Is Medical School Tuition Debt Deterring Prospective Students?

Yesterday I received a call from the son of some old friends. This 30-year-old man has been an elementary schoolteacher for the past few years and recently decided that he would like to go to medical school and eventually become a surgeon. He wanted to know what I thought of the idea.

Suppressing the urge to tell him not to even consider becoming a doctor, I tried to help him think it through. He is looking at about 10 years of hard work including taking a year of post-graduate pre-med science courses, four years of medical school and five years of surgical residency training before his dream becomes reality. Here are the issues.

He is still paying off his college tuition loans. He will have to pay tuition for his post-grad year. Medical school tuition alone will cost at least $40,000 per year [private] or $20,000/$40,000 per year [public, resident/non-resident]. Fees, health insurance, books, housing, food etc are not included. According to the AMA, the average debt facing graduating medical students in 2009 was $156,000. Here is a Wall Street Journal story about the worst case scenario for medical school tuition debt, a whopping $550,000 tab run up by a family practitioner.

He will not be able to earn much money during his five years of residency training. The average salary for a surgical resident is about $56,000 per year, which will force him to defer paying the principal on his loans while the interest keeps on accruing. By the time my young friend is ready to start his residency [2015], I fully expect the current allowable work hours to be significantly lower than the current 80 hours per week. This may lead to a lengthening of the duration of surgical training to six or seven years.

At best he will be 40 years old when he is ready to start practice. No doubt Medicare reimbursement for physicians will be reduced as this was barely averted for 2011 by a last-minute compromise band-aid bill passed by Congress. The insurance companies will surely follow with decreases of their own.

God only knows what will happen to malpractice insurance premiums, the cost of running an office and other practice expenses. One thing for sure is that decreases are unlikely. “Private practice” may not even exist by 2020. Every doctor may be salaried as regulated by the government.

So do you want to invest ten years of your life to become the 21st century’s version of an indentured servant who runs up a debt so big that it can never be repaid for the privilege of working 60-80 hours per week for the rest of your life? If that sounds like a good deal to you, then go for it.