I've been reading this forum for along time now as I've been trying to decide whether I should attend medical school in the fall (recently accepted!). I have found it to be an invaluable resource, and I am hoping some of you can give me some insight into how I might be able to "have it all."
I'm 25 with no children, but I plan to have a family one day and when that day comes, I want to be able to stay at home with my young children until they are at least 1 yr old. This will likely mean part time work right after residency. However, I will be one with a lot of student loan debt, and I'm not sure that this is feasible.
All of the schools I was accepted to had high tuition (>30K/yr) and an estimated student loan debt of around $240K upon graduation. I am most interested in psychiatry, but now as I'm working with a group of midwives, I've also developed an interest in pediatrics. I was originally planning on applying for a NHSC scholarship or a rural pathways full scholarship at my school, but this would lock me into full time work for 4 yrs after residency at a time in my life that I will want to be part time.
So, my question is how did other physician moms with large student loan debt manage their loans? Is part time work at this stage feasible? I will (probably) not have a physician husband, and possibly not a high earning earning partner! I really have no conception of what payments are like for a loan that big or what I could expect for a part time salary in either psychiatry or peds. Also on the part time subject, how many hours a week is the norm for part time physicians?
The other option I am looking into would be to do a 2 or 3 yr accelerated graduate entry psychiatric nurse practitioner program. This would be less of a time and debt commitment, and would still allow me to work with a population I love.
I started med school when I was 24, same thing, plans to be a doc and to have a family. I finished at 30 but did not take the boards and met my today husband, a year later had my daughter and it is been 7 years now and only 2 weeks ago I paid for step 1. Not to mentioned the loan over 150K that is in deferment since graduation. This is not the way. What I should have done was to take the USMLE steps during med school and enter a residency training right away. During residency you can get marry or not and have a kid if you like after residency training or in the last year of training. If you plan to stay home until your kid is 1-2 y.o you can always apply for economic hardship (if you will not be working) and post pone the loan payments for a year or two and pay only interest so it does not accrue on your principal balance. All this is if you go for MD. Once you finish you can do many things to help pay for the loan but yes it will require a commitment of few years. The ARMY, a community hospital, working at an area of need, are few examples.
Now, if you chose the path of Nurse practitioner (which is very promising, in very high demand, specially Psych) it will take considerable less time and money and it is very well pay. Once you get your RN, you can start working at a Hospital or other facility that pays for your Master training or get employed at a place that has tuition reimbursement.
Don't forget that you have about 10 years in your favor(for the family/children idea) to play with. Between 35 and 38 you can have 2 kids. This is just the way I see it. It is my opinion based on experience. You need to figure what do you want and set priorities. One thing I can tell you is when you have kids(if you turn to be like me) I don't want to be away from my daughter or miss any activity.
Good luck, and may you find the right choice
First, how did you arrive at your estimate of $240K total indebtedness? If it's the number your school gave you, throw it out. If it's the amount of debt your plan to incur as a first year student quadrupled, it's too low. Tuition and the cost of living increase every year and most of your loans will accrue interest while you are a student.
Second, estimate your monthly obligation. This is easy; there are a number of online calculators to help. I like
. But here are some ballparks to get you started: if you borrow $250K at a weighted average of 7.5% (remember that Stafford loans are locked at 6.8 and Grad Plus is locked at 8.5) and elect to pay off your debt over 25 years, your monthly payment is around $1850/m or $22K/y. Remember too that you'll pay all or almost all of this sum in aftertax dollars. If you worked half time in a lower paid field (psych), your student loan payments would easily eat 30-50% of your take-home salary. To me, that makes no sense at all. For what it's worth, I would not go to medical school if I were you.
Why not have your children now, enjoy some time home with them, then go to professional school?
The cure for anything is salt water: sweat, tears, or the sea. -- Isak Dinesen
There are many options to help with paying off med school debts. I guess what you have to figure out for yourself is how you (mentally) deal with the notion of debt. Some people cannot stand it even though it is school loan/debt which I think should be viewed as an investment and not at all the same as credit card debt, etc. But some people view it all as the same and want to pay it off ASAP. You can get a job with an FQHC which usually will pay you less per year than if you were in private practice, but for every year that you work for them they will pay a year of your schooling, so it more than evens out. There are military scholarships that require a certain number of years of service. You can also negotiate your employment contract to have a loan repayment element, but this is often dependent on location & demand.
I manage my loans just fine even with a mortgage, but my attitude was that I would lock it down at the lowest interest rate and pay it for the next 60 yrs! I was fine with that, but I know a lot of my colleagues were not. I pay a little less than $1000 per mos. My loans will die when I die-- my family will not have to pay them & on my taxes the interest is tax deductible. But again, it all depends on your relationship with debt.
I have a friend who is a psychiatrist and she works ~12 hrs per wk (I think), but she has no benefits (no 401K, no health insurance, etc.) She is a contracted agent. She pays her own malpractice and afterwards takes home "resident pay" I think. Her husband is a fellow physician in a more lucrative field though.
It is difficult to find part time positions and it often depends on your field, your location & the culture of where you practice. Most primary docs work around 50 hrs so part time is usually around 30 hrs.
With all that said-- I was 29 yrs old when I became an attending and will be 35 yrs old when I become a mother (God willing), so I could have realistically worked for 4 years and gotten rid of those loans. You don't really know what will happen in your life's path. You can't really plan all of it.
Emily - I looked over the budget sheet my school gave me, edited it a little in the living expenses section since I know I will live more frugally (and have been for years). Its hard to get it too low with a tuition/fees of almost $38k/year. I didn't edit the money allotted for travel in the 3rd and 4th years because I don't know what to expect there. So, from medical school debt of 4 years, the total would be a little over $217K and then I have $20K of undergrad debt, too :/
English made a good point that it depends on how you feel about being in debt. I could handle some, but I'm not comfortable with $240,000 before interest is calculated in. It would probably be different if I wasn't concerned about being able to work part time or take time off, but I'm not willing to budge much on that.
Also, to pathdr2b - while that is good advice, the most important thing to me is going to be starting a family in a little later on. I know I'm not ready this year for a baby and neither is my partner. I want to know exactly what I am getting into with a possible career in medicine and how its going to effect my future life before I sign up.