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.