Isn't using student loan money to put a down payment on someone else's house illegal? Aren't there any restrictions?
78
There are websites where medical students discuss among themselves their motivation for practicing medicine. For most, as the debts pile up, it's money. Instead of free health care, which some Pollyannas are trying to sell us, how about providing free medical school to those who make the grade? This would reduce the greed that is driving medical costs sky high. Attract the best of the best. And keep their motive what it should be: helping others, not themselves. What a sick and disgusting health care system we have! It begins with medical school.
96
Now when you go the ER you see a PA or an NP but not a MD. Who is supervising the PA and the NP? They have masters degrees not MD degrees. Go to an urgent care free standing facility and again you will see a PA or an NP. No MD on the premises. Your medical bill will not reflect delivery of care and will be the same as if an MD treated the patient.
61
Velazquez should have had insurance at age 13 or so when Obamacare was enacted.
17
I'm glad you showed a white girl in the article. THIS ALL is race independent and a socioeconomic class war! How would I know? Well I was poor white kid who had no money in Boston in medical school and HAD to join the US Air Force to pay or not go to medical school. I am now one of those people who can write a check for my kid to go to college. Medical school should be free or near free in the USA, like it is Canada or AUS. I know this cause I train foreign MDs at an Ivy League hospital in NYC. They have zero to 10,000 USD educational debt. Capitalism again has run amok in these institutions of higher education. Sad. The testing should not be thousands of dollars either.
628
I can relate to the stories represented in this article. I come from an immigrant, low income, single mother household. I completed pre-med with many hardships such as coming back home knowing that we were being thrown out of our apartment due to building violations and having no means to go anywhere else right before the Christmas season. I was not able to afford the extra tutoring, expensive study tools, and such needed compared to my affluent counterparts. I am currently studying for the Medical College Admissions Test, and it is challenging to study and score well or competitive enough on the exam while having to work everyday in order to be able to afford a prep course and study tools , which is counterproductive because it takes away from putting in effective time and energy into studying for this arduous exam. The stress I have had from my own household such as expenses and making ends meet on top of studying for the MCAT which can be very frustrating and challenging to give it your all at times. On the other hand, I look at these obstacles and challenges as a way of grit, resilience, and relentlessness, which you can't learn in school. All in all, I won't allow these challenges to deter me from becoming a physician, as a Latina I know I am needed to fill in gaps where its much needed. I pray more take notes on offering tuition free medical schools, money should never have to hinder anyone from reaching their goals and dreams that they are passionate for.
63
I admire the ambition of everyone in this article. I'm sure that their hearts are in the right places. But these financial issues are NOT new to anyone regarding medical schools. Everyone knows about these particular expenses whether they're in medical school or not. I wish all of them the best success despite their struggles. I do agree with others who commented that they could have gone to cheaper state schools.
30
This article also does not mention the cost of "matching" with a residency and overnight trips to multiple (8-15 or more) residency programs for interviews. Two generations ago, medical students may have interviewed at 2-3 sites, but that number has at least tripled. Students in rural areas with few residency options may need to drive multiple hours or spend money on expensive flights.
42
Be a NP or PA. Classes online. Far less testing and travel. No liability when you practice medicine with less training because the docs are always liable. Medicine will continue to deteriorate in terms of quality but that seems to be what the country wants.
43
*SOLUTION*.
Use recorded lectures for first 2 years and ditch the expensive brick and mortar expenses. 90% of my med school class didn’t attend lecture by the end of it because it’s more efficient to watch a video, then read notes and read the appropriate section in the $40 review book. You do this and cut the med school cost in half. We are using 18th century economics in our supply chain with the current approach to delivering quality medical education.
We all need to know the same lecture material at every medical school, so why are we sending people to places with high fixed expenses and duplicating the exact same product when the final product we consume is a digital-format video that has no variable production cost?
Unlike undergraduate study, medical school has a fixed set of material to be learned and tested. There is no time for lengthy discussion during a 60 minute 80-slide lecture, so the $60,000/year return on investment to physically sit in the lecture hall is negligible.
65
I find it sad that all these test prep programs seem to be de rigueur. They are not and students should be offered an alternative. I never used a test prep program, I studied using a book and later with friends in med school. We organized our own program. I think this is very possible to do today, but people are brainwashed to think test prep programs have some kind of magic. They don't.
36
I was horrified by this article, and though it is well and good for Times readers to weigh in, supporting its conclusions, isn't there a way to funnel some gifts to such needy students?
27
The comments seem to fall in two groups. One acknowledging the evil of a system that places such barriers in front of those striving to become productive members of society and those who view this as a matter of making sensible decisions on borrowing with an expectation it will pay off for oneself in the future.
In one way or another, in our country it is all about money.
That seems to me to reflect a deranged society.
75
This story further illustrates the brilliance of the administration of NYU's medical school to go "tuition free" in 2018. There is obviously much more to be done, especially at the universities with billion-dollar endowments.
63
Bit by Harvard? Wonderful school and experience, but you knew it was a financial snake when you picked it up. Go to an excellent state university for med school in a town with lower rents, and loans can be much smaller.
33
Harvard's endowment is $40 billion. That's billion with a B. To charge what they charge for medical school tuition is criminal, especially for the those students from limited financial backgrounds.
171
As a child of working class immigrants, and a surgeon who has recently completed training, I empathize with these students. I have indeed lived the same struggle and I am reminded monthly with expensive loan repayments. Medical education is inordinately expensive, and it doesn’t get any better during residency with loan repayment, licensure, board exams, etc. This problem extends to so many other professional fields, and there needs to be impetus at the national level to address this problem. At a time when capital is so easily wasted and destroyed (I.E WeWork), it is a shame that truly intelligent minds who want to improve society are yolked with an undue financial burden.
125
I don’t doubt that students from less well off families experience additional debt-related stress during their medical training. However, I question whether their concern is completely rational. Even in poorly-compensated specialties, the majority of doctors make over $200,000 a year. Moreover, since we have a shortage of physicians, doctors (unlike most others) are all but guaranteed to always have a job. Before complaining too loudly, young doctors should recognize that a significant fraction of society (those with large student loans, medical bills, and/or plain old mortgages) carry hundreds of thousands of dollars of debt without nearly as much earning power or job security as they will ultimately have.
28
First of all, many specialities make less than $200,000. Ask a pediatrician. And by the way, after 4 years of medical school and 3-7 years of residency and fellowship working an average of 80hrs per week, don’t you think physicians should be generously compensated? This article’s purpose is to show people that beyond the incredibly high tuition, there are MANY additional expenses in medical school that are a tremendous burden for students from low income families. It doesn’t matter how much they’re going to get paid 8-10 years down the road. Right now, in this moment, they’re struggling.
133
Everyone in medical school works hard, but children of privilege like myself were free from almost all of the additional concerns faced by the individuals in this article.
True health care reform needs to address access not only by addressing insurance coverage, but also by addressing medical education and the recruitment/application process. You shouldn't have to be wealthy to get into and complete medical school. Primary care fields require some financial incentives.
Perhaps a national health core would make sense with some element of voluntary service. Loan forgiveness for primary care fields balanced by higher tuition payments (assessed once out in practice) for graduates who enter more lucrative fields. Legislatures can drive some behavior and outcomes for state supported schools. Boards of Trustees can do the same for private schools.
NYU's free tuition program is a wonderful experiment. I hope it results in a more diverse population of physicians providing more primary care to at risk populations. One Park Avenue dermatologist or plastic surgeon every 20 blocks is probably enough.
Jack Percelay, MD
73
Would anyone consider contributing to a kickstarter or GoFundMe campaign to help some of these struggling students? Clearly even a few hundred dollars could be beneficial. Obviously we can’t overhaul the system overnight, but we could enact real change by donating a little money to help them out. I’d be interested to see if the times would allow us to get one of these started.
30
A down payment on a home for parents? From a student loan ? In law school I would never have used my precious loan resources for anything but school and rent. It was doled out carefully each month by me to me. I made it last and every cent was repaid on time per the original schedule. Empathetic yes, but use your common sense please.
69
Medical Schools in the US are a wonderful, fruitful industry. Great rates of return accrue to those who own them. Prices keep going up - gravity does not work here. The Medical Education Industry is alive and kicking. Why does David Velasquez think he deserves a break?
8
College is too expensive for any low income student, period.
21
This is one of the most accurate statements in the article: ""For some students, the pressure of medical school expenses becomes a limiting factor as they survey their professional options. A well-paying field like plastic surgery begins to look more appealing, while lower-paying jobs in family medicine lose their luster". Humans are driven by incentives--oftenly financial incentives. From the financial perspective, it does not make sense to become a family doctor, psychiatrist or pediatrician. Instead physicians pursue careers in orthopedic medicine, cardiology or dermatology. That's the ugly thruth.
Medicine is not charity. It is a job that must be remunerated according to the principles of supply and demand. I felt that people expect physician to sacrifice themselves and their families by providing affordable--"cheap"--- services. Sadly, lawyers, engineers, politicians are not held to the same expectation.
Finally, this is another reason why the medical community is terrified about Medicare for All. Can you imagine? Picture a single payer who will dictate how much physicians can charge for their services.The government will have the last word over reimbursement. It is time for the resurgence of concierge medicine.
11
@JediMD Insurance companies already dictate how much physicians can charge. Read your explanation of benefits (EOBs) that your insurance companies send out. You'll see how much your insurance company (or Medicare) has agreed to pay. It's far less than what the physician or hospital "charges." For example, my orthopedic surgeon "charged" $17,000 to replace my knee; Medicare reimbursed him $1,783. Insurance companies deny tests all the time. They deny certain prescriptions if those are not on the "formulary." Review nurses frequently deny or delay procedures that turn out to have been necessary. "Utilization review" tells people they cannot stay in the hospital after a certain number of days, sometimes without regard to their condition. Is that so much different from what one could expect from a "single payer dictating" how things would be done? I worked in medical settings for 40 years. It's complicated. Insurance executives make multi-million-dollar annual salaries by denying or limiting care. Physicians spend a great deal of time arguing with insurance companies on behalf of their patients' needs. You're a physician; you should know this.
69
These students will struggle thru med school and then join the upper middle class. No problem paying off loans. It’s those other students with loans for degrees in fields with little chance of propelling them into middle class incomes or above that I feel badly for
33
Is it reasonable for family members to expect a struggling student to give up money desperately needed for training, in order to help with whatever the latest crisis is at home?
Should the progress of the one who is trying to "make it" be stalled by endless demands?
This is about fairness, and not just about being family.
40
I was told by a wise professor many years ago to be careful “not to hold the hand that could hold me down” as many demands were placed on me as I was struggling to make it.
34
Hey kids - avoid medical school at all costs. I wish I had. There are reasons why over 50 % of US doctors wish they could leave medicine. You will bow to corporate overlords, be judged on why you haven't discharged patients quickly after being admitted, be forced to see more patients in a day than possible, be tethered to you laptop and spend half your time filling out forms.
Another issue you will face: you are now competing for jobs with much lesser trained nurse practitioners and PAs. The healthcare corporations are happy to hire NPs over doctors as they don't have to pay them as much. Only surgeons are safe (and soon robots will take over their jobs).
https://www.forbes.com/sites/johngoodman/2014/09/11/why-are-doctors-so-unhappy/#53a9db681771
49
Sadly my incredible Manhattan OB/GYN quit private practice at the age of 45 because he could not afford to be a doctor anymore. The costs for practice insurance were over 100K per year and the lack of sleep and stress were overwhelming. He is now teaching. He was forced to factor necessary costs such as administrative staff, office space (very expensive in NYC) and personal cost of living just to thrive. The profession just does not pencil. He was incredible at what he did but it’s tough when doctors cannot afford their professions anymore.
21
Join ROTC in college, go to med school on ROTC scholarship. I know a number of people who went this route. I went to med school on the GI bill.
21
I question whether medical school truly leans toward “rich” students. Upper middle class, certainly, and if you’re a truck driver’s kid, it may be a distinction without a difference. However, the “rich”, it seems to me, generally ease their kids into business rather than the professions. While physicians are generally not poor, they aren’t usually wondering if they can make the rent.
I do think it’s unfortunate that the schools don’t do a better job of understanding the economic diversity of their students. Indeed, they should be embracing the fact that their students understand patients’ lives.
18
Because my daughter is a sophomore premed at an Ivy, I've been familiarizing myself with medical school admission stats. What I found is that admissions to US medical schools show the same biases as in undergrad admissions to the Ivy+ schools. To be admitted, a white student, and especially an Asian American student, would need significantly higher GPA and MCAT score than their Hispanic and African American peers to get into the same med schools. My daughter tells me that all the premeds at her Ivy know that and they evaluate how well/not well they are doing based in part on their own race.
26
@Miss ABC Advise your daughter to go to a state medical school. They're a great bargain. Yes, the Ivies might lead to a more prestigious residency, but, in the long run, medical school faculties at the state schools are, for the most part, equivalent to those at the most expensive med schools. My husband went to a state medical school and the GI bill. Admittedly, it was 40 years ago, but, since I worked two jobs while he was in school to pay our living expenses, he came out of school with no debt.
14
It is hard to see how sending parents money for a down payment is a “hidden cost of medical school.” The loans supplied are really meant to be used for the study aid and not as “a rainy day fund if someone at home gets sick.”
I understand that students can feel compelled to help their families in need, but the financial aid and loans are calculated to support the needs of the student, not their entire extended family.
76
When I was a resident at the BI I had the privilege of teaching med students from Harvard and from UMass. The latter group were generally more knowledgeable and, frankly, smarter. Why? Tuition was way lower at UMass - as a result it was actually harder to get in to, and people who got in had more grit, like the protagonists of this story. There is a lesson here. If you want a good medical education ignore the brand and go where your fiscal peers go. If you can only get into Harvard, so be it, but if you can get into the state school that has the same goals as you, forget the label and go there. The education will be better anyway.
36
Something in the article doesn't jive -- wouldn't being in primary care allow loans to be repaid faster because fellowship/specialized training time is reduced? Why would loans propel people to take up higher paying specializations? Starting salaries of family physicians are $250,000; some of this can definitely be used to payoff loans.
I am all for a system like Britain or France where medical education is largely free, but then earnings are one-third of what US doctors make. You can't have your cake and eat it too.
6
Primary care (3 years of residency) makes more like $220k/year whereas a specialist (4 - 8 years of residency, depending on specialty) will make somewhere between $300-700k/year which puts the lifetime earning potential significantly higher by specializing. Loans are only growing by interest after finishing school so an extra $100k earned per additional year of training (essentially), outweighs the interest accrual by a good margin. Someone making $300,000 vs. $220,000 (without taking taxes and raises, etc into account) can then earn over $2M more than the lower paid primary care doc in a short, 25-year working lifetime. Conversely, the primary care physician would have to work approximately 34 years to the specialist’s 25 years for the same lifetime earnings.
5
Wow. Excellent piece. Please write and publish more important stories like this.
16
Why are medical school graduates paying exorbitant interest rates? In some cases they pay 3 to 4 times a typical mortgage rate. When I’ve asked bankers why interest is so high I’m told it’s because they are high risk for default. Well, it turns out that defaulting on medical student debt is considered unprofessional conduct and State Medical Boards can take disciplinary action against a defaulting doctor’s license. Therefore doctors are actually lower risk to default. Reform could start by limiting the interest a doctor should pay on school debt.
45
This is a topic the Democrats should address, especially because the issue of Medicare keeps coming up. Until 1980 the Federal Government did pour money into medical schools. Until the mid 1980s - Federal and State money also generously supported residency programs. When that money evaporated - that was when tuition began to rise substantially. Add to that - physician reimbursements from health insurance companies are generally pegged to what the Government will pay on Medicare - (so despite GOP warnings about "socialized medicine" the govt. already, essentially sets the rates) . In this way, the Government does have a very large role in determining who can afford to go to Medical School, and who can afford to repay loans. Obviously this is not a sustainable system.
22
I have reservations about “free college for all” promises, but med school is a different matter altogether. Applicants for medical school have proved their academic potential and willingness to contribute to the wellbeing of our society. We need more doctors than we currently have, especially more family physicians and gerontologists who are currently underpaid by our insurance reimbursement system. When medical students know they are accumulating huge debts, they are almost forced into higher paying specialties where they may not be so badly needed. Medical school should be free, at least for students who commit to working in rural areas or with communities of need. eventually I believe it should be free for all who qualify and can keep up.
17
"a national study found that over 75 percent of medical school students came from the top 40 percent of family income in the United States"...the top 40% of family income? What is this a joke? 75% seems to be not such a unreasonable number since the med school costs are high and only students with a reasonable family income would attempt.
8
As an attorney who has represented physicians for 30 years, I can attest to the fact that these men and women are dedicated to their profession and are not in it for the money. The cost/benefit ratio wouldn't make any sense. Family members who have become doctors were working for minimum wage during residency and were expected to do so for about 100 hours a week. The 'best and brightest' students are going to Wall Street, not medical school. Sure, the hours are nutty in the world of finance as well, but they are in pursuit of an early and, more often than not, lucrative retirement. Making a pile of money is not a calling. Medicine is. In a country with such abundant financial resources, if someone is talented enough and motivated enough to want to become a doctor, medical school and the subsequent training should be absolutely free and include reasonable expenses. "'Cs get degrees," as the saying goes. I want the 'A' students in the OR.
54
Another reason why, with all the various ideas about student loan forgiveness/reform, the DEBT TO INCOME ratio should be taken into consideration. A doctor making 200k has a nice salary. But many now owe 700k or more in student loans by the time they finish training and actually start earning the “big bucks.”
Let’s talk about lower interest rates, let’s talk about allowing pre-tax student loan payments (similar to the way any business is allowed to deduct expenses.. corporations are people after all, right?...)
18
I'm still stuck on the 11 hours a day of studying part. Wow.
6
One word: gatekeeping.
8
Its time for everyone who has attended a university to NO LONGER donate money until the university makes tuition affordable. All universities need to go on cost cutting missions to provide cheaper education. A focus needs to be made on value for money. I would like to see a breakdown of where exactly universities are spending their money. Perhaps the schools just need to simplify their offerings/campuses so they can provide an affordable education. But this all starts with alumni no longer opening their wallets!
13
The Armed Forces will pay for Medical School. I know because they paid for mine. These scholarships still exist. You just have to serve 1 year for each year of Med School after graduation from residency. You can also do your residency in the military. I did mine at Walter Reed. I had zero student debt after serving my time in the military.
36
Medicine will change them more than they will change medicine. Except for the rare truly sacrificial choices (public health, medical missionary work) the insane earnings will erode most if not all deep or enduring compassion and desire for reform.
5
Excellent article. As discussed this is true for Caucasian students who's families aren't wealthy. I recently told one of my nieces, "just go to medical school" The first words out of her mouth weren't, "I can't get in," rather "I can't afford it."
6
The path to becoming a physician is hard for all interested students. Medical training is layered with classism, sexism, racism, and homophobia. People who know me casually think I am a nurse even as they see me around the neighborhood studying for medical school.
The threat of losing access to one’s intended income stream if you lose hospital privileges, a medical license, or insurability because of malpractice claims is stressful. Adding financial insecurity to all of that is real for any physician.
I wish the presidential candidates understood that the economics of medicine and dentistry disadvantage first-generation physicians and dentists. Some of us have large incomes offset by large loans and no other source of family money. I would happily reduce my salary for loan forgiveness to work in a Federal facility.
(And for the record, DC has no state medical school so I had to attend a private institution.)
11
What a great country we live in. All of these students are going to be monumentally successful financially compared to the vast majority of their peers, and they are going to be leaders in caring for others as well as shining examples for future generations to follow. How fortunate for all of us that the opportunity exists to "drag yourself up by your bootstraps" and that it is possible to get loans and grants that allow all the hard work to pay off. Of course it is easier if you don't have to worry about money. Perhaps the fact that their children won't have to go through what they did will motivate them to further successes. I am a second generation doctor whose grandparents came to America to escape persecution. My father earned his way into one of NYC's best high schools and then into college and Med school in an era when doors were not open for those of his ethnicity. Because of his hard work, my path was simpler and I am forever thankful and have been able to give back in the form of endowments that help support students financially at his medical school and, in the near, future, at mine. What a great opportunity these doctors and trainees have to be tomorrows leaders.
18
The debt physicians graduate with are because those loans are also paying all living and supply costs in addition to tuition. Because you really can’t work and do medical school at the same time. And then you work way below minimum wage throughout residency allowing interest to compound. So while the pre- expenses are prohibitive and the residency interviews and STEPS need extra planning to make it, once in the vast majority live entirely off of loans. So this article is undercutting itself by taking a weird path to examine an otherwise important problem...
6
This brought back so many uncomfortable memories.
I am the first doctor in my family. I really knew nothing about the process of getting into or going through medical school, and honestly, probably wouldn’t have tried if someone had explained it to me. I came came from a family that couldn’t support me financially, or really emotionally, because they didn’t have the resources for either. I didn’t spend money on MCAT prep courses because I didn’t know they existed. I didn’t spend money on application fees to a bunch of schools because I didn’t have it. I went to the school in my state but needed every dime of loans available to cover my living expenses. When I finally “finished” and became a resident, my parents had no idea I was still really a student. I am ten years out of training and my loans are a few years away from being paid. I am doing well, but I am light years behind colleagues who were gifted their education (and down payments for first homes). So what?
33
Thank you for shining a light on this experience. An addendum is the additional debt, which will be many thousands more, they will occur as fourth year students and they pay for the privilege of a guest rotation in hopes of being invited to interview after they’ve also paid an application fee.
7
I would think that in many ways that coming from a lower socioeconomic background would make medical school less expensive rather than more. These students would be entitled to financial aid from the government as well as the school. Students from upper middle class families aren't entitled to these benefits. They have to pay full freight. And many of those families just don't have the kind of money (or the willingness) to pay for 4 years of medical school much less the living expenses. I received no financial aid and no parental support and I was able to borrow enough to cover all of my expenses in New York City. So I don't understand why these underprivileged students aren't able to pay for everything they need. Plus they should graduate with less debt than someone like myself. For those wanting to go into primary care, there are often loan forgiveness programs or scholarships if you make a commitment to work in family medicine for x number of years after graduating for medical school. There may be financial obstacles to paying the costs of applying and getting into medical school, but once you're enrolled poorer students don't have any more challenges than wealthier students without parental support.
21
It's been said already, but the title is misleading. PhD students do not pay for school in tbe US, and actually get a stipend that provides a living wage. Thus, there is no inherent financial wall that low-income students face, unlike the MD.
10
@JMK - You are mistaken. PhD students in the United States most certainly do pay for their course of study - graduate school is generally about twice the cost of undergraduate, whether from a public or private university. The existence of a stipend is very recent - much more frequently, a graduate student works as a Teaching Assistant whilst doing his/her own graduate studies and then finances his/her own research and dissertation production. In 1987, my PhD from UC (excluding books or room and board) cost me a total of $4800, and included both fellowships and work study. Today, that PhD for an in-state student would be about $15,000 pa, for an out of state student, about $55,000.
19
@JM You are wrong. PhD students do a get stipend that contributes to their living expenses, but it is barely enough to survive. This stipend is not enough to pay for transportation to the grad school or even for one round trip holiday ticket home. The stipend is generally barely enough to pay for shared university housing. Phone,
clothing , entertainment - forget about that. That is why
in most graduate schools in the USA, 95% of the class
comes from upper to middle class families.
13
@GWPDA
I didn't pay for my PhD (in the late 90's). I got free tuition and a stipend, in exchange for serving as TA.
7
I have a PhD too in not having money due to the high cost of pharmaceuticals. So, as a young Dr what are you going to do about it? Or, is this just about you?
7
I graduated med school with loans that covered all those expenses in the late 90’s. My parents could not afford any contribution to my higher education as they barely made $40,000 back in those days for a family of four in NYC. There was definitely the opportunity to pay for your tuition, living expenses and healthcare all as your loan package. I am not sure why this is an issue for those in this story. I can almost guarantee that at Harvard med school this individual had a free ride and therefore he only needed loans for living expenses. I was that type of student and just budgeted my loans to include these additional test fees etc. As was pointed out - when he graduates he will make a very good salary to pay them back. I am also not sure why he should be contributing to anyone’s down payment. If he had to contribute to his parent’s rent because of need that is one thing- but to pay for a down payment is not appropriate. Limits need to be set as a young adult embarking on his own career. He needs to focus on his future.
313
@Adriana Yes, surely the 90s had similar tuition and 40k was the same income as today.
93
@K
But an excellent point about the down payment. What person asks their kid to finance their down payment? Totally absurd and it's not like these loans are super-low interest. It was bad financing - pure and simple.
136
@Adriana Down payments are what are required to get into a place to live that doesn't cost as much as renting! Go talk to anyone in your local Habitat for Humanity. Housing is the most common monthly cost making life unaffordable now. Have you noticed working people living in their cars? Look around. People doubling and tripling up in apartments? Look around.
Also, it's all very well and fine to say "focus on yourself and cut your family off" but do you seriously want to get healthcare -- or any service -- from somebody who avoided and abandoned their family in poverty, and even chronic illnesses and death, saying "sorry but the only thing that counts for me is my future high-income career"?
You sound completely out of touch with current reality and maybe ethics, too. Loan packages include less and less; while costs for near-mandatory degree "extras" and career prep go up and up. It's gotten worse since the 90s (and that was already bad).
363
"The Univ of Arizona Colleges of Medicine in Tucson and Phoenix will provide free tuition to students who agree to practice primary care in Arizona’s underserved communities for at least two years after completing their residency.
In a move to address Arizona’s primary care physician shortage, the UA’s Primary Care Physician Scholarship Program will provide a year of free tuition for every year that a student commits to practicing in rural or urban Arizona communities that lack enough doctors.
With $8 million in annual funding, which was appropriated by the Legislature in May, the UA will provide scholarships for up to 94 medical students — 10% of the class — and will work to increase enrollment for the Phoenix campus.
Beginning in spring 2020, students who are accepted to the program can receive up to four years of free tuition as long as they commit to at least four years of service."
You're going to love Arizona!
16
My husband is still paying his students loans and he finished school in 1994
17
I only had $3.15 to my name when I reported in to the Army for three years. Everything has been fine since. Just don't have the daily latte.
10
Want to pay off your medical school debt? Move to Alaska. Dr. Alan Gross, an Alaska orthopedic surgeon, has written that Alaska doctors often charge and collect 500 percent—or more—than the costs for obtaining the same service outside the state. These higher fees appear to be mostly charged by specialty physicians. Lori Wing-Heier, the Director of the Alaska Division of Insurance, told Alaska Dispatch News in 2016 that some specialist procedures cost 10 times as much in Anchorage as they do in Seattle.
3
Colleges, universities and medical schools need to cough up the money to help low income pre med and med students with these ridiculously high fees. Come on? 1200 for a test? Frankly, many schools can afford it, but choose to look at this area as a privileged part of education. It isn't. The U.S. needs good doctors, and those who have the drive, and the passion to help others in need. Low income ethnic American kids are trying to help change our society for the better, and schools should see it as their duty to help them along. My grandfather, a poor kid from Puerto Rico, became a physician, and you know, he sometimes took a chicken or a pot of stew or some tacos as partial payment from his low income patients who just didn't have the money for care. I doubt he would have been able to be a doctor today if he was starting out. I want a doctor who will take anyone in for care and I want a medical school plan that will give students the ability to become that type of doctor.
10
Here is a question, will the NYU School of Medicine which is now free for all students , but future classes will likely continue to be mostly white. Here is why, The median undergraduate GPA for matriculates is 3.96. The median MCAT score for
NYU School of Medicine is 522 which is the 99th percentile.
These kinds of scores principally come from people who come from privileged backgrounds. Their parents can afford to pay for tutors who can teach them how to take the MCAT.
It is ironic that even when medical school is free, the bar to entrance is so high that it essentially prevents really smart kids from going there.
11
The root cause is our decrepit education system and the unwillingness of Americans to help subsidize poorly resourced areas with funding.
Americans also don’t value education as much as they do firing off guns, fishing, camping, football, rap videos, cooking and the lives of movie actors.
We will continue to have to import doctors and our standard of living will decline as other countries continue to improve.
19
@Irene Cantu Actually, NYU Medical School will get the smartest undergrads in the country, after perhaps Harvard and Johns Hopkins. They will not be getting such high GPAs and MCAT scores because their parents can afford an MCAT tutor. No, they will be getting such high scores because they are really smart and a free diploma from a top med school is priceless.
15
No doubt Harvard and the other Ivy League schools may have a large number of wealthy students but I doubt that is true of most state medical schools.
And if Mr. Velasquez really wanted to help the poor, he should become a primary care physician or psychiatrist. There is a severe shortage of both specialties over all and especially in the poorer communities. There is no shortage of ER docs because, wait for it, they make far more money than either of the two aforementioned specialties and you don't have any patients calling you in the middle of the night.
We could easily give free tuition and all the other added expenses to students willing to enter the lower paying specialties but why give up the potential to earn a million or more a year as many surgeons and cardiologists are doing.
5
@Steve Indeed, and that is what happens. The MD is free for people who complete the MD/PHD program.
Graduates of those programs, rarely choose a career in
primary care because they have told that they are the
cream of the crop and should focus on being the
leaders of the medical profession. Most choose
to train in non primary care specialities like dermatology
or pathology. The graduates of free MD programs most likely will do the same. Of course, one way to stop this would be to link one year of primary care (post residency) to each year of free medical school.
Ie. A payback clause......
4
I recently was at a medical student training where a meal was provided. I was astonished by the way some of the students fell on the food as though they hadn't eaten in awhile. And then it occurred to me that maybe they HADN'T eaten in awhile. We sent all the leftovers home with the students but it was a drop in the bucket. It's another one of those "why does one of the richest nations in the world..." potentiate these inequities?
15
It doesn’t end with medical school. I have $300K in loans 7 years out of medical school as I am just finishing training. The registration for my dual board certification test in pulmonary and critical care medicine are each $2,300. To renew my NYS license I have to pay $700 every 2 years. My DEA must be renewed every 3 years for $800. My parents were never able to help me- my mother worked as a day laborer and my father was a sanitation worker. Regardless of the salary I get next year, the costs associated with being a physician are astronomical and on top of that I have to repay my loans). Many attending I know are in their 50s and still have yet to finish repaying their loans. Meanwhile, in many European countries, this is not an issue. I think all of us would take a lower salary to remove the financial barriers associated with becoming a physician. This would add much needed diversity to the field.
81
I will never forget being admitted to graduate school - they asked for a deposit around 2-3k due in < 3 weeks to confirm my admission. Payable only by credit card. I had to get my parents to do it for me because I simply had no way of paying it myself in that manner in that timeline.
I remember thinking how that would be a disqualifier for most people in my hometown and how disappointing it would be to go through the applications, interviews, tests, only to have that be what stops you.
10
I hope this reporter stays in touch with these students to see how they turned out five years after graduation. Did they go into lucrative specialties to pay off their debts? Work in communities similar to where they grew up? I personally don't think they should be guilted into 'giving back.'
And, the reporter could have mentioned that NYU and Washington University in St. Louis went tuition free for their medical schools. WU only for 'poor' students.
7
Graduate school is succeeding where medical schools are failing. Most graduate students are paid stipends, and while they’re not lucrative by any means (typically $25-$30k/yr), that’s enough to live okay in all but Boston, NYC, and the Bay Area. Students also don’t pay tuition, as their programs cover the fees. The only costs come during applications, and that’s the GRE ($200), each application ($0-$60 per school but many waivers available), and then the interview costs. They’re not cheap but they’re all upfront and then they’re done once you’re in. One of the main reasons I went to get my PhD and not my MD, among many, is that I didn’t want to graduate and be $250k in debt. It becomes a cycle and enforced that new doctors only go into lucrative fields rather than accomplish the goals that brought them to med school in the first place. While the USA trains the best doctors in the world, the corporations profit off of it. To me, it’s akin to pharma inflating drug prices for the needy, and I wouldn’t be surprised if there was some correlation there.
8
Graduate programs in my clinical field don't pay us stipends, unfortunately. I was allowed to work on an upstate SUNY campus for $10/hr in am audiology clinic and TAing for an undergrad class. But the school capped me at 10-12hrs/wk (I dont remember the exact number), on top of a full-time course work and required clinical hours. that paycheck barely covered my transportation to get up there from the Bronx. that school didnt offer housing for grad students, I'm not sure of it's common. I was always under the impression it was only phd research-type programs that did stipends.
6
@me
PhD programs know there are no tenure-track jobs at the end of graduate school. when I did my PhD (English) in the late 90's, the programs basically told applicants not to go into debt for the degree (unless it was a top 15 program), because the job market was abysmal.
My stipend (starting in 1996) was 11k/yr in Boston. Thankfully, I have family money. I had a car and a 2 bedroom apt. My fellow students thought I was living like a movie star. I could afford meat!
8
More American chauvinism to say USA trains the best doctors in the world. Canada, the UK and Ireland, South Africa, Australia, New Zealand, and the western European countries all have very high standards. USA has THE MOST EXPENSIVE doctors in the world is more like it.
11
As with single payer, we need to socialize the whole medical supply chain including the medical schools. Once these are public institutions, merit based entry with no tuition and other expenses will open the door to all high potential students, not just the affluent.
10
The default rate on loans for medical education is virtually non existent because doctors earn such high income post graduation. This article does little to look at the real issue in medical education which is the lack of seats (the AMA restricts supply of doctors by controlling accredited medical schools). The US average physician earns $300K/year far in excess needed to pay back student loans. If a person chooses to practice in specialties areas, the average salaries can be double this amount.
10
@Chris Wrong, the AMA has no power over the # of med schools. That's why the USA has 75 new medical schools created in the last 10-15 years.
5
Hence Americans cannot afford medical care. Physicians are the foundation blocks for the medical costs in the USA.
2
This is an important article, however, the headline is an unfortunate choice - because PhD training in the biomedical sciences does not require students to pay any tuition (Tuition is usually waived), and trainees also earn a stipend (usually around $32,000/year) for the entire time they are working on their PhD degree.
Thus, while I agree that medical school costs should be reigned in, talented potential students should recognize that they can also “give back” to others without incurring debt - through earning the PhD and pursuing a biomedical research career.
4
My daughter in law is now a pediatric endocrinology fellow with upwards of $200,000 in medical school debt. High patient care responsibility, long hours, low income. My husband, still working as an internist at 76, is encouraging her to take her two graduate degrees (public health and research) and consider administration. Forty-eight years ago as a Viet Nam era vet his state univ med school was tuition free. GI bill covered our low living expenses. Free housing in return for cleaning a museum. No one today can afford to pursue Primary Care.
38
Everybody bemoans the dearth of medical doctors in non-wealthy cities. Yet, politicians and Trump-Pence, along with preceding administrations neglect the most simplest fix.
Institute a federal program that will reimburse tuition expenses at state medical schools and private USA based non-profit medical schools IF upon completion of schooling the new graduate will serve 6 years in one or more of the following: military, under-served community (rural and inner city), Medics Without Borders, Peace Corps, or other federally sponsored medical service.
9
This sounds all too familiar to me. My husband is now retired as a family physician. He went to medical school on the GI Bill (he's a Vietnam veteran). He was fortunate to have that, and to have attended a state medical school as well. I cannot fathom the costs of attending an Ivy League medical school. I worked two jobs while he was in medical school. We lived in a run-down triple decker with no heat in the bathroom and little hot water. He went into family medicine and spent a lot of time with patients and was financially penalized for that. In the end, he made less money in family medicine than our daughter, who was a teacher. My heart goes out to these amazing med students. I wish there were a way I could send them encouragement and pay for one of their tests, or help their families at home to take away some of their stress. I also wish I knew how the country is going to deal with the lack of primary care doctors when the majority of med students end up in high-paying specialties to pay for their debts and to take care of their families who have encouraged them. I wish I could tell them it would get easier. I also wish I could convince their classmates--those who are children of privilege--to be compassionate and understanding. They will need that compassion when taking care of patients in the future, no matter what field they pursue.
34
As a parent who paid four years at a D1 State school (we're NOT talking med or law school) just a plain BA. I can tell you I spent north of $100,000 for those four years. And, even for this undergrad degree, there were a lot of hidden costs.
Man, it was expensive this go-round, during my undergrad I don't think I spent more than $5000.
10
The educational experience at these higher levels of study college/universities, graduate school, and medical school, etc. all favor the rich. The application fees alone can be prohibitive for some who cannot apply to the more 'elite' schools.
Yes, medical school involves buying certain medical equipment, but it is not news that at all levels of education,the US system can be seen as 'rigged' against the less well-healed.
10
Fees and tuition should be curtailed or even waived if the medical student agrees to set up shop as a GP in an disadvantaged part of the country for a period of 5 years (or whatever deemed reasonable).
Medical schools are wealthy and can well afford the waivers.
We need no more plastic surgeons or celebrity dermatologists in our already expensive and speciality skewed medical system.
4
The American health care system is totally broken. You could cut out 2 years of education and still produce highly qualified doctors. You could accept training from those educated overseas. Instead the doctors union wants to limit the number of doctors to keep their fees high. Anyone who is not in it for the money and has compassion for helping people often gets weeded out by the system.
3
So you would have your knee replaced by someone with a couple of years of training? Or someone with a degree from a non-accredited school in a third world country? There is so much to cover in med school that four years didn’t seem enough.
7
@Joseph B USA already takes in more foreign doctors than all other nations, combined.
Personally I'm tired of having to see doctors that dont speak English.
7
@Joseph B
I wholeheartedly disagree with your comment.
Medial school education is 4 years and has been for decades, despite the knowledge base required for doctors to master quintupling in size ( at least - if you don't think so, look at immunology over the past 30 years). I don't think one could squeeze this information into 1 or more fewer years.
Graduate medical education ( residencies) are at least 3 years and can be as long as 10 ( "Decade at Duke" for cardiovascular surgery). My specialty of obstetrics and gynecology has debated for several years about increase the time in residency from 4 to 5 years. It now is trying to develop fast tracks for residents wanting to specialize to decrease training by a year.
We do accept physicians who have trained overseas - indeed, more and more of these physicians who have attended medical school ( and sometimes residencies) overseas are being employed in many areas of the country, especially in rural areas where I work.
Physicians to a person have an innate desire to help people. Some may "be in it for the money," but trust me, it is MUCH EASIER to earn millions in business with a MBA than from medicine with an MD.
12
Medical students with wealthy parents often have tuition and living expenses fully paid for. Children of middle class and lower-income parents must rely on loans. I'm part of the latter group, 10 years out of medical school and still paying $1600/month toward my student loans. Sometimes I think of what my future would look like if I could have put all of that money toward savings. I worked my tail off for 20 years in school and still feel like an indentured servant due to the loan burden, going for public service loan forgiveness. Why do we as a society burden our young people with such a high price to move into a different social stratum?
26
While med school in Quebec is relatively cheap and therefore open to more than the wealthy few, the cost of the obligatory exams after getting the degree rings very true -- before making a living wage as an MD (not counting the pittance earned as a resident), new graduates have to shell out thousands of dollars to get accredited, each exam for a speciality adding more -- if you or your parents aren't rich, you are broke anyway by the time you are able to start practising and then even broker with the cost of the certification exams.
As a practicing primary care physicians I can attest that the costs don’t stop after residency and fellowship. The Boards of many specialties continue to impose burdensome and expensive “recertification” exams that have no impact on patient outcomes. Doctors in practice often take time off work to study for these recertification exams and spend money for courses to prepare on material that often doesn’t even apply to a doctor’s day to day.
We have a shortage of primary care doctors in the US and these coats of medical education drive students into other specialties just so they can repay their financial debts.
37
I have a friend who's young daughter had an outstanding school record and top sat scores.She was so advanced in so many subjects by her young teens, she was beyond the levels of her teachers.She won endless cups and prizes,learned Spanish and Mandarin on her own and had her heart set on one of the prestigious universities, after so much encouragement from many in academia.
Unfortunately her parents were on low income.Just going to the colleges around the country and paying the considerable application fees was challenging to meet. Despite glowing interviews and positive feedback she was rejected by every university...and it is hard not to think that had her parents been able to provide funding,the outcome might have been different.The prestigious universities like to claim that lack of funds are no barrier to entry but the reality in the real world is often different.
Thankfully an opportunity to study at a leading Chinese institution arose and she grasped it with both hands.She is doing very well,living in a different culture,meeting different peoples and has an incredibly bright future whether it be in law or finance or whatever.The world is her oyster.
America's loss.
22
I don’t believe it. If she was that gifted a school would have offered her a scholarship.
And stay on topic!
14
My European cousins went to university and then medical school tuition free. No debt.
16
@Zejee
how much control did they have over their choice of specialty and where they practiced after graduation? Could they live/practice anywhere? Could they choose any specialty (or was that decided for them)? Did they have to work or the state, after?
1
The collapse is complete!
1
Another option is through the United States Military branches. My sister became a doctor with the Air Force. She had all of her medical tuition covered, a bonus for singing up, and received a tax free stipend every month for living expenses. All of her books, equipment and test exams are covered. She serves as her payback without any medical malpractice insurance payments or student loan payments.
26
These test prep services should be banned if poor students cannot afford them. They are tweaking the meritocracy to favor the rich.
8
@Patricia
Medical schools should offer need-based assistance.
@Lynn in DC
The MCATs are taken before a person applies to medical school. They help determine which school will admit that person. How can medical schools provide need-based assistance to students who haven't even applied yet?
There is no educational institution that can foot the bill for SAT prep or MCAT prep, or any other kind of test prep. The people taking those tests are not going to be students at those institutions until after they take the test, achieve the right score and are admitted.
1
Many MD PhDs Receive lots of aid, work study and paid research - if you want to work on research it is another way to go.
1
@Deirdre However, PhDs without financial support of their own, are at a disadvantage to those with support. Many research projects do not offer paid opportunities, as you suggested. Students who do not have to work to live can attach themselves to unpaid research projects and get a head start on publishing. Other students cannot afford computer equipment and rely on the school library's computers. This poses a challenge in the ability to edit their work in the way demanded by academic discourse.
The list goes on.......
2
Though the article is accurate regarding the economic travails of medical education, some of the conclusions are stilted to an alarming degree. Yes, most medical students come from affluent families, however the schools are not choosing by income, they choose almost entirely by academic merit. If you want a competent physician that is the over riding concern. Medical schools are not the education level where the inequities of our educational system need to be addressed. On the other hand, there is no doubt that the price of medical education is outrageous and should be addressed so that students of lesser means can have less difficulty attaining their goals. Another thing that the articles glaringly failed to mention is that medical education can be free of cost if students are willing to serve in federal government service in the armed forces and or the public health service. Students enrolled in such programs also have all ancillary costs of licensure covered as well as as receiving a monthly stipend. I suspect that if Mr Velazquez hustled a little more at the tuition assistance office he might find some relief from his economic issues. It worked for me.
23
There may already be some opportunities for Medical school loan forgiveness if the graduate agrees to work a number of years in a location with physician shortages. Similarly, primary care and geriatrics are under-represented because the pay is less than most specializations. Loan forgiveness for going into these areas should exist, requiring government intervention.
I graduated from medical school in 2010 and this all rings very true. I was fortunate to have help from my parents for rent, but everything else came from loans. Now. almost 10 years later, my student loan balance is higher than it was when I graduated, despite having paid on time every month through income-based plans (including during residency and fellowship training). I'm a public employee and on track for loan forgiveness in 2.5 more years. Things have only gotten more expensive and difficult in the last 10 years.
I did not see any mention of this in the article, but my medical school forbade us from having a job during school. We had one summer break, between our first and second years, and many of us had summer jobs then, but after that there were no more breaks and no more opportunities to bring in any income other than loans. Even if it wasn't prohibited, the medical school schedule would make any kind of regular employment impossible to sustain anyway.
28
A few comments:
1. The in the old days, Medical school classes were white and male. These days, they are mostly a combination of female, Asian, and various forms of Middle and Far eastern cultures, as well as many of South American descent. Almost All US citizens.
2. The article says that the average admitted student parental household income is about $75 k. The 2019 average American Household income is about $61,000.
So the issue is one of cost of education. Not wealth and privilege more than anything else out there.
One person in this article appears to be an MD-PhD. This is a very different and unusually tortuous path to take than a straight MD program.
3. Yes. There are expenses along the way. But many discussed are totally un-necessary. This and that prep course etc.
4. Debt levels on average are indeed VERY high coming out of residency and fellowship training on average. What concerns me is the lack of awareness of the impact from the beginning and the conversations I hear for new docs in practice at the end. There simply must be some sort of debt education process for anyone going to college.
Tuition choices matter. Stay in state for instance. Try for scholarships. Go to a community college for the basics and transfer into a more expensive setting in your junior year. Do some part time work during college to offset debt.
The key on this issue for future medical students is to aim for minimal debt going into medical school.
11
I advise prospective students to attend in state public schools if possible. Every medical schools use the same textbooks for the most part and the National Boards are taken by all students. You don’t end up with as much debt and get the same education as the private schools.
5
This is the kind of article that makes me grateful for my education in the French system (in France). Selected by a free, competitive, national examination, I received a stipend and the schools provided a complete and well-rounded education. Clearly integrating in a predominantly upper class world was an emotional and psychological challenge (e.g. some optional courses within the university had mysterious entry requirements), but my single mother would never have been able to help get in without the French low-tuition higher education system.
9
Velasquez could have gotten free tuition at NYU's medical school. NYU implemented free tuition for all its medical students, regardless of need, starting last year. Meanwhile, my son studying film at the Tisch School will rack up more than $100k in student loans (along with money I had to borrow), even after we begged the school for more help. I really worry about his future and his ability to save for a home, start a family and afford retirement some day. The student loan crisis is real, folks.
9
He would still need to be a successful as an undergraduate, apply, and take the test, before going to NYU’s free school.
5
@JS
Then don't attend film school. many great actors and directors did not. Granted, Tisch has a great track record.
Years back, George Lucas spoke at my college. He said to the congregated undergrads, by now, you know whether you have the talent to make it as a director (or actor). Either you have it or you don't. You can't learn it in school.
6
If you're smart enough to get into and complete medical school you are smart enough to program computers to help pay for undergrad and to pre-pay medical school.
Instead of complaining, get a useful computer science degree as pre-med and then work in industry for a period before medical school.
Medical students can also have the military pay for their education by doing their residencies with the military.
A far, far more troubling issue is that students deserving of financial aid in grants or loans aren't receiving them because of faulty financial aid formulas. Yet, the NYT or MSM never seems to write about these faulty financial aid formulas.
8
@David MD You're suggesting that rather than make medical school more affordable, or perhaps restructuring the path to medical school to make it more financially stable, you want pre-med students to spend 4 years on a completely different undergraduate degree, then spend years working a tech job so that they can have access to ENTER medicine??
There are other ways to diversity in medicine than to suggest that they get a profession to get into another profession.
11
@Theresa
Thank you for pointing out that I wasn't clear.
I am suggesting that instead of doing biology or other pre-med degree to instead do computer science, not to do computer science in addition to their undergraduate degree. I am not suggesting spending many years but working a few years.
Computer science degrees satisfy almost all of the pre-med requirements except one year Organic Chemistry and lab and one year Biology and lab.
The costs for medical school aren't going to change anytime soon.
I am offering a pragmatic solution for young aspiring doctors today.
6
Computer programming is not like waitressing. When I was in college, I could pick up a waitress job fairly easily. You only need minimal experience, don't even need a HS degree. A lunch shift or a dinner shift is only three to four hours long. This kind of job works with college.
Meanwhile, coding jobs are for people who can compete in an intense environment where the standard is not an eight hour day, but a ten or twleve hour day or more. They've even developed a special liquid diet for programmers so they don't have to leave their computers to eat.
And you need a degree.
Nobody is going to go out and pick up a coding job while in medical school.
15
As a physician, I don't believe in socialized medicine but I strongly believe in socializing physician salaries. None of these poor students would go into primary care; why would they? with the primary care to surgery to salaries roughly 1 to 2 to 4; They will want to earn a good salary so their children have better opportunities. I support them also! Until there is a leveling of physician salaries where PC is better rewarded, this is what happens. AND please don't complain that physician salaries are too high.
6
What about a similar program as the G.I. Bill? The government pays out a certain percentage of med school bills, and based on the amount paid, the Physician must return a certain number of years back to the government as a Primary care physician in an under-served area. When the debt back to Uncle Sam is paid, we have an army of Primary Care docs with no tuition debt.
5
@megachulo this already exists, it's called the National Health Service Corps.
4
It is a right of passage. As I went through school I often found myself on the short end of the stick. I knew I had to do more with less. Now that I have “made it” I hope I can provide a comfortable life style for my children. It is the classic immigrant story...nothing new.
4
Agreed. I scraped by, driving a beater that didn’t always run, and walking to med school when it didn’t. Then I spent 6 years as an indentured servant(resident/fellow) making minimal money while paying off my loans.
Still can’t see myself doing anything but medicine, it’s a calling.
4
"A professor recently asked students, as an icebreaker, to describe their favorite family vacation spot. Mr. Johnson began to sweat, racking his brain for an answer before awkwardly offering the truth: His family had never taken a vacation."
Perhaps a crucial first step is having the faculty stop assuming the students they are teaching have similar backgrounds and experiences.
My parents NEVER took us on a vacation either because they could not afford it, but more importantly, they and us needed to be home every single day to milk our herd of cows, collect the eggs chickens laid, and to clean out the pens and stalls of the pigs and cows and feed our various live stock.
While circumstances may differ, the end result is the same - not everyone has/had the luxury of a family vacation, much less having a "favorite family vacation spot."
Our favorite part of the day was dinner time and my Ma's home cooked meals where we laughed a lot, eat great and delicious food, and enjoyed a meal together, as a family, and relaxed. Dessert was always my favorite part.
9
The real question is why are medical school tuition costs so high? I'm quite sure that all of that money is not used for education of medical students. At the University of Pittsburgh, where I got my degree and later served on the faculty for over 30 years, faculty members are not actually paid to teach out of tuition funds. Faculty members are expected to bring in their salaries through either clinical income or research grants. They get paid essentially nothing for teaching medical students on the hospital wards or clinics. So where is the tuition money going?
41
I was fortunate in life when I went to medical school. I had had a career beforehand that left me very well off financially.
College, on the other hand, was a challenge. For complex reasons, I was financially independent when I matriculated. I had nothing. In addition to the practical hurdles mentioned in this article, there was the constant, crushing sense of inadequacy. It became so overwhelming by the end of my freshman year that I just didn't show up the following September.
I took a year off to gather myself, then applied as a transfer student to another Ivy League college, and eventually I found my footing.
I have no words of wisdom for others; we each need to find our own way. But I can offer this person as an inspiration; a migrant farm worker in California's Central Valley, who became a renowned neurosurgeon:
https://en.wikipedia.org/wiki/Alfredo_Quinones-Hinojosa
2
One of the answers to these students financial plight, is reviving the National Health Service Corp that was effectively dissolved under President Reagan in the the 1980s. The only reason I could afford to become a primary care doctor was the NHSC Scholarship that paid for 3 yrs of my Harvard Med School education in exchange for working in Primary Care in a underserved health manpower shortage community for 3 yrs. After my 3 yr commitment, I stayed in the area and opened my own primary care private practice and never would have been able to do this with the huge loans my classmates from middle and lower income families incurred. If we want primary care doctors born in the USA, we will have to revive programs like the NHSC to make med school affordable for poorer students and the middle class.
24
As an African American Family Medicine physician (and PhD) have lived these statistics and still bear the debt burden of my training years. These numbers don’t change during residency (when moving, test, and licensing costs also increase), and as women and minorities we are often paid less when we do land in clinical or academic settings.
396
@Dr. Christina Johnson I seriously question your claim that women and minorities are paid less in clinical or academic settings. I suspect pay is not the only variable.
24
@Markus The pay gap for women has been well-researched and documented: https://www.ncbi.nlm.nih.gov/pubmed/15289217 " Large deficits in rank for senior faculty women were confirmed in logistic models that accounted for a wide range of other professional characteristics and achievements, including total career publications, years of seniority, hours worked per week, department type, minority status, medical versus nonmedical final degree, and school. Similar multivariable modeling also confirmed gender inequity in compensation."
102
Why question the claim, it is true across dozens of career paths?
54
A lot of this sounds very familiar. My parents went to graduate school, and I am white. But after college they gave me nothing, and I had to get through graduate school on my own. There were a lot of bulk ramen purchases, I had no health insurance (in violation of the school's policy, but was able to make it to graduation before they carried through on expulsion threats), I lost my car (it was run down to begin with, and I could not afford gas or repairs, and without good public transportation where I was in school I had to rely on others and walk great distances). I made it through, with a lot of debt but with a degree. Decades later it is all good, because I outworked it. I don't at all discount other challenges arising from a less plentiful childhood than I had, or from racial, gender, or other issues. But to a degree, money is money, and not having it feels similar in some ways regardless of who you are and where you came from.
260
@george agreed-I also struggled through medical school after my parents put me through college. Money is money but I have to say my experience was very privileged compared to those who had to send meager earnings home or had more familial problems to deal with than I did. The cost of medical education is too crazy and we are facing disaster, or only having wealthy individuals becomes doctors, if reform doesn't happen.
68
I’m a surgery fellow now in my 8th year of training. The issues outlined in the article don’t just end in medical school. It often gets worse after in fields like mine.
You leave medical school with debt. As a resident, especially one in a field that requires many years of training, the ‘debt’ problem worsens. You have a growing family. Maybe you’re the breadwinner. your partner may have to stay home to care for the kids due to your long hours. You’re paid a salary that does not account for unexpected life events, living in an expensive city, moving costs, and interview expenses.
We’re told that there’s a light at the end of the tunnel, but quite often that light is so far away and the burden so tiresome that we feel pressured to get done with training. What becomes of the fields that need specialists? Where is the time allocated for academic development; time to develop a research profile and an appreciation for the science in your field outside of long OR cases and middle of the night calls. How can we train experts in their respective fields, when the obstacles to developing the experience necessary to get there feel insurmountable.
We need to figure out how to reduce the cost of becoming a trained physician. A way that does not burn us out with financial burdens, in addition to the stresses of training. If money weighs heavily on your mind for years, it often time becomes a factor of primary importance later. Where is the room then for empathy and care for the poor.
51
I was the first person in my family to go to college and medical school. Two hundred thousand dollars is an average and each medical school cost varies when you consider room and board in addition to tuition. My medical school expenses: post-bac program $48,000 per year (2 years) and medical school $75,000 per year (4 years). One also has to consider that that debt then goes into repayment 6 months into residency which can be anywhere from 3 to 8 years depending on ones specialty. Residents get paid an average of $42,000 per year working 80 to 100 hours per week or $8.75 per hour. My debt load after leaving residency was $580,000 after accumulating 10 years of compound interest. I am currently at $537,000 in a 7 year repayment program. This is why we don’t have enough primary care physicians.
844
Preach it! A mortgage payment without a home.
64
@EH
Totally agree. Docs are visible, low hanging fruit for those complaining about the asymmetry of wealth in this country. But as most things in life, its not that simple.
80
@EH
You have a major problem as far as your debt. Largely self-inflicted however. In state tuition in Texas for med school plus all fees, books, supplies. room and board health insurance and transportation as well as testing is about 45K a year. Out of state is gonna hit at around 60K all in.
Average resident doc salary in the US in 2017 is $57,400 and in many programs you can moonlight at local ERs etc overnight for 60-150 pr hour. 1K a night.
The post-bac program is financially self inflicted.
$537,000 in debt is very very scary/but largely avoidable and purely elective.
28
The educational debt of $200K includes the rent and living expenses, including the fees.
In terms of earning potential, the school choice for physicians is actually less important than other physicians (hospital reimbursement is the same for an Iowa State medical school graduate and for a Harvard medical school graduate). There is still prestige in an Ivy education, and it may lead to more residency choices, but once you account for specialty, Harvard and Stanford graduates don't out earn their peers from other schools.
Paying the debt on an attending's salary is fairly easy (can throw $50k/yr at the debt). I don't want to diminish the accomplishment or the choice of those in the article, rather wanted to point out that a student who can be accepted to Harvard medical school also has cheaper options.
The military still pays for medical school if you commit to 5 years of service. And Public Service Loan forgiveness is still an option if you want to go to serve a less well off community.
There should definitely be support for lower-income students, but I think much of the issues isn't purely financial, it is exposure to people of a different background. It takes discipline to spend less when your peers are spending more, but there are lots of white students with lower income backgrounds having the same struggle.
201
Public Service Loan Forgiveness takes 10 years and one still has to take pay back the loans during that time at a rate proportional to income. At the rate of pay for most jobs that fall under the Public Service Loan Forgiveness plan, that’s still a big chunk of a paycheck for 10 years.
By the way, if anyone is currently using that plan to pay back their loans PLEASE make sure you are signed up for it. You cannot simply call to have your loans forgiven after 10 years. You actually have to be signed up for the plan on year 1 and call back each subsequent year to re-enroll. Do not assume you’re enrolled. Double-check!
77
@Kim R there's actually no "enrollment" in PSLF per se, but you do need to make sure you are paying on a qualifying loan through a qualifying plan and that you have the correct employment. It's definitely best to do this from the beginning so you don't end up surprised if your payments aren't qualifying for the program.
You can get your payments/employment certified every year to see where you stand. I do this annually, and I keep my records to make sure I have a paper trail in case there's any push back from fedloan when it's time for my forgiveness (currently on track for spring 2022).
I definitely agree with you re: the cost and time involved with PSLF. I've paid $60K since 2011, including through my entire residency and fellowship. $16K has gone toward principal, and the rest has gone toward interest, yet my overall balance is still $20K more than when I graduated. It's depressing to even look at my fedloan accounts, but I know I'm way better off than many of my colleagues.
27
@James I think the problem is that there so much cost associated on the front end of even applying to medical school. Many of my friends spent over $4,000 applying in a single cycle. On top of that, the MCAT is probably the biggest determinant to one’s potential to matriculate into medical school, and as the article shows, it’s absurdly expense. This effectively creates a paywall at the very beginning of the application cycle, blockading the less-affluent and minorities from applying. Sure, once you’re in, you can find ways to pay off the debt. But you’ve got to get in first. And if it costs $4,000-6,000 to do that, even for an extremely qualified candidate, that may not be feasible for someone who can’t turn to their parents or a bank loan for assistance.
57
This article has its heart in the right spot, but focused on the wrong socioeconomic group.
5%ers- Mummy and Daddy pay in full.
The Poor- Qualify for financial aid and low interest loans.
The rest of us- A pound of flesh to Sallie Mae for the next 30 years.
31
@megachulo
It doesn't seem that you read the same article as I did.
1
@LFK
Why the negativity? Of course I read the same article. It's difficult to hear that for some parts of our society the middle class actually are at more of a disadvantage than the poor. But its still the truth.
11
Terrific and needed article, but also don’t forget on the application it helps greatly if you have done volunteer work—good luck if you’re needing to work to make money to live—and shadowed a doctor—good luck finding one to follow around if you don’t have a willing relative who’s a doctor. The AAMC needs almost as much reform as our country’s health care system. But bravo to those students featured!
7
@Schuyler Bishop
When I was in med school (late '80's) the administration put out a yearly handout that was more like a textbook (hundreds of pages), each page listing opportunity for a high school or college student to get involved in varying types of medical research. And that was pre-Google. The opportunities are there for all to do volunteer work. The problem is with College tuition- many students are already working off-hour jobs to put themselves thru college, and have very little time to add a non-paying research gig.
4
My son's best friend is in medical school, and I'm certain his parents are footing the entire bill in cash to get him through.
Reading the part of the article where Mr. Johnson's family had never taken a family vacation reminded me of something my son once told me after I asked him about how his day went (at high school, 10th grade). He said they were going to talk about the French Revolution in History, and, in preparation, the teacher asked the class, "Who here has visited Versailles?" Half the kids raised their hands (including my son--we had gone months earlier). In addition to concluding these medical students need more financial aid, the story also called to mind the many things in life I have to be thankful for....
3
@Diane So that was a ruse to announce that your Family has been to France on vacation? Bravo! How unique :)
6
All I know is that there are far more students that graduate from undergrad that have the ability and interest to complete medical school, than there are spots.
12
The leading predictor of future earnings is intelligence. Is it any wonder that rich parents tend to beget children who are smart enough to win acceptance to medical school?
I think it's fantastic that underprivileged students get into med school, but let's not assume that the disproportionate number of med students from well off families is a sign of inequity.
4
@Francis Actually, the best indicator of success (as measured by socioeconomic status) isn't intelligence or ability, it's your parents' wealth.
https://www.wnpr.org/post/georgetown-study-wealth-not-ability-biggest-predictor-future-success
11
As a physician who supported myself through medical school, this article is spot on - it’s all true. But the article should also mention that there are many opportunities for students of any socioeconomic background to leverage to reduce cost. For me, I applied for and entered the Health Professions Scholarship Program funded by the US Air Force. The Air Force paid for all of my very expensive private medical education and also offered me a living expenses stipend and covered the cost of my textbooks, medical equipment, and Board exams. Sure there were a lot of sacrifices involved in joining the military, but it was worth it to complete my medical training with no debt. There are also fully funded Medical Scientist Training Programs that allow qualified students to earn an MD/PhD funded by the government, and some private medical schools, recognizing this problem, are now free. There is also the National Health Service Corps which offers scholarships similar to the military for medical students willing to practice primary care in an underserved area. I would strongly encourage all medical students to consider any one of these options. It seems like a fair trade to me to sacrifice a certain degree of autonomy for the financial benefits of avoiding debt and having a very modest income during medical school. I think we should expand and promote such programs as a solution to the onerous cost of completing a medical education.
70
@Ben Smith Great suggestion....my husband and I graduated 9175 with, we thought, impossible debt. Fast or slow forward to our son's graduating class of 2015 and they are in logarithmically greater debt.....God bless the benefactors who are beginning to endow medical school. Family physicians are so challenged and underpaid, this may make it possible for this noblest of callings to be attractive to the new grad physicians.
5
I did not come from a "poor" household but we were very tight and almost all my expenses were covered by my very high interest HEAL loans as well as the occasional short time odd job. ITs just not "poor people, its pretty much all medical students except for those that come from 1-2 percent. As a physician, I am in the 3- 5% (depending on location) and I couldn't afford to pay full freight for my kids if they wanted to go to medical school.
24
most medical students have $5 to their names. what lies are you telling? the article clearly states that medical students come from upper middle and upper class backgrounds. the fact that you can't distinguish between that and being without a home, is troubling.
Once a professional starts speaking openly about not coming from a wealthy background, professional opportunities dry up. The problems might trail these students for the rest of their careers.
8
Of the five med students mentioned, two go to Harvard and one Mt Sinai. What's wrong with your local in-state med school? SUNY or UMass?
15
@Midwest Josh Ironically, its probably easier for someone from a disadvanteged background to get into a top tier med school like Harvard, specifically because those schools actively recruit from underserved under represented populations, where most state schools do not. I don't see this as a bad thing.
13
Yeah, that’s great, but UMASS medical school tuition alone is $37,500 per year for in-state residents.
1
That’s about half the Harvard tuition
5
One receives an MD from medical school and a PhD from graduate school. Considering these folks are going to medical school, the headline quote doesn't make much sense.
6
@Tim T It's not literal, I think the PhD reference means "I'm an expert in not having money." It would not make sense to say "I have an MD in not having money."
19
@Tim T If you read the article to the end, the quoted student is referring to understanding on a visceral level the sort of choices and challenges his poorer patients have to make. Like not getting an infected tooth treated right away because of a lack of insurance, or having to choose between prescriptions and food. His “PhD” is metaphorically in living that experience, as he has his whole life.
4
@Tim T
He’s merely expressing that he has a lot of experience being poor. Geez, what’s so hard to understand?
10
“For a kid like me, Harvard’s like a movie.”
I think that's true for most of America, including me and I'm solidly middle class from the NYC area. SUNY and Rutgers are real life.
Having said that, a ton of talent is being wasted in this country by not giving greater access to education to the lower socio-economic ranks. And it wouldn't even cost much to help. Penny wise, pound foolish.
47
Osteopathic medical schools (D.O. schools) have a much better track record of accepting minority and unconventional students, but god forbid that the NYTimes mention the name of an osteopathic school in any of its articles.
15
@Pg Maryland
What next? Naturopathy and Chinese Herbal Medicine as alternatives to Med School?
1
@Pg Maryland DO is essentially the same degree as MD, and the cost of Osteopathic education is not cheaper.
2
not a problem that cutting back on avocado toast will solve
the system is broken
8
The American Way: everyone wants to take their pound of flesh.
2
Wow, you would almost think we had the best health care system in the world.
8
People who attend medical school are adults. They have already completed a full 4-year undergraduate degree. I'm confused how these students suddenly discovered there are lots of rich kids in the world and the disparity of that. And is it the responsibility of a medical school to delve into the personal history and finances of a 20-something year old applicant's extended family to offer additional financial aid or scholarships? This is tough because we do want diverse applicants but what is the right path?
12
@Niche I’m confused, are you actually advocating that only wealthy students become doctors? And anyone not personally already a millionaire feel financial pressure to choose higher paying medical fields like cosmetic surgery over lower paying ones like general practice? If we don’t want even poorer outcomes (doctors that don’t relate to the communities they serve don’t have the best record) and even fewer rural, emergency room, etc doctors than now, the right path is clearly cutting costs or otherwise actually funding these students.
9
@Niche well we were required to fill out the FAFSA to qualify for med school aid and loans, and that's completely dependent on your family financial sitaution.
3
@Niche In order to qualify for med school these "young adults" do not have one business or finance course. They could not be more financially naive
1
I'm a retired family doctor. I finished med school in 1985 with the equivalent of 50k of debt in today's money. Paid it off in 3 years. Thank God for the University of California in the olden days.
Today's med students live in a different world, a much worse world for doctors in a lot of ways. Of course, these kids have already made a mistake by going into medicine.
But better to light a candle than course the darkness:
Young docs-to-be, DO NOT go into primary care. Do not compound your error. You will suffer much more abuse for much less money. Blatherers will blather about how wonderful you are, but it is just a trick to get you to destroy your life for their benefit.
Hear me now and believe me soon, unless of course you already know this, as you probably do.
49
@vbering - I agree.
4
This just in: Medical school is high risk- high reward!
Next up: Wealth begets wealth- revelations in socioeconomics.
7
@Matt But really, should we make it so difficult for doctors in training? Shouldn't Harvard with its huge endowment, offer something to help?
3
This is American as apple pie,and health care is first a business. We treat healthcare as a privilege not as a right. We spend 18% of GDP for healthcare , contrast this with only 3% for defense. France spends just under 11% for health care. Besides spending less then us the silly French only charge 200 euros a year for medical school. Our system of for profit health sees the cost of treating patients as a loss. Health care is a business which spends millions marketing themselves Even Kaiser,the largest and NON PROFIT spent $295,000,000 for naming rights for a park and plaza next to the new Warriors building in SF Makes me sick to see this kind of waste.
14
Med school is ridiculously expensive, but what they’re selectively chosen to leave out is that poor minorities can get massive scholarships. The rest of us pay out the nose with hundreds of thousands in debt. Harvard for free. That’s a huge deal so no I don’t feel especially sorry if you have to take a living loan out if you are able to skip $500k in tuition that the rest actually pay. Bloomberg gave a massive billion dollar fund to Johns Hopkins. What needs to happen is GPS need to either be compensated at a better rate OR they need to dramatically lower the tuition for a GP. We have GP shortages. Someone needs to come down on these elitist institutions to actually help with our doctor shortages. A GP with hundreds of thousands of debt is flat out a racket. Plastic surgeon whole different story.
21
@Location01 Please provide links to these numerous minority scholarships for medical school that you speak of. My husband is a poor minority who went to Harvard and there was definitely no minority scholarship.
6
@anon it’s well known if your family makes under $40k it’s free. Nyu also now has a program same with columbia. It’s more income based than anything. This isn’t new and it’s well known ivys opened their doors to low income students by providing ample grants and scholarships.
2
Another argument for why college should be very very cheap like it was in the 60's.
I am reminded of Sanders idea for free college and this article in the WaPo came to mind. About how a lot of small red state towns are going into the business of starting publicly owned grocery stores to make sure there is food in town.
I read this sentence: “We take the water out of the ground, and we pump it to your house and charge you,” he told The Post. “So what’s the difference with a grocery store?” and thought that is both Sanders and Warrens entire point on healthcare & college.
https://www.washingtonpost.com/nation/2019/11/22/baldwin-florida-food-desert-city-owned-grocery-store/
3
I wouldn't expect a large number of future doctors to be raised by parents who are economically unsuccessful. and someone should tell David Velasquez that ERs are not intended to treat poor, homeless, undocumented people. He should become a family doctor in a medical clinic. Of course, that will pay only a fraction of what an ER doctor makes.
14
These are medical students. Shouldn't they have M.D.s instead of Ph.D.s in Not Having Money?
4
What are these doctors-to-be complaining about anyway? They make WAY too much money and will soon join the 1%. They should be glad to be blessed with the academic horsepower to be able to study medicine.
4
@SarcasticMan not true, only a small fraction of physicians hit the "1-2%" most are in the 4-5% still a good number but far from the disposable income of a 1%er
2
@SarcasticMan I hope your screen name is the explanation for your comment, but if not, here's a tidbit of information for you: there are deep disparities in compensation between specialties of doctors. Please do not assume that all med school graduates are swimming in money. The average salary for a hospital employed pediatrician is $153,683.
3
Time for a Flexner Report 2.0 for 2020. Our medical education paradigm is stale-dated.
7
$740 billion per year for the Department of War, and growing every year.
23
Please don't mind if I don't shed a tear. These are Harvard Medical School students, future overlords of the medical community of America, I am not the least bit worried about their future. Not one bit.
9
As a physician with over 30 years of practice under my belt, I can tell you that you are wrong. Today’s overlords are health system CEOs, big pharma, IT and device manufacturers. The days of physician autonomy are long gone.
No way would I advise anyone to go to medical school today. The costs—economic and psychological-are far too great for the paltry return. Better to go to nursing school if you are interested in the field.
Lucky for me retirement is just around the corner.
32
This is unfortunately true globally. Only the smart AND rich kids can afford to be doctors. A sad state for the future of the world.
1
@Nikki google Harvard free income cut off you have no idea what you’re talking about ivys are free for many low income students.
2
Medical school should be free for those who qualify. Anything short of that is horrendous. Normalization of pay & limiting lawsuit payouts would also help.
3
What bothers me most about the rich is their absolute cluelessness- to assume everyone in that class has a vaycay house in Aspen or Ibiza or wherever, like HUH?! How come poor people are not that clueless? Unbelievable. I wish Mr. Velasquez and every normal person in that article the best of luck. I'm currently enrolled in my first year (regular college) seeking a degree in public health so I can do the same: help people that look like me because no one else will. The system is designed for us to fail but we'll make it anyway.
7
I too am a nice enough guy....after numerous "tomorrows" I began making Pickles. Thirty years later and my daughter is in University, my son just passed the bar, and my grandson loves daycare. There is always room for another pickle maker; I can't keep up. .....a stove, a pot, any vegetable, salt, maybe a bit of vinegar....a few vessels. Make PICKLES NOT WAR!
Growing up poor and white, my family couldn;t afford college or medical school. I was lucky enough to have the military provide for both college and medical school, as well as great training afterwards. Military medicine is a great option for those of us without wealthy families not wanting to be mounted with high student loan debt. Otherwise, proboably should be looking for less expensive state schools, rather than the most expensive colleges and medical schools. Patients care how good of a doctor you are, not what your diploma says. Believe me, having worked at famous private medical schools/centers, the overall education for students is really no better.
14
Tens of millions will be spent (and that's being gentle) on political campaigns, but students like these who truly want to serve others are scraping to get through. Crazy priorities.
13
Thank you for this article. Education should cost something, but not nearly the price tag it has now. The consequences of taking on 150,000$+ of debt are often not fully realized for many years. Physicians in training have no idea if they will ultimately like their chosen profession, and with excessive debt, they have little choice to change. This contributes to burn out and to career dissatisfaction.
Many don't realize that it is very difficult to work during medical school, which translates to 4 years of zero income. No vacation fund, no extra cash for dining out, and as this author pointed out, sometimes no cash for needed supplies.
Once you graduate, it doesn't get much better. Salaries during residency training are low, often so low that many cannot afford to make loan payments until after residency training. In my case, I am 15 years out of medical school and still paying my loans back, with the end at least 5 years away. I have a mortgage but no house.
Finally, some medical specialities are lucrative, but many are not, yet the training costs the same. I feel for any student entering this path if they have to pay their own way. It is a long journey and may not lead to life you envisioned.
16
Our medical model is all wrong. Doctors are viewed by their own profession as self employed businessmen. They are forced to capitalize their medical educations as well as startup costs for independent practices. Then, they are expected to reap the rewards of that enormous investment by charging enough to pay it all back and support a very comfortable upper middle class lifestyle. The luckiest of the lot, plastic and lasik surgeons and those with entrepreneurial skills become rich.
This is all wrong. Medical training should be funded by state. Doctors should be employed by public or nonprofit institutions where everything that they do is related to best practices in medicine not optimizing their business incomes. Medicine in the United States unfortunately includes some of the very worst aspects of market economics. The industry privileges profit, corporate and individual over the welfare of individuals and society. It is a system very ripe for profound reform.
54
@Yankelnevich
You know why plastic surgeons,lasik providers and dermatologists do so well? Much or all of what they do is not paid for by insurance.
4
@Yankelnevich the vast majority of doctors are now employees. We are expected to optimize the income of the institution for which we work.
4
I used some books someone loaned me. I was 28 , 40 years ago, Still manage to get all 8-10 and one 11. You don't need a $1000 prep course. I too came from a large working class family. But the article is right, the system favors the rich and privileged, and those who know they system.
9
As a first generation, low-income law student, I see many parallels between my story and that of these medical students. I’ll never forget buying my first suit for my first law school event and feeling incredibly guilty about spending so much money because I knew what $120 meant for a family like mine. The legal and medical profession need more practitioners from diverse backgrounds (diversity in experience not just representation alone), but the elites in these fields maintain so many barriers to entry. I can confirm it’s such an odd feeling when professors and classmates discuss people on welfare in such a distancing way. As someone whose been on food stamps and Medicaid, it makes me feel like a complete outsider; but, it also gives me a superpower as I can actually relate to the low-income people we discuss and represent.
480
@Samantha Steed One difference though between law students and medical students...... the length of time it takes to actually make some kind of a salary... and yes I know not all attorneys make big bucks... medical school takes 4 years......law school 3
Lawyers: assuming one passes the bar and get a decent job as a lawyer, you start to make a pretty good income after 3 years of law school.
Medical school you have to pay for and take two certification tests usually before finishing medical school Step 1, an 8 hour exam & Step 2 which is a two part exam, each a day.. On graduating medical school those who are now Doctors and presumably have done well enough on Step 1 & 2 exams have had to apply and be accepted into a residency program which are minimally 3 years in length (i.e internal medicine, pediatrics ). Typically some time in the first year of residency, they take the last of the Step exams Step 3, a two day test; also which must be paid for. During residency, the Doctors are not paid very much . If calculated based on hourly work ...would really not be paid much at all. At the end of 3 years of residency, so essentially minimum of 7 years of schooling they have to take yet another exam -board certification ...and then and only then can they make some kind of an income (not as much as many people think today) that one might expect a very well educated person to earn. If that person is a specialist...then they still need more year(s)training ...and testing
42
@Jack b
Don't forget the recertification work and exams all specialties require to maintain that board certification....hundreds of dollars on a yearly basis.
18
I am a physician who was lucky enough to have parents who were able to fund my entire medical student education, including all the hidden "extras", like textbooks, study aids, etc. When I started medical school, I was flabbergasted at the amount of privilege that my fellow students hand--the majority were well off, had parents who helped financially and emotionally (bringing dinner, doing laundry, etc.) I've always thought that it's nearly impossible for those without similar privileges and opportunities to enter medical school, let alone medical training. It doesn't end there; medical students have to pay for their own flights and hotels to attend residency interviews, pay for board licensing, all out of their own pocket. It is absolutely contributing to inequity in medicine.
628
@Audrey thanks for also mentioning the emotional support aspect of this! I really believe this too cannot be undervalued. Medical school can be so stressful to the point that doing laundry can put students over the edge, and having someone to help with those things, which poor kids and families can't afford, shouldn't be underestimated
137
@Audrey
Thank you for mentioning the other hidden costs. Currently my daughter is in her 4th year, going to residency interviews across the country. Grateful she has these potential spots, but the cost is staggering, and a hardship for middle class families like ours. We've often commented that without a support system how can a low income student ever make it.
141
@Jonathan Katz: I am a physician and have taught residents and medical students for 20 years. With respect, I could not disagree with you more. Medical school, residency, and medical practice are incredibly difficult. The better your self-care, self-discipline, and financial skills, the better you will do. However, the support of a family, a partner, and a secure source of funds cannot be overestimated. I see many residents who succeed despite financial struggles: residents who succeed AND raise children; residents who succeed AND cope with the cultural stresses of being first generation in the education system.
I myself succeeded because during residency I had very little financial stress: I came from an elite academic background and was exceedingly well prepared: I had a loving and supportive partner at home. It was still hard.
One of the things I work on with each resident is helping each identify their unique strengths, and play to those -- what the student in this pice described as "I have a PhD in being poor." That's a gift. Often the resident with financial or class-identity struggles has incredible raw intellectual gifts (that's how they arrived.) It sounds like your son had a very supportive "family of origin" who taught him successful life skills (eat when you can, wash clothes -- I wear scrubs...) And I'm sure he never needed to send you money.
122
What the article fails to mention is the effort on the part of some Medical Schools to ease the financial burden of medical education. NYU School of Medicine recently adopted a tuition-free policy and other schools are also following along this line. This certainly makes medical school more reachable for lower-income families and encourages graduates to enter lower-paying specialities without having a huge tuition-debt to repay.
9
One might think that Harvard, with a multi-billion dollar endowment might be able to spring some of that cash loose to pay the tuition and fees for medical students a la NYU.
3
@David Lubell i think NYU tuition was endowed by the Langone family, not the university
US culture treats college like a product or service that individuals need to purchase in order to live a happy and fulfilling life rather than an institution that provides society with the trained workforce necessary for the health of that society. Post secondary education has mutated into a thing tantamount to a McMansion or a Mercedes. Not only is this problematic, but an indictment of a civilization.
16
I am a fourth year medical student. Unfortunately, I cannot find anything to dispute within this article. I found it to cover almost all the explicitly and implicitly mandatory costs we face, with the exception of residency applications.
I am paying thousands of dollars to travel the country with little flexibility in my travel dates, as well as needing to buy refundable tickets in case a last minute interview opportunity arises and I have to change my flight to travel back to the opposite coast. This process is even worse for students applying into competitive specialties who have to do more interviews and less flexibility in scheduling their interview dates.
Oh, the other thing that wasn’t mentioned now that I think of it was secondary fees for medical school applications - in short, pay $75 per school to explain “why Harvard” or how you contribute diversity. Almost all schools send these secondaries to every single applicant. I sent in a secondary to one school and was rejected less than 24 hours later. Other schools have no supplemental essays and you just pay the money.
11
Unfortunately, and unfairly, we know that the daughters and sons of the wealthy are far more likely to have been well-educated, well-nourished, and safe. Their linguistic, social, and intellectual development is likely to have been far greater than their disadvantaged peers. Thus they are much better equipped to handle medical school and the medical profession.
Fixing the problem will require far more than discounted test prep classes.
I think it's important we do so, I have worked with many physicians whose elitism interferes with patient care.
11
A great and thoughtful story. Thanks.
I can understand some of these folks.
My mother had little money and we rarely ever took any vacations as some of our other acquaintances did. Luckily in my case, I had scholarships thru all education till I graduated from Caltech.
I wonder what AMA thinks of this practice where many of these doctors are forced into debts - and then have to charge princely sums to treat patients - just so debts can be repaid.
While I am totally against socialized medicine - I think this story illustrates that medical professionals are really a club.
And to belong to the club, entrance fees are unreasonably high.
6
When I started medical school in 1985 I had $25 to my name. My parents could not afford to pay anything toward my expenses. I graduated with $125K in loans. The financial aid officer suggested that I go into one of the more lucrative specialties, so that I would be able to pay back my loans.
My loans have been repaid. I contribute to a fund at my medical school which helps to defray expenses for poorer students.
I still think that it is insane that the cost of higher education, especially medical education, is so high.
75
It’s a sad state of affairs when even the American Association of Medical Colleges is charging hundreds and hundreds of dollars for test registration and preparation material. And the fees seem to go up every few years. The system is broken and I don’t see it changing soon.
10
@Ahmad Alach
It is not "broken" it has been corrupted by greed.
The solution is to limit fees to actual costs. And to not "collect twice" that is to charge for something that has already been paid for in another way.
9
Only the Wealthy should be able to access our nation's best schools. Why on Earth might we allow the 'bottom' 90% to pursue ANY avocations, which might enable them to penetrate the Upper Classes?
Look no further than our current Presidential progeny for perfect examples of how that works out.
16
@Willy P
Trump was paid from his father's business from the day he was born. I think the NYT article about the family scam with Fred Trump's wealth says he got $300K a year to start. He was a millionaire by the time he was 8.
He is/was definitely not 'upper class" in the cultured educated way you may assume that title implies, but he was always wealthy.
5
Thanks, magicisnotreal. My point is not how trump got there, but how his (and other fabulously-well-to-do's) progeny will likely inherit Control of this Planet.
The best and the brightest? Good luck.
6
I appreciate the fact that Mr. Johnson wanted to help his family, but supplying a down payment on a home while attending med school on loans? There's real family dysfunction when the adult parents infringe on their children's ability to get an education by asking for money for housing, medical care, et cetera. Cycle of poverty, indeed.
125
@Amv with mom continuing to call a struggling med student periodically for "help."
I haven't walked a mile in his shoes but I hope for his sake he learns to just say no. Imagine the expectations otherwise when he actually has his MD and is extorted to choose between paying pack his loans and continuing to support his parents.
26
@Amv maybe they have no choice!
5
@Amv How do you know the details of that issue? Maybe his family was renting and were on the verge of eviction (which happens literally every five seconds to low-income people). Was he to let his parents sleep on the streets?
18
What you'll never see in these articles, but underlies medical education, is that becoming a doctor in this country is a system of indentured servitude. Putting medical students in debt runs counter to the Hippocratic Oath, "to teach them this art, if they want to learn it, without fee or indenture." 75% of graduating senior medical students have debt and the average debt is around $200,000. At that level, most doctors will take 20 years or longer to pay off their education. That can't be good for the health of America.
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@Schad N. Freud
The point is it be better able to control those docs who might actually try to practice medicine instead of making money for whatever hospital or group they go to work for.
Other than making profits off something that should not be for profit, controlling people is the main reason all college educations cost so much now and student loan debt is impossible to discharge in any other way than paying it regardless of circumstance.
7
Take it from this former medical student--there is much less that you "have to buy" in medical school than you think. Just because other wealthy students "whip out their credit cards" doesn't mean you can't opt instead to a) find used equipment at a steep discount or b) share equipment with your friends (e.g. borrow your friends' stethoscopes, ophthalmoscopes, etc) when they are on their psychiatric rotations and don't need them. Buying a new reflex hammer or tuning fork is as big a scam as purchasing a class ring. Ignore the marketing.
Ditto expensive test prep books. Hint! Medical science as tested by the USMLE doesn't change much from year to year. Buy books from 2011 instead of 2019, they are not hard to find.
The licensing exam fees are truly absurd, though.
75
I feel bad for these students. I was fortunate enough that my parents covered most of my medical school costs..... I might quibble with the article’s assertion that most med students are from “high income, typically white” households. A large portion of my fellow medical students were of east Asian, south-east Asian, and/or Middle Eastern origin .... so, for folks who prefer to refer to others by their skin color: “brown.”
44
This is not good for anybody. I don’t want my doctor to be in the operating room because she’s rich. I want her to be there because she’s smart.
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@Glen
I want them there because they want to heal not because they want to make a lot of money.
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@Glen Personally, I would rather have a doctor who has a sense of compassion rather than the one who had perfect test scores.
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@Glen
Having had a round of spinal neurosurgery a decade ago, I would say that the criteria are "smart" and "excellent eye-hand coordination & fine-motor skills."
Compassion & bedside manner are, in my opinion and in my experience, vastly overrated.
56
The U.S. should offer free tuition for all medical students willing to serve as licensed physicians in the most underserved and impoverished areas of the country, including Native American reservations.
57
I graduated Dental School with a high debt. The interest rate alone is killing the borrowers. Every month I pay close 3000 dollars. This barely touches the principal of the loan. Just like the students on this story I didn’t come from a rich Family. I was actually a Refugee with goals and ambitions . I hope my kids will see the rewards of my struggle. I want them to compete and get a fair shot at Life. I don’t begrudge anyone that can afford to send their kids to best schools and prep-courses!
31
If you're in medical school in the US no one cares about your problems, that's a fact. We all have the choice after undergrad to get a job and make money or go to grad school and stay poor for a few more years, make your choice and deal with it. Everyone deals with pressure and obstacles in life ok? Overcoming your background is a big challenge, but that doesn't mean that a kid from money has it made.
This article glosses over the tuition for students from poor families, is it the same for all students? (That guy Shawn Johnson better have a serious talk with his parents/family or he'll always be broke)
8
@Scott Not that you thought about it, but if everyone just followed the money, your own quality of life would be much worse.
2
Why can you become a doctor in most European countries for free? Why does it cost 120 grand and up for a college degree? When are American's going to wake up ? I think the next recession could come with a little civil unrest.
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@robert conger Yes, Mr. Conger, the sooner the better. Proven results usually come about following more than just "a little civil unrest". Hong Kong should be our contemporary example in this regard. To the streets my fellow Americans.
22
We need to find a way to lower the cost for students because it contributes to graduates feeling justified in charging outrageous amounts for their services later.
That is one of the large barriers to reforming US healthcare, lowering costs, providing coverage to more of the population, and improving performance measures.
Physician earnings are less in other countries which provide better healthcare.
While high incomes certainly provide incentives, they may also lessen the proportion of motivation that comes from desire to serve.
Reducing cost for students should also make the field more accessible to people from all backgrounds.
11
@Citizen
Primary care doctors make the least amount of money compared to other professionals, such as lawyers or MBA recipients. If you want to make money, Medicine is definitely not the route !! I should know it ! I am a practicing internist.
27
@michele Saying every lawyer or mba has it made really highlights your medical tunnel vision.
5
Bill Gates should start a US focused fund to help students who work in areas critical to our society.
27
I think we all benefit from a diverse medical profession and should support it because I believe diversity (of opinion, experiences, culture) strengthens institutions and therefore society as a whole.
My family is very white, but when I went through my son's medical school graduation class picture and saw lots of different skin tones and family names, I appreciated that he received the benefit of learning in a diverse community of future doctors.
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@S D
Skin color doesn't represent diversity. It just shows that plenty of rich people of all colors can get their kids into medical school.
4
@S D medicine is medicine. The science is science. Every doctor that comes out of school has the same training. Skin color should be completely irrelevant.
3
One the one hand, elite institutions like Harvard say they want a diverse student body. On the other hand, in spite of having the resources, they don't cover the expenses of applying to and being in med school.
It's insane for any new doctor to graduate with a couple hundred thousand dollars of debt. It just perpetuates the inequality of our health care system.
If medical education was truly free - all expenses covered, not just tuition - students could focus on learning and not how they'll repay huge loans. And we'd likely have more doctors where they're needed.
30
Everything in academia is skewed toward the rich teaching the rich how to ignore, or at best, objectify "the poor" -- as though the poor aren't real Americans, and increasingly the majority of Americans.
I know many who've been forced to drop out of (or never attend) med school, law school, grad school solely because they can't afford it.
And many who finished solely because they could throw endless amounts of family money at it and then go on to well-paid jobs with an attitude of entitlement.
The cost of medical school is hurting healthcare and perpetuating a segregationist nation.
73
It is an absolute shame and outrage that US medical schools should be so expensive, when the vast majority of European countries provide education for a profession deemed indispensable in a civilized society, at very little cost to the student. But of course, the US leads in capitalism, classism (if not outright racism) when it comes to every single aspect of healthcare - even medical schooling. Primum non nocere indeed.
32
The student loan industry in this country is a large part of the problem. Why are federally subsidized loans to students being offered at rates of 7.5% compounded daily. It is disgusting that a bunch of do nothing bankers see fit to profit off the future generation of actual workers, in this case the ones that could potentially save their lives.
264
It’s perfectly obvious that we have a national interest in producing enough medical doctors (and other heath-related professionals). Think about all the medical professionals needed for the Veteran’s Administration alone. It seems perfectly reasonable for the federal government to either create medical schools attached to the largest VA hospitals or to invite public medical schools to become part of the VA system and provide free education to those students who would be required to work for the VA system (or in tougher for 5 years.
Apart from all this, given the billions of dollars in research funding and endowments for medical schools, it’s a disgrace for so many medical students to live in such economic hardship. Administrators need to answer for this.
10
That’s a great idea. UCLA is already associated with the West LA VA. Students and residents are required to do some rotations there. However, pay at the VA is so low that hardly anyone wants to stick around for a job there after training. Free medical school would be a great incentive.
12
My medical student husband's father was a migrant farm worker. My husband was the first in his family to graduate from high school, then college, then be accepted to medical school. He had the highest MCAT score and the lowest GPA of his entering class at Stanford. The financial burden was crushing. Our food budget was $20 a week, and god forbid our phone bill ran even $5 over or it would have to come out of the food budget. Student loans only covered some of the expense, and I worked like a dog so that we could afford the basics. It took him 5 years to finish, and it finished our marriage as well. Nothing much has changed, unfortunately, for low-income students trying to change the world one patient at a time.
221
Thank you for this article. I hope all of these students who have so patiently paid for their training get paid back in spades both in lifting up and serving their communities, and also in being highly paid professionals. I think Doctors are horribly underpaid given the lengthy training they go through. At this juncture, when you can go to a 10 week coding camp and get a $200K a year job in big tech, we're headed on a path where no one will work in primary care, let alone many of the other specialties that require yet more years of training and don't produce enough fees through procedures.
43
@Nick There are a limited number of training slots for primary care physicians. They are increasingly competitive, and all of them are filled every year. I don't blame you for not knowing this, as the media is always sounding the alarm about a shortage of primary care physicians without bothering to do basic background research. (The real shortage, by the way, is in comparatively low-paying specialties that require fellowship training beyond residency, such as rheumatology and endocrinology. These slots do indeed go unfilled.)
11
These extreme burdens serve another function. They limit the supply of physicians to the point that increases the demand for those who are in practice to the point that they can charge exorbitant rates. Like most things in life, it's all about making money. Then after the students do graduate medical school, they have another battle which is to get a residency. Those too are limited in supply. And guess who pays for most residencies? Medicare and Medicaid.
33
@Bruce Rozenblit The supply of physicians is indeed limited by the residency slots, not the financial burdens of medical school.
Being a graduate of a US allopathic program has the highest probability of gaining a residency slot; but if you don't match your first attempt the odds get much worse.
But the students are still competing with osteopathic graduates, Canadians, and foreign graduates (the Caribbean medical schools).
Failure to Match Category
6% US MD 1st time
56% US MD 2nd time
21% US DO
29% Canadian MD
47% International MD (US Resident)
51% International MD (Non-US Resident)
18
No one needs to spend $1200, or anything, on a test preparation package. For less than $50 you can buy a cram book with sample tests. If you cannot do well on the test after that, you don't belong in medical school.
Princeton Review and its competitors are scams.
16
These classes are extremely good at teaching for the test. One is disadvantaged without taking this type of class. You can do without but your competition is not.
40
@Jonathan Katz I am a physician who has coached and mentored young people who are applying to medical school in preparing for the Medical College Admission Test. This test is the single largest barrier to medical school for most students. The median score for an accepted student is 85th percentile. This is in a group that is very highly prepared to begin with. The Princeton Review is not great, but it is better than nothing. This is particularly true for a poor person who does not have access to mentoring or coaching amongst his friends and family.
58
@Jonathan Katz I agree that all that is needed is to buy the book. I am a physician 11 years out of medical school and used to teach MCAT prep courses. A student smart and driven enough to be accepted into HMS can simply buy the books for much less than the whole course and study on his/her own. There are ways around the $1200 price tag. The classroom portion is not totally necessary. I taught students at each of the elite institutions in Boston, and it was always clear on day 1 of the courses I taught which students would do well on the exam.
11
This article brings to light the additional costs of medical education beyond just tuition (which is bad enough). It is clearly a greater burden for individuals the less financial support that is available. It would be worth pointing out that even though many students have credit cards that they use to pay these charges, many are still worried about paying them off and may carry substantial credit card debt in addition to their loans.
I would love to see Ms Goldberg proceed with her research into after medical school. Then the students start residency where they are paid minimal salaries for stressful and arduous work/"education" while the interest accrues on their medical school debts and there are ongoing tests to be completed as well as licensing fees that are required after internship and for "moonlighting". I cannot imagine how these young students will ever get out of debt. It will be even harder for them to maintain their empathy and compassion to be the true healers they aspire to become.
14
@Kathy Rates of pay and the hours of work for medical residents are criminal.
2
Somebody needs to find a way to get set up sponsor programs for med students, something like gofundme except organized by the university. I bet there are a lot of people who would gladly donate $5, $10, or $100 if they knew it was going to someone like the people identified in this story to be able to make rent or take an important exam.
21
@B. Or maybe instead of donating individually, or begging from billionaire philanthropists, to patch up a little of the gaping injustice in the system ... we FIX THE SYSTEM.
32
David Velasquez is my hero. We owe it to him and other people like him to do whatever we can to fix our broken systems.
57
Thank you for keeping it real in this article. It is worth mentioning that what you say about medical school - with the vast majority of the students from wealthy backgrounds - is increasingly true of nearly every professional endeavor, from med school to an MFA.I notice that nearly every up and coming performer I read about in the arts section has an upper middle class or better background - how else could they survive up to ten years as journeymen until they break through? Likewise, there are no poor or working class people in publishing, where the pay is abysmal, or in academia, where ten years or more of adjunct or other temporary at will employment while you pay your own way to the conference papers and publications you need to rack up is the rule. College graduates alone, especially from the more competitive colleges, are overwhelmingly well off or out-and-out rich. Everyone else crashes and burns, or is scared away. The student loan horror, the defunding of public schools and colleges, the falling of real wages and rise in the cost of housing — all these have taken away what used to be a motivated first generation college student’s best chance.
172
The wealthiest country in the world cannot figure out how to train but not tourture medical school students that come from the non-wealthy class is perplexing. Maybe the alumni might figure out how to subsidizes these young people in hopes that their minimum daily dietary requirements are met.
125
"He sublet his apartment and slept on the medical school campus for several months so he could send his parents the money for a down payment on their home."
This statement reminds me of a Times story a few months ago on another financially challenged student who had continued to send money home. IIRC, years later, they were still using a credit card taken out in his name or expecting him to pay bills. Many readers observed that if you are poor and in graduate or professional school and then starting a career, you must focus on yourself.
Harsh but true.
115
@Lifelong Reader I agree with your observation. Expecting financial assistance from a student to support their parents is very wrong! Mr. Johnson, I am sorry your parents are taking away from your education.
19
@Lifelong Reader I was surprised by this. Sending loan money with a 7.5% interest rate home for a down payment is just a bad idea all around.
18
I applaud these young men and women for their courage and grit, because 20 years ago, I did not even consider fighting this reality - even to get a PhD. What this, and an earlier article about an Amherst student, highlight that is very important - that when a family is poor, not only do they not help, but they expect and ask for help; financial as well as other kind. I had to come home after school to babysit my brother; when my high school honor society committee refused to admit me because I lacked after school activities I saw they did not believe me when I said I had to go home to help out.
If we want affordable medicine, doctors who care about patients instead of just working the conveyor belt to make the most money; young talents who are willing to become internists and pediatricians - we need to make medical schools affordable. There is no way around it.
242
That's what they all say that Medical schools are expensive. But once they graduate and find a place to work, they are born free and live happily ever after.
My doctor friends always tell me medical school is tough. But they always send their kids to medical school whether they are smart enough or not. It is a job to make lots of money and win prestige all at once.
I seldom hear medical doctors or surgeons went bankruptcy. But I always hear other professionals went bankruptcy, not to mention blue collar or ordinary folks.
The world is not fair for sure, but the reward of success is tremendous.
12
@Usok
Medical school costs are high, but students who pay with loans are assured professional salaries that not only allow them to easily make repayments, but to attain wealth. The medical profession is lucrative.
9
@Usok Sending a child whose parents are physicians to Medical School, whether they are smart or not, is risky. 3% of medical school graduates don't match, then you just have an expensive degree without the ability to create the cash flow to pay back the loans.
The schools should have an ethical duty to ensure that they don't accept students who cannot graduate.
https://notadoctorjustamd.blogspot.com/2015/03/not-doctor-just-m.html?showComment=1427172072515#c3535627127933567282
3
What neither of you seem to realize is that not all medical specialties are lucrative. A doctor’s wages vary between 150k-500k (or more) a year, depending on the specialty. We need more primary care doctors but they don’t get paid as much as surgeons. A primary care doctor may get a decent salary compared to an average worker (but not, say, a coder as someone previously mentioned) but when you factor in a 200k loan repayment and the cost of living, that doctor isn’t making much at all. Most professionals in a lucrative field start their working lives earlier than doctors, who don’t start making enough money until after residency. Sometimes 5-10 years after those other professionals.
90