Loan payback in this era...

As an older pre-med (45+)I am concerned about being able to pay back school loan debt, particularly in view of the managed care environment and high malpractice insurance costs. Are any of you having a tough time contending with this in your practices?

I’m in the same situation. I think that I’ll get the maximum in loans that I can, and delay payment on them as long as I possibly can, or get into a loan repayment position for a few years and have that pay the loans off.
In short, I’m not worried about it. As a physician making at least $120K per year, paying $1000 or $1500 per month shouldn’t be a hassle. Just don’t get a lot of other debt.
If the idea of being a quarter-million dollars in debt bothers you, just keep saying “a quarter-million dollars in debt” until it rolls off your tounge. Or check out the various options that will pay your loans off for you - both governmental options, specialties and practices in rural areas that need doctors, etc.
Too bad I’m too old for military HPSP’s - I think being back in the military as a physician would be OK, but I doubt they’d want an entry level Lt.Col.


As an older pre-med (45+)I am concerned about being able to pay back school loan debt, particularly in view of the managed care environment and high malpractice insurance costs. Are any of you having a tough time contending with this in your practices?
Hi there,
I am a 51-year-old general surgery resident. First of all, I got a full-ride scholarship (tuition and academic expenses) from my medical school so I only had to borrow for living expenses. I owe about $55,000 total loans. My scholarship was based on my incoming MCAT scores and my GPA. I had to include my parent’s income info on my FAFSA and school financial aid application but the scholarship money was well worth the effort.
Second, you should apply to your state schools (where tuition is generally lower) and avoid very expensive private medical schools. While Howard is a private school, it has a charter so look into attending a chartered school. When Howard offered me a “full-ride” I immediately withdrew my acceptance of a place at MCV.
Third, you can apply for Public Health scholarships which will offset your second, third and fourth years if you agree up front to go into primary care. One of my classmates who is now in a Family Practice residency did this and only owes about $30,000. He is obligated to spend three years serving an underserved population. For public health the primary care specialties are Family Practice, OB-Gyn, Internal Medicine, Psychiatry and Pediatrics. I had no interest in being locked into primary care so I opted out of this one but for some folks, this is a good deal. Do keep in mind that these scholarships are pretty competitive so you have to do well in medical school during your first year.
The interest on my $55,000 is about 5% so I am not too worried about being able to pay this off after residency since my projected salary is well over $260,000 per year. I am even planning a year of vascular surgery fellowship after I finish residency.
A non-traditional student has to be somewhat creative about financial aid but financing medical school is definitely possible.

I have NO IDEA you had a full scholarship to Howard! Man, and I can’t even get a measly loan for my first term of medical school. (one of the drawbacks of an offshore school, I know) You have had a wonderful ride so far. I love keeping up with all you do! It keeps me plugging along!


As an older pre-med (45+)I am concerned about being able to pay back school loan debt, particularly in view of the managed care environment and high malpractice insurance costs. Are any of you having a tough time contending with this in your practices?

I agree with Natalie, do your very best to minimize the debt you incur by applying to state schools, etc. Don’t get used to the idea of being in a huge state of debt! It all seems like “funny money” when you’re signing the forms and seeing the checks deposited in your student account, but believe me, when they total it up at the end it is sobering and damn depressing. I have essentially doubled my family’s debt load by going to medical school, since our mortgage is $200K and my loans and accrued interest are about the same, and it is not a good feeling. We will manage but I am not sure how, exactly! Since I’ll be consolidating my loans for a thirty-year term and starting repayment on them at the age of almost-52, there’s a chance I’ll be making loan payments until after I retire (that’s ridiculous, I’ll be working to try and make sure that doesn’t happen).
There are lots of other money issues that everyone, traditional or OPM, worries about. Mortgage, money for kids to go to college, undergrad loans, etc. As OPMs we actually don’t have the exclusive on worrying about this debt - my young classmates with hopes of buying a house and having kids some time in the not-too-distant future are also worrying about how it’s going to play out. My husband and I already own a house and the LAST of our kids will finish college as I go into private practice, so those aren’t our worries… instead, I’m wondering if we’ll ever be able to retire! We don’t have much set aside, we haven’t been able to save anything for the years I’ve been in school rather than working, and the prospect for investing for retirement continues bleak. (Motto to you younger folks out there: save NOW for retirement! All of a sudden you discover you got old!)
The “managed care environment” - you know what, to be honest this is just not worth worrying about, but rather something to learn well when you get there and figure out how to survive and thrive in that environment. My residency program does a really good job of helping its residents understand how to make sure they’re getting a fair shake from the system. I’ve heard lots of doctors moan, “I don’t want to learn all that stuff about coding.” You ignore it at your peril - poor coding for an office visit costs YOU $$$.
Malpractice - well, it’s a cost of doing business and yes, it will cut into your bottom line… contemplating the challenges of practicing medicine in a financially successful way in the current environment makes me appreciate why some docs are getting MBAs, frankly. Even if you HATE business, you will be well-advised to pay some attention to it, or pay someone else to pay attention to your business for you. It is definitely possible to make a reasonable income as a physician but it takes hard work and vigilance.
Now, some physicians avoid these particular headaches by becoming contract employees. You can work as a salaried provider, and your malpractice is covered and YOU don’t have as much personal worry about how much the institution brings in … however, you will be held accountable for your time and efficiency. I have a friend who worked for Columbia HCA as a salaried physician and she hated it - her job performance as a doctor was evaluated by the nurse office manager, and the performance assessment was pretty much based on bottom-line factors, NOT quality of patient care. And there are any number of specialties (anesthesia, emergency medicine are two that come to mind) where you get a good salary and someone else worries about coding, malpractice fees, etc.
I think you’ll find most of us are just kinda hoping it will all work out, in varying degrees of Pollyanna-tude!

How have you handled paying for your kids college while you were in med school?
My son goes to college in one year. We haven’t the savings to pay for it so he will have to get loans. I wish they had special scholarships for kids with parents in school

We had money set aside, fortunately (why we don’t have $$ in retirement funds!) … but what has also helped is that the one who graduates this year is on Navy scholarship. And going to Virginia Tech (Go Hokies!) which is CHEAP. The one who will start college this year was told, "You can go to any college you want, as long as it’s a Virginia state school."
Prepare to be annoyed: your FAFSA will give you “credit” for having a kid in college, and your EFC will be accordingly adjusted. HOWEVER, your son’s FAFSA will not return the favor. There is no place on the kid’s FAFSA to indicate that a parent is in school, which really sucks. So despite the fact that we’re all part of the same family, my EFC was much lower than his.

See that stinks. I think their FAFSA should include that on it. Ahhhh, If we ran the world…
I am trying and trying to convince my son to look at Tech since we are going to live 7 miles away. He hates the school because they went to the ACC. My husband and son are big WVU fans so they didn’t like that the VA Tech president said they weren’t going to go and then they did. I say WHO CARES, IT’S FOOTBALL.!!! I am now hoping he starts dating some nice young lady who happens to be going to TEch and then maybe he will stay around locally.

OMG who cares what conference they’re in, it’s still fun. I mean, I was really disappointed that they bolted, too, and thought it sucked, but (shrug) it’s hardly the end of the world. Tech is just such a great school - the kids all just seem so happy. But ya know, I bet the college-bound kids in the B’burg area tend to go elsewhere just to go somewhere else. Like my daughter who inexplicably applied to George Mason; when she got in she said, “Well, I wouldn’t want to go, since it’s right here.” Ummmmmm and the $40 application fee was for what exactly?? Kids! Good luck with the college thing, it can make ya nuts.