Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The far-reaching consequences of medical school debt

Kelly G. Elterman, MD
Physician
April 21, 2017
282 Shares
Share
Tweet
Share

From a young age, I knew I wanted to be a physician. There were no physicians in my family, but I had interacted frequently with doctors as a child and felt a strong desire to similarly help others as I grew older.

To this end, I focused on academics. In choosing a university, I chose the one I felt was academically best, despite being a private school in an expensive city far from home. I didn’t think about the price tag, not because I had a college fund, but because I simply didn’t think about it. My parents were immigrants who arrived in America thirteen years before I started college with nothing but two kids and two suitcases. They could not have saved enough to pay for college, much less pay for it without saving, so I needed student loans.

I completed college and medical school in seven years, during which I also worked part-time. I skipped opportunities to travel or spend a semester abroad because I knew doing so would mean sacrificing the minimal income I had, as well as taking on more debt.  Nonetheless, upon graduation, I was approximately $250,000 in debt.

At the time, I did not think much of it beyond, “I’ll be able to pay it back after residency.” This is probably a common thought among medical students graduating with student loans and, while true, represents only a shallow understanding of the situation. I could not have imagined then all of the ways in which this debt would come to affect my life.

I began realizing some of the implications of this burden when choosing a specialty. While there were fields I enjoyed, I ultimately decided against them because I felt overcoming my debt would require a greater income or fewer years spent training than some specialties offered or required. Instead, I chose a field that I enjoyed, but that also offered what I considered a good balance in terms of expected income and years of training.

During residency, my loans were in forbearance. Although I finally had an income, as a resident living in an expensive city, it was not enough to afford the required payments. After residency, I pursued a one-year fellowship, during which I moonlit to pay my loans. At the end of that year, my husband, also a resident with an equally large student debt burden, graduated and planned to start fellowship in a different state. In deciding our plans for those years, we had to choose between moving together or living apart, as I considered a second fellowship.

Ultimately, our loans decided for us. Weighing the costs and benefits of each option, it became obvious that if we lived apart and I pursued another fellowship, our debt would only grow to astronomical proportions. We chose to move together.

I wish I could say that was the only instance in which our debt influenced our decision-making, but that is not the case. Our debt made an appearance in our discussions on when to have a child, whether or not to a buy a home, and where to work after my husband’s fellowship. At times, it felt like the debt was an additional family member, one whose needs and opinions had to be taken into account. In some of these instances, we let the debt persuade us, in others, we put it’s “opinion” aside.

Now, we are both full-time physicians with a child and a home. We have made progress on our loans, but our debt still affects our daily decision-making, such as whether or not to work extra hours, how many, if any, vacation days to use per year, and how much we can afford to save for our child’s education.

In all of these instances, we made choices that were right for us; others may have made different choices. However, this is not meant to be a lament of missed opportunities; I do not regret my choices nor my career path. Rather, my intention is to show the effects student debt can have, that many, like my younger self, may not even be aware of when choosing a career in medicine.

Medical school debt is common. Currently, the average medical student graduate is approximately $180,000 in debt. Whether that debt feels burdensome or insurmountable depends on the interest rate, one’s earning potential, cost of living, and whether or not one’s spouse has debt. Regardless, most would probably agree that at the very least student debt is influential; many doctors must make personal decisions with debt in mind.

The only way to minimize this influence is to minimize the debt. For some, this comes in the way of government programs offering limited loan repayment in exchange for research, military service, or provision of primary care in underserved areas. In the last decade, the Public Service Loan Forgiveness (PSLF) program offered students the chance to have some debt forgiven after working for a non-profit institution and making monthly income-based payments for ten years. This year marks the end of the first decade of PSLF, and as students who enrolled at its outset become eligible for forgiveness, it appears uncertain whether the program will keep its promises. We have yet to see forgiveness, and in the meantime, stories of application denial are emerging.

Much like I’ve described, these students made choices based on debt. They chose lower salaries and smaller loan payments which, if forgiveness is denied, would mean they sacrificed income, while their debt grew, for nothing. While forgiveness was never guaranteed, such a scenario is nonetheless disheartening.

Significant student debt affects individual lives, but may come to affect all of medicine. The combination of increasing education cost, moderate to high student loan interest rates, limited options for repayment programs and uncertainty of forgiveness as well as decreasing physician reimbursement is an unfortunate one that may eventually deter students from choosing to be doctors. If our best students start choosing other fields, what will happen to American healthcare?

I am not hopeful that the cost of medical education will decrease, but I am hopeful that future students will continue to choose medicine. Yes, it is a long road, yes, there are a lot of sacrifices, and yes, the price tag can be hefty. While considering the long-term cost is important, following your dreams is worth more.

Kelly G. Elterman is an anesthesiologist.

Image credit: Shutterstock.com

Prev

Welcome to planet medicine

April 21, 2017 Kevin 0
…
Next

To fix health care, we need to examine our shared values

April 21, 2017 Kevin 0
…

Tagged as: Medical school, Residency

Post navigation

< Previous Post
Welcome to planet medicine
Next Post >
To fix health care, we need to examine our shared values

More by Kelly G. Elterman, MD

  • Advice to aspiring medical students on work-life balance

    Kelly G. Elterman, MD
  • Am I a doctor or a mother first?

    Kelly G. Elterman, MD
  • How do you define success after residency?

    Kelly G. Elterman, MD

Related Posts

  • The unintended consequences of free medical school

    Anonymous
  • End medical school grades

    Adam Lieber
  • The medical school personal statement struggle

    Sheindel Ifrah
  • Why medical school is like playing defense

    Jamie Katuna
  • Why this physician teaches health policy in medical school

    Kenneth Lin, MD
  • A meditation in medical school

    Orly Farber

More in Physician

  • The hidden gems of health care: Unlocking the potential of narrative medicine

    Dr. Najat Fadlallah
  • The dark side of immortality: What if we could live forever?

    Ketan Desai, MD, PhD
  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The far-reaching consequences of medical school debt
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...