Tag: medical school

How The Surgeon and The SurgeonSpouse Managed Medical School

This originally was included inside the post about how to manage loans and finances while in medical school. Though the summary advice of that particular post is: don’t spend too much, get a roommate, and manage your finances closely – perhaps some of you were looking for more salient advice. Given that, I wanted to break out what we did into it’s own post for more detail.

What Did YOU Do During Medical School?

Before Med School

For some personal background about the SurgeonSpouse (tm) here at SurgeonJourney, I worked for a healthcare software company (with a solid 401k & benefits) right after undergrad. Though I had great benefits, I totally didn’t know it at the time. Knowing what I know now, I was lucky I decided to throw a bunch of money into my 401k – I didn’t know about suggested investment strategies and I didn’t know what resources to use on the web.

While I was working at the healthcare company – The Surgeon was doing research and preparing for medical school. At this time we lived in different cities and correspondingly kept our finances separate. To her immense credit, the Surgeon is a frugal BOSS and knows how to stretch the dollars when she needs to.

Med School – The First Year

Fast forward a year or two and the Surgeon is in her first year of medical school. We’re still in separate cities and I visited with my hard earned consulting airline miles (I’ll have to do a post about some frugal travel tips in the future. Would certainly help for residency interviews). The Surgeon, being the frugal badass that she is, lived with a fellow grad student and had a carefully planned weekly food budget and menu. She packed all her own lunches and cooked dinner at home.

Much of this meal planning and living arrangement takes discipline and a healthy amount of delayed gratification. Skills that apply not only to finances, but to a variety of things in life – like staying the course to becoming a doctor. Luckily, the Surgeon has an abundance of both! If you’re reading this blog and have made it this far, you, too, likely have these attributes.

Second Year and Beyond

Through her first year, The Surgeon kept to her budget and did a really good job of limiting expenses. At the start of second year of med school, I left my healthcare consulting job and moved to be in the same city as The Surgeon. We looked around and found an affordable apartment near the school and made the big decision to move in together!

Moving In with a Partner?

There are a lot of practical decisions to make when moving in together, it’s a great step in a relationship. We had to talk about and make decisions on things like:

  • Who’s paying for groceries?
  • Are we splitting rent? If so, how are we going to do that – evenly or based on income?
  • Are we putting both our names on the lease?
  • Which name(s) are we going to use for utilities?
  • Are we sharing streaming accounts?
  • What do we do with our furniture?
  • Which way does the toilet paper face? (FACT: there’s only one right answer to this and I’m sticking to it)

Sure, the questions can go from the more practical and reasonable to slightly more esoteric – but you’ll encounter every aspect of a partner when living together. It’s important to have these discussions upfront – especially about the TP.

Some of the financial conversations can get sticky if not broached early, by talking about them ahead of time, it can save a lot of angst down the road. Alas, I digress, back to financial advice.

Being a Partner of a Med Student

I found a job in the same city as The Surgeon, which worked out well while she was in school. We were fortunate that her med school was in a larger metropolitan area but still relatively affordable – in the Southeast, I’m sure you can guess which city. There’s a vibrant startup community and I was able to get a great job while The Surgeon finished the remaining three years of med school.

Having an income really helped out our financial situation while The Surgeon was in school. Since we lived together, I tried to pick up expenses where I could to minimize loans. It should also be noted that we had been together for four years at this point (since senior year of undergrad), so sharing expenses and living together was the next ideal step for us.

Photo by Volkan Olmez on Unsplash

Fourth Year!

Until forth year, spending is fairly predictable. It is worth noting, amusingly, that generally med school tuition goes up for third and fourth year. Of course this is when you’re done with your didactic years and moving to clinical rotations. You’ll have sparing classroom time once clinicals start, though it was always strange to me that tuition goes up for your final years when you’re not really in a classroom.

What throws a wrench in finances for your forth year is residency interviews. Once you choose a specialty, you’ll start picking out residency programs based on your scores and aspirations. Depending on what you choose, you may end up applying to a few dozen programs. For every program that extends an interview, that travel is on your dime.

We also got married, which isn’t exactly cheap endeavor – but still file taxes separately! #PSLF.

Residency Interviews – Unavoidable Travel Expenses

For The Surgeon’s residency interviews, we used a combination of airline miles, low cost carriers, and creativity to keep costs low. But when you don’t have a lot of scheduling flexibility nor advance notice – flights can get expensive. To save on hotels when she could, the Surgeon would find a friend who lived in the interview city, if possible. Otherwise, it was AirBnB and hotels.

You might end up spending a few thousand dollars on interviews once you’re done. Between all the travel, and also the interview attire, it adds up. In the future, I’ll do a post on some credit cards I’d recommend to take advantage of all that travel spend, something I wish I thought of sooner.

Final Thoughts on Med School Finances

Overall, you’ll make it through! We did it with a combination of saving and careful planning, coming out with federal loans just shy of $200,000 (that interest was already adding up) – hooray! I made some loan mistakes that I definitely will cover in the rest of the loan and PSLF series.

What questions do you have about finances during med school? Questions for The Surgeon and The SurgeonSpouse?

-SurgeonJourney

During Medical School: Managing Debt and Living Costs

So you’ve chosen a medical school, enrolled, and are happily studying through first year and loving anatomy lab. How do you manage your expenses and loans while in school? Excellent question, dear reader, and this builds on the previous post in the series that provides a high level summary of securing student loans.

Every person has a unique financial and life situation – perhaps you have a partner and are sharing living expenses. Are they in school? Are they working? Do they make a comfortable amount and are you close enough such that they can support you while you’re in school?

What kind of loans do you have, private or public?

From the perspective of managing loans while in school, both private and public loans generally allow you to defer making payments while you’re a full time student. Note however, that your loans will continue to accrue interest whether or not you’re making payments. Because you’re fully focused on school, it doesn’t make sense to make payments until after you’ve graduated. I’ll go into detail about ways to manage your public and private loans once you’ve graduated from medical school in a future post.

Managing Expenses – Find a Roommate!

Here’s where having the discipline to focus on keeping a budget will save you in the long run. By using one (or more) of these tools, you can get a perfect picture of your monthly income and expenditure, and carefully plan out what you’ll need each semester.

If you don’t have a partner that you’d consider sharing expenses with, there are additional options you have to save on housing costs. Check with your fellow classmates to see if they’re looking for roommates – do make sure you’re compatible living together. If the idea of living with a fellow med student is like bringing work home with you, see if you school has other graduate programs. Like med students, students in other grad programs are typically focused, high achieving, and might make an ideal roommate or three.

Ultimately, shacking up with a roommate for a few years while in school isn’t the worst thing you can do. It’s a great way to save on your largest expense outside of med school tuition and can reduce your need for loans.

Budget for Larger Expenses

As you progress through medical school, remember the long game. By the time you become an attending, (if you’re in the US), your superlative education will include:

  • Four years of undergrad
  • Four years of medical school
  • at least 3 years of residency
  • TOTAL: 11 YEARS after high school

If you’re like the Surgeon and planning on a surgery sub-specialty, that’s a seven year residency (including research). Tack on roughly two years of fellowship. Say you’re interested in becoming a Thoracic Surgeon. That’s a 17 YEAR ride after high school – buckle up.

My point with this isn’t to scare you, but to realize that your high income years (at this point) are about a decade away, the decisions you make regarding finances early on can save you much later in the long run. Remember, life is a marathon, not a sprint.

During medical school, larger expenses might include mandatory testing (like STEP exams), vacation (responsibly), transportation (keeping your car alive), and in your fourth year: residency interviews. Loans are certainly one way to manage these expenses. But another, perhaps more prudent option, would be budgeting and planning for these expenses ahead of time.

What Should YOU Do?

In the end, I can’t tell you what to do. I know what worked for The Surgeon and me, and I’ve seen what can work for others. Ultimately, it’s about being responsible with your financial decisions, closely evaluating living arrangements and expenses, and keeping your mind and body healthy for the long run.

It’s also great to instill these habits early, so that once you are making a bit of an income (at least adding to the positive side of the ledger) in residency, you can work on saving. Keeping those habits into your attending years will have you set up to be debt free while maximizing your financial potential for your life time!

What questions about expenses and budgeting do you have while in med school? How to make ramen more tasty? Adding an egg and some leafy greens can really kick up a ramen pack on the cheap.

-SurgeonJourney

Part 1: Med School Loans and How to Find Them

Accepted to Med School, Now What?

Congratulations! Your hard work through your undergrad years has paid off – that GPA and MCAT score and your summers spent doing research and shadowing have prepared you for the next four years, studying to become a doctor. As the glow fades from your monumental achievement, reality set in as you must figure out how to finance this expedition. (If you found this post by accident and you don’t require loans for medical school, go have a mai-tai and then come back for other info).

Let’s jump into the different ways one can pay for school. You’ll likely have information from the medical school you plan on attending to secure funding to pay for tuition and living expenses. You can skim through this section if you took loans out for undergrad. Keep in mind, the type of loan you accept will alter the different repayment options you can choose down the road. This decision, though seemingly minor, can have a large impact on a doctor’s financial situation for potentially decades.

Once you accept an offer, get your checkbook out – typically there’s a deposit required to hold your spot, and the school will provide resources to you for financial assistance depending on your situation. In my anecdotal experience, it seems that these Financial Aid offices can be anywhere from mildly helpful to possibly committing willful malfeasance. Your mileage may vary. Nevertheless, there are a TON of resources to talk you through the different options.

Since this blog is focused largely on surgeons with a residency of at least five years (my surgeon is in the greater than five year category), plus an additional one or two (or possibly three) year fellowship, I’ll focus on the decisions you need to make that will allow you to qualify for PSLF. I should note, also, that there are some longer residency + fellowship combos with medicine specialties that make this information helpful (cardiology, for one).

What’s PSLF? I’m Glad you Asked!

PSLF is an acronym for Public Service Loan Forgiveness, and the Consumer Financial Protection Bureau has a great summary of the program:

The Public Service Loan Forgiveness (PSLF) Program forgives the remaining balance on your federal Direct Loans after you make 120 qualifying monthly payments under a qualifying repayment plan while working full-time for a qualifying public service employer. 

–consumerfinance.gov

So, what does that mean? Let’s break it down:

  • Federal Direct Loans
    • This means that the US Department of Education (and Betsy DeVos) is your lender. Basically you’re securing your loan directly from the Department of Education.
  • Qualifying Monthly Payments, 120 of them
    • Meeting the required payment each month as specified by your payment plan is all you need to do here. If you are attempting to qualify for PSLF, you should choose FedLoan as your servicer – they’re the only loan servicing operation that will manage PSLF.
  • Qualifying Repayment Plan
    • This is where some real value can come into play with the PSLF program. Federal loans can qualify for a number of different repayment plans, I’ll dig into this with lots more detail in a post dedicated to PSLF, but know for now that it can dramatically decrease your monthly payments to as little as $0.00.
  • Working Full-time
    • At least 40 hours a week. If you’re a general surgery resident, this will be less than half your week (unofficially; of course your week is officially 80 hours).
  • Qualifying Public Service Employer
    • In nearly all cases, as a resident you’ll be employed by a non-profit – 501(c)(3) – organization affiliated with your teaching hospital and have nothing to worry about here. (I’ve heard reports that Kaiser in CA does have their physicians, including residents, employed by a for-profit entity; I’ll do some more research on this).

So there it is! Work ten years for a non-profit while meeting the payment required each month and the remainder of your loan will be forgiven (principal and interest TAX FREE!) by good Ol’ Uncle Sam.

Too much of a good thing?

I have heard that there is brewing interest in Congress to institute caps on forgiveness, but for now there aren’t any. At the time of this post, it’s still safe to go for PSLF as a med student. If there are changes, most speculate that existing borrowers won’t be affected – depends how the US Treasury is looking.

Photo by Ricardo Rocha on Unsplash

Loan Decision Time

I digressed a bit with the PSLF intro, but let’s get back to paying for med school – it’ll all fit together, I promise. Once you get over the sticker shock, put together a rough budget of your expenses you think you’ll have each year, broken down by semester – there are lots of guides online for this, so I’ll just create an example here:

By Semester:Cost:
Tuition$25,000
Miscellaneous and spurious fees$4,000
Living costs: Housing ($1000/month), Food ($400/month)$8,400
Total (per semester):$37,400

Depending how frugal (or not) you are, you’ll be spending at least $70,000 per year between tuition and living expenses.

Getting that Cheddar, Public or Private?

Two main options are private and public loans. In order to qualify for PSLF, you must use a public loan. After submitting a FAFSA form, you’ll likely be approved for two federal loans, Direct Unsubsidized and Direct PLUS. The former are capped at $40,500 per year, though Direct Unsubsidized Loans don’t have any strict requirements, like credit checks, and come with a pretty reasonable fixed interest rate.

You might be wondering what’s the difference between Unsubsidized and Subsidized Loans – I sure did when I first saw it. It has to do with how the interest on your loan is handled. For Subsidized Loans, the kindly U.S. Department of Education will pay the interest accrued while you’re in medical school. They do come with more restrictions than unsubsidized loans and are based on financial need. You’re responsible for the interest accrued on unsubsidized loans while you’re in school – if you choose not to pay interest while you’re in school, it will capitalize (your interest accrued gets added to the principal) on your loan.

If you find yourself needing more than $40,500 per year in loans, and you very well might, Direct PLUS loans are your next stop. These do come with more requirements, like a credit check, and may have more restrictions for borrowers with an adverse credit history.

SurgeonJourney’s Suggestion

From my perspective, I didn’t fully understand how PSLF worked until my spouse’s last year of medical school. By that time, we had maxed out the Direct Unsubsidized option every year and covered the rest of tuition with private loans. Were we to do it again, I would likely try to take out all public loan options for the purpose of PSLF.

We were fortunate that while my spouse was in school, I was working a full time job at a software startup, which certainly eased concerns for living expenses. I know that not everyone will have this situation, so it’s important to know your loan options and also focus on managing your expenses wisely. There are some great budgeting tools out there I’ll cover in later posts.

Let me know your thoughts and questions in the comments!

-SurgeonJourney

Managing Federal Loans and Qualifying for PSLF, a Practical Guide

Loan decisions start as soon as an aspiring doctor receives their acceptance to medical school. After the wave of excitement passes, assuming you don’t have a trust fund, the next question is invariably: how am I going to pay for this education? Navigating loan options is complex and confusing – having first hand experience (well, via my spouse), I’m here to help!

This is going to be a multi-part series focusing on different phases in the progression of loan acquisition, spending, and eventual payoff or forgiveness.

Med School Loans: A Series

With the rising cost of medical school – even for state schools, it definitely is important to evaluate payment options and consider your residency and speciality wisely. Each of these decisions will have an impact on your future finances, from the type of loans you choose to your income as an attending. The length of residency and potential fellowship you choose will also affect which loan forgiveness and payment plans you will qualify for if you have federal loans.

We’re going to start at the beginning, right after you accept an offer to attend medical school. From there, each segment will focus on a different phase of the medical education and training process, culminating in graduation from residency and fellowship.

Along the way, we’ll look at different ways to manage student loans for medical school. If you have any questions, comments, or suggestions for this series – let me know in the comments!

-SurgeonJourney