This is amazing. I graduated from medical school two years ago with $300,000 in debt. I'm a software developer on the side and would love to stop residency to try a healthcare startup and/or pursue a research, but the risk is too great - I need the attending salary to pay off the debt.
I’ve started thinking of the obligation to stick in industry to pay off my loans as an analog to having an organization like the US military pay for my degree. I have a few friends in the military studying at university for free. Their payment for those degrees essentially consists of X number years of obligatory post-degree military service, in addition to whatever military obligations during their study. [1]
It’s an imperfect analog I think, but it’s helped me contextualize my situation and remove some feelings of bitterness towards the debt I still owe.
[1] I’m not military so I don’t know 100% how that works - open to corrections
I was active duty military for over 10 years. I went to bootcamp shortly after my 18th birthday. My job required 6 years service obligation; air traffic control. Before I separated I had my bachelors and two masters degrees paid for.
Most of your tuition is covered while you are active duty, $750 per credit hour. If not you can tap into your GI Bill to pay the rest; I did this as I didn't want to fund any of it. Though I could have paid the difference, saving my GI Bill, which would have netted more money for school.
Overall, you analogy is correct. But the military is an easy route when you are 18 - 22 (easier than most people think), as most jobs are not combat related. My job provided services to the general public as well.
ROTC (military scholarship[1]) pays tuition as you go, so there's no debt incurred. If the military allowed[2], you could study underwater tiddlywinks without any concern for unpayable loans.
You're analogy works for academic programs that lead to careers that pay reasonably well. But, not for underwater tiddlywinks - no amount of time spent in that field will allow you to pay down the debt.
1 - They pay for four years, plus some expenses. Generally, if you drop out of the ROTC program after the start of year two, you owe Uncle Sam whatever has been paid on your behalf. If you finish the program, you are committed to 4+ years of service (differs by branch and job role, with some allowing the commitment to be split between active duty and reserve).
2 - ROTC programs prioritize technical degrees and foreign languages over other degrees.
> You're analogy works for academic programs that lead to careers that pay reasonably well. But, not for underwater tiddlywinks - no amount of time spent in that field will allow you to pay down the debt.
Agreed, but that’s your onus to calculate the cost/benefit (whatever those benefits may be) of any pursuit, not just academic. It’s just especially important for studying in the US, given the insane cost of education.
Like you said, there’s a skew towards technical degrees, but I think about me and my peers at 18 and man we had no idea what we were doing and had little context for how such a big life decision would affect us down the road.
Sounds like smart thinking to me. I do similar rationalizing myself, and I wouldn’t worry too much what others think.
These things are tough to reconcile but we are all wrestling with them, and we have to keep our heads healthy to contend.
The only mistake I’d warn against is letting this influence your judgement of others, or your prescription for future generations. They are counting on us and we are counting on them. The point about the military speaks to the reality that you are not alone, but the bottom line is we have been dealt an injustice. We must not pass this nonsense on to those depending on us to make it right. We’ve got to stand together against the agregious opportunism undermining the livelihoods of Americans.
If nothing else, I don’t want to bare this weight through my middle age and still have the kids speaking of me in the way they speak of baby-boomers today. This isn’t to say the baby-boomers are to blame, but it is tough to feel sorry for them given the opportunities they had.
I’d much rather get the praise the Great Generation gets. Let’s work for it.
Love yourself, and all the moreso by loving others as well.
> The only mistake I’d warn against is letting this influence your judgement of others, or your prescription for future generations.
I’m curious what your segue is from contextualizing and rationalizing decisions I’ve/we’ve made for myself/ourselves to judgements on others.
My point, I guess, was that it’s easy to think of university costs purely in monetary cost and ignore the inherent time-cost required to pay.
The calculus I did when looking at schools was: it costs X much, median starting salary for this field is Y, I’ll have to “do my time” for Z years as payment for my education. Looking at it that way, I’m paying for school with time, not money.
My brother did this - but went full-on. Deans list silver star at the airforce, pentagon, largest hosputal in the airforce, now is the director of the VA for Alaska.
Yeah they paid for everything - but it had its issues - but he was also exceedingly lucky.
So only do this if you want to do medical and military for a really long time.
this is the one issue I never see proposed by the politicians trying to buy votes with free college. it should only be "free" provided you give back to society as prescribed by the education you receive. this might mean there is no free college for the profession you choose but so be it. we have it for teachers and there are other fields that would warrant investment as well.
Everyone studying could give back to society in some way. It doesn't really need to be related to the degree, honestly. I'd expect this to be paid work, though, because most folks can't just go without income for 1-3 years giving back to the community. This would simply wind up being civil service work for the most part.
Most folks can train as a CNA and do some sort of home health care, for example. Most folks have the ability to work in school kitchens, provide janitorial services for schools, hospitals, and government buildings. Many folks have the capacity to work in day care centers, as substitute teachers, bringing meals to the elderly, mowing lawns for folks that need it, different sorts of service for parks and other public places, and so on.
You can specialize this for some areas: Art degrees? Make beautiful areas. Theater? Free to the public plays. Language degrees? Help out at community centers or translate for folks that need it.
These things allow for necessary training - like plumbers, electricians, car mechanics, business managers, and so on - that aren't traditionally the "give back to the community" sorts of jobs, yet are pretty good to have. Including all sorts of schooling allows for a better educated, well-rounded society in general. As a bonus, the civil service will give folks a chance to be around people they might not otherwise meet.
We can do this before, during, or after college. Part time or full time.
I'd also exempt some folks. Doctors, nurses, teachers, and anyone else in such roles - the folks that by the nature of their jobs, give back to the community and are better off simply doing their jobs as soon as possible.
If I may ask, how exactly do you have the time to be both a resident and a software developer? There aren't enough hours in the day. Do you even sleep?
Heh, I'll chime in as I did residency at a busy program and advanced my coding skills on the side. Even working 80hr+ weeks you find downtime. Some of that you use for sleeping and studying. With whatever's left, some of my co-residents liked to read. Others had sort of social lives outside the hospital. For me, I coded with most of my freetime. It helped scratch an itch-- problems are solved with 100% certainty, errors can be found with testing preventing many mistakes before they actually affect people, you can build something with your creative juices and get a level of independence not possible in medicine... The list goes on. But my point is, residency is demanding, but you still have a little downtime here and there.
To parent and others, with due respect, I assumed that the OP was a professional software developer, based on the phrasing about using software to pay bills. Coding on your own time is more so a hobby, but as soon as you try to make money from it, even consulting on the side, the hours pile up. There's opening your own business, contracting, soliciting clients, meetings, status updates... way more than just the programming aspect.
So in these cases, we talking coding as a hobby, or coding as a profession alongside medicine?
I did a prelim-surgery intern year. The hours are worse than medicine, but there are way less "mandatory" activities (no lectures, no endless rounding, etc.). For the most part, you're on the floor waiting for pages. I used the time between pages to write code.
Now I'm a radiology resident and have much more time.
Someone make this: a plugin for an IDE that pops up a page from a whitelist (probably of documentation, but it could be anything you want to study) whenever you compile.
There is time for life outside of residency. My wife started residency with a 5 month old and had another child half way through, this delayed her graduation a total of 4 weeks.
I think the debt level is crazy. But it sounds like you wish you’d had a free medicine degree so that you could be free not to practise medicine. I’d think if you get the degree for free then you almost should feel more obligated to practise.
Um... we do kind of need some research doctors. It might not be traditional practice, but how else are we going to advance medicine? I would think similarly about doing things with a healthcare startup - doctors are in the unique position of understanding medicine to a degree that makes it more likely to base the startup around actual facts instead of simply hiring a practicing doctor as a consultant for the project.
There are more roles in medicine than simply delivering care.
48 yo surgeon here - be careful, bc without board certification, you'll limit yourself to who will let you work in their clinic. You're getting paid for residency, just do two more years, get your FP / int med certification.
As an aside, I went to UNC Chapel Hill 1992-1996 and it cost $2k/year tuition. Now it's $20k. We've had a shift in attitude in this country of "why am I paying for something that benefits someone else," but it's going to bite us in the ass down the road as intelligent / hard working people say "why should I accumulate debt to work that hard? I'll just choose something else."
General Surgery and OB/Gyn have gone from being the hardest residencies to get, to now only requiring you graduate from medical school. The hours and the pay are the reason. Orthopedic surgeons get $1000 to put a scope in a knee and scrape a little whereas general surgeons get $400 to take out an appendix in the middle of the night. Ortho is hardest residency to get.
I was top 25% of my class and if I tried to become a surgeon 10 years earlier, I wouldn't have. Most older surgeons were top 1% of their class. My senior partner was, and man is he super smart. Anyway, I still love my job, but the hours suck (80/week). Society benefits from my service (returning sick people to the workforce) and taxes I pay ($200k / year). Not too bad return on investment, imo.
You're going to work as a "GP" with at most one third of the training of almost every other doctor in practice? Seems like you're shorting your future patients a bit. My advice as someone who sees a lot of patients who were incompetently managed at urgent care is to avoid going this route. You're setting yourself and your patients up to fail with potentially devastating consequences.
This is not surprising. On my last two visits to late night urgent care I encountered complete incompetence. On the first occurrence, the Doctor did not know how to suture my hand. She put in four sutures when at least twice as many were needed and placed them way to close to the margin. She failed to even clean it properly. It ripped open again while I was sleeping. On the next, unrelated visit, the doctor was drunk. His face was all red and he reeked of alcohol.
> You're going to work as a "GP" with at most one third of the training of almost every other doctor in practice?
Not really a GP, more like a glorified triage nurse. Urgent care is where they give antibiotics out generically, and immediately transfer anybody sicker to the ED. (worked there, done that as part of residency)
> I'm a software developer on the side and would love to stop residency to try a healthcare startup and/or pursue a research, but the risk is too great - I need the attending salary to pay off the debt.
This is exactly why I pressed a giant pause button halfway through my MD to get a PhD in computer science. There was no other time I could do it. After 4th year? Too much debt; also looks bad for residencies to take time off. After PGY-1? Too much debt; would hurt me if I wanted to do a full residency. After residency? Too much debt; also that forces me to wait quite a few more years before pursuing my research/software dev ideas.
Right now I can manage the debt from the first two years with my graduate stipend + summer internship gigs in the industry. If I had waited even one more year to do this, the debt would have been be prohibitive.
Geniune question: why does a degree cost that much? Is it the teaching staff salaries? Is it extremely state of the art equipment? Is it possible to disrupt that?
Some things that don’t help are the artificial restrictions on building new medical schools, the difficulty of becoming a doctor in America if you were trained in a foreign country (even a developed country like France), and union-style laws that prevent nurses from doing routine procedures reserved only for licensed MD’s (even banning certificate programs).
What? High demand made a degree skyrocket to $300,000? Half of Europe provides free education and doesn’t have a quarter of a million cost per student even close.
But it would be a total waste for society if they paid your education in full and you did not practice.
One related challenge of inexpensive education is the 'brain drain'. I am Canadian and hold a PhD in Engineering. Tuition was about 3,000 CAD a year throughout my education, with scholarships I ended up no dept at all. Now the temptation is move to the US or Europe is pretty strong, but I am still far from having 'repaid' the gouvernement's 100s of thousands of dollar (with ~160,000$ of in-pocket scholarships) investment in me.
I think free or near-free education is great, but it's a bit of a gamble.
