Respectful Insolence

A weight off my back

Today, on my way into work, I did something momentous, something that marks a turning point in my life. It was a small act, but one that has lifted a huge weight from me.

I put a check in the mail to pay off the last of my student loans. Free at last! And it’s only been 19 years since I graduated from medical school, too!

Thinking about it, my overall debt when I finished medical school was relatively small, around $55,000 or so. True, it did balloon up to around $80,000 during the years when I could not afford to make payments due to the low pay of residency and the small stipend when I was in graduate school while interest accumulated, but by today’s standards, even that’s still nothing. I really can’t figure out how these kids finishing medical school today $100,000 or even $200,000 or more in debt will be able to pay off their loans before they’ve become considerably older than I am now that I’ve written that last check.

At the risk of turning this blog into the poll of the day after having asked people to relate their memories of 9/11 two days ago, I thought I’d take the chance and dip once more into the well. Those of you who are presently medical students (or are married to, engaged with, or living with a medical student), how much debt do you anticipate having when you finish medical school. Those of you who have finished medical school within the last five years (or are married to, engaged with, or living with a a young physician who has), how much debt did you have when you graduated?

More importantly, from the perspective of an old fart like myself who was worried that I’d still be paying off my student loans until I was ready to retire, how will you manage to pay off your debts?

Comments

  1. #1 Xerxes1729
    September 13, 2007

    I’m a first-year med student. If I sell the mutual fund my grandma bought for me when I was born, I can probably get my debt under $185,000. (I’m not selling it until next year, when capital gains taxes are eliminated for people like me in the bottom income brackets.) By the the end of a four-year residency, it will be around $230,000. My plan is to maintain my style of living during residency, in terms of expenses and what not, for several years afterward and attack it aggressively for a few years. As to choosing a specialty, money will play a role. I know it’s not supposed to, but it’s very unlikely that I’ll go into primary care (although this would be true even if I had no debt) or practice in an academic setting, unless I can get in on something like the NIH’s loan repayment program.

    That said, I still freak out about the debt sometimes. I start messing around with spreadsheets and payment calculators, realize that I could very easily be making payments until I retire, and get depressed.

  2. #2 Dianne
    September 13, 2007

    I graduated 14 years ago, which I suppose doesn’t count as “recent” anymore (how DID that happen?), but for what it’s worth, I had about 40-50K debt (public med school, lack of dependents, occasional help from relatives, and general cheapness combined to give me the relatively low debt load) that ballooned during residency and fellowship. I managed to pay it off last year. Just in time to start thinking about how I’m going to put my kid through college and what I’m going to retire on. Maybe I’ll be one of these people who refuses to retire and hangs out as an emertius forever. Assuming, of course, that I can con someone into giving me tenure some day.

  3. #3 Sarabeth
    September 13, 2007

    My husband had loans worth $70,000 after medical school. He graduated 12 years ago. We paid off the debt when we sold our first house–about seven years ago. Instead of that debt, we settled for the debt of owning another house with a 100% loan. That has worked well for us, but we have had to be rather frugal in not taking large vacations.

  4. #4 Dan
    September 13, 2007

    Congratulations, Orac! A debt-free life must be wonderful.

    I’m married to a fourth year medical student. My wife attends a public medical school in Texas, which seems to take care of its students. Out-of-state tuition at her school is less than in-state tuition at schools in her home state.

    Anyhow, my wife has received scholarships all four years. The last two years have been full scholarships. We expect to have about $50,000 in medical school debt at the end. That will all be government loans, too.

    Of course, we both went to a private university and I have private loans from that . . . but she only borrowed something like $8500 for undergrad so my wife’s total is under $60,000 for college and medical school.

    We’re very lucky. My wife talked to other people who came out of Washington University Medical School with over $250,000. That kind of thing is going to have to stop. Rising tuition plus falling medical reimbursement plus increasing demand for physicians (especially in low paying primary care fields) is a structure that will break sooner or later.

  5. #5 Jared
    September 13, 2007

    I plan on paying off my medical school loans by moonlighting as a candystriper at the private hospital.

  6. #6 vlad
    September 13, 2007

    I had a very skewed impression of doctors and finances. I though residents made 60k plus per year and full doctors were in the 150k to 200k brackets one I knew in his 50’s was at the 500k mark. Assuming you have no dependents I would think you could kill the debt by living frugally for 3-5 years after residency. From what I understand about residency you have no time other then to eat sleep and work, thus you wouldn’t have time to build debt then. I think I completely misunderstood what being a doctor entails financially.

  7. #7 Niles
    September 13, 2007

    My suggestion to avoid the MD debt is to take the MD/PhD track. Find a professor who is willing to get your out in six years with both degrees, and they’ll give you a project that’s been pre-gurgitated by a postdoc. In many institutions, the MD degree is then subsidized as part of the cost of your education.

    Sure, you don’t learn the scientific method as well as full PhD students (since you are in the lab much less), but it gets you out and into your residencies earlier and with a lot less debt.

  8. #8 PlanetaryGear
    September 13, 2007

    My wife graduated about 13 years ago and we are now debt free also. But that is only because her parents were able and willing to help considerably and I worked throughout her schooling, residency, internship and fellowship and so we were able to continue to make payments. People that were not married to someone with a job and who’s parents were not able to help easily graduated with debt over 100k. Some of our best friends even married after med school with over $100k a piece in debt for a family debt of over $200k!! I think they will be paying that off for a very long time.

  9. #9 PuckishOne
    September 13, 2007

    Congratulations to you, Orac. I remember feeling the same sense of relief the day I received my last promissory note stamped “paid in full” (although for far smaller sums, as a non-science grad). Either way, the feeling is palpable and very welcome. :)

  10. #10 Eric
    September 13, 2007

    My fiancee is a third-year MS, and we anticipate having somewhere between 180-190k when she graduates in 2009 (assuming there isn’t another 19% jump in tuition next year like there was this year). Luckily, both of us went to state schools and got scholarships as undergrads, so we don’t have any loans from that. As best we can figure, it will probably take us at least 20-25 years to pay them off, depending on a lot of other factors, of course (like what sort of job this soon-to-be PhD can manage to find for himself). Of course, I would probably be less optimistic if she had her heart set on rural primary care (like one of our really good friends).

    Xerxes1729, I would recommend that you hang on to that mutual fund and put it towards something later, like a down payment on a house. As far as debt goes, you’re a lot better off working through the (relatively low interest) student loan debt without throwing all of your assets at it right now. We faced this choice when my fiancee (quite unexpectedly) received a substantial inheritance from a family friend and we decided to invest it rather than a) living off it for a year or so; or b) applying it to her loans. Of course, once we have the house, we can always go the Sarabeth route.

  11. #11 Courtney
    September 13, 2007

    Orac, I read your blog voraciously and enjoy it immensely. Congrats on being newly debt-free! I’m in the non-traditional position of a career-switcher to medicine. Now in my late 20s, I’m taking premed courses after working a number of years in a field I never wanted to be in with an undergrad and master’s degree in that same unwanted field… and a $60,000 student loan debt load to go along with it.

    So I’m already headed into med school with that hanging over my head. Niles’ suggestion of an MD/PhD program is excellent, and it’s what my heart has been desiring since I started a part-time lab job last year, but I fear that I’m too old to take so much extra time. My friend just finished med school on a military scholarship, but the military in its current situation is anathema to my political views.

    My acquaintances who believe I’m switching to medicine simply for the money should read this discussion!

  12. #12 Hans
    September 13, 2007

    I’ll join in the chorus of congrats, but a word of dissent: you’re forgetting the effects of inflation. Using the inflation calculator at http://www.westegg.com/inflation/, $55,000 in 1987 was equivalent to $94,093.64 in 2006 (the most recent year they can give numbers fort). So someone graduating today with $100,000 in debt in 2007 is really no worse off than you were in ’88. $200,000, that’s another matter, but then again, did some in ’88 graduate with $110,000 in debt, or was your figure of $55,000 at the high end of the scale back then?

  13. #13 waldteufel
    September 13, 2007

    Congratulations!

    I can still remember the feeling of paying off that last student loan, oh so many years ago.

    I read and enjoy your blog often. Thanks.

  14. #14 Rob
    September 13, 2007

    I graduated in 1990 and had over $100K in debt. Now my payments are small compared with others, but still have around $30K owed. I envy you in this – you are no longer tied to “the man.”

  15. #15 spudbeach
    September 13, 2007

    I put my ex-wife through medical school, graduating in 1990. Since I was an actuary, I was making some pretty decent money, and we had a grand total of $25,000 in debt at the end of medical school. All of it was paid off within five years of the end of medical school (two years after a family practice residency). So, it’s not just a question of how much you spend, or who your parents are, but also who you marry.

  16. #16 Susang
    September 13, 2007

    Looks like someone’s buying dinner next time they’re in town! Congratulations, wanna contribute to the poor starving artist fund I’m considering starting?

  17. #17 Callandor
    September 13, 2007

    My cousin Steve is a pediatric surgeon, and when he graduated medical school I know he had 100,000 – 120,000 dollars of debt. I sadly have no clue as to how he’s done in paying that off. He’s at least not living in a box, nor starving, so some progress is likely being made.

  18. #18 Sara
    September 13, 2007

    Another option for reducing med school debt is to join a program like the National Health Service Corps – it’s similar to a military scholarship, except when you finish, your “service debt” is to an underserved part of the country instead of the military. You get some input into where you’ll go to do that service, but there is some element of the program telling you where to go for a few years, which would make it less-than-ideal for someone with a family or other strong geographic ties. There are also state-sponsored programs in some states. (I know Arizona is one such state, I’m not sure about others.)

  19. #19 John McKay
    September 13, 2007

    Medical students aren’t the only ones to finish school in debt servitude. My degrees were in History. Although my debt was much smaller than those of a medical student, my earning potential was also an order of magnitude smaller.

    I finished paying off my loans a few days before my 49th birthday.

  20. #20 Robert M.
    September 13, 2007

    My wife is a fourth-year osteopathic med student, and we just got her final loan statement. We came in at just under $190,000; about 75% of that is in private loans.

    We’re planning to keep our current standard of living during her residency, and devote her salary to the med-school debt, which should halve it by the time she’s ready to join a hospital or practice.

    The kind of rural, underserved, and urban medicine programs Sara mentions are a good option for those that are able to finance their debt using public programs, but they can’t pay off private money–which means lots of students are stuck, under the current system.

  21. #21 Melissa G
    September 13, 2007

    Congratulations! That’s a great accomplishment.

  22. #22 Mike O'Risal
    September 13, 2007

    I’m a PhD student, not med, and my only student loan debts are from undergrad. The biology department at my undergrad institution was kind enough to pay for one semester for me, so I have only 7 semesters worth of debt… nothing even close to six digits. Even with low post-doc pay and the like, I should be all paid off right around the time I retire.

    I hope the cost of dogfood hasn’t gone up too much by then. Do you have any idea of what the rent is on a decent appliance box in Massachusetts?!

  23. #23 Ezekiel Buchheit
    September 13, 2007

    Congratulations!

  24. #24 David
    September 13, 2007

    In Canada, MD/PhD students generally pay a third of the tuition of MD students (which is already much less than US medical schools) and receive a reasonable stipend (~$20 000 per year) through nearly the entire degree. All in all, it is possible to graduate in the black if you budget well!

  25. #25 George
    September 14, 2007

    I’m at $67,000 right now (2nd-year), so I’m thinking $150,000 when I graduate. And I’m going to a state school with in-state tuition. I’m not too worried, though. I’m a pretty frugal guy and I don’t mind living on the student budget I have now for several more years.

  26. #26 bcpmoon
    September 14, 2007

    First of all, congrats on being debt-free, Orac!
    This reminds me, how different the educational system in the USA is from Europe. My parents were able to put four children through university without going broke (only my father worked for money, as a teacher) and my personal debt at the end of my PhD was 5000 Euros. This is a strong caveat before you compare incomes and taxes between countries.

    Btw., what is this with cheques and mail? I think I have only cashed in a check twice in my life and never written one. Is there an explanation of this phenomenon?

  27. #27 JGL
    September 14, 2007

    I’m just over two years out of my residency. I had about $110,000 in student loan debt when I entered practice (a relatively modest amount — a benefit of attending a state medical school). This spring I refinanced my house and got enough money out of it to pay off the student loans. So I’m still servicing my debt, but now it’s in my house, so at least I can deduct the interest on my federal income tax return (most docs earn enough that they are excluded from deducting student loan interest).

    As for Sara’s idea of working for the feds in an underserved area for purposes of debt forgiveness — a good thought in principle, maybe not so good in practice. The difference in earnings between working for the government and being in private practice is in most cases more than enough to cover the cost of the debt.

    It’s sad that financial realities are driving docs to choose specialties and practice styles that often are at odds with the altruistic motives that got them into medicine in the first place. Factor in the years of training, the long hours, the nights and weekends of call, and the ever-present fear of a lawsuit, and all of a sudden the luster of a career in medicine starts to dim.

  28. #28 dlnevins
    September 14, 2007

    Congratulations on retiring your debt, Orac! Financial freedom is a wonderful thing.

    I gradulated from medical school in 1995, carrying approximately $120,000 in medical school student loans. I can’t complain, as I make a more than decent living now, but the debt and the decade-long deferred opportunity costs (mostly related to missing retirement savings) does mean my actual lifestyle isn’t nearly as wonderful as most people would guess just from looking at my annual salary. (Which is OK in my case; I didn’t go ino medicine in order to be come rich. I do worry that high debt loads might discourage some promising students from considering the field, though, especially those from lower-class backgrounds who may be afraid to take on such significant levels of debt and non-traditional students who may be supporting dependents.)

  29. #29 J. Brown, MD
    September 14, 2007

    Paid for medical school with the Army Health Professions Scholarship program. 7 Years after graduation I was a civilian doctor with no debt and about $100K in the bank.

  30. #30 Lily
    September 14, 2007

    Congratulations!
    I’m a second year medical student, so I’ve still got a few years to acquire debt before I can even think about paying it off. Fortunately I’m married, and my husband works hard which means I have to take out loans to cover tuition but not living expenses, so I’m *only* facing around $80,000 (it’s strange that such a large number is at the low end of the spectrum now). Last time I checked the average debt for a recent grad was $110,000, but I’m sure many of my classmates will have $200,000 or more. Fortunately many of us are used to a relatively frugal lifestyle, so I think as long as people continue to watch their expenses (especially after residency when they finally start to make a decent salary), they’ll pay it off in 10-15 years.

  31. #31 Dan
    September 17, 2007

    I decided against medical school (and opted for a PhD in Public Health, fully supported) precisely because of the massive debt I would accumulate. I knew I’d make more as a physician, but if, for some reason, I become unable to work it would be impossible to manage student loans of 150K-200K.

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