How much should I weigh possible debt in this decision?

Pre-Med & Medical School Multiple Degree Programs
41

No, $100K sounds about right because you need to allow for interest accrual, and extra money to pay for stuff above the published costs of medical school. Like buy/renting a car to get to training sites, moving expenses, buying more take out food than you might normally, renter’s and car insurance, vacations when you get time off…

If you take out loan to help pay for med school, that loan begins accruing interest from the day it’s disbursed. Current interest rate for federal professional student loans are 7.94%. Unless you pay off the interest monthly during med school, at the end of the year the interest owed will get rolled into the original loan, increasing the base amount you owe on the loan. You are now paying interest on the original loan amount + the unpaid interest owed for the prior year(s). Rinse. Repeat. So your loans at the end of 4 years will be higher than the just the amount you borrow.

During residency, you will be paid–though not a whole lot. Your salary will depend on where you match. Each hospital has its own salary scale for residents. You may earn only about $38K/year or as much as $75-80K/year. You will get a slight salary bump for each year of residency you complete.

Although you’re earning a salary, you won’t be taking home the full amount of the your income, You have state and federal incomes taxes, social security tax, and FICA deducted from your salary. You will also have the option to start paying into a retirement account–that amount will be deducted from your salary before you get it too. You may have a health insurance premium to pay for your medical coverage that’s deducted from your salary too. You will want to buy private profession-specific disability insurance during residency because you will be able to buy it at the lowest rate ever because you are young and healthy. (You can keep this rate for the rest of your career! That’s why it’s important to do early.)

So, now your loans…during residency you have 2 options:

  1. enroll in an income based payment plan and begin making monthly payment of 10-15% of your discretionary salary toward paying off your loans.
  2. enter forbearance. During forbearance, you will not be making payments on your loans and your interest will continue to accumulate and roll over.

So why, you ask, would someone choose forbearance? Simply put because they aren’t earning enough to live on because their salary is low-ish and they live in a high cost of living area .

Post residency, if you are in an income based repayment plan your monthly payment will be recalculated using your new salary as the base. You will be paying 10-15% of you discretionary income. (Post tax with a modest allowance for living expenses) How much you’ll be paying will depend on your salary and how many people are in your family. Your spouse’s income will be used to determine your minimum payment,

Post residency, forbearance ends and you must enroll in a repayment plan of some sort. It might be an income based pay or some other schedule. That’s a decision between you and the lender.

In both cases, unless your monthly payment covers 100% of the annual interest you owe, any unpaid interest will continue to roll over and increase the base amount of our loan.

How long it will take to pay off your loan will depend on the terms of payment contract. It could be 10 years, Or longer. Or shorter. You do [usually] have the option to make extra payment on your loans to pay it off sooner.

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42

Start running some scenarios, you are smart enough to get a handle on the finances now.

Here’s a debt calculator/income repayment calculator that you can use to model various scenarios.

However, if you want to model loan payment with granularity especially if you want to build in forbearance, best to build your own spreadsheet.

There are also income based repayment plan calculators too.

You will have to google current loan rates and make some estimates about loan terms.

43

Generally, doctors tend to delay most payments until they get their attending salaries (although some choose to pay it back earlier by moonlighting during residency, which can be quite lucrative) - let’s say you have $100k in direct unsubsidized loans. After three years of residency at 6% interest, you have $125k as an attending. Assuming a 10 year repayment, that’s about $15k per year. Let’s say a pediatrics attending makes $140k after tax - minus the loan repayment that’s 125k per year.

44

The Grad Plus loan program will no longer exist after June 1 2026.

And current federal professional student loans have a 7.94% interest rate.

Given that national median salary for pediatricians is $194K/year I’d say that $140K take home is a pretty generous estimate. $194K is in the 24% federal income tax bracket. Then subtract SS and FICA and any state income taxes.

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45

I have a friend who is a doctor, and who married a doctor. She did a second residency (first is psych, second in neurology) which at her wedding all the other doctors couldn’t believe she was doing that. She did, then she had a baby, then another. They were ‘living small’ even with her doctor husband making pretty good money as an oncologist in DC. Well, there was a time when something clicked and they bought a big house, put in a pool, traveled.

I think their student debt was paid off and their life was just different. They worked hard and I don’t think regretted the debt at all.

I think you should ask to speak to a grad of School A’s BS/MD program that can help you figure out the options at that school. It will be rough estimates, but help you understand what to do.

For School A, is that the med school you want to go to? If so, I think that’s your best option. School A will help you for 4 years to be ready to enter med school.

46

I think it’s one of the med schools I want to go to? It seems to have the things I want. I imagine that after more years of shadowing, and clinical experience, etc . . . I might have a better sense of what I want, and there might be other schools I like more. But right now, other than saying that I’d like one of the tuition free options, I couldn’t name one I like better.

My understanding is that if I got to my junior year and realized that I wanted something different in medical school, I could withdraw from the BS/MD program, and apply elsewhere.

What are things people look at when choosing a med school?

47

What jobs would they do? How do you moonlight when you are working a ton of hours with no control over your schedule?

48

Residents moonlight when they have free slots in their calendar. Some rotations are lighter than others. Some rotations you’re working grueling 26 hour overnight shifts 5 times a week. Other rotations you may be only working 3 10 hours shifts on the non-acute floors, and you’ll have 3-4 days off during the rest of the week. Or you may be on one of your 2 weeks of annual vacation.

And although you don’t control your schedule, you do receive your schedule usually a month in advance so you know ahead of time when you’ll be work a lot and when you’re going to work less.

RE: moonlighting

  1. You can’t moonlight until you are eligible an independent medical license (not just the training license you get during residency). You have to complete at least one full year of residency first to be eligible. There is a lot of paperwork to wade through because you need to apply and be approved by state medical board to get your independent license. It can take up to 6 months or longer to get your license. And you usually have to be within 1 year of graduating from residency.
  2. Your program has to give you permission to moonlight–and many programs will not. Moonlighting without permission means you can fired from residency for violating your contract
  3. it depends on your specialty field. There are many fewer moonlighting jobs for pediatrics or surgery than in, say, EM , FM or IM.

Some programs offer some students “in-house” moonlighting which mean they pay you extra to cover shifts in the hospital where you are training. In-house moonlighting doesn’t require an independent medical license since your training license allows you to work in the hospital. Usually these moonlighting opportunities are undesirable shifts–overnight in the ICU is pretty common. And you’re not paid what an attending would get should they cover the shift. You typically get the hourly equivalent of your resident salary.

IOW, moonlighting is nice to make some extra pocket money, but you’re not going to pay off your loans or bank a down payment on a house by moonlighting.

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49

  1. cost of attendance

  2. proximity to support network (family, partner, significant other)

(the rest in no particular order)

  • home hospital on campus
  • early exposure to clinical medicine
  • traditional vs flipped classroom instruction
  • mandatory class attendance
  • recorded lecture availability
  • p/f didactic grading
  • p/f clinical grading
  • in-house vs NBME exam for clinical rotations
  • Alpha Omega Alpha vs. no AOA (AOA is the med school equivalent of Phi Beta Kappa)
  • in-house residencies for desired future specialty
  • faculty mentoring for desired future specialty
  • availability of specialty research
  • prestige
  • traditional 2 year vs compressed 1 or 1.5 year pre-clinical curriculum
  • first time USMLE failure rate
  • dedicated time for Step exam prep
  • professional dress code enforced at all times on campus
  • competitive vs cooperative spirit among peers
  • curriculum specifics (frequency of exams)
  • condition of med campus facilities
  • location of med school (urban vs rural vs suburban)
  • climate at med school (cold & snowy, hot & humid, hot & dry, etc)
  • hands on human cadaver lab vs virtual anatomy lab
  • quality of clinical preceptors
  • ranked vs unranked class standings
  • research thesis w/ publication requirement vs no thesis requirement
  • quality of the medical library
  • availability of on campus quiet study rooms
  • PBL vs no PBL
  • administration’s responsiveness to student complaints
  • class size ( ranges from 50 students/year to 1550 students/year)
  • clinical sites–close by or requiring periodic relocation to distant site
  • diversity of patient population in training hospital

I’ll add more as they occur to me.

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50

This list is awesome!

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51

Most look at the one school where they get accepted and find every reason to be happy and thrilled to be there.

The list posted by @WayOutWestMom gives some criteria for application options.

I would suggest that students applying to medical schools apply to a mix of MD and DO schools that meet the criteria they most want.

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52

Not application options, but a way to distinguish the pluses and minuses of fit should an applicant be fortunate enough to gain multiple acceptances.

Med school applicants should apply to a carefully crafted list of schools that offer a reasonable chance for acceptance based on the student’s stats, ECs, state of residence, and career goals/mission.

Until an applicant gets more than one acceptance they cannot afford to be picky about what med school they will attend.

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53

I’m just trying to figure out if there’s some reason why this school is a bad choice. I realize I can’t compare it to the specific school I might get into if I went to School B. Just trying to figure out what things to consider.

54

That’s exactly what I meant.

55

School B saves you money but upfront you don’t seem to like it. Plus, and I’m not 100% sure you’d have to take a gap year, but regardless it comes with the possibility you won’t be able to study medicine.

Is that a risk you’re willing to take ?

56

How high is that GPA? How does it compare to college GPAs that pre-meds need (in addition to other things) for a realistic chance of getting admitted to medical school?

Is MCAT required at school A, and (if so) how high do you need to score?

57

The amount of debt is minimal by today’s standards but nothing and I mean nothing replaces no debt.

Also even if you get into your residency of choice you could end up working for a VC group that you don’t like. This happened to a female doctor I know and two year’s into private practice is starting her family. All with the pressures of quotas per se and not loving her contractual situation. There are always things not to like. That’s just life.

Am I the only one that prefers selection B? No debt. I had to get lucky and use house equity in a lucky booming market to pay off medical loans after years of forbearance. I wasn’t as fortunate as you are.

But you can’t replace no debt.

Why would I pick this option. Like many that ask for help I am not convinced you might want it bad enough. What do I mean by this. I could be wrong since I haven’t read your other posts. But a few times it’s being alluded to the possibility of not going into med school/profession. That you would change courses in life and go in another direction. You absolutely have that right and possibility. But to me a bs/MD type program is for those that “want it “badly. That’s all they want.

Until you really know that life decision I would pick No debt. There are many medical schools to apply to. I have many pre med undergraduates that worked in my office for year’s. They all got into where they wanted to go to. They are NOT name brand schools but whether it’s for MD/DO or for PA school etc they have all gotten accepted and had the working experience from our office. All worked to put themselves through school. All couldn’t see themselves doing anything different. The guarantees are there with selection A but if you want it bad enough and do the right things, I don’t see a scenario that you don’t get in. But it just might not be your med school of choice.

Also having a family shortly after residency is going to preclude you making an income. But still have to pay off your loans.

I would reach out to female doctor’s that have done it. There might be a group of female doctors to talk with now so you know the realities of your decisions. There are definitely Facebook groups and such.

You have a good problem. Either decision will work out.

Here is something to consider…. If you go route B will your parent’s invest some of that money for you now? Because getting a residency, apartment, possibly a car and then starting a family shortly after if life works out perfectly doesn’t leave much else. Yes your partner might also have a income but we can’t be guaranteed anything especially in today’s world.

Just a different take from someone that paid back over $350,000 for both my wife and my medical student loans. Back in the day they say.. Lol.

Good luck

1 Like
58

Systems-based vs traditional curriculum (not very important IMO)

The relative presence or absence of PBL learning

59

The GPA is 3.6 which is high, but seems to be lower than the average GPA of students admitted to most medical schools. The MCAT is required, but they don’t require a certain score. I think it’s for data collection?

It seems to me unlikely that if I am dropped from the program for academic stats, I’d get in elsewhere with the same stats from School B.

60

https://www.aamc.org/media/6091/download can give you an idea of admission rates to MD schools for various combinations of GPA and MCAT.