Medical school choice.. going for best fit or best finances?

April 15, 2010 8:22 AM

Accepted at multiple medical schools. Now facing the choice of which one to attend and how to weigh the different price tags. If you are in med school now or have made it through to the other side, what factors do you recommend considering? How much debt is reasonable and has it impacted your career? (a little more info after the jump)

I'm considered a nontraditional student having been out of college for several years and am in the fortunate position of having options for next year. The choices basically boil down to schools that would be relatively affordable but didn't feel like good fits for various reasons (undesirable location, lacking research opportunities, unfriendly students, less well known, weaker in my areas of interest, etc) vs a few schools that seem like great fits for me (preferred locations, strong academics, research, friendly students, my curriculum style of choice, etc) but have hefty price tags. It could be a choice between finishing with $100,000 in debt vs $200,000 or $300,000. I'm trying to determine how much that could impact career choices and lifestyle. I grew up without much money, and am basically used to getting by on $25,000 per year in living expenses, but I do anticipate wanting a house/travel/some stability in the future - nothing outlandish. And I'm considering careers in relatively low-paying specialties or academic medicine and research, so that's a consideration.

If any of you have faced similar choices, I'm wondering what do you think matters most, looking back? How much debt is too much, even for a future doctor?

Thanks!

posted by newlyminted to Education (9 answers total)

Debt sucks and does impact your career options. If what you want to do is research (which pays less well), check out NIH's loan repayment program. If what you want to do is primary type care, there are similar repayment schemes for working in under served areas. The financial aid office at the expensive school will be very familiar for walking people away from the sticker price.
posted by a robot made out of meat at 9:04 AM on April 15, 2010

Consider what didn't feel like a good fit for you. Was it the education for the first two years? Or was it the way the clinical component was described?

I would look for the combination of lowest price tag and best fit. The loan burden for a private medical school is hard for me to think about sometimes, so I don't want to tell you to totally discount it. But you have to go where you think you're going to learn best, which is going to require some serious self-assessment on your part. Do you think you'll learn better on a systems-based curriculum, or a more traditional approach? How are their exams structured and scheduled? Are you going to be okay with having a solid week of exams a few times a year, or would you rather have more frequent exams that aren't crammed into a "finals week"? Do you plan on going to every class, or is attendance required?

Clinical education is also important, but there's usually enough freedom after third year to personalize your experience enough - less of a factor for me in deciding, at least.

With regard to price tag, remember that there are options to consider if you are seriously thinking about entering into a primary care field (namely the National Health Service Corps, which offers scholarships if you're in school, and loan repayment options once you're out, if you serve in an underserved area). You're used to living on small sums, which will help you out when you're living on loans - this will help you out, too, when you enter into repayment. My current plan after residency is to live on basically what I live on now, and throw everything else at my loans.
But also remember that you will change your mind about specialty at least twenty times.
posted by honeybee413 at 9:04 AM on April 15, 2010

Make sure you go somewhere that will look good for a residency. If you can't match with a good residency later, it won't really matter where you went to med school.

That said, do you know what field you might be interested in? That could also help you choose, but I realize you may not know yet.

Good luck to you!
posted by 6:1 at 9:13 AM on April 15, 2010

First, congrats! Second, and at the risk of decreasing my own odds by increasing the competition, the NHSC is a pretty damn good deal if you get in, as are the SR- and JR-COSTEP programs through the USPHS. These are all programs that you enter while in med school. Most of those deals are one year of service for one year of tuition; some pay living expenses. Additionally, USPHS officers can have swords, so there's that.

Once out of school, the same agencies (and a few state agencies) have programs that will repay a certain percentage for every year spent in practice. NB: all of these opportunities are exclusive to primary care docs and a select few specialties (OB/GYN, Psychiatry, &c). More research-minded parties might be happier with the NIH, or bumping their MD up to an MD/PhD for the funding.

That's pretty much the extent of my research on the subject, which is shameful considering how fast we're coming up on block 1, so I'll be watching this thread with a great deal of interest.
posted by The White Hat at 9:38 AM on April 15, 2010

Make sure you go somewhere that will look good for a residency. If you can't match with a good residency later, it won't really matter where you went to med school.

I think your residency placement depends largely on your USMLE scores, not what med school you went to. I would go with the cheapest option.

Congrats, and good luck!
posted by anniecat at 10:08 AM on April 15, 2010

Lower debt is always better when it comes to med school.

Biggest impediments to getting into a good residency would be things like if it was a foreign medical school with a reputation for being the sort of place people go because they can't get into an American medical school (and even then, most except a few top competitive programs will still be open to you)

Then there's the residency itself: are you planning to become a dermatologist? Do you want to pursue a research career at a prestigious university? If the answer to both of those questions is, "no," then odds are good that you whatever med school you end up at will be fine.

Another thing: are you planning on going into a medical specialty that doesn't make massive amounts of money? Because then you definitely want to reduce your debt load. If you're planning on becoming an orthopedic surgeon, then the difference between a $100,000 debt load and $200,000 might not be as significant as you might think. But still, $100k is $100k: do you really want to fork over that money, never to see it again?
posted by deanc at 10:18 AM on April 15, 2010

Response by poster: To follow up: All of my options are reasonably good MD programs in the US, with rankings that range from top 10 to somewhere close to 70th, I think. I haven't relied on rankings much when it comes to determining fit, and I'm not sure how much they matter in matching for residencies outside of the most selective ones, and those haven't interested me so far. My serious interests have been non-surgical, medical subspecialties that generally require primary care training (IM or Peds usually) followed by a fellowship.

Ideally I would like to see patients and conduct research, so NIH and university affiliated hospitals that may not pay as highly are my likely destination. It's safe to say that I'm not in it for the money. I've looked into some of the funding options (military is not on the table) and don't feel certain enough about my interests to commit to the NHSC, for example, because it requires a solid commitment to primary care that I'm not ready to make this early on. The NIH and other ideas for repayment and loan forgiveness are something I will definitely keep in mind as my career focus becomes clearer! Thank you for all of the suggestions!

Keeping all of that in mind, I'm still not sure how deeply in debt a person can go before it becomes a barrier when making career choices, and that's the main outcome I hope to avoid. I've had time to develop a clear idea of what I want/need, so I do feel confident in my feelings towards the schools, which seems to leave the difficult decision between a couple of good fit/lots of debt schools and poor fit/less debt schools. My pragmatic side leans towards the cheaper options and the career-minded side thinks the opportunities available at the good fit schools are too good to pass up.

Thanks for all of the feedback so far!
posted by newlyminted at 12:24 PM on April 15, 2010

Med school graduate with plenty of med school graduate friends and plenty of friends in med school who recently matched. I've spent a good deal of time chatting up friends trying to figure out what the difference was between our respective medical schools.

My opinion. Go to the second-looks at the various med schools. You'll have a good gut feeling about the ones you like. Out of those, pick the cheapest. Lectures are important but a lot of medical school was insane amounts of reading and repetitive regurgitation (sprinkle some critical thinking in the final years.) Many schools have recently built simulation centers. Don't pay 10K extra per year for 10 visits to the simulation center. They are fancy and cool but more useful for residents. As a student, you'll never be running codes.

If your not doing MD/PhD, ignore research opportunities. During your 1st year, you'll have an opportunity to do research but everyone knows that you can't do any substantial research in 2-3 month period.

In addition, be careful about your surroundings affecting your choice. Many people were very prestige seeking during admissions/first yr/second yr of school. It was very infectious as it even affected me. As 4th year rolled around, most people were more interested in finally starting a life, getting married, having children, and therefore, their residency choices were more geared towards finding solid reputable programs while getting closer to family. This would provide that social support network during residency that would allow them to have a family while churning out 80 hr work weeks.

Others didn't care about the prestige and preferred scenic locales like Univ. of Hawaii, Miami, etc. About 15-20% followed the prestigious routes. Nothing wrong with any of those routes but look ahead 4 years to figure out what might be your frame of mind.

Short answer: Pick the cheapest. Ignore classmates issue, you'll mesh with some of them and even if you don't like them, there's plenty of people outside of the walls of your school.
posted by InvestorMD at 12:51 PM on April 15, 2010 [3 favorites]

If you are doing public service (NIH, county hospital, most non-profits), your loans will be forgiven after 20 years on Income Based Repayment. Therefore, if you can live with 15% of your qualifying income (income that is over 150% poverty rate for your family) being contributed to your debt for 20 years, the rest will be forgiven.

Plus, there are tons of grants and funding that is being thrown at students who are pursuing primary care.

In any case, I would still choose the school with less tuition. It will open up the opportunity for you that if you don't want to do public service and prefer to go private practice, you don't have to worry too much about debt.
posted by InvestorMD at 1:01 PM on April 15, 2010