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Correct, but I don't know a single doctor in the US who actually paid it upfront instead of taking out all those loans and then easily paying them back with the

Correct, but I don't know a single doctor in the US who actually paid it upfront instead of taking out all those loans and then easily paying them back with their newfound doctor salary later.

sndean 7y ago
Yeah, the only people that I know who don't have >400000 in loans with a >5% interest rate coming out of residency have wealthy parents who paid for everything, did the military's HPSP program [1], or did a free 7-year MD/PhD program. It's an interesting process. [1] https://www.medicineandthemilitary.com/joining-and-eligibility/medical-school-scholarships https://www.medicineandthemilitary.com/joining-and-eligibili...
- cycrutchfield 7y ago
  Plenty of medical schools give need-based financial aid. So those folks who took out loans probably came from pretty well-off middle class families.
  - Retric 7y ago
    There is well off, and then there is paying 400+k to several schools while also supporting their other kids and retirement savings etc. A family in the top 5% of incomes with one child and zero financial issues and can pull it off. But, that’s well past just middle class.
  - adsljfl3 7y ago
    Can you explain your logical reasoning for why you believe most folks with medical school debt come from well off middle class families? I'm confused because need based financial aid for medical schools is still mostly loans. My partner who comes from a relatively poor family (they used to be on welfare) had most of their need based financial aid in the form of loans. Out of her residency class the highest % of folks taking out loans were from low to middle income families not well off families. So I'm curious where you got that stat from?
    - cycrutchfield 7y ago
      Anecdotally, I know some people who did not come from well off families who got need-based financial aid that covered the entirety of their medical school tuition. There was still some loans for living expenses but that’s about it.
Retric 7y ago
Many people fail to become doctors and or lose their license for various reasons. So, it’s a huge gamble in the US that can easily cause massive financial issues.
- redis_mlc 7y ago
  What's interesting is that student pilots face those same issues now. To go from ab initio to an airline pilot role, the cost is in the area of $200,000 - $250,000 now and there's a lot of ways to end up not getting picked for an airline job. Entry salary is up from $18,000 to $40,000 or so now, but that's not much improvment considering the cost of training. Part of the issue is the 1,500 hour experience rule, which is government-imposed. (There's an option for 1,200 hours, but then your major has to be airline-focused., preventing them from wisely diversifying their career options.) US airlines are in a bind because their policy is to not subsidize initial training, but cannot fly without pilots. And students are getting sticker-shock, and thinking about other careers with better ROI and certainty.
  - Retric 7y ago
    Yea, but that’s only half the story. Military pilots get training for free, which is vastly more and has massively suppressed airline pilot salaries. There are a few other approaches that can similarly reduce costs, but sticker shock is huge.
  - soared 7y ago
    A friend of mine flies island-hopping cargo/shipping in the Puerto Rico area which is a common route to make money, live well, and get enough flight time to land a commercial pilot job in the future.
adsljfl3 7y ago
It's interesting because you know we are weeding out talent that comes from low socio economic backgrounds and who need cash flow to support their families. At end of the day, we shouldn't be weeding out our doctors to only be folks who don't need to support their families for the next 10 years.
- wolco 7y ago
  There is a limit put in place on supply (seats at medical schools) already. Weeding out is part of that system already. The question is should cost be part of that.. we decided somewhat yes which is fair if you decide to limit supply in the first place.
  - jacobush 7y ago
    To limit supply is mostly to control price, like how OPEC controls oil. Current doctors have a vested interest in remaining a scarce commodity and lobby accordingly on the boards it matters.
  - nradov 7y ago
    The actual limit is residency slots. Every year there are many students who graduate from medical school but are unable to practice medicine because they can't get matched to a residency program.
    - adsljfl3 7y ago
      Yep, that's the true barrier to entry. The main issue is there is that Congress has capped the Medicare funded residency roles to the same number since 1997 (Balanced Budget Act of 1997). In that time period, the US population has grown 21%.

Correct, but I don't know a single doctor in the US who actually paid it upfront instead of taking out all those loans and then easily paying them back with their newfound doctor salary later.

sndean 7y ago

Yeah, the only people that I know who don't have >400000 in loans with a >5% interest rate coming out of residency have wealthy parents who paid for everything, did the military's HPSP program [1], or did a free 7-year MD/PhD program. It's an interesting process. [1] https://www.medicineandthemilitary.com/joining-and-eligibility/medical-school-scholarships https://www.medicineandthemilitary.com/joining-and-eligibili...

cycrutchfield 7y ago
Plenty of medical schools give need-based financial aid. So those folks who took out loans probably came from pretty well-off middle class families.
- Retric 7y ago
  There is well off, and then there is paying 400+k to several schools while also supporting their other kids and retirement savings etc. A family in the top 5% of incomes with one child and zero financial issues and can pull it off. But, that’s well past just middle class.
- adsljfl3 7y ago
  Can you explain your logical reasoning for why you believe most folks with medical school debt come from well off middle class families? I'm confused because need based financial aid for medical schools is still mostly loans. My partner who comes from a relatively poor family (they used to be on welfare) had most of their need based financial aid in the form of loans. Out of her residency class the highest % of folks taking out loans were from low to middle income families not well off families. So I'm curious where you got that stat from?
  - cycrutchfield 7y ago
    Anecdotally, I know some people who did not come from well off families who got need-based financial aid that covered the entirety of their medical school tuition. There was still some loans for living expenses but that’s about it.

Retric 7y ago

Many people fail to become doctors and or lose their license for various reasons. So, it’s a huge gamble in the US that can easily cause massive financial issues.

redis_mlc 7y ago
What's interesting is that student pilots face those same issues now. To go from ab initio to an airline pilot role, the cost is in the area of $200,000 - $250,000 now and there's a lot of ways to end up not getting picked for an airline job. Entry salary is up from $18,000 to $40,000 or so now, but that's not much improvment considering the cost of training. Part of the issue is the 1,500 hour experience rule, which is government-imposed. (There's an option for 1,200 hours, but then your major has to be airline-focused., preventing them from wisely diversifying their career options.) US airlines are in a bind because their policy is to not subsidize initial training, but cannot fly without pilots. And students are getting sticker-shock, and thinking about other careers with better ROI and certainty.
- Retric 7y ago
  Yea, but that’s only half the story. Military pilots get training for free, which is vastly more and has massively suppressed airline pilot salaries. There are a few other approaches that can similarly reduce costs, but sticker shock is huge.
- soared 7y ago
  A friend of mine flies island-hopping cargo/shipping in the Puerto Rico area which is a common route to make money, live well, and get enough flight time to land a commercial pilot job in the future.

adsljfl3 7y ago

It's interesting because you know we are weeding out talent that comes from low socio economic backgrounds and who need cash flow to support their families. At end of the day, we shouldn't be weeding out our doctors to only be folks who don't need to support their families for the next 10 years.

wolco 7y ago
There is a limit put in place on supply (seats at medical schools) already. Weeding out is part of that system already. The question is should cost be part of that.. we decided somewhat yes which is fair if you decide to limit supply in the first place.
- jacobush 7y ago
  To limit supply is mostly to control price, like how OPEC controls oil. Current doctors have a vested interest in remaining a scarce commodity and lobby accordingly on the boards it matters.
- nradov 7y ago
  The actual limit is residency slots. Every year there are many students who graduate from medical school but are unable to practice medicine because they can't get matched to a residency program.
  - adsljfl3 7y ago
    Yep, that's the true barrier to entry. The main issue is there is that Congress has capped the Medicare funded residency roles to the same number since 1997 (Balanced Budget Act of 1997). In that time period, the US population has grown 21%.