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)