Tag Archives: careers

For med students, debt stifles idealism

Forget the youthful idealism you started med school with, real doctors need to look out for number one. This constituted about 50% of a talk I attended over lunch the other day. The speaker was talking about the need for doctors to be politically active not only out of concern for our patients, but also out of concern for ourselves. He was interesting, but I disliked the amount of time he spent talking about physician income, the cost of malpractice insurance, Medicare reimbursement, and money in general. It’s not that I think these things are unimportant–I think they’re terribly important–but these things aren’t why my classmates and I are in medical school.

Originally, when I decided to go to become a doctor, it was because I wanted to do missions work and help people in desperate need of medical aid. I’d still love to do this eventually, probably part-time or over a short term, but I haven’t yet taken enough steps toward missions work to be headed in that direction.

I am, however, headed in the direction of having a tremendous amount of debt–about $250,000. My wife routinely reminds me about what a huge sum of money this is. The loan repayment calculator at finaid.org estimates I’ll need a salary of at least $181,000 and ideally $345,000 to repay this loan. The more often I look at my loan statements and my financial aid “award,” the more pressure I feel to make a lot of money. How can I care for my wife if I don’t? How can we have a family?

If there’s anything that squashes the idealism of young medical students, it’s the need to acquire the realism of a working physician.

The 2009 AAMC Graduation Questionnaire found that the average education debt of medical graduates in 2009 was $156,456. The loan calculator suggests that a graduate with this amount of debt ideally should be making $216,000 to repay this loan. The OOH from the US Bureau of Labor Statistics states that primary care physicians have a median annual income of $186,044. (The median salary of “specialists” is $339,738. And we wonder why we have such a shortage of primary care physicians.)

My concern about debt increases with each semester, and if I bring it up among my friends, the main response I receive is that we should quickly do away with that topic and move on to something else. Likewise, I’ve found there’s no better way to ruin an evening with my wife than to bring up the subject of student loans. (Without a doubt, reducing tuition costs would encourage more students to enter primary care.)

It’s not that I didn’t look carefully at the numbers before I started. For one thing, the loan calculator above assumes that paying anything more than 20% of “discretionary income” for loans is “financial hardship.” I grew up in a lower-middle class family, and I’m pretty sure that if I’m making $150,000 a year then I can afford to pay a bit more into my loans. If I do choose to go into a specialty, I really shouldn’t have any problem at all.

That being said, I applied for an NHSC scholarship last spring. This is a government scholarship that pays for medical school if you agree to practice primary care in a medically under-served area for a certain amount of time. I’m currently waiting to hear whether I’ll receive an award this year. Since I prefer to go into primary care anyway, this would be a pretty sweet deal for me. I would likely make significantly less money than the average physician, but I would also have a very manageable amount of debt. While this isn’t the missions work I dreamed of in high school, it’s pretty close, and there are a lot of people in the US who are in desperate need of medical care.

NHSC is a wonderful government program, but it only solves a part of the student debt problem. If I’m awarded a scholarship, I can focus on caring for patients without worrying about loans, but my classmates will make their decisions with $200,000 weighing heavily on the scales.

And if I don’t receive the scholarship?

Well, I can only spend so much time calculating, talking to physicians, and looking up salary statistics. After I’ve done as much as I can, all I can do is trust the Lord to care for me.

Therefore I tell you, do not be anxious about your life, what you will eat or what you will drink, nor about your body, what you will put on. Is not life more than food, and the body more than clothing? Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they? And which of you by being anxious can add a single hour to his span of life? And why are you anxious about clothing? Consider the lilies of the field, how they grow: they neither toil nor spin, yet I tell you, even Solomon in all his glory was not arrayed like one of these. But if God so clothes the grass of the field, which today is alive and tomorrow is thrown into the oven, will he not much more clothe you, O you of little faith? Therefore do not be anxious, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the Gentiles seek after all these things, and your heavenly Father knows that you need them all. But seek first the kingdom of God and his righteousness, and all these things will be added to you.

Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient for the day is its own trouble.”

-Matthew 6:25-34 (ESV)

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Married young?

[Note: I posted this earlier, but when I read it over again a few days later, I decided it was a terrible post and didn’t at all say what I meant it to say. This is a revised version that’s a little more on target–my apologies to whoever read the first one!]

I was married at age 22, and marrying my wife was the best decision of my life. I haven’t once regretted it, and I don’t anticipate that I ever will regret marrying my wife. This is in contrast to what people seem to expect when they say things like, “Congratulations, but you look like you’re about 15.” (And yes, that was a comment someone actually made to us–on our honeymoon of all places.)

I imagine that’s the type of person who wrote this New York Times article. It’s a very long article, and rather poorly argued, so don’t read it unless you’re bored. The argument was this: In our current society, people aged 20 to 30 are going through an identity crisis, and they just can’t make up their minds about what they want to do. “Kids” these days are living at home longer, changing jobs madly, getting more education because they can’t find anything else to do, getting married later, etc. Because of this, goes the argument, we should consider 20-something-ness to be a sort of second adolescence, and we should find ways as a society to make it possible for them to travel, explore jobs, stay a little under their parent’s wing, etc. That might be the sentiment people have when they remark that I got married young–my brain just wasn’t well developed enough to make those sorts of decisions!

Now, I think finding ways to further prolong adolescence is a terrible idea. My generation is getting married later, and we’re getting more educated and living at home longer and whatever else. However, this isn’t because we need more time to grow up or develop further. Most of my friends who are living at home don’t want to live at home–they just can’t find a job. And all of my friends who can’t find a job desperately wish they could find a job. Before I started medical school, I worked in the food industry, which isn’t a bad job, but it’s a bad job when you have a college degree. Young adults who move from job to job aren’t doing so by choice; it’s just a little hard to make ends meet.

As for getting married older? Well, most of us are responsible people, and we wouldn’t get married until we can support ourselves, until we’re satisfied enough with our future to be able to plan ahead a bit, and until we’ve met the person we want to spend our life with. (As an aside, I know plenty of people who were married younger than I was, and 22 doesn’t seem young to me at all.) This is something everybody wants to do eventually, but we can’t get married if none of us have jobs. If anything, society needs to make the transition to adulthood easier and quicker, rather than drawing it out longer–the article was just terrible. I sincerely hope you didn’t read it.

For me, marriage has been a way to become more mature and to understand another person in a profound way. Marriage has made me a wiser person, and it continues to make me a wiser person. Things have gone the same way in other parts of my life also–getting a job, paying bills, making a budget work, etc. It’s not that I needed to grow up before I got a job–it’s that I needed to get a job in order to grow up.

I got married because I met the woman I love more than anyone else in the world. I went into it knowing that there would be hard times, and that everything wouldn’t be rosy and happy like it was when we were dating. Armed with the knowledge that arguments, money problems, and even worse things will come, my wife and I are doing just fine. But I certainly have learned a lot. In fact, I think I wouldn’t have learned these lessons unless I got married, meaning that if I waited until I was 35, I would still need to learn the same lessons without being any wiser to begin with.

I’m the cream of the crop, I rise to the… middle?

For most of my life, I have been among the best of my peers in everything academically related. This changed for me in medical school, as it does for most people. The thing a lot of first year med students have trouble dealing with is the fact that nearly every one of their peers was also at the top of their college class. Unless you have a rare intelligence (or are masochistically hard-working), you won’t be at the top of your med school class.

Don’t get my wrong, I did just fine during my first year of medical school. I’m going to be an excellent physician. My grades are good, and there are plenty of students who didn’t do as well as me. My point is that there are also plenty of students who did much better than me. The ego I had going into medical school was tested and found to be much too big for its britches. So at the end of my M1 year, I was feeling a little defeated, since, like everyone, I’d been hoping to be the best of the best. In a fateful coincidence, I also didn’t have anything to do over the summer. I’ve always been good at research, and a professor at school had invited me to work in his lab over the summer. Hungry for some good hard science (which I’ve always loved) and the chance to do something I’m actually good at, I decided to do a little bench research. I don’t anticipate that it will look particularly good on a resume, I just thought I’d enjoy it.

The summer was wonderful. I was a scientist now. No longer a dejected first-year medical student, I was seeking to know something no one on earth has ever known before. My project was to isolate and characterize a protein involved in RNA processing. I started out very excited, working hard at transfecting bacteria with cloned DNA so they would produce massive amounts of the protein I was interested in.

Then, for awhile, I got discouraged–having come from a physics background, I wasn’t quite aware of the grueling hard work and failures that come with biomedical research. For awhile it looked like I might not even isolate my protein, let alone characterize it. But finally, two weeks ago, in the eleventh hour of my summer, I got protein! I grinned from ear to ear when I saw the big black splotches of protein in my gel. I even had time to run a few experiments and find out a little about how my protein behaves and what its function might be.

Now I was really something. Not only had I done some real science over the summer, but I’d finished the project I’d proposed to do. All through the summer, people had been asking me about whether I was doing an MD/PhD, and I started to seriously consider it. I was good at this, and I could just imagine myself being the best of the best again, doing cutting-edge research and understanding things no one else understood…

I guess the ego comes back easily. Since my grades are only good, and not excellent, it’s unlikely I’d get accepted even if I wanted to spend three extra years in medical school. So on Friday it was out with the research, and this morning it was in with more medical school. Back to the still slightly-dejected, middle of the bell-curve life of me as a medical student.

(Again, don’t get me wrong. I love medical school, but a little conceited part of me still misses being on top.)

“My heart is not proud, Lord,
my eyes are not haughty;
I do not concern myself
with great matters or
things too wonderful for me.
But I have calmed myself
and quieted my ambitions.”
-Psalms 131:1-2

The Last Summer of My Life?

My second year of medical school begins on Monday, which means 70+ hours a week of class and studying, little sleep, and quite a bit of stress for the foreseeable future. The summer break after M1 year is the only summer break in medical school–for the final three years school goes straight through June, July, and August. This past summer has been amazing–I went fly-fishing in Montana, visited the Maine coast with my wife, relaxed on weekends and evenings, and spent my days doing research in a lab at school.

Last year, as the M1 class discussed summer, the M2s frequently gave us lots of advice, usually referring to this summer as “the last summer of your life.” The advice was predictable–have fun, travel, see family, don’t do anything stressful–but did they really need to be so ominous about all the other summers we’re going to live through? What exactly am I getting myself into?

For all the complaining we do, medical students are pretty fortunate people–the AAMC says only half of applicants to medical school are admitted. As medical students, we get to sample a number of specialties before choosing our career. In most fields of work, this isn’t an option. Once we finally do start working, our wages are pretty reasonable, even with all the debt from school. I know medicine is going to be difficult and time-consuming, but it’s also going to be interesting. No other field of work has such a blend of cutting edge science, social interaction, and the opportunity to directly make a difference in someone’s life. God has blessed me by allowing me to become a doctor.

So am I really about to end the last summer of my life? I don’t think so–I only took three weeks of real vacation this summer anyway. There will be plenty of other summers, and although I’ll be working hard, I’m pretty sure I wouldn’t want to be doing anything else with my life.