April 8th, 2016

The Costs of Being a Doctor

Ahmad Yousaf, MD

Ahmad Yousaf, MD, is the 2015-16 Ambulatory Chief Resident in Internal Medicine at Rutgers New Jersey Medical School.

I start this article with a disclaimer: I am not here to comment on the decreasing salaries of physicians or the knowledge that I will never get paid the way the prior generation of doctors got paid. It is hard for me (and the American public) to feel bad for anybody making more than $200K a year when the median household income is in the mid-$40K range.

median US income

BrendelSignature (https://en.wikipedia.org/wiki/File:Median_Incomes_US.png), CC BY-SA 3.0

What this article is about is the absurd costs of becoming a doctor (both in medical school and residency)! Let me tell you my story to put things in perspective:

I went to a state undergraduate university and, thankfully, left that school with no debt. I then entered a public medical school, with no way of paying the tuition on my own. I faced the decision of taking out loans or dropping medicine and doing something else. I stuck with it — like many of my colleagues — because I could not imagine NOT being a doctor… and honestly, I was naive about the financial hardships I would undergo.  I lived at home for 2 of the 4 years of med school, was single for 3 of those 4 years, had no kids, and had amazing parents that subsidized my living arrangement with home cooked meals and car insurance payments.

empty wallet

Despite that, at the end of my med school education, I had acquired $180,000 in loans (close to the national average), almost all of them with an interest rate of 6.8%. To put that into perspective: My monthly interest accrual was ~$1020 a month, and good old Aunty Sallie would capitalize the interest into the principal at the end of every year! Then came residency. Finally a salary of my own… or so I thought. The average resident’s salary starts between $40K and $50K a year. At 70 to 80 hours a week of work, that comes out to $9.50 to $12 an hour. Most residencies prohibit moonlighting (for reasons beyond my comprehension), so the money you get from your institution is the ONLY money you get.

I live in northern Jersey, where monthly rent for a 1-bedroom apartment is around $1000-$1400… a 2-bedroom ranges between $1500 and $2400. I… lived in a 1-bedroom. I cleared about $3000 a month after taxes. $1000 went to paying just the interest on my loans and never touching the principal, and $1200 went to paying rent. I was left with $800 to spend on food ($100-$300, thank God for a mother and mother-in-law who have phenomenal cooking skills), gas ($160), car payments ($200) because you cannot move between three hospitals on public transportation, insurance payments ($200), cell phones ($80) with no landline, internet ($50), and, well… there is no money left. So, I guess I could have just paid the minimum on my loans and have had money for heat and electricity. Problem is, that after 5 years of residency, I would have owed Ms. Mae close to ~$250,000.

borrowing-repayment cycle

This is the thing… I was better off than many residents. I had parents who gave me money when I was short and paid my EZPass bills. I went to a public undergrad school(many people I know have debts in the $350K range when starting residency). I never had any large unexpected costs during my training (e.g., medical bills, big car bills/accidents). For much of my training, I was not yet a parent. Residency sucks… and not just because of the intensity of the training and the stress of trying your best to become a decent physician.

This article is not over yet. The real impetus for me to write this has to do with the loads of money I recently dumped to fulfill the next step of my “training.” What many people outside of medicine might not know about are the enormous costs of tests/licensing that doctors are REQUIRED to complete/obtain/maintain to practice medicine. USMLE Step 1,2,3 tests cost about $2200. The American Board of Internal Medicine exam costs about $1200, and the American Academy of Pediatrics board exam costs a whopping $2250. Most residents spend about $1000 to $2000 on prep courses and materials for each of these exams WHILE IN residency.  And then, there is licensing: NJ state license is about $1100, the DEA/CDS licenses cost another $760, and there are others, depending on your practice. All of this occurs BEFORE you make ‘doctor money,’ all while your student loans continue to grow.

government loans

My concern is not for my own misery…. that time has passed. My concern has to do with the next generation of physicians who have already started pre-med tracks in their undergrad colleges.  What type of candidates will medicine attract when the associated costs of becoming a doctor are no longer the extreme intellectual rigor and high academic expectations of the training… but instead, financial suffering?  To put it in plain English… Who in their right mind would do this when you know you are putting yourself, and potentially your family, in great financial peril?

My inner optimist tells me that there will always be a group of highly motivated people who will bear the difficulties, because the goal is lofty and righteous enough to keep their eyes on the prize. But what are we saying as a society when we make an education in healing so difficult to attain?

~Yousaf

78 Responses to “The Costs of Being a Doctor”

  1. Drew E says:

    There is another avenue that you did not acknowledge; a military scholarship. I put my time in and got a damn good experience, served my country, and had all of my 4 years of medical school covered. I have no sympathy for anyone who complains about medical school bills with this service opportunity out there. But I do agree that the maintenance of certification exams and other expenses are outlandish and serve only to fill the pockets of the specialty board members.

    • Katy says:

      The problem with that is, military scholarships are not open to all. I have ulcerative colitis, for which I have been on Remicade for years and years, and that disqualified me for military service. Some medical problems (mild intermittent asthma, etc) can be accommodated w a waiver, but there are many conditions that are simply disqualifying

    • Gabe says:

      I looked into going the military tract, but since I’m diabetic I could not go that route. While I agree it’s a great way to go, remember not everybody is eligible.

    • KB says:

      For some of us who do have medical expenses in addition to the above, and because of medical issues therefore don’t qualify for military service despite trying every single branch of the military, this is not an option, and the expenses are worse.

    • Katie says:

      While this option is a good one for many, it is not an option for everyone. Prior to med school, my husband attended the Naval Academy where he received an honorable discharge due to an injury that occurred while playing a sport for Navy. Said injury will keep him out of the service for life. So hello $300k+ in student loans.

    • M A MARRELLA, MD says:

      RE: DREW, No sympathy from you huh,. you took a “military scholarship.” I’d get 2-3 offers like that a week for 39 years in my junk mail.
      “Putting your time in,” doesn’t at all compare with the commitment required to treat the devolving working class; the uninsured, or poorly insured with shrinking paychecks with no unions, no pensions;the newly impoverished, chronically ill elderly on Medicare, at the mercy of Big Pharma and Health Insurer profiteers; the women and children dependent on the spartan medicaid coverage that have no dental care, no access to specialists, substandard education, attacks by right wing demagues, and even poisoned drinking water.
      Those living in living in extreme adverse conditions, are their interests part of your duty to “serve the country?,
      The real world of poverty, misery, and social injustice was brought about greed of those unelected power brokers, using nightmarishly dehumanized military with its bloated public funding of imbedded private contractors, and financed by a thoroughly bribed congress, almost none of them having “served.” The deceiving of the desperate vulnerable high schoolers with no options, new immigrants who want citizenship to engage in heinously cruel foreign wars with people and places they never in places never heard of where theres oil and profit. These young people are often forever damaged by the physical and psychic injuries they receive and inflict.
      You avoided debt and confronting a doctor’s responsibility to a better society in your proud military. “Serve my country,” you say. You serve not for human rights of others, not for their self determination, You serve not to heal for the sick, or to alleviate suffering, as in a physician’s first oath. But you serve those who exploit the unprotected in the poorest places on the globe, and bring about nothing less than the destruction of the planet.
      Save your sympathy. Count your stripes, smug military doctor.

      • Drew E says:

        Marrella MD, you’re welcome for being given the opportunity to spout off against the US military and to honor your self-righteousness by disparaging me and the military. Nothing honorable or noble in anything you said or think. I’m not in the military anymore and am happily and honorably providing care as a civilian to critically ill neonates in a greatly underserved part of the country. So it’s cute and all for you to just use my comment as a pedestal for decrying the military and to advocate for social justice. But you’re barking up the wrong tree and are terribly misinformed and quite clearly uneducated about the reality of the world and US military role. I guess a military scholarship is not for you.

        For everyone else, I recognize that the military is not for everyone and that some people who want to join aren’t medically qualified to enter. There does tend to be a certain liberal bias in the medical field, as evidenced by the good doctor’s comments above, that marginalize military involvement. That person even goes so far as to vilify it. There’s nothing honorable in those statements or thoughts.

        Reform is needed in the realm of medical education expenses at all levels, from medical school up through board specialty certification and MOC.

        • Laura S says:

          It’s easy to vilify the military while sitting in your comfortable, safe living room with wifi, running water and electricity. If it weren’t for the few that leave that comfort for their country I wonder whether all those luxuries would be available or better yet military service would be mandatory

        • M A Marrella, MD says:

          Dr E:
          At the risk of repeating the obvious, my remarks (or “spouting off,” as you say) were triggered by your own dismissive comments about the young conscientious doctor’s financial struggles to provide decent care in the exploitive medical marketplace:
          “I have no sympathy for anyone who complains about medical school bills with this service opportunity out there.”
          I’m not going to argue with your self described “honorable” service to your country, and self serving justifications for exempting yourself from the consequences of your actions; as you are doubtless unused to being confronted with actual facts. Liberal bias indeed….the dreaded “l” word!
          Seizing the opportunity to have us all pay for your obsequious strategy of unearned trust and rank is one thing, but to brag about it…. that’s just not something one let pass.

        • AMEDD Doc says:

          MA,
          To me, Dr. E did not seem to be bragging in their comments. It’s clear you do not share the same views on military service and feel that any involvement in the military is one that should be both discouraged and outright disparaged. You would fit in well with the Vietnam War era generation of young people who blamed and punished the Soldier for the Politician’s War.

          Dr. Yousaf’s article raises a great point about the cost of becoming a doctor in the current era of excessive medical school and CME/certification bills. However, the article leads the uninformed person with the sense that there are no alternatives to funding medical school. We poor doctors, oh what are we to do? This self-conception obviously doesn’t garner sympathy from those who found alternative routes to fund their life’s mission of taking care of people through the health profession; ref: Dr. E’s comments in original post. I’m sure the public finds it insightful about the cost’s of being a medical professional, but most likely sympathy also is lacking within that non-physician community as well.

          I would suggest diligent research and an open mind for any person who truly believes that their life’s work is in the medical profession. Below are links to both military and non-military routes for funding medical school. Some people may not find military life to be to their liking, or may not qualify for service (as some have indicated in this blog); there is a non-military link attached as well. However, it is important to dispel myths about military service; I know because I served as a physician during OIF.

          1) The military will not make you become whatever type of doctor they want. If you’re qualified to be a surgeon and that what’s you want; you’re good. If you want to be a FP, well there are plenty of families and children of Soldiers in the military medical system. All of the medical fields, specialties and subspecialties are present in the military medical system. You can have your medical school paid for and still enter whichever branch of medicine you want and are qualified for. They’re spending a boat load of money to pay for your medical education. They’re not going to jam you into a field that you don’t want simply because they can.
          2) You’re not going to die in the military. With extremely rare exceptions, all of the military physicians deployed in the past wars of Iraq and Afghanistan returned home. Those wars have, or are soon to be, closing down from the high levels of military deployment seen in the past. Now you may be deployed as any kind of doctor, don’t mislead yourself that you’ll never see desert sand by being a dermatologist in the Army. Also, we have no way of know what wars are in the future. This is a risk that you must be aware of; leaving your family for a year at a time and being in a scary part of the world. If you’re okay with that, then apply for one of the scholarships below.

          But please don’t take Marella’s comments to heart and view military involvement as a nefarious strategy for paying medical school bills. Given that approximately1% of the population has served in the military; it’s understandable if people like her are uninformed and sharply biased about military life and what it means to serve your country in this way. She clearly lacks an open mind and quite obviously finds it easy to view one’s pride in military service as being “smug” and braggy. I hope she’s in the minority of civilians who view present or former military servicemen and women in this way. As an ounce of caution on the merits of her comments; based on the original FB newsfeed comments on this article, it seems she also identified herself as someone who has chosen not to enter the medical profession for various reasons. That’s all perfectly understandable and there’s nothing wrong in directing one’s life elsewhere. But comments under pseudonyms come across as rather dubious.

          If you’re interested in learning more or have questions for me, please reply to this comment.

          http://www.goarmy.com/amedd/education/hpsp.html

          https://www.navy.com/joining/college-options/hpsp.html

          https://www.airforce.com/careers/specialty-careers/healthcare/training-and-education

          http://nhsc.hrsa.gov/scholarships/

        • M A, MD says:

          I will not attempt to address the specious and amusing allegations made me by the mysterious Laura S and “Dr E,” who have ready Fox News talking points to guide there opinions about state of the world and me.
          I don’t know where you two were, but 49 years ago, we were the boldest of patriots. We did put ourselves on the line to end the Viet Nam war (which, in case you missed it, has now been unequivocally revealed as a colossal tragedy of death, destruction, and waste of treasure). We met with more than a little resistance, with brutality, in fact. We paid the price, some with their lives, others attacked by felon demagogues like Spiro Agnew, targeted by the Selective Service and Hoover’s FBI.
          You speak of the pride you have in participating in the military onslaught of Iraq and Afghanistan, resulting in hundreds of thousands of dead HUMAN BEINGS…..Or haven’t you noticed? By the way we never vilified the returning soldiers – an obscene lie, spread almost all, by chicken hawks who push for war, but who never serve. I, myself, have in my 42 years as a child and family psychiatrist, treated those same veterans, physically and psychically maimed, and witnessed at close hand the damage to the lives of their wives and children. They could be found in the jails and the state hospitals, and then among the uncounted homeless. Have you seen them?
          Then there are the pathetic Budistists refugees from Pol Pot’s Cambodia, from Laos, and the unwanted Viet Nam allies. Other adventures brought mothers and children from Honduras, from El Salvatore, from Nicaragua and nowadays, Yemen and Syria. And for what Dr E? Has ithe money been that good? .
          Listen, I know you could avoid the costs and the hardship by accepting military funding for your medical training. Some of us see that as unconsionable for THIS ARMY at THIS TIME in history. (http://www.nbcnews.com/health/big-striking-horror-us-military-doctors-allowed-torture-detainees-new-8C11515107)

          Just to reiterate the objective facts: Medical school debts, the result of extraordinary high tuitions, fees and above market interest loan programs, designed by bankers to be legally inescapable and backed the US government are not an inevitable result priorities of a free society. The public’s universal need for medical doctors (or teachers, nurses, or mothers for that matter), not only has not been considered, but has been exploited by the market based profiteering, of public institutions in the pay of private interests which knows no limits to its greed. This hegemony of power over our lives, this corruption of the social contract, which now pervades all aspects of our society, has been accepted as normal, and we are told, inevitabe How is it that all developed countries and some poor ones, provide higher education, including medical school at little or no cost, and medical care as a human right with quality standards at least as good (and mostly better), and, at less than half the cost of the US? (#37 in WHO ; and repeatedly last of 11 industrialized countries. by Commonwealth Fund surveys) http://www.commonwealthfund.org/publications/fundreports/2014/jun/mirror-mirror

          Since you two already assume to know so much about me, I’ll fill in some additional details for the record. In 1968, medical school admission was tough in many states, with many qualified students unable to be accepted, leaving many vulnerable to the military draft. Social activists were particularly denied CO status and especially prosecuted with imprisonment by Nixon administration’s Att’y General, this confirmed by recent disclosures by Nixon’s top aide Ehrlichmann. There was a genuine danger of being brought unwillingly into the coflageration if you were not medically deferred or not a “fortunate son,” i,e., Bush, Chaney, Trump, Romney, Roger Ailes, Newt, Rush Limbaugh.and almost all “Red State” contemporary politicians. or Rush Limbaugh. Medical school at that time, was a heady rush, an all out sprint, But if you lived at home with aesthetic life style, state school tuition was manageable with the wife working and thrice weekly IV team at $45 a night. You learn a lot about your surprising ability for survive without sleep or recognition. But then we wanted to have a child. Lots of wild midnight shift moonlighting dramas in big city ER’s, with its unexpected beauty and ignominious defeats. But it was the good fight, you know? Taking care of patients is a pure, rare privilege in this far too complex and compromised society.Did you two miss that too?

          As a subscript, I’ve had to curtail and cease my practice this past year as a relapse of my diagnosed Multiple Myeloma has disabled me. As a patient at Dana Farber specialty clinic, I noted an extremely high cohort of Viet Nam vets, their cancer presumably resulting from exposure Dow’s agent orange defoliant, liberally sprayed along rivers to remove the indefatigable enemy’s cover. Many still wear their army fatigues, and insignias, as if frozen in time, never able to get back to what they were before, or exorcise the memory of that time. Have you met them Laura? Look where they sleep like babies in the cardboard boxes under the bridges in summer. Slip them a buck for wiping your windshield at a red light.
          Peace, but peace with justice as we used to say.

        • M A MARRELLA, MD says:

          My last post, written in the early morning hours was meant to address “AMEDD Doc,” and his the remarkable comment about my comment, which disagreed with Dr E’s solution to avoid the costs and hardship of medical education and training by joining the military.
          My argument, which I suppose could be debated civilly, is that to join in a nation’s military, particularly at times of war, such a decision incurs moral and societal implications that iinvolve shared responsibility for the actual goals, methods and consequences of those military actions.This in fact, is the very basis of the principle of international law utilized in the Nuremberg trials after WW II in which Nazi commanders, officers and physicians could not evade prosecution by maintaining that they were only following orders, and thus “good soldiers” were in fact ,responsible for war crimes according to their actions and their rank. If these commentors, be they native Americans or foreign born have contrary opinions about what constitutes violations of human rights, genocide,torture, and criminal responsibility,they should take that up with the World Court.
          I must say that the comments directed towards myself by “AMEDD Doc” go beyond the pale:
          “it is important to dispel myths about military service; I know because I served as a physician during OIF.”
          OIF, or ” Operation Iraqi Freedom” was Bush /Chaney euphemism for the invasion of Iraq after knowingly false claims of WMD’s which resulted in on going severe humanitarian crisis, and o engendered major economic, political, legal, military and strategic repercussions. (https://www.globalpolicy.org/humanitarian-issues-in-iraq/consequences-of-the-war-and-occupation-of-iraq.html)

          As for your condescending comments about me personally, (I’m a “he” rather than a “she.” I hope you’re not a gynecologist.) It’s hard to get upset with your insults, As Cato is said when he was struck by a wild animal as he walked from the public baths: “It is unreasonable to expect a boor to be anything but a boor.”

  2. Amy says:

    Thank you. I was indeed sensing this seeing how costs are going up. Other disciplines have seen this long ago. There are so many extra costs just to live today. The awareness started when the “group” was being introduced to the consumer as one of 30 patients seen a day.

  3. James says:

    Beautifully written. Thank you!

  4. Casey Rodriguez says:

    Don’t forget maintenance of certification and the loads of money you will spend on CME once you get your board certification. It’s easy to become bitter when you hear about how much hospital administrators are making without all this expense, and without adding value to medical care.

  5. Geoff says:

    Great piece. I’m a 3rd year medical student who will graduate with over $300k of debt. I really appreciate you bringing awareness to this absurdity. Not sure what I can do to help change this but I want in on making a change.

  6. Bill says:

    Hello! I am in my first year of practice after finishing 4 years of residency and 2 years of fellowship. I was very happy to read your article and hear from someone else with a similar experience. Not only are we >10 years behind on saving for retirement, we have to put it further on hold to pay back all this ridiculous student loan debt that has been accruing! To add such financial stressors onto an already stressful job is rough!

  7. Loretta S says:

    Thank you for this post, which lays out the costs of becoming a doctor very clearly. I recently had a long conversation with a very bright nursing student. He’s the kind of student that reads medical journal articles and textbooks because he *wants* to, and because he loves learning science and medicine. He was thinking of going to medical school. He knew it would mean taking a heavy science load just to get through the MCAT experience, and was willing to do that. But when he sat down to do the med school math, he decided against becoming a doctor. The numbers were just too staggering. How many other bright, motivated people are being discouraged by the financial realities? And why should we be surprised when medical students choose a specialty that pays far more than primary care?

  8. Most of my comments are in my blog post: http://blogs.timesofisrael.com/why-humans-will-never-successfully-be-able-to-care-for-humans/

    I trained in Canada, lived at home, did not marry, and my father paid the ONE thousand dollars a year tuition for my Bachelor’s and Med School (30 years ago). I believe in socialized basic utilities: education, health care, and even basic nutrition. It works in Israel, where I have been living for 25 years. This is not a political comment. This is a simple fact that the US medical training system is untenable financially and totally outdated in terms of curriculum (see my blog post). You cannot fix something when people refuse to accept what the real problems are.

  9. Kristen Cain says:

    Another cost for doctors is that we are taxed at the absolute highest bracket. So once you make your “real” salary, you can no longer deduct your student loan interest or even your kids.

  10. Sameerah says:

    This is so true! Feeling the pinch right now!

    • M A Marrella, MD says:

      EXACTLY, JIM.
      As a member of PNHP since its inception in1987, I am continually amazed that the message and the obvious logic of a single payor health plan accepted by every other devoped country on the planet, can be so effectively distorted by the corporate money and political influence that not only by the reactionary right , but mainstream Democrats. These representatives of the people who disparage it as a socialist pipe dream, and dismiss the clearly expressed public opinion that medicare should be a right for all people, and not a revenue source for predatory Health insurors and big Pharma donors.
      I would just want to remind you doctors and nurses, PA’s et al, that unlike the richly compensated Health Care CEO’s, drug marketeers, hospital presidents, and execs and managers for cost containment, managed care, and electronic medical record industries, and their armies of lawyers and tax accountantants only you have the primary mandate to care for and for the good of the patient,
      Only Bernie Sanders for 39 years, has the courage and integrity to promote the Medicare for all, and it resonates with all the voters who are allowed to receive the message,

  11. Jim Recht says:

    Thank you Dr. Yousaf, for this thoughtfully, beautifully written piece. I hope that your voice will be heard in wider circles (and I hope you don’t lose your optimism).

    Students, residents and early-career professionals can do something about this mess. By working to support national single payer health insurance (by joining and becoming active in Physicians for a National Health Program, for example), committed physicians also promote an opportunity to restructure the U.S. physician workforce in some very powerful and potentially liberating ways. The military currently provides the equivalent of a loan forgiveness program. Why only the military? There is no reason not to provide the same support for those entering primary care residencies and for those who provide service in underserved areas.

    There’s much more we can do, but as several commenters have already suggested, success will require much more extensive physician participation in the political sphere.

  12. Kismet says:

    Very true, but I think there is yet another thing which needs to be added to the cost of being a doctor– YEARS OF ‘LOST’ INCOME. Over the course of 8 years of postsecondary education doctors ‘lose’ out on hundreds of thousands of dollars. Even at $40 000 per year this equates to $320 000 of lost income while in school. This is another huge cost and should not be forgotten.

  13. Enrique says:

    Very interesting article. I thought Spain was a bad country to study and to earn the life working as a physician, but at least we don´t go into debt studying medicine. Here we work hard and earn low while politicians and others earn their money with the sweat of our brow; perhaps in USA the insurances and others make money with your effort. Probably, as I sometimes say to my teammates, in future monkeys will give health to the people. 🙂

  14. Claire Smith says:

    Another cost which was not considered in this article is the reality of 8 years of lost wages whilst in undergraduate and medical school. For the past 8 years while in full time studies I have not had any significant income. Friends of mine, on the other hand, who chose to enter the workforce after high school have been making livable wages for the past 8 years. At $40 000 per year this adds up to $320 000 of lost income…

    This is another very real cost of becoming a doctor which shouldn’t be forgotten.

    • EKo says:

      Oppurtunity cost is lost for sure. However, its more than adjusted with future increased income potential and job security.

      • PGY 1 says:

        You could say that about every point that is raised by this article…that in the end a physician’s salary is worth it and that all financial hardships work out eventually, but this mentality defeats the entire spirit of this piece. Whether or not future income potential offsets income losses during training, lost income during training is a reality, it is significant and should be considered when fully tabulating the cost of becoming a doctor.

  15. Debbie MacIntosh says:

    The Canadian scene is worse .Our local training institutions are subsidizing the schools by taking international students ,forcing our Canadian students to train in other countries

  16. Marc Edma says:

    Thank you Dr. Yousaf for sharing your concerns with us. My name is Marc Edma and I am a pre med student at Umass Boston. I will be applying to medical school this year and I don’t believe that I have ever heard a Doctor speak so eloquently on the topic of Medical school’s financial burden. I believe that most undergraduate students are not fully aware of the financial burden of attending medical school. When I consider other students who graduate in countries throughout Europe who don’t have nearly the amount of debt, I still don’t quite understand why It costs so much to obtain medical education in the USA . However, I believe that a student like me who truly believes that being a medical doctor is a life mission I will never give up. I hope one day this situation will change. Only the patients can benefit from a better health education system and better health care in America.

  17. Matt says:

    Yes it’s costly but it’s worth it. If you’re not willing to sacrifice then medicine isn’t right for you. Use your residency years to learn how to live frugally and then when you are out of residency if you don’t change your lifestyle then you can pay your loans off easily within 4-5 years. Especially with only $180k. Plus we are about to see the first wave of student loan debt forgiveness in a few years for those who make income based repayments with a not-for-profit employer, so no excuses for not being able to pay the loans off in a timely manner.

  18. Melissa says:

    You forgot to mention the costs of applying to residencies and the travel costs associated if you get the interviews. Last minute availability of interviews equate to expensive airline tickets.

  19. David H says:

    This is a very realistic portrayal of what it “what it takes (financially)” to become a physician. But without this kind of debt, the banks would not make any money! I mean, who is the real driver behind putting us all into debt. Drew E even points out that he was indebted to military service. What next? Do we all have to sell a kidney? No wait, we will have to do our own organ harvest and then sell the kidney. The bottom line is that it is much easier to become a physician if you have financial security, and with debt so high, among all other things, it is definitely deterring well qualified people from the medical profession.

  20. HK says:

    Dr Yousaf,
    Thank you for sharing your experiences. I am a nursing student at a Big 10 university. When I contemplated a career in healthcare, I chose nursing over medicine or physician assistant programs for financial reasons. Through scholarships, savings, and work, I will finish my nursing degree with approximately $15,000 in debt. After several years of direct practice in acute care, I intend to return to school for my DNP. Many DNP programs offer full-time and part-time options allowing students to continue practicing. The part-time route is longer, but it does allow many students to take advantage of employer tuition reimbursement programs and balance work/life/family commitments.

    Medical education is rigorous (and should be) and already takes four years of didactics, but perhaps it can be redesigned to lower the overall cost and to create multiple avenues into practice.

    My sister is a physician who can relate to many of the items in your article. We are both equally passionate about what we do, but we have chosen different paths to pursue our passions.

    Thank you again for sharing.

Resident Bloggers

2020-2021 Chief Resident Panel

Stephanie Braunthal, DO
Holland Kaplan, MD
Vivek Sant, MD
Sneha Shah, MD
Masood Syed, MBBS

Resident chiefs in hospital, internal, and family medicine

Learn more about Insights on Residency Training.