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Medical School = Debt That’ll Kill Me

February 10, 2009
Money in Medicine

Money in Medicine

So, as I’m nearing graduation, I’m faced with paying for my past 7 years of university. I was fortunate to have scholarships that were sufficient to cover tuition and living expenses for my undergrad years, but as soon as I started medical school, the scholarships expired and the costs rose. Now my life is such that convenience and comfort and time mean far more to me than money, so instead of penny pinching I spend on the things that make it easier. I have an apartment close to the main hospital and to major transit routes. I use a car when I have to commute to peripheral hospitals (1.5 hrs or sometimes impossible on public transit) or get a big haul of groceries. Although I made my lunch almost every day in undergrad, now I buy one almost every day. Going to a nearby city for a visit, I fly instead of drive. I’ve stopped picking up pennies off the sidewalk. It’s just not worth my time.

Government student loans (province of BC) don’t cover the full balance of tuition. I get about $13 500 as the maximum allowable loan, and tuition+fees is about $14 500. Many classmates are in this boat. Sometimes we are able to get bursaries from the Faculty to help out, but often the minuscule stipend we are given in our clerkship year – which works out to about $10/day, the amount we spend on cafeteria food since there’s no time to make a lunch – renders us too “rich” to receive a bursary. The government doesn’t seem to be listening to our lobbying. Despite a new federal budget, nothing is changing for the better for students in general.

So, we need to get cash somewhere else. Where? Banks. “Professional Student Line of Credit” warm the hearts of all the major Canadian banks, when they see us asking about it at the teller’s desk. Even before our first day of class, we are provided with information comparing the institutions. Usually, it’s a loan of up to 150k, with a Prime interest rate. We pay interest while we go to school, but don’t have to pay the principle back until after residency. This differs from Canada student loans, which have no payments during the MD degree + 6 months, and then payments of interest/principle during residency and thereafter, at a much higher interest rate. Either way, that Major Bank will have it’s hooks in us for a long long long time.

I’m getting to the point where I’ll have to decide whether to consolidate my loans. If I pay off the government one with my line of credit, I’ll incur a much reduced amount of interest, however, my contributions will not be tax deductible.

The lucky few with affluent parents don’t have this stress. Those kids get have zero expenses, drive a Lexus SUV, vacation in Hawaii a few times each year, and have their dinner on the table as soon as they get in the door. Without the stress of a huge financial burden, they are better able to focus on their studies. It’s not that my parents don’t help me – they have immensely, whether with a phone call calming me down before a big exam, a loan (with interest!) when I just can’t bear to take more from the bank, letting me practice examining their knee for OA when I’m visiting over the holidays, or teaching me how to drive stick so I could abscond with their well loved car. Being from a middle class family, although I have financial struggles, it is nothing compared to the barrier that those from lower socio-economic classes must face. It may appear insurmountable, meaning low income bright students won’t even apply for professional school.

When I entered medical school, our school’s Financial Officer made a budget with me. She promised that even with an extremely modest lifestyle, I’d owe $125 000, by the time my MD was in hand. Great. Am I on track to owe that much? Yes. I’m surprised it wasn’t more, but a few generous people and a few right decisions have helped to compensate for the areas in which I went over. Canadians are destined to owe a fortune (article from CMAJ 2003, CMA 2005, )but it’s not only them. US students have the same problem, and it’s getting worse: The NY Times noticed, barely and the AMA has studied it. What can be done? Lobby. But that hasn’t worked yet, and it certainly won’t help me, only those who follow. What can I do myself?

Deciding which speciality I would pursue, money was definitely a factor. A shorter residency would mean I’d be out in the field sooner, but Family Practice is the least lucrative and bears the highest overhead, compared with other fields. Ahhhh, but I can locum. Maybe that’s a way to be happy doing what I’m doing, and still be able to climb out of this quicksand pit of financial ruin. But  according to one paper, remuneration does not significantly influence specialty choice.

Should I pursue loan forgiveness? Unfortunately, the program in my province is terrible. One can receive 1/3 of their BC component of their federal student loan, per year, for working in a particular rural or underserviced region. Well, for me, that would amount to an extra $4000 a year. Not incentive enough to make living somewhere I may not want to worthwhile. If I’m going to live there anyway, sure I’ll take the bonus, but it’s not a deal-maker. Texas seems to have a better plan. However, in Ireland, they are cutting pay for Junior Doctors. See this Article, and Breakdown of Proposed Cuts. That sounds like backwards land!

Should I join the army? That’s a post for another time.

5 Comments leave one →
  1. Anna permalink
    February 10, 2009 4:58 pm

    I am totally in agreement with your post…

    What’s interesting is the nation’s cry for doctors….the apparent shortage across Canada and especially in northern, rural areas of Canada…yet, med students continue to face the overwhelmingly, stressful burden of financial debt upon exiting med school. Lord forbid, you are a student who experiences a traumatic life event (the illness of a family member, one’s own illness, etc.) and need to take an extra year to complete school…forgot a loan minimum of 125,000…an extra year of tuition and living expenses are piled on.

    What can we do about it? Lobby? That might help down the road for future students which I am all for, but what about those in school right now! The ones who will be graduating soon and will be the first ones to help start alleviating the doctor shortage….no such luck for us.

    We are captives of the Professional Student LOC….lucky Ontario has some good rural incentives….5 years isn’t all that long…who knows maybe I’ll like living in small town, northern, rural Ontario 🙂

  2. February 11, 2009 8:50 pm

    Hi,

    Thank you for this post, its a reality that the school must face. I will forward to a few decision makers I know, maybe the grain of sand will make a difference.

    Cheers

    CiscoGIII

  3. February 11, 2009 9:48 pm

    thanks CiscoGill
    I’d never heard of the Office of eHealth strategy in my 7 years at UBC (and 4 of those in the same Faculty!). Hmmm. Makes me wonder if our MD program couldn’t do with a few modules about tech and health. I bet Dean would be all over this!

    I appreciate you sharing the link.

    I don’t think anyone expects drastic changes, but it would make many people happy if:
    1. government loans covered tuition + some part of living expenses
    2. government loan principle wasn’t due until AFTER residency was complete
    3. loan forgiveness or ‘return of service’ programs were better or more available; eg) total loans expunged in exchange for 5 years of rural service.

  4. Nico permalink
    June 21, 2009 2:34 pm

    People here often think medicine’s the big money degree, so why worry about what they have to pay off. (Not ironically, the urban city I’m in is also home to the only/largest trauma center for the maritimes, and is also chronically understaffed as people leave for better pay.)

    I do know that finances, and finance issues ate at my ability to concentrate on studies. I can’t get a student loan, and you know how much of a struggle that was for me.

    If Canada wants educated workforce people, then they’re going to have to make it accessible, I know too many gifted, bright people here who aren’t even thinking of a degree simply because it’s just out of reach entirely. My university has a very weak bursary/endowments system, so that was of no use.

    But as well, here, people think the university educated simply aren’t good for anything….hey, why are there no doctors!??

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