Medical school student loan calculations

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Skarlo
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Joined: Sun Mar 29, 2020 3:11 am

Medical school student loan calculations

Post by Skarlo »

I will be matriculating to medical school next year and want to get an exact sense of what my debt will look like until I am an attending physician, and what my finances will look like at that time. Are my calculations below correct, and if not what am I not accounting for?

Example: assume I borrow 200k direct unsubsidized federal loans, attend med school for 4 years, residency for 5 years, and make a salary of 300k as an attending. The current federal unsubsidized student loan rate is 4.3%, and the origination fee is ~1.06%.

Medical School: let's say I borrow semester-by-semester to minimize interest accrual.
  • (0.043/365) x 25,000 x 182.5 = 537.5
  • (0.043/365) x 50,000 x 182.5 = 1075
  • (0.043/365) x 75,000 x 182.5 = 1612.5
  • (0.043/365) x 100,000 x 182.5 = 2150
  • (0.043/365) x 125,000 x 182.5 = 2687.5
  • (0.043/365) x 150,000 x 182.5 = 3225
  • (0.043/365) x 175,000 x 182.5 = 3762.5
  • (0.043/365) x 200,000 x 182.5 = 4300
  • Total = 19350 + 200,000 = $219,350
Add the origination fee...
  • 25,000 x 0.0106 x 8 = 2120 + 219,350 = $221,470
Residency: let's assume a salary of $75k per year. Take-home is probably less from cost of living, 401k? I know interest also compounds now, so my new "principal" will be $219,350.
  • What does the math look like at this stage?
Attending: let's say I make a starting salary of $300k per year. I know there is lots of income lost from taxes, mortgage payments, etc.
  • What does the math look like at this stage?
  • I know some attendings enter 10-year/25-year repayment plans. Why would you do this when you can live below your means and pay off all your loans in 2-3 years?
oldfort
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Re: Medical school student loan calculations

Post by oldfort »

Skarlo wrote: Fri May 22, 2020 11:30 pm I will be matriculating to medical school next year and want to get an exact sense of what my debt will look like until I am an attending physician, and what my finances will look like at that time. Are my calculations below correct, and if not what am I not accounting for?

Example: assume I borrow 200k direct unsubsidized federal loans, attend med school for 4 years, residency for 5 years, and make a salary of 300k as an attending. The current federal unsubsidized student loan rate is 4.3%, and the origination fee is ~1.06%.

Medical School: let's say I borrow semester-by-semester to minimize interest accrual.
  • (0.043/365) x 25,000 x 182.5 = 537.5
  • (0.043/365) x 50,000 x 182.5 = 1075
  • (0.043/365) x 75,000 x 182.5 = 1612.5
  • (0.043/365) x 100,000 x 182.5 = 2150
  • (0.043/365) x 125,000 x 182.5 = 2687.5
  • (0.043/365) x 150,000 x 182.5 = 3225
  • (0.043/365) x 175,000 x 182.5 = 3762.5
  • (0.043/365) x 200,000 x 182.5 = 4300
  • Total = 19350 + 200,000 = $219,350
Add the origination fee...
  • 25,000 x 0.0106 x 8 = 2120 + 219,350 = $221,470
Residency: let's assume a salary of $75k per year. Take-home is probably less from cost of living, 401k? I know interest also compounds now, so my new "principal" will be $219,350.
  • What does the math look like at this stage?
4.3% interest on 220k is $9460. Assuming you earn $75k/year, you should be able to at least make the interest payments during residency.
Topic Author
Skarlo
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Re: Medical school student loan calculations

Post by Skarlo »

oldfort wrote: Fri May 22, 2020 11:37 pm 4.3% interest on 220k is $9460. Assuming you earn $75k/year, you should be able to at least make the interest payments during residency.
That's good to hear. Are my calculations for the interest rate during medical school correct?
MedSaver
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Re: Medical school student loan calculations

Post by MedSaver »

These precise calculations are kind of pointless at this early stage. You presumably know where you’re going, but you won’t know your exact living expenses until you’re there for some time. There are countless expenses you may not be thinking of apart from COL. Will you be far from home? If so, add some money so you can come home during breaks. Are you going to do medical missions in Med school? Add some more to travel budget. Want fancy medical equipment, step tutoring, a parking pass? Keep adding. Are you considering a competitive residency? Add to your travel budget so you go on enough interviews to clinch a spot. Are you willing to work with underserved populations? Maybe you will qualify for loan forgiveness. By the time you’re out of training the world will be very different.

My advice: find good roommates in your class that keep you motivated, don’t buy a house until you’re done training and you’re in a secure job you love, pay what you can on your loan in residency, max your Roth IRA, pay enough into 403b/457 to get matched, get good disability insurance in residency and pick a specialty you enjoy. Good luck.
Topic Author
Skarlo
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Re: Medical school student loan calculations

Post by Skarlo »

MedSaver wrote: Sat May 23, 2020 12:29 am These precise calculations are kind of pointless at this early stage. You presumably know where you’re going, but you won’t know your exact living expenses until you’re there for some time. There are countless expenses you may not be thinking of apart from COL. Will you be far from home? If so, add some money so you can come home during breaks. Are you going to do medical missions in Med school? Add some more to travel budget. Want fancy medical equipment, step tutoring, a parking pass? Keep adding. Are you considering a competitive residency? Add to your travel budget so you go on enough interviews to clinch a spot. Are you willing to work with underserved populations? Maybe you will qualify for loan forgiveness. By the time you’re out of training the world will be very different.

My advice: find good roommates in your class that keep you motivated, don’t buy a house until you’re done training and you’re in a secure job you love, pay what you can on your loan in residency, max your Roth IRA, pay enough into 403b/457 to get matched, get good disability insurance in residency and pick a specialty you enjoy. Good luck.
Thanks that's good advice. I will definitely be sure to follow your tips.

However, I do think that having more exact knowledge helps me prepare/feel more confident for the future. I am someone that likes to plan. Could you at least provide a general guideline for what repayment during residency, and then as an attending might look like? For example, I know some residents enter PAYE/REPAYE, is this because their salary is insufficient to support even interest payments?

I'm going to UCSF btw and am budgeting per their suggested budget here: https://finaid.ucsf.edu/application-pro ... ent-budget.
liynus
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Re: Medical school student loan calculations

Post by liynus »

Focus on the speciality. That matters more than loans.
At this age increasing your potential future capital outweighs any savings you can earn while in medical school.

But yes loan less if you can. Be frugal but not cheap. Don’t miss the one in a lifetime medical mission if you want to. Don’t cheap out on not auditioning for the residency you want because of costs. You can have anything, just not everything.

Great job for thinking ahead. I remember I was able to pay med school tuition with a credit card and no fee so I got a lot of free airline tickets for me and the future wife. Most of my peers had no idea about finances but most aren’t too worse off for it. You are way ahead attending a state school.

The fact you know about a 401k/Roth and the value of time with compound savings already puts you super ahead. As long as you finish medical school and practice you already won the game. The question then is by how much do you want to win it.

Keep reading the board, buy books, learn slowly. It takes years to become a great physician. It will also take years to become a competent Bogle head and we all keep learning every year. The white coat investor book is pretty good for early physicians.

Enjoy med school I had a blast and miss it a bunch. Was Such a great tortuous experience!!

Remember you can’t buy time, which honestly is going to be the issue when you want to start a family.

2nd don’t buy a house. I did in the summer of 2008 before starting residency. That wasn’t a smart idea when we had to move 3 yrs later!!! Luckily it wasn’t a very little expensive house. Value your mobility, sometimes great opportunities require vast relocation. Not possible for some with families but u have to decide on the compromises.
Dennisl
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Re: Medical school student loan calculations

Post by Dennisl »

You’re not going to be very flush in residency. Let’s use USC as an example. Pgy1 starts at 55k with a 5k raise per year. The higher salaries account for cost of living, so don’t assume you’ll be comfortable. NYU starts at $68k per year. For ucsf, cost of living is brutal in the city. Don’t imagine you’ll save much after your landlord and Uncle Sam take their cuts.

Your Med school loan will be accruing interest during Med school. Try to make interest payments at least in residency. Depends where you go. I graduated from a state school with only $160k in 2008. Friends in private medical schools came out with 350-400k in loans. If your school is in a hcol area, you’re going to end up borrowing more money for room and board. If you have kids in residency, may be tough paying off the loan. You’re going to need supplemental term life insurance, which is cheap, but also your own disability at some point, not cheap. Pray that you don’t get really sick or disabled before you finish your training.

I forgot to mention, your cost of tuition will continue to rise. For UC’s, not sure if they still have this. Gov Arnold decided it would be a good idea to balance the budget on the backs of students when I was in school. They created the professional school fee, an extraneous fee based on the assumption that you could afford to pay it back. The fee grew from nominal to 20k ish by the time I graduated.

Your income as an attending will vary widely depending on where you practice and what specialty you practice in. If you come out during a time like now, you’re screwed. In surgical subspecialties, nobody is hiring right now because all groups are cash strapped. You might end up being a mercenary doing locums so that you can pay the bills, esp if you are married and have kids. One of my former colleagues is flying out to South Dakota from Florida to cover call on weekends. Billing and compensation is quickly changing. There is always the Medi-cal and Medicare chipping away at your payments so that you keep having to do more and more to keep compensation stable. There is constant negative news from the media making it seem like doctors are making too much, even though the numbers show most growth going to execs and insurance/drug companies. You can hit $300k easily in certain specialties, whereas you’ll really have to hustle in others. Don’t let that be the main determining factor when choosing your specialty. Radiology and anesthesia were hot when I was graduating. Maybe less so because reads can be shipped out to india or may be taken over by imaging software in the future. Anesthesia, like other fields will have crna’s, or in other fields np’s and pa’s setting up shop and calling themselves doctors and cutting away at the perceived value of your years of blood and sweat.

Tax situation might change. Right now SS and Medicare is capped. That might change soon given the winds of politics and the needs of the country since revenue from income has been cut, but the SS checks and relief checks need to keep going out. That being said, society will have no pity on doctors and you will not have your loans forgiven.

Finances are going to change. They’ve changed dramatically over the 5 years that I have been in practice. It may be unrecognizable by the time you get out in 7-11 years depending on whether you do primary care vs neurosurg. You might even need to take some time off to do some research depending on the field you want to pursue, further adding to your debt.

Anyhow, congrats on Med school and good luck.
Katietsu
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Re: Medical school student loan calculations

Post by Katietsu »

It sounds like this book has the information you are looking for to get started:

https://www.amazon.com/White-Coat-Inves ... 0991433106

It looks like you can get a used copy for just a few dollars if you want to save a little.
ModifiedDuration
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Re: Medical school student loan calculations

Post by ModifiedDuration »

Katietsu wrote: Sat May 23, 2020 3:15 am It sounds like this book has the information you are looking for to get started:

https://www.amazon.com/White-Coat-Inves ... 0991433106

It looks like you can get a used copy for just a few dollars if you want to save a little.
The website is also outstanding for doctors and doctors-to-be:

https://www.whitecoatinvestor.com/
potatopancake
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Re: Medical school student loan calculations

Post by potatopancake »

Skarlo wrote: Fri May 22, 2020 11:30 pm Residency: let's assume a salary of $75k per year. Take-home is probably less from cost of living, 401k? I know interest also compounds now, so my new "principal" will be $219,350.
  • What does the math look like at this stage?
Attending: let's say I make a starting salary of $300k per year. I know there is lots of income lost from taxes, mortgage payments, etc.
  • What does the math look like at this stage?
  • I know some attendings enter 10-year/25-year repayment plans. Why would you do this when you can live below your means and pay off all your loans in 2-3 years?
Fine school to attend, congratulations. You will be able to go into any field given the ucsf pedigree. I would suggest figuring out early what piques your interest. Weigh your level of interest in the field, day-to-day workflow of the field, and work-life balance when picking a specialty. Are you leaning towards something already? 5 years is a particular length of time: urology, ortho, etc?

The budget will be tight during residency. You will likely join REPAYE (if single) or PAYE (if married to high income earner). You can invest in retirement fund, usually roth ira. Most residency programs will not match 401k. Renters, disability, and life insurance if you have someone who depends on your income.

Your planned repayment schedule will vary. PSLF if you go into academics with 220k debt will get you some forgiveness at 10 years. Otherwise, you may choose to refinance privately. This is a long way out and not something to worry about. The next four years it will be more important to crush school and figure out where you are going in life.
blammo
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Re: Medical school student loan calculations

Post by blammo »

Depending on what specialty and practice type you go into, you may be able to pay your loans back on an accelerated basis. The private market for loans may be cheaper than federal depending on your final weighted interest rate. I refinanced into a private loan at the end of fellowship because the rates were much better and my new job did not qualify for PSLF.

I went to school during the higher interest period of late 2000's where subsidized loans were 6.8%. So, my consolidated loan was 5.625% during residency and fellowship (8 years). I paid around 1100 per month throughout residency.

I was lucky to have less debt than many due to working wife for part of residency and careful planning. My salary was 46k my first year, then around 50 on PGY3. At that point, my wife had a major medical issue that took her out of the work force, and we had a young child. Money was tight for a long time. I've been out for several years now, and still budget very carefully. The time period we're in is why - my net production is down 85% for March and April, so I will be in the red for several months. Life is unpredictable sometimes.

My wife is from CA. Many CA natives are highly motivated to stay in CA for the long haul. Be very careful to consider the impact of COL on your finances for residency. As others have said, the stipend that the HCOL places give you to "make up" for the increased COL don't come anywhere close. Your life may also look very different during residency - marriage, kids, etc. Those substantially change your costs.

I bought a house for residency because I was in a long residency. I saw friends in short residencies (3-4 years) lose 10-20% on their house because of the 2008-9 housing crisis and lack of recovery. I'd recommend against buying if you're in a short residency. If you go somewhere on the cheaper side, you may find real estate very affordable on a resident's salary. If a HCOL, it won't be affordable to buy and maybe not even rent solo.

If you go to residency at a top flight place (top10 or 20 in your specialty), you can get a job anywhere in the country. So, consider moving out of state for residency to decrease your costs, then coming back for practice if that's what you want. If you are dead set on staying in CA for residency and training, you will pay a substantial price for that decision.

FWIW, we ultimately told family during my 3rd year of residency that we wouldn't be moving to CA afterwards, as the costs of living there seemed impractical. I'm really glad we made that decision, and her family understands.

b
MedSaver
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Re: Medical school student loan calculations

Post by MedSaver »

I knew I wasn’t going to do academics so I started on PAYE and consolidated to a low rate after fellowship (5 year term). I comfortably pay about $4k/month currently and am nearly done. I don’t remember how much I paid in residency. I think a few hundred. Honestly the difference between paying your interest and not will be less than one paycheck for most specialties so I think it’s more important to fund your Roth and living expenses. My intern program matched a 403b. My understanding is that UCs don’t pay into social security. Instead, you’ll fund your 403b and you can defer salary to a 457 if you have extra. SF is a fun city but expensive. You will have no extra money as a Med student. Whether or not you gave some extra in residency will obviously be determined by your residency, location and personal situation.
Topic Author
Skarlo
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Re: Medical school student loan calculations

Post by Skarlo »

potatopancake wrote: Sat May 23, 2020 8:06 am Fine school to attend, congratulations. You will be able to go into any field given the ucsf pedigree. I would suggest figuring out early what piques your interest. Weigh your level of interest in the field, day-to-day workflow of the field, and work-life balance when picking a specialty. Are you leaning towards something already? 5 years is a particular length of time: urology, ortho, etc?

The budget will be tight during residency. You will likely join REPAYE (if single) or PAYE (if married to high income earner). You can invest in retirement fund, usually roth ira. Most residency programs will not match 401k. Renters, disability, and life insurance if you have someone who depends on your income.

Your planned repayment schedule will vary. PSLF if you go into academics with 220k debt will get you some forgiveness at 10 years. Otherwise, you may choose to refinance privately. This is a long way out and not something to worry about. The next four years it will be more important to crush school and figure out where you are going in life.
Yes the 5-year residency length I chose due to an interest in Urology. I have some previous research and mentors in the field, so it would be easier to continue on this path if I so choose in med school. I am keeping an open mind though.

Also have a SO I have been with for 4 years now with whom I hope to start a family, so what you mentioned re. PAYE vs. REPAYE is very interesting considering timing of marriage.

Thanks for all your advice thus far!
blammo
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Re: Medical school student loan calculations

Post by blammo »

Interesting thing about my med school experience that may be pertinent.

I got married between 1st and 2nd year of med school. Because this impacted our income, I lost my grants and had to replace with loans. Fortunately, I got some scholarship funds for 3rd and 4th year. So, consider the timing of your marriage and how that might impact your financial aid during medical school.

b
Galaxy8
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Re: Medical school student loan calculations

Post by Galaxy8 »

How are you covering living expenses? I had to take out extra loans for this to the tune of $15k per year (you can't earn appreciable job income in med school, and my parents couldn't afford to help). The final year I had to take out an extra $10k for residency interviews, moving etc.

That's potentially another $55k of principal.

You're fooling yourself if you think you will make $75k in residency. Currently resident salaries in NYC start at $69k. In NC, my starting salary as a resident 4 years ago was $49k.

Depending on your specialty and practice settings, many attendings don't get their "full pay" until 6 months to 3 or even 5 years in practice. My current job payed me 90% full salary for first 6 months. Another job I interviewed with paid 50% salary for first 3 years.

For anecdotal evidence, my med school tuition was $58k per year, and I finished residency with $452k of debt from med school. Over $100k of that was accrued interest.

I would say increase your projected debt by 50% at least.
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Skarlo
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Re: Medical school student loan calculations

Post by Skarlo »

Galaxy8 wrote: Sat May 23, 2020 1:31 pm How are you covering living expenses? I had to take out extra loans for this to the tune of $15k per year (you can't earn appreciable job income in med school, and my parents couldn't afford to help). The final year I had to take out an extra $10k for residency interviews, moving etc.

That's potentially another $55k of principal.

You're fooling yourself if you think you will make $75k in residency. Currently resident salaries in NYC start at $69k. In NC, my starting salary as a resident 4 years ago was $49k.

Depending on your specialty and practice settings, many attendings don't get their "full pay" until 6 months to 3 or even 5 years in practice. My current job payed me 90% full salary for first 6 months. Another job I interviewed with paid 50% salary for first 3 years.

For anecdotal evidence, my med school tuition was $58k per year, and I finished residency with $452k of debt from med school. Over $100k of that was accrued interest.

I would say increase your projected debt by 50% at least.
I'm already under-estimating to account for that. I received some scholarships/grants that will help bring total debt balance without interest including cost of living (tuition at my school is also ~50% that) to ~160-170k at graduation. But that's a good point about attending salaries starting lower for recent residency grads.
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user9532
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Re: Medical school student loan calculations

Post by user9532 »

Skarlo wrote: Fri May 22, 2020 11:52 pm
... Are my calculations for the interest rate during medical school correct?
I would assume the lender will compound interest on a monthly basis. Plus the origination fee will be added to the principal balance and will also start accruing interest. So the final total will be slightly different: $ 222,883.
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Skarlo
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Re: Medical school student loan calculations

Post by Skarlo »

user9532 wrote: Sat May 23, 2020 1:48 pm I would assume the lender will compound interest on a monthly basis. Plus the origination fee will be added to the principal balance and will also start accruing interest. So the final total will be slightly different: $ 222,883.
Thanks! But I believe interest is only compounded after your graduate from med school.
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goodenyou
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Re: Medical school student loan calculations

Post by goodenyou »

These numbers are staggering. I finished med school in 1991. I finished my Residency in Chicago (big city expensive) in 1996. I moved to a no income tax state with a very high compensation and VLCOL. I paid off all my student loans very quickly and saved like crazy. I enjoy work much more now that I have no need to do it. Not having to worry about retirement savings, mortgages or paying for 3 kids college and graduate school expenses is a luxury worth considering. I see many of my peers that finished when I did still sweating it out especially now with what the COVID fiasco has done to medical practices. It is worth considering when you finish in debt.
Last edited by goodenyou on Sat May 23, 2020 2:36 pm, edited 1 time in total.
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GMan82
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Re: Medical school student loan calculations

Post by GMan82 »

I would highly suggest reading the book written by the White Coat Investor. You can find it on Amazon. In addition, he posts on here on the regular, and has his own website. I only discovered his website and book midway through residency and WISH I had known about it earlier. The kind of personal financial education you can get from it is NOT taught in medical school or residency and is priceless.

Using what I’ve learned from him, the Bogleheads, and other reading to continue my financial education, I’ve sort of become the finance educator for my own residents.

If it hasn’t been mentioned in the prior posts, I highly suggest starting with his book and website, and Taylor Larimore’s book “The Boglehead’s Guide to investing” when you get a chance.
Katietsu
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Re: Medical school student loan calculations

Post by Katietsu »

Since you want to look far out into the future, consider being open to geographic arbitrage. In other words, not only will the cost of living be reduced in Iowa vs San Francisco, but, for a physician, the salary will probably be higher. This is the opposite of many professions where a lower COL is associated with a lower income.
bhough
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Re: Medical school student loan calculations

Post by bhough »

I suggest you download a 1040 from the IRS and plug in the numbers you’ll owe for fed tax, social security, FICA. Then add that to what it will cost to pay off $200,000 in 5 years. You might run those calculations for $300,000, but also for $250 and $350. For fun, plug in numbers for rent, car payment, cell phone, internet, electric bill, etc. you’ll be left with less than you think.
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CardioMD
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Re: Medical school student loan calculations

Post by CardioMD »

Just enjoy it. Don’t worry about those details at this point. Get through your training as cheap as possible. Lifestyle creep starts earlier than you think. Medsaver has great advice. By being a Boglehead I’m confident you’ll do well on all fronts. Congrats and good luck.
“The stock market is a giant distraction from the business of investing.” -Jack Bogle
potatopancake
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Re: Medical school student loan calculations

Post by potatopancake »

Skarlo wrote: Sat May 23, 2020 12:25 pm Yes the 5-year residency length I chose due to an interest in Urology. I have some previous research and mentors in the field, so it would be easier to continue on this path if I so choose in med school. I am keeping an open mind though.

Also have a SO I have been with for 4 years now with whom I hope to start a family, so what you mentioned re. PAYE vs. REPAYE is very interesting considering timing of marriage.

Thanks for all your advice thus far!
Urology is a great career choice and ucsf is a good place to be a med student interested in uro. Bit of turnover in leadership recently but still, strong program. I would reach out (if you do not know the attendings) and try to get involved with some research during pre-clinical years. Step 1 being p/f makes way for extracurriculars (ie, publications and research projects).

You are leaps and bounds beyond your peers in finding this website and asking these questions. You will do well. Don't worry too much about the financials. Enjoy frugally, medical school and residency, when you have time.
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MetaPhysician
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Re: Medical school student loan calculations

Post by MetaPhysician »

Skarlo,

Congrats on UCSF.

A few thoughts:
1. Some students take an additional research year during med school. You may want to include that in your budgeting.

2. 75k for residency may be a bit high, my friend.

3. Take care of yourself. Honestly. Uro especially has a particularly large amount of burnout. It perplexes some because it is a great field. What I am saying is your sanity/wellness/health is a big part of how you make it through the next 9 years. Ask any physician on this board- we all know someone from med school, residency, practice that was unable to finish or didn't finish for one reason or another. I don't want to be too dark here but you get the point.

4. Include a couple of grand for residency interviews and traveling to present for conferences.

5. Consider the possibility of a year or two for fellowship, as well.

Best of luck!
MedSaver
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Re: Medical school student loan calculations

Post by MedSaver »

Just a heads up. I would use another bh account in the future. You’ve come dangerously close to doxing yourself. Medicine is a small world and ucsf med students interested in urology and finance with a partner of 4 years is even smaller.
Topic Author
Skarlo
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Re: Medical school student loan calculations

Post by Skarlo »

Grateful to everyone who shared their experiences and tips re. med school and finances. I'll keep doing research on this and make smart decisions moving forward!
MedSaver wrote: Sun May 24, 2020 1:48 pm Just a heads up. I would use another bh account in the future. You’ve come dangerously close to doxing yourself. Medicine is a small world and ucsf med students interested in urology and finance with a partner of 4 years is even smaller.
Thanks for the heads up! While I haven't said anything online that I would regret having associated with my actual identity, I can appreciate the value of a separate, anonymous online identity as you alluded to.
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