Wednesday, December 15, 2010

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.


busysynch mac said...

Yes, but if he becomes an anesthesiologist ("rock star" in Latin), he will be the envy of everyone. For, as you know, the world is divided into anesthesiologists and people who wish they were anesthesiologists.

Michael Kirsch, M.D. said...

I think there are many forces beyond tuition cost that are deterring students from choosing medicine. There's a reason that many physicians are not encouraging our kids to pursue medicine, in contrast to our predecessors.

J. Anderson said...

Honestly, I doubt potential debt is deterring that many students. When you look at the amount of student loan debt across the board (not just the medical industry) - it becomes hard to fathom that many students are being deterred by future payments. It's more the ability to get proper financing that scares many potential doctors off.

J. Anderson
Medical School Tuition Coordinator

Anonymous said...

You have mentioned all the downsides but not any upside. Maybe he is one of a minuscule fraction of people that would enjoy every single moment of life as a surgeon.

Believe me, I am not in that fraction. But don't you need to mention the slight possibility he doesn't care one bit about debt and has a life philosophy like Mother Teresa?

Steve Jobs has cancer and more money than he will ever need, yet he made the effort to introduce iPad 2. That is how much he cares about Apple. That is what he would WANT to do if he was free from obligations.

Basically, I think the whole thing would have been a lot better if you included the caveat "unless you are a very exceptional individual".

I'm fully in agreement with your main point by the way. I could not imagine going through that training for something I would get not nearly enough joy out of.

Skeptical Scalpel said...

@Anonymous. I appreciate you thoughtful comments. I know the young man and he is concerned about the debt. Despite my dire warnings, he has been accepted to an excellent post-grad pre-med program and is going to give it a go.

Just one thing. It is possible that Steve Jobs showed up to introduce the iPad2 to help protect his vast holdings in Apple.

Unknown said...

My congratulations to the individual working to think out the many interacting issues. I, along my wife, worked part time throughout medical school, residency & fellowship to avoid all debt; quite difficult/sleep deprivation (lots of it) but not impossible. We were successful. Debt, as per Dave Ramsey FPU, is a form of slavery to be avoided at all costs yet promoted by many businesses, universities and the government.

Without out success doing this, medicine would have been a financial failure. Yet even as it is and despite an excellent reputation for helping people stay-out-of-trouble or recover-from-their-problems, practicing medicine remains financially challenging.

The school teacher should study this answer, realize that the medical industry is about disease and that the public has long been indoctrinated into the nonsense idea that "Health-Care" is a right, one they are entitled to (thus do no have to pay for).

Given that it is human nature to be lazy, greedy, scared, self-centered, myopic, confused & attention seeking, working to help other reduce their suffering after obvious is a challenging line of endeavor, doable yet also extremely difficult with limited financial rewards.

Skeptical Scalpel said...

Milton, thanks for your perspective. Since I wrote this post, the subject has secured a place in a US medical school and is doing well.

Unknown said...

Skeptical Scalpel et al,
I was pleased to find this discussion via Google when I searched, once again, something about becoming a doctor in your thirties. I am 32, and long ago in middle school I had a deep want to be a surgeon after seeing some videos on television and believing it a grand thing to become a doctor like my father. But my father, now a retired emergency room physician, discouraged me from a path to medicine. I gave up the idea shortly afterwards.
And then, years later at 29 years old, I became a polytrauma patient by sliding on a sheet of ice in my truck on a two-lane road and hitting a semi head-on. Fortunately I was alone, and fortunately I remember very little immediately after the impact. By all accounts, I should be dead. Well, wouldn't you know that surgeons helped save my life? If it weren't for surgeons, at the very least I'd have no right leg anymore. But I am walking and talking. Hell, I'm even running and doing squats at the gym! This is after multiple broken bones in the right leg, foot, and ankle. Broken ribs, a contusion in each lung, bilateral pneumothoraces and a week in a medically induced coma. What got me thinking about being a surgeon again had everything to do with this experience. Then I researched, and researched, and researched. And I realized how little of a life I'd have, and how poor I'd be. I decided to take one step at a time, and so I started volunteering at a hospital in the emergency department. And that's good enough for now. Once a week, I go in and can be a part of something that has the capacity to bring people from the edge of death. But I just cannot at this time take those five pre-med courses I'd need, to then take the MCAT, to then do the interviewing, to then take out all that loan money and add it to my existing student debt, to then spend four sleep-deprived years behind books and inside hospitals, to then etcetera. No. Instead, I've decided that at this point, the only reason I'd take a run at medical school is if I won the lottery. It's a cold, hard fact that when you're dead, money doesn't matter. In this world of the living, however, it matters too much to me. So does having a life—a life that was given back to me by people who actually had the stones to take the plunge. I am forever grateful, but I think I am unfortunately too selfish to be included in the group of lifesavers who save people like myself.

Skeptical Scalpel said...

Nicholas, congrats on surviving and doing well after a massive trauma.

It sounds like you have done the right thing. Unless you are deeply committed, it's hard to go through med school even if you start at age 22. It's much harder in your mid 30s.

Skeptical Scalpel said...

Update: The subject of this post graduated medical school and is currently a first year transitional resident.

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