Medical School Debt

There was recently a video online from a radio show where the host ridiculed the caller regarding he and his wife’s student loan debt. Both were doctors heading into residency. The caller was asking for advice and instead got talked down to and disrespected. Although that is the right of the host (it’s their show), I thought it was in very poor taste. What startled me even more, was when I read comments from people that watched the video, so few people really understood what the full medical school journey is. That, coupled with the constant questions of where hubs is in his journey, got me to thinking. I imagine there are a lot of people who really do not understand all that goes into becoming a doctor. All you hear about is a lot of school, insane hours, and insurmountable debt. I can assure you, all of those are correct. However, there were a lot of assumptions people made- at least based on their comments- that were incorrect. For example, that a Family Medicine physician does surgery. That is incorrect. They may do some small procedures, but Surgeons perform operations. That was just the beginning of the misconceptions. Here is a crash course on what the process and cost is.

Let’s talk timeline to fully lay out what this journey looks like.

Year 1: Classes that will require ridiculously expensive books (usually around $500 if lucky), laptop ($800-$1,000 for a decent one), apps for studying (upwards of $100-$200).

Year 2: Classes that again require books, Step 1 (the first of 3 board exams and the cheapest one at $600), Step 1 study course ($4,000 – $15,000 depending on what you choose), Step 1 study apps ($100-$300 each), Step 1 practice test ($50/test and you usually want to do multiple tests to ensure you’re scoring within passing range). If you don’t pass Step 1, plan on paying for all of that again.

Year 3: Rotations begin so transportation to/from practicing locations. Study items related to your rotation- not required but recommended. Step 2 (the second of the board exams and I believe around $1,200), study materials for Step 2.

Year 4: Rotations continue (see above). The largest cost is residency applications: $99 for the first 10 and then a per application fee after that. That doesn’t sound so bad right? Well, in most cases you will want to apply for MULTIPLE programs to increase the odds for interviews. For example, most people I talked to had applied to 35-40 programs, some even more. Using the current pricing, the cost for the applications alone would be over $400. That does not include travel to each interview you’re invited to. You are responsible for travel, lodging, and food. We’re talking hundreds of dollars for each trip. Now, you don’t get invited to interview at every place you apply. But, a few people I talked to had 5-10 interviews they attended. Think about that: 10 interviews at (conservatively) $700 per trip, we’re at $7,000. Of course, if it’s booked last minute and your airfare alone is $900 and it’s a high cost area so your hotel is $200 a night, that can break a budget quick.

So, once you’ve made it through fourth year and graduate, you’re a doctor! But you still have Step 3 you need to complete (I believe it’s around $1,600 for the test alone). The fun doesn’t end there- you now have residency! That is where you rotate through your specialty program for usually 3-5 years and get paid a meager salary- usually making less per hour than the custodial staff. But, it is better than nothing. If you chose to go further in your specialty, you would then do a fellowship, which is another few years. The fun can last for 10-12 years beyond undergrad! Are you ready to start your med school journey yet??

Now looking at that timeline and the number of non-tuition items that come up, you can see why my blood pressure skyrocketed while reading those comments. I’ve previously written about the journey to get into medical school. So, if you make it through that mayhem, you have to figure out how you’re going to pay for medical school. That is assuming you don’t have a wealthy family member than can cover the $30K/year tuition cost, lab fees, books, and living expenses since you cannot work while in medical school (we’ll get to that later). So, if you don’t have a rich Aunt Agatha or even a stingy Uncle Scrooge (that wouldn’t fund it anyway), you need to figure out how to pay for school (up front). There are a few options:

  • Save up your money and pay cash. So, after you finish undergrad, often a graduate degree as well, begin setting aside as much money as you can. For a state school (typically the cheapest) it’s usually $30K-$40K per year. Multiply that by 4 years and that is the amount you need. So, on the safe side, assuming you do not need basic living needs such as shelter, food, clothes, insurance, etc., you should be covered with about $160,000. But be careful to not have any unexpected things happen because that may cause you to reallocate your robust savings.
  • Enlist in the military. All branches (that I’m aware of) offer a “scholarship program”. This is different than an academic scholarship which we personally have not encountered often, if at all. You sign up to serve in the military, at their mercy for 4 years after medical school and they will pay for medical school and even provide a living stipend. Yay for Ramen money!! Actually, hubs did try this path since he had previously served in the military but was not selected. We’re not sure why, I say it’s because he’s old. All kidding aside, this is a great option. But, like we discovered, not everyone is accepted (even with previous military experience and active duty service). So, for those who go through the rigorous process of applying and getting in, but do not get the scholarship, please, forget the work and money you put in and just quit. That must mean it’s not meant to be.
  • Reach out to Sally Mae. So, when your rich relative and the military cannot help you out, there are student loans. You can get enough to cover tuition and then even a refund (to be addressed later). You may have an option after becoming a doctor to practice medicine in an underrepresented area (rural or urban typically) and after a period of time have all or a portion of those loans forgiven. We may go down that road, but are more focused on getting to the “becoming a doctor” part first.

Now, let me address this refund thing. A lot of people seemed to get annoyed that medical students get a refund. I will say our case is a little different because we have 4 kids. For most medical students, it’s just them and perhaps a spouse. Even so, beyond the tuition there are books, food, clothes (especially if you’re in clinic and don’t have business clothes), insurance, transportation, rent/mortgage, school supplies (laptop, paper, pencils, etc.). There are many expenses outside of just tuition. As a medical student, at most medical schools, they do not allow the students to have a job. Being a student is your job. Quite honestly, I can’t imagine hubs even trying to have a job. Between classes full time, studying in off time and something called sleep that doesn’t happen often, there is no time for a job. Not one that would pay for all the things mentioned above. You cannot stop and start school either. You know if you were in undergrad and didn’t have tuition for a semester, you might take it off and work and then come back in the fall. That’s not possible with medical school. It’s all or nothing. If you don’t believe me, ask the 8,000+ wives of doctors and students who regularly weigh in on these topics. So, in our case, that refund helps to replace the income that hubs had before school. Believe me, it’s merely a fraction of what he made, but every little bit helps. We don’t live extravagantly and use the money for vacations or big ticket items. Well, unless you count the car seat we bought for Ariah. Then yes, we did buy a large ticket item.

Let me really rock the boat for a second. Stop and really think. How many people do you know, coming out of undergrad and/or graduate school that do not have any student loans and have resources to pay cash for medical school? You know, that $160,000 for tuition? Don’t forget living expenses, travel expenses for year 4 when you have to travel all over the country for residency interviews and other miscellaneous items that come up during 4 years. Now, did that person you’re thinking of (if you can think of one) grow up in poverty? I’m not talking about race, I’m talking about class. Did they grow up living comfortable- surviving well beyond paycheck to paycheck? With an already growing doctor shortage, I just cannot understand how someone could say that the only people who should attend medical school are those that pay cash for it. I feel that would not only severely limit an already understaffed profession, but it would feel like we’re stepping into some caste system that allows only those with money the ability to pursue careers that can be lucrative. Not only as a physician, but lawyers, dentist, etc. I’m just saying, I don’t feel like the ability for my doctor to practice medicine hinges on how much student loan debt they have. I would rather they be great at their job- taking care of their patients- than what their net worth is.

So, I write all this to say that I cannot fathom how one could go to medical school without some type of assistance. Medical school is not just 4 years of science. It’s hours upon hours of studying, serving, and testing. The drive needed to be a doctor, in light of the debt you’re likely to have coming out, has to be fierce. We need doctors that are willing to practice medicine, care for patients, and change the world of medicine for the better. They’re mentors for our future and role models for our children.

 

 

Med School- Another Truth

With year 1 and 2 under our belt, and the third underway, I thought it was fitting to talk a little about the not so bright side of med school. This will be more of a “keepin it real” post- from my perspective as the wife. I think it’s important to share the ugly side of this process for the people that have comments or are critical about my lack of participation in activities. I want to fully explain what is going on and ask to be cut some slack for the next little while until my head can stop spinning. My feelings are not unusual. I say that from extensive discussions with spouses/partners of other med students and from a number of awesome online resources. I’m telling you, get some med school wives together and that is some for real camaraderie! The only other place I’ve experienced that was as a military wife!

I’ve been really hard on myself about how crazy our life has been. Hubs finished second year, spent a month out of state prepping for his board exam, we moved (because everyone loves moving- especially during the craziest summer ever) and he started rotations. Oh, and I am working and traveling too. It’s a lot of work. Unlike anything else I can imagine. We’ve been through a military deployment and that was not fun but also nothing like this. Not in a “med school is more difficulty kind of way”. I worried about him making it home alive from Iraq, I don’t have those fears now (thank goodness!). Now I worry about thing like hubs getting stuck with an HIV sharp while working (which is surprisingly more common than you would think).

I’ve talked in the past about the different aspects of med school- getting into med school, details of the first year, signs of living with a med student, etc. Those were fun and all, but now I want to address the stuff that doesn’t get talked about. On a good day I feel like we’re hanging on by a fraying thread. I’m about one trip out the door from forgetting my purse, or a kid for that matter. All because I’m so worried about keeping up this facade of how we’re breezing through medical school like anyone can do it. I’ve been carrying such a guilt with me because in the midst of all of this going on, I feel like I am unable to do everything or sometimes anything. The house is a mess (of course things are still in boxes so I’ll use that as my excuse for now). I’m terrible about the little things. I think of how I should send a card or make a quick call and before I know it, a week has passed and I still haven’t done it. I have great little ideas but forget to put them into action.

So, here are the cliff notes of how I felt when we were going through each year. This may help explain- or validate- what you see from other med students and families.

Year 1- A very rude awakening, an initiation if you will, to the chaos of what medical school will be. It’s where you sign your life over to the institution that is promising to make you a “world class medical professional”. It’s the place where, if you’re single, it can still be overwhelming and hard to manage. If you’re married, and with kids, forget about it! It wasn’t made for you! You have to work that much harder to not only make med school work, but your family life as well. It’s the place where you learn how strong your spouse is, you learn how strong you are, and if you make it through, you feel like you can conquer the world. It’s a challenge in not only academics, but mentally and physically too. It’s not for the faint of heart.

Year 2- You’re on a bit of a high from surviving year one. You feel like if you made it through that first year, second year should be a breeze. It went by fast, you learned more than you thought possible in that time frame, and you’re still walking and talking. You’re getting closer to the clinical part, which, let’s be real, that’s the reason most people came to medical school. To work with patients- the hands on stuff. By now your spouse is used to the crazy schedule. I said used to not liking– there’s a distinct difference. This is also the time where you begin to realize that you’re too far in to back out now (what other job will cover the amount of debt you have) and you have the first board exam around the corner. You’re cramming to get classes situated and do well, all at the same time scheduling your rotations, which is such a methodical process that I could almost physically see the request being processed by the RAM in hubs computer.

Year 2.175- Step 1 time! It’s your first board exam and really the major exam that will determine, or have a huge part, in determining your placement for residency. So, no pressure!

Year 3- Rotations start and hubs is now super amped up about being able to do hands on learning. He’s successfully completed 2 rotations so far and just started his third. I will admit his first 2 were really easy compared to what’s coming in the next few months. He had fairly regular hours (aside from studying for step 1).  He did miss Elijah getting his tonsils out- I’m sure the first of many things that will be like that. But, it’s part of the process. The rotation he’s in now requires on call status so there might be times where he gets called in at weird hours of the night. That will be a new process for us. It’s going to be a learning curve for sure, but we’re over half way there so it keeps me going.

What always surprises me are when people presume that being doctor is “easy and carefree”. Both the path of becoming a doctor, as well as being a doctor, are neither. You sacrifice time with family and friends and you’re in high stress situations with a mountain on liability riding on your shoulders. Yes, there are financial perks. There have to be. Otherwise no good business person would consider medical school- the cost to attend is so high, you need a return on that investment to even break even.

All in all, it’s been highly stressful, exhausting and downright irritating sometimes, but hubs and I are closer than ever. He’s doing what he loves- which makes me happy for him. We are forced to communicate, not just frequently, but effectively as well. We plan better, even if in-between is a whirlwind. Most of all, we’re a team- so at least I don’t feel completely alone. Well, not until he has 36 hour shifts and then I’ll hog the bed and binge watch Netflix to fill in the gap!

TO: The Others (“Med Student +1”)

Part of being the “+1” of a med student is learning to cope while life, as you know it, changes. It doesn’t matter if you’re dating, married, or married with kids. Life changes. A lot. And it’s not pretty at all. I try hard to stay smiling and keep my head up for hubs, after all, he’s in the thick of it. It’s best if he has one less thing to worry about. However, I am human. I started blogging as one outlet, but it tends to be a one sided conversation so that’s not always therapeutic.

Towards the end of last school year a professor at the med school asked hubs if I would be interested in starting a spouse/partner support group for the undergraduate medical students. I decided it was worth a shot. I’m not a group leader of anything so I wasn’t really sure what to do. I really wanted to hear what others expected out of the group. I thought, based on how I was feeling, it didn’t seem to make sense to do some big, extravagant get together and act like everything is perfect. It’s not. Life is chaotic on a good day and more often than not, I feel like I’m sharing hubs with 179 other people. It seems a little Facebookish to pretend it’s fine when it’s not. I really wanted to hear what others had in mind. So I brought lots of food and hoped it would cover the fact I had no set plan. Of course I had a small panic attack while I was heading to the meeting. What if I’m really the happiest person there and everyone else is on the brink of disaster? Or, what if I’m Debbie Downer? Or what if I’m the only one who shows up?! I’m happy to say that none of the above happened. We had about 7 or 8 people attend and they’re all incredible! They have good days and bad ones. It’s been challenging and every single frustration or story that was shared was wholeheartedly agreed upon by other group members. It was amazing!

So, for those that have a person in med school (or any other similar situation), here are some words of advice as stated by folks in the group.

  • You are NOT ALONE! If you’re person is not alone in their situation, you’re not the only person in yours. Find your peers and vent together, smile together or just know you have each other when needed.
  • It’s always changing. Each semester changes and new challenges are introduced while old ones (if we’re lucky) go away. Be prepared for change and embrace it as an opportunity to see what you are capable of.
  • Share the good, bad, and ugly of what you’re going through and expect that almost everyone (outside of your group of peers) will not understand. It’s okay to be human and no one should expect you to be perfect all of the time.
  • Take it one step at a time. Don’t look at all of the different tasks over the next several years. Handle it a task at a time. For example, don’t stress about where you will match for residency your first year. You have a few years before that comes up.
  • COMMUNICATE!!! I cannot stress this enough! Everyone in the group said this too- talking about things makes it easier when tough stuff comes up- which will happen. Even if it takes them 2 days to text you back, keep trying, don’t give up!

For those of you who are friends or family to the “+1”, here are a few bits of advice:

  • Be kind. We know that this was a choice. It’s not like our person woke up one day and was required to go to med school. They chose to go. But when we’re having a bad day, we don’t need you to remind us that “you chose this, deal with it”. Sometimes we just need to vent.
  • This ties into the first point of being kind. Allow us to be grumpy, depressed, have a bad day, or whatever we need. There are periods of time where things really are crappy- and that is putting it really nice. Sometimes we need a moment to have a pity party and then move on. It’s not all sunshine and rainbows here people!
  • Stop acting like med school takes 3 decades to complete. It’s only 4 years and then residency. Most people agree that when you have kids, you blink your eyes and they go from a baby to elementary school. The same applies to our med school person. I can hardly believe that hubs is half way through his second year. It doesn’t seem possible!
  • Please don’t assume that just because hubs will be a doctor that I no longer want to work and I will be a “Doctor’s Wife” (said with my best snooty enthusiasm). He was a teacher when we married so I clearly didn’t marry him for his money. I built up my own career and enjoy it. Not to mention we will have a ba-zillion dollars of med school loans to pay off so I’m pretty sure I’ll be working until I’m 110.
  • Don’t be offended if you do not get first dibs at the med student. As a “+1” we wait patiently day after day, text after text, waiting to hear back from our person, daydreaming of an extravagant date night watching DVR reruns of The Blacklist and eating old takeout. We’ve dealt with their roller coaster of emotions during these different blocks of classes and have earned that alone time. Don’t worry, you’ll get your time, just be patient.

I’m sure there is a lot more- which I would love to hear. But most of all, don’t give up. Know you’re not alone and that the end of this grueling process is not far away. It’s worth it.

The First Year of Medical School- From the Wife’s Perspective

Well, it’s finally over! The first year of med school is behind us! I do say “us” because, although hubs had to suffer through crazy hours, studying, and terminology that I think he may never use again, life was crazy for me. Life with a full time job and 3 kids is crazy as it is, throw in med school and that’s just complete chaos- on a good day. I’m not complaining, I’m just keeping it real. Either way, it’s behind us. So, one year down, three more to go until we can call him Dr. Hubs. Similar to my post about applying to med school, I thought it would be good to recap the first year. There were a number of things that I observed as the spouse of a first year med student, that I’m sure friends and family may have noticed as well. Here are a few that are worth noting.

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Acute Rhinitis, and Other Words- Sign #2 That You Live With a Med Student

It occurred to me recently that, in an effort to support hubs, my vocabulary was changing. I try my darnedest to understand what the heck he’s talking about, using words with more letters in them I thought possible in the English language. I mean, really, who sat around and decided some of these names? Myocardial infarction (heart attack), acute rhinitis (runny nose), emesis (vomiting). Why not just say she’s barfing her guts out? Or he has a snot face? I suppose that’s not really professional, but who has the time (or brain capacity) to learn all of the “alternative” words for our common daily ailments? I do try hard to at least kind of know what he’s saying. Sometimes my space cadet expression gives him the hint to elaborate on whatever he’s said. Other times when he’s wandering around the house talking about a lecture he heard or a study he read and starts sputtering off some random words, I actually understand him! In fact, a couple of times I’ve even surprised him by knowing a few things (thank you Grey’s Anatomy!). When I tell him that I learned it from TV he rolls his eyes, which makes it even better.

I do have to be careful though. Sometimes I say a technical word outside of the house and I’m sure I sound like an obnoxious know-it-all. Which is not my intent, it kind of comes out before I can catch myself. Be assured that I am NOT interested in becoming a medical doctor. At all. I just am trying to support hubs learning all of these crazy words so he can sound like a doctor. Well, and be one too.

So, in the last several months, we’ve had our fair share of different illnesses with the kids. The common cold, puking, diarrhea, fevers, you name it, I swear we’ve had it. I struggle when I take the kids into the doctor, how to properly communicate. If I say they’re puking, does that sound too simple? But if I use technical words, does that sound too textbook? Or, my worst fear would be that the doctor would then begin communicating with me in all the doctor lingo that I really don’t understand. It’s like being in a foreign country and knowing about five words. When you use them, locals think you can speak the language and begin a lengthy conversation with you. Before you know it, you’ve sold your kidney on the black market for a mere $7. So, I typically opt for the simpler vocab.

All in all though, based on what hubs says, it doesn’t seem that doctors really expect patients to be able to say the technical words. In fact, there have been a few times when I’m going over my medical history, that I will say that I had a P.E. (pulmonary embolism- blood clot in the lung) and I get the look from the in-take person as if they’re confirming with me if I really know what I’m talking about. Yup, I’m pretty sure I won’t forget that whole experience, thank you very much.

I suppose this whole process might just be another sign (side effect) of living with a med student. I wonder at times, if I learn enough by osmosis, can I get an honorary degree? Seems like a good idea right?

Playing Doctor, Part 2

As you know, the last few nights I have been helping hubs out by playing a patient and allowing him to conduct a full physical exam. Well, the hazard of conducting such exams later into the night- after I’ve worked all day, did pick up of the boys, homework, dinner, bedtime, etc…is that I am just about as not normal as you can get. So, at the risk of REALLY embarrassing myself, here are a few items that came up in part 2 of playing doctor. Continue reading

Playing Doctor- Sign #1 That You Live with a Med Student

Many of you may wonder what it is like to be living through med school, what is “normal” for the day-to-day stuff. Well, it varies. Most of the time our lives are crazy, on the go non-stop making sure the boys are where they need to be, when they need to be. Then, if we’re lucky, able to catch some time later in the evening together. There will be many blog posts about this I’m sure, so today, I will focus on one particular item that is a sign that you may be living with a med student. Playing doctor. Continue reading