Thoughts on the Big Day

[The Knife & Gun Club]

Hey all - I’m a SDN premed veteran, recently elected (by some miracle) chief resident and just matched my fellowship. I had some thoughts, that are a bit sober, I wanted to share with everyone giving it their all this cycle.

In medicine there is a day that most people don’t even recognize the significance of. No, not the day you get accepted. No, not match day. It is the day you sign your first student loan check and pay that first payment to the med school of your choosing. This should be a day of immense pride. You ran the gauntlet and fought for a spot in the most competitive graduate school market in existence. Congratulations, that achievement is remarkably impressive.

But be wary. From that momentous day forward, for the next 10-20 years, the system owns you. You are entering into a level of (non-bankruptcy-dischargable) debt so high that it will be next to impossible to ever repay it without finishing med school, completing a residency +/- fellowship, and working like a dog for several years as an attending just to break even. Not be rich, just back to the $0 net worth college kid you were at 18. But now you’re 35. You never saved for retirement or funded a college fund for your kid. You never got a house.

You can not leave, you can not quit, you can not turn back when the crap hits the proverbial fan. From that first day, the only way out is through. Until your debt is paid, the system dictates the terms of your existence.

BUT! It is great, you have one of the coolest jobs on the planet.

Personally I bring people back from the dead for a living. I F’ing love going to work (usually). It’s pretty damn cool, I have good stories to tell at parties, and my wife’s parents think I’m the bees knees. The other day Delta upgraded me to first class on a flight, because they don’t know “Dr Knife,” who graduated college nearly a decade ago, is still punch ass broke.

I don’t mean any of this to say don’t do medicine or do do medicine - but I do mean to make any readers here stop for a moment. Realize that moment which may come 6-12 months from today for you all is a big F’ing deal and not to be taken lightly. Congratulations in advance, and may the odds be ever in your favor.

- Knife

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[Moko]

In medicine there is a day that most people don’t even recognize the significance of. No, not the day you get accepted. No, not match day. It is the day you sign your first student loan check and pay that first payment to the med school of your choosing. This should be a day of immense pride. You ran the gauntlet and fought for a spot in the most competitive graduate school market in existence. Congratulations, that achievement is remarkably impressive.

But be wary. From that momentous day forward, for the next 10-20 years, the system owns you. You are entering into a level of (non-bankruptcy-dischargable) debt so high that it will be next to impossible to ever repay it without finishing med school, completing a residency +/- fellowship, and working like a dog for several years as an attending just to break even. Not be rich, just back to the $0 net worth college kid you were at 18. But now you’re 35. You never saved for retirement or funded a college fund for your kid. You never got a house.

You can not leave, you can not quit, you can not turn back when the crap hits the proverbial fan. From that first day, the only way out is through. Until your debt is paid, the system dictates the terms of your existence.

I agree that for most people, the only way out is through. Very few jobs outside of medicine can reliably pay off medical school loans within a reasonable time frame. Some of my friends from medical school realized during their clerkships that they didn't like clinical medicine, but begrudgingly went through residency as they otherwise had no reliable means of paying off their loans. So for aspiring matriculants: it's important to honestly explore medicine as a career prior to committing to this path.

Having recently become debt-free, it's nice to see my net worth finally being >$0. My partner and I celebrated with sparkling cider, because good champagne would have dropped us below $0 again.

 

[Mr.Smile12]

Congratulations on all of the accomplishments!

 

[Angus Avagadro]

Congrats! Imo, being debt free was my big day. Took my wife and I 7 yrs to retire our med school debt. Debt is tyranny, where you get up every day and go to work and pay someone else. Not to get overly political, but remember a certain Pres and party took over the student loan business to make college and grad school more affordable. Yeah, at 6 to 8 %. Never forget. It is hard to get out from under the debt, with home buying, kids, furniture, college funds, debt, etc.. But it can be done with some delayed gratification. Good luck on your journey and best wishes!

 

[lal4life]

Hey all - I’m a SDN premed veteran, recently elected (by some miracle) chief resident and just matched my fellowship. I had some thoughts, that are a bit sober, I wanted to share with everyone giving it their all this cycle.

In medicine there is a day that most people don’t even recognize the significance of. No, not the day you get accepted. No, not match day. It is the day you sign your first student loan check and pay that first payment to the med school of your choosing. This should be a day of immense pride. You ran the gauntlet and fought for a spot in the most competitive graduate school market in existence. Congratulations, that achievement is remarkably impressive.

But be wary. From that momentous day forward, for the next 10-20 years, the system owns you. You are entering into a level of (non-bankruptcy-dischargable) debt so high that it will be next to impossible to ever repay it without finishing med school, completing a residency +/- fellowship, and working like a dog for several years as an attending just to break even. Not be rich, just back to the $0 net worth college kid you were at 18. But now you’re 35. You never saved for retirement or funded a college fund for your kid. You never got a house.

You can not leave, you can not quit, you can not turn back when the crap hits the proverbial fan. From that first day, the only way out is through. Until your debt is paid, the system dictates the terms of your existence.

BUT! It is great, you have one of the coolest jobs on the planet.

Personally I bring people back from the dead for a living. I F’ing love going to work (usually). It’s pretty damn cool, I have good stories to tell at parties, and my wife’s parents think I’m the bees knees. The other day Delta upgraded me to first class on a flight, because they don’t know “Dr Knife,” who graduated college nearly a decade ago, is still punch ass broke.

I don’t mean any of this to say don’t do medicine or do do medicine - but I do mean to make any readers here stop for a moment. Realize that moment which may come 6-12 months from today for you all is a big F’ing deal and not to be taken lightly. Congratulations in advance, and may the odds be ever in your favor.

- Knife

I feel like I need to point out a different perspective here, and also discuss a few thoughts on the idea of “debt free”. First, I’ll give a bit of a background.

I graduated from residency two years ago in a not so lucrative field and a not so glorious specialty. While I finished undergrad without debt, I took out max loans in medical school all 4 years. After year two of medical school (8 years ago), I’ve been the sole provider in my family and my family has grown from 2 to 5. My wife has stayed at home since our first child was born. We realized earlier this year that our net worth is positive. No, I’m not debt free. But with only a few financial moves, my med school debt would be gone.

There are a couple of things that really helped out. First off, I went to the cheapest school I got into. We also lived in suburbs and commuted, which helped our cost of living. Briefly, my wife and child qualified for food stamps and Medicaid for a small portion of medical school, which is a service I’ll forever be grateful for. Then, when it came time for residency, we sought out lower cost of living areas again and found a place I could moonlight 1-2 times monthly for a little extra money. With very little cash in hand, we bought a house starting PGY 2. No money down, no PMI. (There are loans to help all of us do that!) We did very frugal vacationing throughout residency and as our family grew. Our house appreciated by ~$30k by the time we sold it.

I skipped fellowship and started working. Found a midsized city across the country for our family. Instead of throwing all our money at our student loans, we used extra to save and invest somewhere that should get us a higher return on investment. Instead of paying off loans with a 5% interest, we’ve been investing in something that should get us about 8% interest in return, effectively making 3% on that money. Also, we bought another house. And that house appreciated. Sure, I have a mortgage. And I have a ton of student debt. But I live comfortably, and if I wanted to, I could seek or refinance my house and pay off all my student loans. Am I debt free? Far from it!

This year, I’ll turn 35. I’ve had 3 kids. I’ve saved for retirement. I’ve saved for a college fund for my kids. I own a house. I don’t work myself to the bone. I make more than I expected when I started the process, but my specialty is still on the lower end of pay.

Yes, I partially signed my life away when I signed up for medical school. But I would do it again. It’s not all doom and gloom. While OP points out things that need to be considered, let’s look at all that could be considered here.

 

[Angus Avagadro]

I feel like I need to point out a different perspective here, and also discuss a few thoughts on the idea of “debt free”. First, I’ll give a bit of a background.

I graduated from residency two years ago in a not so lucrative field and a not so glorious specialty. While I finished undergrad without debt, I took out max loans in medical school all 4 years. After year two of medical school (8 years ago), I’ve been the sole provider in my family and my family has grown from 2 to 5. My wife has stayed at home since our first child was born. We realized earlier this year that our net worth is positive. No, I’m not debt free. But with only a few financial moves, my med school debt would be gone.

There are a couple of things that really helped out. First off, I went to the cheapest school I got into. We also lived in suburbs and commuted, which helped our cost of living. Briefly, my wife and child qualified for food stamps and Medicaid for a small portion of medical school, which is a service I’ll forever be grateful for. Then, when it came time for residency, we sought out lower cost of living areas again and found a place I could moonlight 1-2 times monthly for a little extra money. With very little cash in hand, we bought a house starting PGY 2. No money down, no PMI. (There are loans to help all of us do that!) We did very frugal vacationing throughout residency and as our family grew. Our house appreciated by ~$30k by the time we sold it.

I skipped fellowship and started working. Found a midsized city across the country for our family. Instead of throwing all our money at our student loans, we used extra to save and invest somewhere that should get us a higher return on investment. Instead of paying off loans with a 5% interest, we’ve been investing in something that should get us about 8% interest in return, effectively making 3% on that money. Also, we bought another house. And that house appreciated. Sure, I have a mortgage. And I have a ton of student debt. But I live comfortably, and if I wanted to, I could seek or refinance my house and pay off all my student loans. Am I debt free? Far from it!

This year, I’ll turn 35. I’ve had 3 kids. I’ve saved for retirement. I’ve saved for a college fund for my kids. I own a house. I don’t work myself to the bone. I make more than I expected when I started the process, but my specialty is still on the lower end of pay.

Yes, I partially signed my life away when I signed up for medical school. But I would do it again. It’s not all doom and gloom. While OP points out things that need to be considered, let’s look at all that could be considered here.

Congrats on your success! Every situation is unique and requires a unique solution. You were successful with your approach. I'd just like to add some texture for the folks reading as conditions have changed since you embarked on your journey roughly 12 yrs ago. That was a time of a historic bull market with solid market returns and cheap money, ie., low interest rates. Some mortgages were less than 3%. Typically, in a bull market, you need to live in a home for generally 5 yrs for it to appreciate enough to recover your closing costs. You caught the home market at a good time. Home values will be dropping soon as inventories are rising along with interest rates. The Fed will shortly raise interest rates another 0.75%. Maybe now wouldn't be a good time to buy a house during residency as you could lose money in a few years as values decline. Secondly, we now live in a time of high inflation. Solid returns with respect to inflation may be challenging. Making 10% returns with 9% inflation is a net 1%. Paying off debt earns 6 to 8%. As inflation will be with us now for years, it will seem harder to make financial progress. I lived during the last cycle and inflation wasn't tamed until interest rates exceeded the rate of inflation and were as high as 17%. That was my experience and my 2 cents. Good luck and congrats again!

 

[voxveritatisetlucis]

im curious, why a chief year and fellowship for EM with that much debt? I was under the impression that EM docs didn’t usually do fellowship and chief year was mainly reserved for people going for GI or cars

 

[Neuroscifan]

Congrats on your success! Every situation is unique and requires a unique solution. You were successful with your approach. I'd just like to add some texture for the folks reading as conditions have changed since you embarked on your journey roughly 12 yrs ago. That was a time of a historic bull market with solid market returns and cheap money, ie., low interest rates. Some mortgages were less than 3%. Typically, in a bull market, you need to live in a home for generally 5 yrs for it to appreciate enough to recover your closing costs. You caught the home market at a good time. Home values will be dropping soon as inventories are rising along with interest rates. The Fed will shortly raise interest rates another 0.75%. Maybe now wouldn't be a good time to buy a house during residency as you could lose money in a few years as values decline. Secondly, we now live in a time of high inflation. Solid returns with respect to inflation may be challenging. Making 10% returns with 9% inflation is a net 1%. Paying off debt earns 6 to 8%. As inflation will be with us now for years, it will seem harder to make financial progress. I lived during the last cycle and inflation wasn't tamed until interest rates exceeded the rate of inflation and were as high as 17%. That was my experience and my 2 cents. Good luck and congrats again!

I’m an incoming M1 with two kids, and my wife is able to work remotely. We were approved for a mortgage at nearly 7%. You’re exactly right that The market is certainly not where it was 12 years ago lol. Our mortgage on a small home in the suburbs would be 3300 a month with 15k in closing costs beyond the down payment for a house valued at 450k. We found a house to rent in a much better neighborhood valued at 675k, and our rent is 2600. Unfortunately the market currently is in a horrible place for buying. With gas at $6 a gallon, commuting is also prohibitively expensive. I’m buying a motorcycle to save on gas, and that’s how we will be able to afford living 11 miles from campus. Finances are tight and stressful for those raising families. For single people who can live with roommates and walk to class, I envy you lol. If my wife wasn’t able to work from home at a low stress job, we would have to take out exorbitant amounts of private loans just to survive on the bare minimum. I saw some figures a couple months ago that demonstrated based on housing costs vs wages that it is more difficult to purchase a house now than it was in the Great Depression.

 

[TelemarketingEnigma]

im curious, why a chief year and fellowship for EM with that much debt? I was under the impression that EM docs didn’t usually do fellowship and chief year was mainly reserved for people going for GI or cars

Not sure about OPs program but in some specialties chief is a leadership position chosen from the final year residents and not an extra year (as in medicine or pediatrics). There are a variety of fellowships you can do from EM, including several that aren’t possible/common after something else like IM. (and I think getting increasingly popular as people eye future exit paths)