Your student loan vs. My student loan

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Digital MD

Your'e better off asking your pet for advice.
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First post. SDN is an amazing resource and I thank each and every one of you for staying involved in the forums where ever you are in your career.

I am about to apply for medical school @32. My educational science background is very solid and I have worked the last 6 years building digital strategies for major companies in the US and the UK (just some background).

Every time I think about medicine, the cost vs. investment scares the hell out of me. Future decrease in pay, increasing educational cost etc etc. I don't know if a 200K loan + interest is working well for my own health.

My pre-question: I see alot of people mention they are in 300-400K student debt with a 10+ year repayment plan. For my state school - tuition, books (new), and student insurance will cost me roughly $125,600 for 4 years MD school. Personal cost (housing, transportation, fun) is not included in that amount. I live in a low cost-living state (finally a plus!).

Am I missing something that will actually balloon the cost to the mentioned 300-400K range!? I feel like I haven't overlooked anything although I lack the full experience and may not see it.

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Housing and transportation are pretty big costs once you figure those in, however being in the workforce currently obviously you have those handled so that's something you have going for you. Most of those 300-400K figures are people from private schools and also people attending out of state.
 
I'd also add most of those in the 300-400k range not only attend out-of-state public schools (usually the most expensive) or private schools and don't have any savings/help from family, but they often have undergrad debt as well.

I agree with PL198 that housing and transportation are pretty big costs--I'm just guessing here because it's been a few years since I was in medical school, but I think $20-25k was budgeted for those per year. Certainly at least $15k/year, which is still at least an additional $60k over 4 years. Of course, even if you're not living at home, if you're smart you can live on less.

If you're going to an in-state school, live decently (not living on Ramen noodles, but not also living in a solo downtown apartment/living the lavish life), and don't have any undergrad debt or other unusual expenses, you should not end up anywhere near 300K.
 
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I don't think you are missing anything major in your numbers. I think some things that contribute to the $300-400k debt that most students have is:

1. non-tuition living costs
2. academic books, supplies, & small fees not included in tuition
3. interest on the principle
 
If somebody or something is paying your living expenses, great, otherwise add those costs onto your debt. That money has to come from somewhere.

Rent is just one thing of many. You have to buy health insurance, either what the school offers or on your own, and if you actually go to the doctor then you have to pay copays. You may need to have a car - unless you're in a major metro area with great public transport, assume you have to get yourself 50+ miles away from school for clinical sites. Your school may require you to have a particular computer. There may still be some med students who don't use a smartphone, but nobody uses a pager anymore. At my school, attendings text students every day during 3rd year. Cost of attendance is a 9 month budget for M1 and M2 year, so when you divide the year's living budget by 12 it feels a lot less generous.

Almost nobody buys textbooks where I go, but online tools are absolutely essential. You might make it through M1 year without buying stuff, but you won't make it as an M2 without buying Pathoma and UWorld. Some people swear by DIT ($700) . Some people start using Firecracker as an M1. Most of my classmates buy the shelf and board self-assessments which are $50+ a pop, and we used about 20 of these during M2 and about 8 during M3.

Tuition/fees usually includes the cost of board exams, but not travel for Step 2 CS (6 sites in the US) or travel for interviews. Doing 20 interviews, which is normal, can be a 5 figure amount. Doing away rotations as a 4th year isn't in budget. If you want to do something interesting between M1 and M2 year, like research, you might get a $3k stipend, and if you're lucky you won't have to pay double rent that summer.

So yeah, if you get into a public school and if you only have to borrow tuition/fees and if you have family support for emergencies and gifts then yeah, you can get out of med school with under $150k debt.
I was very surprised by how many of my classmates get six figures of support from family. My school is 50% OOS with $60k tuition per year, and every class has about a dozen military scholarship people (I think we have the most outside USUHS). I've started asking the financial aid office people how many people are in "the 400 club" and it's gone from 1 to 20 in the last 2 years.

Best of luck to you.
 
Wow, thank you for the in-depth responses. There are a few things you have mentioned that I would not have known outside of normal personal expenses. Starts to put things in a better perspective.

I am starting to feel fortunate that where I live is finally a plus. In-state tuition, cost of living, and a program to start making decent money before getting out of residency. I am about to move to an apartment on a golf course (free golf) for $750 a month 2b/2ba. I have lived in Manhattan and felt the contrast of standard of living. It makes me wonder why going an out of state, even to a prestigious school, is beneficial (looking at numbers vs. living). Thanks again, very insightful.
 
Outside help, and of course the big one is the length of your residency (with its crappy pay and hours to keep your mind off financial matters) and the effect of that compounding on your outcome. Since I did it before they changed grace/defer terms (so I hear) and did 7 years of training (during not so great interest rates) my loan total nearly doubled, its incredibly painful to take in. Its unlikely if you already make a decent income that the cost of tuition/opportunity will come out positive unless you do a short term residency with higher income potential. Not too mention all the liability and pain you take for the pleasure of doing so.

The other thing people forget about is applying to residencies, cost of interviewing, etc....as well as fellowship, etc...and again for your actual job....all cumulative.

If you take the opportunity cost perspective it will take quite some time for it to pay off without some other form of income (which it sounds like you may be able to do). Best to do a short "lifestyle" type residency that will give you ample time and opportunity to moonlight and increase your income during residency and be able to make attending wages sooner than others. This is super important as time is obviously the most important thing, and you're already a bit older and will be 40 before being an attending at the most liberal estimate. Time in the market as they say.

The only upside is you didnt spend your youthful years doing it, also a drawback. Tradeoffs, its the whole game really.

There is a 400 club? I was probably one of the first few to hit that great number.
 
A large student loan requires to be managed properly in order to make the best of it. You must avoid other loans like payday loans and try to cut corners on everyday expenses instead. With proper management you will be able to pay it back easily without getting under a huge amount of debt.
 
Some of those people I know with the $300-$400k range of debt also had kids and non-working husbands. I ended up around the $200k range in debt when I finished. A bit of that was from interest during forebearance. I did consciously limit my expenditures on fancy restaurants, alcohol, and clothing during training. I tried to either get used textbooks or borrow them from the library. The software purchases were somewhat unavoidable for me, although I did have classmates that got by just fine without them.
 
1. Undergrad loans + interest
2. Transportation costs: public transport or garage fee + school parking + car loan + insurance
3. Credit card debt
4. Rising tuition. Might want to check with your school about this and see historical changes; here, anyway, the quoted tuition for M4 year during M1 year is not what it actually ends up being (ie, we aren't locked in/guaranteed a tuition price). Rose several thousand dollars on me.

Most of the other stuff has already been mentioned. New computer. Step 2 CS travel + hotel. Board review materials. Interviews. Moving + settling in expenses for residency. Unexpected health costs. Away rotations. Kids/daycare. On starting residency: copies of transcripts; background checks; licensing fees.
 
My pre-question: I see alot of people mention they are in 300-400K student debt with a 10+ year repayment plan. For my state school - tuition, books (new), and student insurance will cost me roughly $125,600 for 4 years MD school. Personal cost (housing, transportation, fun) is not included in that amount. I live in a low cost-living state (finally a plus!).
If you feel left out, your $125,600 number upon graduation can double after x years if you let it get out of control; i.e., forbearance during a long residency then paying absolute minimums post-residency. You, too, can gun for $300K or more in student loans if you try really hard and believe in yourself. :hungover:
 
First post. SDN is an amazing resource and I thank each and every one of you for staying involved in the forums where ever you are in your career.

I am about to apply for medical school @32. My educational science background is very solid and I have worked the last 6 years building digital strategies for major companies in the US and the UK (just some background).

Every time I think about medicine, the cost vs. investment scares the hell out of me. Future decrease in pay, increasing educational cost etc etc. I don't know if a 200K loan + interest is working well for my own health.

My pre-question: I see alot of people mention they are in 300-400K student debt with a 10+ year repayment plan. For my state school - tuition, books (new), and student insurance will cost me roughly $125,600 for 4 years MD school. Personal cost (housing, transportation, fun) is not included in that amount. I live in a low cost-living state (finally a plus!).

Am I missing something that will actually balloon the cost to the mentioned 300-400K range!? I feel like I haven't overlooked anything although I lack the full experience and may not see it.

Yeah, you're missing the fact that you have a very cheap state school and that debt growing at 6-8% for 7-10 years balloons very quickly. Imagine that instead of having to pay $31K a year that you have to pay $60K a year. Let's also assume another $20K a year in living expenses. Some can do it cheaper, others with families may find that amount very difficult, but it seems a reasonable amount. So $80K a year. After 4 years, at an average rate of 7% (tough to get the best rates when you're taking out $80K a year) that $80K x 4 = $320K has grown to $380K. Now, let's say you do general surgery. So after 5 years of tiny PAYE payments, you're now at $533K. Heaven forbid you want to do a fellowship.

At any rate, if you can get out for less than $150K (maybe $200K by the end of residency) you're ahead of the game. Be grateful.
 
First post. SDN is an amazing resource and I thank each and every one of you for staying involved in the forums where ever you are in your career.

I am about to apply for medical school @32. My educational science background is very solid and I have worked the last 6 years building digital strategies for major companies in the US and the UK (just some background).

Every time I think about medicine, the cost vs. investment scares the hell out of me. Future decrease in pay, increasing educational cost etc etc. I don't know if a 200K loan + interest is working well for my own health.

My pre-question: I see alot of people mention they are in 300-400K student debt with a 10+ year repayment plan. For my state school - tuition, books (new), and student insurance will cost me roughly $125,600 for 4 years MD school. Personal cost (housing, transportation, fun) is not included in that amount. I live in a low cost-living state (finally a plus!).

Am I missing something that will actually balloon the cost to the mentioned 300-400K range!? I feel like I haven't overlooked anything although I lack the full experience and may not see it.


I'll just cut to the chase...
Don't do it. 32 years old? Going to start at 33 or 34? Done at 37, residency when you're damn near 40? Not worth it. If you've made your money and can pay cash or your parents can foot the bill then by all means have at it. But really, don't do it. I was doing surgical residency at about your age. Fellowship a bit later (and could feel my energy winding down). Now....there's no way. And really if you're going to do IM or family or something the financial incentive just isn't there, the real money is in specialty. I love it but if I had it to do again at this age, it's just not realistic (and I'm not some lazy fat ass, I work, jog 3-4 miles 4 times a week and do research). Any specialty training that's going to make it worth it financially at your age, and your're getting close to old isn't going to be what you want in 4-5 years. Add to that tacking on huge debt that late in life and you'd be crazy.
Want a certain job in a nice location? Someone that's been out in practice and has money banked will undercut you. Get a decent job at 40, partners know you're on the financial ropes and will work you into the ground. That's reality.
I'm not just saying this to be a dick, I look at you the same as someone playing on the train tracks, it's my duty to tell you to get the hell off, there's a train coming.
Take my advice for what it's worth, medicine is great but there's a lot of great things out there. Don't do it.
 
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I'll just cut to the chase...
Don't do it. 32 years old? Going to start at 33 or 34? Done at 37, residency when you're damn near 40? Not worth it. If you've made your money and can pay cash or your parents can foot the bill then by all means have at it. But really, don't do it. I was doing surgical residency at about your age. Fellowship a bit later (and could feel my energy winding down). Now....there's no way. And really if you're going to do IM or family or something the financial incentive just isn't there, the real money is in specialty. I love it but if I had it to do again at this age, it's just not realistic (and I'm not some lazy fat ass, I work, jog 3-4 miles 4 times a week and do research). Any specialty training that's going to make it worth it financially at your age, and your're getting close to old isn't going to be what you want in 4-5 years. Add to that tacking on huge debt that late in life and you'd be crazy.
Want a certain job in a nice location? Someone that's been out in practice and has money banked will undercut you. Get a decent job at 40, partners know you're on the financial ropes and will work you into the ground. That's reality.
I'm not just saying this to be a dick, I look at you the same as someone playing on the train tracks, it's my duty to tell you to get the hell off, there's a train coming.
Take my advice for what it's worth, medicine is great but there's a lot of great things out there. Don't do it.


I couldn't agree more!

And there's nothing more to add, because this post is 100% accurate.
 
I'll just cut to the chase...
Don't do it. 32 years old? Going to start at 33 or 34? Done at 37, residency when you're damn near 40? Not worth it. If you've made your money and can pay cash or your parents can foot the bill then by all means have at it. But really, don't do it. I was doing surgical residency at about your age. Fellowship a bit later (and could feel my energy winding down). Now....there's no way. And really if you're going to do IM or family or something the financial incentive just isn't there, the real money is in specialty. I love it but if I had it to do again at this age, it's just not realistic (and I'm not some lazy fat ass, I work, jog 3-4 miles 4 times a week and do research). Any specialty training that's going to make it worth it financially at your age, and your're getting close to old isn't going to be what you want in 4-5 years. Add to that tacking on huge debt that late in life and you'd be crazy.
Want a certain job in a nice location? Someone that's been out in practice and has money banked will undercut you. Get a decent job at 40, partners know you're on the financial ropes and will work you into the ground. That's reality.
I'm not just saying this to be a dick, I look at you the same as someone playing on the train tracks, it's my duty to tell you to get the hell off, there's a train coming.
Take my advice for what it's worth, medicine is great but there's a lot of great things out there. Don't do it.



It really boils down to doing what you love. If somebody wants to be a doctor for the money and prestige and lifestyle, they shouldn't do it. I can't tell someone "don't do it" when they might just want to help people and don't care if they are paying off loans til they are 70.

Be a doctor because you can't picture yourself doing something else. Don't do it to get rich.
 
It really boils down to doing what you love. If somebody wants to be a doctor for the money and prestige and lifestyle, they shouldn't do it. I can't tell someone "don't do it" when they might just want to help people and don't care if they are paying off loans til they are 70.

Be a doctor because you can't picture yourself doing something else. Don't do it to get rich.

I can't picture myself doing anything else because I love the technical aspect of what I do. But I'd still advise as above. I'd do something else I don't like for 8 hours a day and less debt and enjoy my free time if I was to start at 32 knowing what I know now. If I was on the same timeline I started on or someone that age asked me my advise i'd say go for it, I'd explain the reality but that even if you go for the "ideal" reasons and are slapped hard by reality at least the money is still good.

"Helping people" is a fallacy. We patch them up. I operate on the obese people that have been "helped" by doctors that love helping people that come in with a hbA1c of 13 and slap a LIMA on their LAD so they can go back to sitting on a couch stuffing potato chips into their faces without having to be reminded they're killing themselves by that damn chest pain. You "help" maybe 10% of people. Really. Does any practicing doctor outside of a pediatric soecialty really think they help more?
The romantic part is bs. It's a job. I'm lucky that I like the technical aspect. My patients do well because it's a point of pride for me to operate well...not because I really believe I'm doing anything but prolonging the frankly horrific position they've put themselves in.
And it motivates me to never turn out like that.
 
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It really boils down to doing what you love. If somebody wants to be a doctor for the money and prestige and lifestyle, they shouldn't do it. I can't tell someone "don't do it" when they might just want to help people and don't care if they are paying off loans til they are 70.

Be a doctor because you can't picture yourself doing something else. Don't do it to get rich.
There are many ways to help people and it isn't so much about the money as it is about the difference a high debt load will make on your life especially for someone without as many earning years left. What if you end up not actually loving your job? You will end up a slave wage until you retire (at a very late age) hating every minute more than the last. What if a different health care job would have let you still feel you are helping people but wouldn't have made you mortgage your future to achieve? I think too many people have a romaticized image of being a doctor and end up disillusioned. Bad enough if that happens without a bunch of debt, but terrible to have a giant debt hole to try to crawl out of too.
 
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It really boils down to doing what you love. If somebody wants to be a doctor for the money and prestige and lifestyle, they shouldn't do it. I can't tell someone "don't do it" when they might just want to help people and don't care if they are paying off loans til they are 70.

Be a doctor because you can't picture yourself doing something else. Don't do it to get rich.


I'm sorry, but your assertion is patently ridiculous. Very few actually "love" the work -- that's just what we tell ourselves to justify it all. We've already established that "helping people" is a fallacy. What's worse is that you'd encourage someone to work into their 70s doing it.
 
As others have mentioned, interest has been the really bad thing for me and my loans. If you're either in forbearance or doing income based repayment during training, your loans are going to grow a lot during the 3 to 7 PGY years.

However, yes, you're lucky that your costs are still going to be relatively low, and as others have mentioned, you can save money in other ways. Also, with income based repayment (should be PAYE for you), worst case scenario is paying off your loans in 20 years. You won't be paying them off in your 70s.
 
As others have mentioned, interest has been the really bad thing for me and my loans. If you're either in forbearance or doing income based repayment during training, your loans are going to grow a lot during the 3 to 7 PGY years.

However, yes, you're lucky that your costs are still going to be relatively low, and as others have mentioned, you can save money in other ways. Also, with income based repayment (should be PAYE for you), worst case scenario is paying off your loans in 20 years. You won't be paying them off in your 70s.
You won't be paying student loans on your 70s but if you couldn't focus on retirement savings because of high debt load (or worse if you get stuff on credit because you feel you deserve it even though you can't afford it) you may find yourself still having to work at 70 and beyond. This is particularly true for someone who is entering the career later on in life. Not saying that somr won't still find it worth it, just that it is something else to consider.
 
I'm sorry, but your assertion is patently ridiculous. Very few actually "love" the work -- that's just what we tell ourselves to justify it all. We've already established that "helping people" is a fallacy. What's worse is that you'd encourage someone to work into their 70s doing it.

Please. You are the one being ridiculous. I never would "encourage someone to work into their 70s" to do anything. What I am saying is that if they can't imagine doing something else, than that's what they should do.

Is your advice that nobody should ever again go to medical school? Because that would just be idiotic. My advice is to not go to medical school for the money. My advice is to do it in spite of the money if that's what you really want to do. Because those people will be happiest in the end.
 
As others have mentioned, interest has been the really bad thing for me and my loans. If you're either in forbearance or doing income based repayment during training, your loans are going to grow a lot during the 3 to 7 PGY years.

However, yes, you're lucky that your costs are still going to be relatively low, and as others have mentioned, you can save money in other ways. Also, with income based repayment (should be PAYE for you), worst case scenario is paying off your loans in 20 years. You won't be paying them off in your 70s.

Since he's applying at the age of 32 he wont graduate until hes around 37, even the shortest residency would put him just over 40, add 20 years and he's 60. That is not materially different than 70 for this discussion. There are lots of other "worst case" scenarios that could push that out farther, and some better ones that could shorten it of course.
 
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