but I am one of the very lucky ones who graduated in the early 2000s when rates were really low. I'm locked in at 2.8% over 30 years. I think only my class (2003) and the ones before and after me got lucky
txpsych Psychiatry
Posted Jan 09, 2009 at 11:58 AM
Yes, this issue of medical debt is a significant concern. I too have med school debt around 190k with an income less than that. I rent an apartment, and my loan payments are more than rent. I can not wait to be done with paying back all this debt. Hopefully there will be some more programs available to future physicians and myself included in terms of paying back these loans such as loan forgiveness for those of us who work in major metropolitan areas. Appreciate you writing about this issue, significant concern to many of my physician colleagues. Would be interested in discussing further.
watty1 Surgery, General
Posted Jan 09, 2009 at 12:49 PM
we, certainly, do not go into medicine for the money. My wife and I graduated with >250,000$ of debt. We live frugally nad will not likely pay off our loans until we are near retirement- then there's the mortgage, retirement, kid's education, taxes etc...We are not in the "poor house"- but it sure aint easy!
Andrea33333 Psychiatry
Posted Jan 09, 2009 at 1:20 PM
I have about $75,000 total debt from med school and have no idea how I am going to pay it off.
I think this is hardest for primary care doctors.
bpoterjoy Pediatrics
Posted Jan 09, 2009 at 2:01 PM
I finished med school with 135k that went to about 150k after 3 years of econ hardship deferral and 3 years of forebearance. I was fortunate that at consolidation in 2002 the interest rate was just under 4%. And it went a bit lower that year. I will complete payments when I am in my early 60s unless I start paying it off faster. Unfortunately there are other bills to pay- credit cards that accumulated $$$ while struggling to make ends meet thru 6 years of post med school education with a growing family. Cars, mortgage. I am very blessed that my wife and I have careers (she is an RN) where we can rotate our schedules around our children, hence we have no need for daycare. If not, her salary would be going thereand we would be no better off. I don't know how my contemporaries who have a dual-doc household make ends meet, especially if one (or both) are in primary care.
The PA state senate education committee has a bill that the House passed in summer 2007 where, in exchange for 10 years of indentured servitude, the doc can trade off the educational debt. And there it sits. After many angry letters to our local senators, and some help from our rep, I found out that the dilemma is where the soney would come from.....it is a great concept- akin to the natl health service corps. As much of a small govt person I am, I would welcome such a program, mostly cuz I am a native PA guy with no intent to leave.
That being said, as hard as the economic situation is, I love my job and would not discourage any of my 4 children from going in this direction for a career. Hopefully things will be different in 10-20 years
Sp1ndoctor Oncology, Hematology/Oncology
Edited Jan 09, 2009 at 2:08 PM
<in exchange for 10 years of indentured servitude>
It is rather telling that after 4 years of college, 4 years of med school and 3 years of a pediatric residency (or more), bpoterjoy (and I am sure others) would *WELCOME* 10 years of indentured servitude ....
(from the sound of things, doctors are begging for the opportunity)
If I were in the current federal govt position, I would say things are going just about perfectly - what better way to make doctors support a nationialized healthcare system, than to make us willing, no, obligatory, slaves?
There is no field, NONE, where the participants are *punished* and *enslaved* more for their skills and compassion than the practice of Medicine ....
bpoterjoy Pediatrics
Posted Jan 09, 2009 at 3:01 PM
Sp1n-
The way the bill is written, the state of PA would pay of 10% per year in exchange for remaining in PA for 10 years. What has not been clear is if it would be open to ALL docs, or just primary care. They have it structured to be a tiered selection, geared to keeping PA residents in PA. I joke about the "servititude", but for me, a born, raised, educated from Kindergarten thru med school in PA, married to a Philly girl (the Philly definition of moving is going 1 neighborhood away from where they grew up) - I am not leaving unless I need to, or one helluva opportunity comes up. My oldest is 10, and she doesn't want to leave her school, and cringes when we talk about upgrading to a bigger home (typical, I know). So for my purposes, if Harrisburg pays me to stay, that's great cuz I win and they win.
Sp1ndoctor Oncology, Hematology/Oncology
Posted Jan 09, 2009 at 3:23 PM
Sounds better than "indentured servitude" but it really doesn't matter - the point is, someone would have no freedom for 10 yrs after completing what most would already consider indentured servitude, after PAYING FOR THE PRIVELEGE and going into massive debt ...
slatosky Family Medicine
Posted Jan 09, 2009 at 3:23 PM
it is sad but my student loan payment is higher than my morgage payment. it is even sadder that i am taxed as if this was income. tell me again why no one is going into primary care.
bpoterjoy Pediatrics
Posted Jan 09, 2009 at 3:52 PM
Sp1n- I agree with u 100%. I actually think that the central issue is the cost of medical school itself. Did u see the above comment about Temple being 42k per year- insane! Just 10 years ago I was paying about 20k, and I thought that was high. SOOOO in terms of 'reform", the cost of the education should be on the list also....
donthomasj Rheumatology
Posted Jan 09, 2009 at 4:15 PM
It is a shame that I actually make more money per hour by doing internet surveys and talking to research groups that what the HMOs/insurance companies/Medicare reimburse me for taking care of patients. I have not cut back seeing patients to do more surveys and do group consultation work and I don't plan on doing so in the future. However, it sure crosses my mind sometimes on difficult days.
docnag1 Family Medicine
Posted Jan 09, 2009 at 4:46 PM
I was fortunate to get a slot in the national health service corp loan repayment program. But, the $25,000/year payment, barely covered the nearly 20% interest on the $140,000 balance I had by the time the program became available. The NHSC bought me 5 years of interest payments nothing more. I am over 20 years in payback and still making very large payments with perhaps an end in sight but who knows in the current economy. Also, understand that in the NHSC, one gets a salary or has a private practice option, neither of which allows much of an income. Hence my current income after over 20years being equivalent to a tenured NYS teacher...that's upstate NY. Of course I could take a job at the local pretend hospital supervising a dozen midlevels and make some big money. I just can't do that. I am not unhappy but I resent that people equate being a physician with having alot of money and they think we don't need to be paid for our work.
maggieruby40 Pain Medicine
Edited Jan 09, 2009 at 4:59 PM
I had about $200,000 in medical school loans when I finished training. I graduated in 1993. I had to do forebearance for a few years. I call it the house I do not live in.
I am still glad I am a doctor. But sometimes I get annoyed when people assume I am so "rich" because although I do live better than most, there are many who live much better. There are also many who while we were making 30 cents an hour in Residency and Fellowship for all those years, were already working in their professions and are doing a lot better.
I resent that people resent me for being a "big rich doctor". I worked hard, I do not remember much of life other than Work for many years and because of my debt I am really not that "rich"
I believe that I should live well and be respected for it.
B1Fixer Orthopaedics
Posted Jan 09, 2009 at 4:57 PM
since when did the media become "clients"? So anything said here can be quoted in Forbes? How many other news organizations are "clients"? Which ones?
Andrea33333 Psychiatry
Posted Jan 09, 2009 at 5:02 PM
Fixer's questions need to be addressed.
Leland Family Medicine
Posted Jan 09, 2009 at 10:16 PM
Return on investment in Primary Care fields is not what it was, nor what it should be. There is nothing I personally would want to do besides being a Physician, yet I was relieved that neither of my children expressed any desire to follow in my footsteps. Life is tough enough. Only wanting to do something urgently and desperately could explain the sacrifices those of us that have chosen this life are willing to make. I suspect if I were attending Medical School in this era, I would be more influenced toward choosing a higher paying specialty. I am fortunate to have graduated from an excellent mid western Medical School in an era when it was possible to graduate without a six figure debt, and to have had dedicated and supportive parents. When I read some of the stories above, I realize how very fortunate I have been.
So I am posting most of this thread from SERMO.com (kind of like Facebook, but for licensed physicians only). This discussion was prompted by a Forbes magazine journalist. You can see his initial question and the responses.
Here is the final article passed about 6 months ago:
http://www.forbes.com/forbes/2009/0202/060a.html
The fact is, medical school debt has skyrocketed....$155K average for 2008.
The government just voted out your ability to defer payments during residency:
http://www.med.unc.edu/ama/news/20-220-to-be-maintained-until-july-1-2009
This means you will be forced to start paying off your loans as soon as you graduate, when you are making about $35K/year as an overworked intern/resident. Think about it.
Think about what you are about to spend. Think about what you might make in salary when you are done and how long it will take you to pay off your debts. Read the comments and decide for yourself if medicine is right for you. But most of all be informed. Debts of these size are crushing and unforgiving.
Here is the thread - apologies for the length.
Client Posting
From the media: Medical school debt vs. income
What is a client posting?
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From the media: I am a reporter from Forbes Magazine working on a story about rising student debt. Are you a physician that has a debt load that is two or three times your income? What measures are you taking to manage/pay-off this debt? Would you be willing to be quoted on this topic in a national magazine? If so, please share a few details about your individual circumstance and whether or not you are available to speak tomorrow morning (Friday, January 9.) in more detail.
Tags
debt, medical school, income
Category: General Interest
Posting ID: 31413
[Author] Posted on January 08, 2009 by a Sermo Client
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Comments (102)
102
DocESP Radiology
Posted Jan 08, 2009 at 5:50 PM
Don't forget about other sources of debt that most medschool grads have--loans from undergraduate college, auto loans, perhaps a mortgage if they're lucky enough not to be renting. During their 4 years of medschool, those debts have been accruing interest, while their nonmedical peers have been earning salaries and making monthly payments.
PamCobb Family Medicine
Posted Jan 08, 2009 at 5:54 PM
I am one of the lucky ones. I went to a moderately priced liberal arts college, and then returned to my home state (1974) for medical school at the state's university. This was in my home city, I lived at home several years, and graduated owing $5000. At that time, average debt was about $20,000.
I worked recently with a woman who returned to school to become a physician. She was the chief resident in family medicine. She owes almost $200,000 and, although working in an underserved area, has no loan repayment. She constantly lives "on the edge" financially. She does not spend extravagantly. She was a flutist before entering medicine, and sometimes performs in order to supplement her income.
This situation is a travesty; thank you for considering us physicians. I look forward to reading your article.
rameses75 Neurology
Posted Jan 08, 2009 at 6:34 PM
My current amount of educational debt is slightly less than my annual income. It will likely take me another 5-7 years to pay off my loans. It is ONLY 5-7 years because I usually make two payments per month to reduce the amount of capitalized interest and make a bigger dent in the principal. My car is paid off. My housing expenses are minimal compared to my medical school loan repayment burden every month--this IS my primary monthly expense. I would be glad to speak with you more about this.
wuerfel1 Family Medicine
Posted Jan 08, 2009 at 7:03 PM
as a family doc, out of residency 1 year, my debt is still more than I could make in 1-2 years. (Currently 125,000 and I have paid off 15,000 already). I have no debt from undergrad and no other outstanding debt and still struggle to balance our budget. Like PamCobb above, no extravagances. I pay more per month on my student loans than I do my mortgage and it will take me the same amount of time to pay off both of them. And, about the time I finish paying for my school, I might be able to start saving or paying for my kids' college tuition.
So, when I compare what I am making (once I subtract my student loans) to what my peers are making-- I'm definitely not on the top rung. Add that to the fact that I wasn't able to start making any money until 8 years after those that graduated with a bachelors degree (for example an engineer or other business person), I'm way behind the eight ball in savings, retirement planning, etc.
Like rameses75 I would be glad to speak with you further.
Echopeds Pediatrics
Edited Jan 08, 2009 at 7:06 PM
I love being a pediatrician. If timing of things in my life were different I would have loved to have done a three year fellowship in nephrology. I could not afford to do that given my need to support my family.
During medical school I was pushed at one point by the director of a radiology residency to apply for a slot. When I look at the pay I would make as a radiologist. The same thing during a dermatology rotation.
Likely both of those people were blowing smoke my way. Who knows. I sometimes wonder if my family would have been better off if I chose one of those lines of training.
I love being a pediatrician when I am in the room with a child. I really love being at the bedside of an ill child in the middle of the night. When I look long term at how I am going to support my family I am not so enthralled.
I would be willing to send you an email with more details of my personal financial problems but I do not want to post them here in such a public place. If you send me an email via the sermo system I would be willing to provide you with my thoughts.
If you are going to want to talk/quote numbers(how much I earn/owe) I would be willing to let you do so but not with my name.
loreman Pulmonology
Posted Jan 08, 2009 at 9:15 PM
I am amazed that the general public is willing to pay more to their plumber, stockbroker etc than to see their physician. The incredible amount of time and debt that it takes to learn medicine and help save lives is definately not worth the rewards. I am actively encouraging my children to chose another career. I love what i do but when i think of all the years of debt incurred and nights of studying to have patients complain over a co-pay and state that healthcare should be free why they themselves earn way more than me is disheartening
imsahagun Pediatrics
Posted Jan 08, 2009 at 9:16 PM
I am very lucky to have NO debt... thanks to scholarships and hard-working parents who deprived us of every luxury known to a kid!
TomSabDO Osteopathy
Posted Jan 08, 2009 at 9:40 PM
My debt is higher than my yearly income. I will be done paying my college and med school loans when I am 63 (I re-consolidated at 33).
JRooney Allergy and Immunology
Posted Jan 08, 2009 at 9:56 PM
My wife and I finished medical training in our 30's with $250,000 in combined debt. My spouse cannot work due to illness. My income, after 15 years in practice, is $125,000 before taxes. We're fortunate to have a mortgage of $2700/month in a working class community in New York.
DocLMG Family Medicine
Posted Jan 08, 2009 at 9:57 PM
I finished medical school with $150,00- of educational debt. It is now paid off but it was a struggle starting out as a new physician. There is no way we would have been able to open a new practice with that debt.
chinita Pediatrics
Edited Jan 08, 2009 at 10:01 PM
Thank goodness for California public universities. My undergrad loans are paid off and I have a very small amount left for my medical school loans. (About 1/4 of my annual salary).
Now if only the situation is similarly sunny on my home... (Lost >20% equity since purchase and now a member of the negative equity homeowners).
shawshank Psychiatry
Posted Jan 08, 2009 at 10:04 PM
My debt is >200k, and I make about 60-70% of that per year.
One of my biggest complaints with our debt is that we can NOT tax deduct the interest we pay on our student loans if our combined family income is >150k. This is ridiculous!!! I devote 12 years of my life AFTER college to training, have a significant opportunity cost in doing this, finally get to make over 100k with a job, but can't deduct any interest I pay on 250k in loans? Absurd.
My spouse has 150k in loans also and only makes 50% of that amount. So, together, we have what amounts to an extra mortgage. And again, what really kills me is that we can't deduct any interest we pay on these loans. Put that in your story. And, sure, I'd love to talk more about it.
JohnGalt Family Medicine
Edited Jan 08, 2009 at 10:28 PM
I was fortunate enough to have moonlighting opportunities during my first 4 years out of residency that allowed me to completely pay off my med school debt. I worked my ***** off during those 4 years; was exhausted all the time. Working 100+hrs per week (both regular clinic and moonlighting). Not everybody gets that chance. Debt is one of several reasons that primary care physicians are a dying breed.
auelocks Family Medicine
Posted Jan 08, 2009 at 11:14 PM
I'm in my first year out of residency, making 135K a year. My educational debt is 260K+. It hasn't taken long for my eyes to be opened to the struggles to pay this debt. Other doctors used to say, "don't worry about borrowing money, you'll be making plenty to pay your debt and still live a good life." Not so true nowadays.
So, now I moonlight for a few extra dollars. I'm a single mom or would be working more than I do now. I've gotten pretty good at making a budget over the years. At least for the first year, my employer is paying $1000 of my debt, but that's about 1/3 of my total payments. I'm not so sure this incentive will continue. I'm applying for a loan repayment program, but don't know how realistic my chances of being chosen.
I love my profession, caring for patients, but am already discouraged with being a doctor. This definitely isn't what I thought I was signing up for.
Sp1ndoctor Oncology, Hematology/Oncology
Edited Jan 09, 2009 at 12:30 AM
I was fortunate to have a lot of help from my parents, and fortunate to NOT have been smart enough, or connected enough, to get into any of the Ivy League schools I applied to ...
;-)
... so I had to "settle" for a decent private undergrad university, (which is often ranked as one of the "best deals" in the national rankings) and a top ranked state med school, and if that turn of events were my "first choice", I couldn't have been any happier ... so things turned out all right, after all ...
I have to say that the advice I hear, here on Sermo is true, that one does not ~need~ to attend Private or Ivy league schools for most careers, and I suspect that is true, even if you can be President with a "C" from the Ivy leagues ..
However, I also did lots of "work" from summer jobs, to "scribing for hire" to other odds and ends and always lived and played within my means, so I graduated Med School with modest debt, under $100,000 and was fortunate to pay it off within 5-6 years of finishing residency.
I probably can't offer my stories for your article, but even though it is not the prime focus, I hope your article at least covers the issue of doctor's income during post-graduate training.
I sometimes see articles about the professional schools - Usually Law vs Business vs Doctor -comparing the "starting salaries" .... but starting MBAs and starting lawyers don't graduate only to do another 3-10 years more (known as the "residency") for "on the job" training for a pittance.
Where they enter the workforce, doctors are still "in training" albeit on a token salary --- when I graduated med school, in the 90's, resident salaries ranged from 30 to 50K. I am sure they are a little better now, but I bet not by much.
Most doctors cannot afford to pay their loans during this time, but you can usually defer. My student loans were all eligible for interest deferral, (and did not accumulate) but some of my friends who needed more assistance took on "worse" quality loans and while their interest was eligible for "forbearance" it did accumulate and this can be a big reason doctors may graduate with such heavy debt burdens ...
Debdoc Pathology
Posted Jan 09, 2009 at 2:45 AM
I also had a lot of educational debt, about $180,00 after finishing my training. While I only took out about $35K, I made between $29K and 42K during my 7 years of post graduate training and could not afford to pay off student loans during this time. Consequently the interest rate was capitalized ( and I had the misfortune to be in med school when the interest rates were about 9% for student loans) and my debt grew.
During my internship and residency I was working an average of 120 hours a week, so you can see that the salary was more akin to minimum wage.
I finally paid off the loans about 13 years after finishing med school and largely because I switched from an academic position to a more highly paid private/commerical operation. Student loan debt definitely shapes career choices.
I also found that when I finally made enough to pay the loans off, I couldn't deduct the interest. I would be in favor of a quasi socialized medical system where medical school is free or subsidized and all students are required to do paid national medical service, for a year or 2 as they do in many European and South American countries. This would take care of underserved areas and alleviate the debt situation.
Echopeds Pediatrics
Edited Jan 09, 2009 at 6:34 AM
sp1n last I heard that 20/220 pathway was going away this summer so residents/fellows will not be able to ask for interest deferment any more.
As of last fall this was still an active issue - I have not heard if congress ever acted to restore this rule.
www.ama-assn.org
www.aafp.org
steven Internal Medicine
Posted Jan 09, 2009 at 6:40 AM
My son is at Temple Medical school, tuition 42k/year PLUS living expenses, about 6/yr. He had to take a loan of 20k this year. His roommate is taking loans for 42k/year. they will both come out with mortgage like loans. It is truly ridiculous to think they will not enter a lucrative specialty, not primary care in order to repay those sums.
docnag1 Family Medicine
Posted Jan 09, 2009 at 8:00 AM
My debt is old. I think I was one of the first physicians in such a horrible upside down financial situation. I came out of school with $97,000 debt at a time when interest was 17-19.5% capitalized and compounded daily. My first year in practice I had to go out and borrow $10,000 to pay taxes on the educational loan payments as the tax laws changed to make the interest not deductible. I used the forbearance route for a very short time and the balance very quickly grew even greater. Only in the past couple of years has my income finally exceeded my debt yet my income is right about the same as a tenured teacher in NYS school system.....except I don't get their premo health insurance coverage. I have to pay for my own. The only people making enough money to service current educational debt load in medicine are those who have been forced to sell their souls. Medicine was a dream of mine since I was a very young child. My father was a laborer with eight children and my family tried to convince me that medicine was not the way to go but I didn't listen. I sat at my medical admission interview and answered their questions about loans. I had worked and done my own taxes since I was 16yo. I had even had an IRS audit already. In those days you paid interest on educational financial investment or you paid taxes on money you didn't pay for education. The year I got out, they very simply changed the rules. The only way any poor kid can go to medical school now is in exchange for their life.
Sp1ndoctor Oncology, Hematology/Oncology
Posted Jan 09, 2009 at 8:45 AM
echo -I read that here on Sermo last yer --- I didn't know it had passed, but wouldn't be surprised ..
PamCobb Family Medicine
Posted Jan 09, 2009 at 10:38 AM
To the Forbes correspondent: I think it is starting to become clear from the responses above that 1) a significant number of physicians, starting in the 1980's, accumulated a tremendous amount of debt relative to their education, and are struggling to pay it off and 2) because of the economic climate, many of us are discouraging our children from entering the practice of medicine, and 3) very few people can afford to enter the general fields of pediatrics, family med, and internal medicine---this has CLEAR repercussions for the American public, and public health, in the future.
DebDoc alludes to a potential "fix" which I would support and has been mentioned before; that is, waive the cost of medical school for qualified applicants that are willing to serve the underserved for X number of years (my suggestion would be a minimum of five years) This would do much to stimulate renewed interest in the fields of primary care. At the end of five years, the hope would be that the applicant would continue to serve in some capacity that area; however, they could choose to enter specialty training, or relocate, or become an academician (which also should be financially supported, in some way.) [email protected]
Bohnstedt07 Neurosurgery
Posted Jan 09, 2009 at 11:09 AM
From Medical school I accrued over $140,000 in debt at an instate medical school and was on the lower end of medical school class for debt when graduating in 2007. Thus, I can only second all of the statements above. It is interesting to me that our society easily dismisses these factors of escalating debt and complains that physicians are paid too much. It is my fear that if the debt issue is not addressed (either by above mentioned ideas or otherwise) and the issue of decreasing compensation that the bright individuals in our society will shy away from medicine much as many of the above have expressed encouraging their children to do. One should not go into medicine for financial gain; however, penalizing them for going into by delaying their ability to earn a supporting income and starting their lives out with $200,000 + in educational debt seems a bit impractical.
DeLaughterDO Emergency Medicine
Posted Jan 09, 2009 at 11:33 AM
Echopeds is correct - as of this year (2008-2009), deferral is no longer available. I am now paying essentially twice my normal rent (rent + loan payment) every month. I went to a state-sponsored institution and fortunately came out with only about 150K in loans (all my undergrad loans were paid off before entering med school), and will likely be paying on my loans for about a dozen or more years, depending on the income I get when I'm done with residency (currenlty making about 48K in residency with 18 months to go).
jsmall0210 Emergency Medicine
Posted Jan 09, 2009 at 11:52 AM
I have about 114k left, but I am one of the very lucky ones who graduated in the early 2000s when rates were really low. I'm locked in at 2.8% over 30 years. I think only my class (2003) and the ones before and after me got lucky
txpsych Psychiatry
Posted Jan 09, 2009 at 11:58 AM
Yes, this issue of medical debt is a significant concern. I too have med school debt around 190k with an income less than that. I rent an apartment, and my loan payments are more than rent. I can not wait to be done with paying back all this debt. Hopefully there will be some more programs available to future physicians and myself included in terms of paying back these loans such as loan forgiveness for those of us who work in major metropolitan areas. Appreciate you writing about this issue, significant concern to many of my physician colleagues. Would be interested in discussing further.
watty1 Surgery, General
Posted Jan 09, 2009 at 12:49 PM
we, certainly, do not go into medicine for the money. My wife and I graduated with >250,000$ of debt. We live frugally nad will not likely pay off our loans until we are near retirement- then there's the mortgage, retirement, kid's education, taxes etc...We are not in the "poor house"- but it sure aint easy!
Andrea33333 Psychiatry
Posted Jan 09, 2009 at 1:20 PM
I have about $75,000 total debt from med school and have no idea how I am going to pay it off.
I think this is hardest for primary care doctors.
bpoterjoy Pediatrics
Posted Jan 09, 2009 at 2:01 PM
I finished med school with 135k that went to about 150k after 3 years of econ hardship deferral and 3 years of forebearance. I was fortunate that at consolidation in 2002 the interest rate was just under 4%. And it went a bit lower that year. I will complete payments when I am in my early 60s unless I start paying it off faster. Unfortunately there are other bills to pay- credit cards that accumulated $$$ while struggling to make ends meet thru 6 years of post med school education with a growing family. Cars, mortgage. I am very blessed that my wife and I have careers (she is an RN) where we can rotate our schedules around our children, hence we have no need for daycare. If not, her salary would be going thereand we would be no better off. I don't know how my contemporaries who have a dual-doc household make ends meet, especially if one (or both) are in primary care.
The PA state senate education committee has a bill that the House passed in summer 2007 where, in exchange for 10 years of indentured servitude, the doc can trade off the educational debt. And there it sits. After many angry letters to our local senators, and some help from our rep, I found out that the dilemma is where the soney would come from.....it is a great concept- akin to the natl health service corps. As much of a small govt person I am, I would welcome such a program, mostly cuz I am a native PA guy with no intent to leave.
That being said, as hard as the economic situation is, I love my job and would not discourage any of my 4 children from going in this direction for a career. Hopefully things will be different in 10-20 years
Sp1ndoctor Oncology, Hematology/Oncology
Edited Jan 09, 2009 at 2:08 PM
<in exchange for 10 years of indentured servitude>
It is rather telling that after 4 years of college, 4 years of med school and 3 years of a pediatric residency (or more), bpoterjoy (and I am sure others) would *WELCOME* 10 years of indentured servitude ....
(from the sound of things, doctors are begging for the opportunity)
If I were in the current federal govt position, I would say things are going just about perfectly - what better way to make doctors support a nationialized healthcare system, than to make us willing, no, obligatory, slaves?
There is no field, NONE, where the participants are *punished* and *enslaved* more for their skills and compassion than the practice of Medicine ....
bpoterjoy Pediatrics
Posted Jan 09, 2009 at 3:01 PM
Sp1n-
The way the bill is written, the state of PA would pay of 10% per year in exchange for remaining in PA for 10 years. What has not been clear is if it would be open to ALL docs, or just primary care. They have it structured to be a tiered selection, geared to keeping PA residents in PA. I joke about the "servititude", but for me, a born, raised, educated from Kindergarten thru med school in PA, married to a Philly girl (the Philly definition of moving is going 1 neighborhood away from where they grew up) - I am not leaving unless I need to, or one helluva opportunity comes up. My oldest is 10, and she doesn't want to leave her school, and cringes when we talk about upgrading to a bigger home (typical, I know). So for my purposes, if Harrisburg pays me to stay, that's great cuz I win and they win.
Sp1ndoctor Oncology, Hematology/Oncology
Posted Jan 09, 2009 at 3:23 PM
Sounds better than "indentured servitude" but it really doesn't matter - the point is, someone would have no freedom for 10 yrs after completing what most would already consider indentured servitude, after PAYING FOR THE PRIVELEGE and going into massive debt ...
slatosky Family Medicine
Posted Jan 09, 2009 at 3:23 PM
it is sad but my student loan payment is higher than my morgage payment. it is even sadder that i am taxed as if this was income. tell me again why no one is going into primary care.
bpoterjoy Pediatrics
Posted Jan 09, 2009 at 3:52 PM
Sp1n- I agree with u 100%. I actually think that the central issue is the cost of medical school itself. Did u see the above comment about Temple being 42k per year- insane! Just 10 years ago I was paying about 20k, and I thought that was high. SOOOO in terms of 'reform", the cost of the education should be on the list also....
donthomasj Rheumatology
Posted Jan 09, 2009 at 4:15 PM
It is a shame that I actually make more money per hour by doing internet surveys and talking to research groups that what the HMOs/insurance companies/Medicare reimburse me for taking care of patients. I have not cut back seeing patients to do more surveys and do group consultation work and I don't plan on doing so in the future. However, it sure crosses my mind sometimes on difficult days.
docnag1 Family Medicine
Posted Jan 09, 2009 at 4:46 PM
I was fortunate to get a slot in the national health service corp loan repayment program. But, the $25,000/year payment, barely covered the nearly 20% interest on the $140,000 balance I had by the time the program became available. The NHSC bought me 5 years of interest payments nothing more. I am over 20 years in payback and still making very large payments with perhaps an end in sight but who knows in the current economy. Also, understand that in the NHSC, one gets a salary or has a private practice option, neither of which allows much of an income. Hence my current income after over 20years being equivalent to a tenured NYS teacher...that's upstate NY. Of course I could take a job at the local pretend hospital supervising a dozen midlevels and make some big money. I just can't do that. I am not unhappy but I resent that people equate being a physician with having alot of money and they think we don't need to be paid for our work.
maggieruby40 Pain Medicine
Edited Jan 09, 2009 at 4:59 PM
I had about $200,000 in medical school loans when I finished training. I graduated in 1993. I had to do forebearance for a few years. I call it the house I do not live in.
I am still glad I am a doctor. But sometimes I get annoyed when people assume I am so "rich" because although I do live better than most, there are many who live much better. There are also many who while we were making 30 cents an hour in Residency and Fellowship for all those years, were already working in their professions and are doing a lot better.
I resent that people resent me for being a "big rich doctor". I worked hard, I do not remember much of life other than Work for many years and because of my debt I am really not that "rich"
I believe that I should live well and be respected for it.
B1Fixer Orthopaedics
Posted Jan 09, 2009 at 4:57 PM
since when did the media become "clients"? So anything said here can be quoted in Forbes? How many other news organizations are "clients"? Which ones?
Andrea33333 Psychiatry
Posted Jan 09, 2009 at 5:02 PM
Fixer's questions need to be addressed.
Leland Family Medicine
Posted Jan 09, 2009 at 10:16 PM
Return on investment in Primary Care fields is not what it was, nor what it should be. There is nothing I personally would want to do besides being a Physician, yet I was relieved that neither of my children expressed any desire to follow in my footsteps. Life is tough enough. Only wanting to do something urgently and desperately could explain the sacrifices those of us that have chosen this life are willing to make. I suspect if I were attending Medical School in this era, I would be more influenced toward choosing a higher paying specialty. I am fortunate to have graduated from an excellent mid western Medical School in an era when it was possible to graduate without a six figure debt, and to have had dedicated and supportive parents. When I read some of the stories above, I realize how very fortunate I have been.
should really be a separate post, maybe if this doesn't go anywhere here I will post it separately):
