There’s one hard truth about medical school. It is expensive. The tuition is astronomically high and 86% of medical school graduates carry educational debt upon graduation. In 2016, the average debt that a graduate carried was $190,000 and 25% of students carried over $200,000 in debt.
I know that you’re thinking, yeah but doctors make a lot of money so it’s OK right?
There are a lot of articles that talk about medical school debt, years of lost revenue and the debt divide that will convince you that medical school debt is a big deal. This article has some particularly nice (read: horrifying) infographics about the real cost of medical school. I won’t re-hash those articles because all you need to do is google “medical school debt” and you can find them. So let me tell you a little about my journey into medical school/educational debt.
I graduated college in 2003 with no educational or consumer debt. I worked through college and went straight to medical school upon graduation. I had always wanted to go to Georgetown for medical school. When I moved into my freshman dorm, I made the wallpaper of my first (and bulky) desktop computer a picture of the Georgetown campus as my motivation. Fast forward 3 years and I was a senior in college and actually applying to medical school. I looked at my in-state public medical school (University of North Dakota) and the University of Minnesota because there was a reciprocity agreement between the two states to honor in state tuition for their residents.
When I looked at the first year tuition between Minnesota and Georgetown there was only a difference of a few thousand dollars per year, so I was ecstatic and eager to pack my things and head off to Georgetown in the fall of 2003. Unfortunately, what I didn’t realize is that the tuition for years 1 and 2 were drastically different than for years 3 and 4 at Georgetown. That, coupled with having to use 100% borrowed money for living expenses in an expensive city, made my debt SKY ROCKET.
I didn’t live extravagantly in medical school. Really what graduate student does? I lived in a studio basement apartment and drove a used Ford Contour. I nearly panicked when I had to go to Express and buy ‘business casual’ clothes for clinical rotations in year 3. Lucky for me, Matt was in the Marines and stationed nearby so he would come and take me out to dinner on the weekends and he really helped me with a lot of things like clothes, groceries and gas long before we were married.
I moved on to pediatric residency in 2007 and my debt continued to climb as my loans capitalized and interest accrued. At one point I tried to pay just $100 dollars a month but most months, I couldn’t even swing that. Resident salaries are pretty bad for someone with 8 years of higher education and ‘limited’ to 80 hours a week, averaged over 4 weeks. That work schedule meant I worked a 30 hour shift every 4 days, which resulted in one full weekend off per month. This was my schedule for three years. I think my starting resident salary was around $45,000 which meant that I was averaging around $11/hour from the ages of 27-30, while the interest on my loans was just rising and rising. It’s not that I wasn’t aware of my debt or the rising interest. I was VERY AWARE. I just couldn’t do much about it.
Another sad chapter in this medical school saga was that in 2007, the Public Service Loan Forgiveness Program was launched. I was in the throes of residency and the above work schedule and I didn’t know this program was launched. I learned about this program a few years later, but my loan types didn’t qualify because I had consolidated them to lock in a low interest rate while I was in school (you know trying to be responsible and all). Sad fact #2 – there was suuuuuuuper fine print that allowed me to re-consolidate for the sole purpose of using that program to make my loans eligible. I figured this loophole out in 2013 when I had finally finished fellowship and had a minute to sit down and work through some of my personal issues. This was devastating because if I re-consolidated in 2007 and made 120 on time payments (10 years) using an income based or income sensitive plan, my loan balances would have been eligible for forgiveness in 2017. I would have been in the first group to have used this program. This program, while it sounds great, has left a lot to be desired, as the online chatter is proving that very very few people have been successful recipients of this forgiveness for various reasons. However, the sting of regret lingers.
Throughout medical school and residency my husband and I would have little things pop up here and there that we didn’t have the money to cover. Emergency flights home for illnesses or deaths in the family…car issues (we had a lemon)…you know ‘life stuff’. Our consumer debt slowly but surely crept up while we clung to the possibility of a brighter future when I finished training.
We moved to Texas in 2010 and felt the sweet relief of a lower cost of living and moved to the suburbs. We made a very hard decision and bought a house in early 2011 knowing that we would have at least 3 more years here and were hopeful that we could build some equity. I was SO NERVOUS.
In 2011, I started making regular payments on my private loans. I had both private and federal loans because each year of medical school, I had maxed out the amount of money the federal government would give me. The private loans are brutal and have a variable interest rate and at times, it has been over 8%.
As I said, in 2013, I graduated fellowship and at the age of 33 (almost 34) I got my first ‘real job’ with a decent salary. Mind you, if you look at the salary chart in this article for physicians, my salary doesn’t even make the chart. It’s well below what is listed for pediatrics. Don’t believe everything you read on the internet. I’m here to tell you that your friendly pediatric oncologists (or really most pediatric specialists) don’t even make the salary charts that are published from these surveys. It was 2013 when I found that loophole to consolidate my loans and I did consolidate them to start the program, albeit 5 years later than I should have. This is the starting balance of that consolidation, which is $10,000 less than the original balance, as I had been paying on my private loans (the bottom number) for two years.
Yes, you are reading that correctly. When I was finally able to start paying on my medical school debt, my loan balance was $273,000 Share on X. Unfortunately, I fell in love with one of the lowest paying specialties in medicine; pediatrics. I love pediatric oncology but that necessitates me doing academic medicine which I have talked about here and that means the pay is less than private or group practice. Fortunately, I love what I do. Fortunately, I have a lot of things that make me happy beyond money.
Fortunately, after three years of applications, I received Loan Repayment through the NIH for doing research in Pediatrics. This program is meant to recruit and retain health professionals into biomedical or biobehavioral research careers. This program has been my lifeline. At the time I received the first LRP award I was 34 years old and wanted to start a family. We had been married 10 years and had put everything on hold until I was done with training. My student loan payments were over $2500 a month on a 30 year term and they were so financially crippling we weren’t sure if it was the right thing to do to start a family. Then the LRP award came. Each year I submit a big renewal application with the hope that I continue to receive money to offset my loans. So far so good. It allows me to stay in research, do what I love, have a family, and live a life with a little less financial stress. We are still in debt, but we can breathe.
This is my story, but it’s not unique. I do think it is important to put a face to this crisis though. It’s uncomfortable. I don’t like telling people how much money I owe even though it was accumulated for a very reasonable reason. I shouldn’t be ashamed, but there is a hesitancy to put words to paper when it comes to debt. This is the face of student debt in America and so it warmed my heart this year when I read that the inaugural class at the University of Houston would have their tuition paid in full and that NYU set up an endowment to provide tuition for all of their medical graduates.
I hope these students understand the gift they have been given. I hope the best and the brightest choose the specialty that speaks to their heart and not the one that pays the most. I hope it encourages the best and the brightest minds to apply to school and encourages more physicians to go into primary care so that we can have a healthcare system focused on prevention rather than reaction.
