How to Pay for Medical School

[Rex66]

Medicare does provide the standard by which all insurances base their rates.

Not a lot of kids on Medicare but what Medicare pays affects everything

[Young Boglehead]

To answer the question though, if you do go through with this, don't compound the error by paying for your education out of your own pocket. Hospital employment is getting more and more common nowadays and PSLF is real and works. If you did something like cardiology you would have like 7-8 years of tiny resident payments a couple of attending level payments then its wiped tax-free. That possibility is way too valuable to throw away by paying outright.

[yankees60]

Medicare does provide the standard by which all insurances base their rates.

Not a lot of kids on Medicare but what Medicare pays affects everything

The Managing Partner of that pediatric practice once told me that their gross billings were "funny money" as all that mattered was what insurance paid them.

[cmr79]

I am definitely going through a mid life crisis if some sort, that is true. I feel like I have reached the peak of my current career as an airline pilot. I have low expenses and hobbies that are mostly free.

I can use my savings and still have long enough to catch up if I don’t want to retire early.

Do you have some sort of compelling backstory, like you were part of a medical emergency during a flight or have an interest in combining your expertise into an aerospace medicine/flight surgeon career?

I knew several nontraditional/older students in medical school, and it is definitely a tougher path to travel for reasons that have been well established above. If you are truly dedicated to this, it needs to be because you view this as a calling and something you NEED to do, not because it is a financially good or bad idea (financially it almost certainly won't pencil out over continuing your current career, but it sounds like you don't think what you are currently doing is sustainable anyway).

If so, you need to come up with a way to convince at least one med school admissions committee of both your conviction and your ability. You will absolutely be penalized/scrutinized for your age and nontraditional path, even if no school would admit to this, as others have mentioned. You will need excellent grades on recent premed course requirements and above average MCAT scores compared to the places you apply. You will probably need to apply to 20+ schools, including most/all in the NE/Mid-Atlantic region if you have a desire/family reasons to try to remain in that area.

If you are seeking greater meaning in your work, have you considered switching from being an airline pilot to an area of aviation you might find more meaningful, perhaps something medically related like being a medical air transport pilot? Your background may be helpful in a management position in a medical transport service, whereas it will mean very little to being a subspecialist physician outside of the niche field of aerospace medicine.

If you just feel very deeply that you want to be in a purely clinical role and make a complete break from your aviation past, you should also consider PA programs. The training pathway is much shorter and the programs are generally much more accepting of nontraditional applicants. If you don't intend to work in a clinical role beyond normal retirement ages or would want to work part time after your early to mid 50s, the financial and time penalties of medical school/residency/fellowship probably won't have time to pay off vs becoming a PA and working in the exact same field in a supervised role.

I have been involved in a handful of medical emergencies in flight. I had a great conversation with a physician that helped on one of the flights. I do not have experience in healthcare other than those experiences. My father had some major issues with his heart and I really became intrigued in Cardiology and the events that went on with that. This is one of the specialities I was interested in. I have not done any volunteering or shadowing yet. The postbac program is something I will need as well. My GPA was not the greatest in college.

I would rather go for MD instead of PA. I tend to go all the way with things and would rather stay in my current role than settle for PA school, not that there’s anything wrong with that. I am tied down a bit to the region I am in for family reasons.

Being both tied to a specific region and potentially interested in one of the most competitive areas within medicine are going to be two big, steep mountains for you to climb. It is also a long career path...you are looking at likely 13+ years before you could be a practicing cardiologist. You will need to be willing to do several things if you want to pursue this:
1) Really commit to a post-bac program or perhaps a masters degree in a relevant science discipline including some degree of involvement in a scientific research project
2) Find a way to get more exposure to clinical medicine than a little casual shadowing...for example, regular involvement in volunteering in a medical field over the period of time that you are doing coursework
3) Take an MCAT prep course and ace the exam, by which I mean getting a score that is a standard deviation above the schools you are targeting for applications
4) Apply to a LOT of schools. Med school is the gateway to residency, which is the gateway to acceptance to cardiology fellowship. You need to climb the ladder at each step; the better the med school you can get into, the more likely it will be that you get into a really good medicine residency which will have higher match rates into cardiology (or another reasonably competitive subspecialty like GI, pulm/CCM, heme/onc). For some other subspecialties like rad/onc, anesthesia, a lot of surgical specialties, derm, there is a direct entry from med school to subspecialty residency as the initial transitional year is either applied for in parallel to residency or is formally combined into the program, so there are even fewer opportunities to climb that ladder. Limiting yourself geographically limits your chances to both get into a school in the first place and also likely ours a glass ceiling on the quality of the program you get into.

I think it will be a knock on your application if, as a nontraditional older applicant, you don't have a pretty compelling story and a pretty specific interest in medicine. You really need to be able to convince an admissions committee that is going to be inherently skeptical of you that you deserve to be there...most of these committees will be rejecting 90-95% of the applications they review. And then you'll have to do it again for residency...and again for fellowship. It would be easy for this to become a Sisyphean struggle for you at any step, and needing to wait a year and reapply because you were too restricted with geography or didn't have a well defined plan to pitch to an admissions committee will really hurt you at your age.

Probably a good idea for you to do some shadowing before even starting on a post-bac program, especially since it is unlikely that you would be able to start coursework for a program before January at this point anyway. Maybe you'll find that this really is just a midlife crisis that you are currently experiencing, and that your idea of it being cool to be a subspecialist physician is either superficial or is an attempt to address some other deeper psychological need (i.e. "My parents always wanted me to be a doctor/lawyer when I was little and I didn't apply myself enough and disappointed them; maybe if I went back and did it now it would make them proud" or something along those lines).

[snowday2022]

Making $250K a year now, with your savings, you can work for 10-20 more years and do whatever you want in life, totally free and independent. Why blow that?

Exactly my thought. No mortgage, $1.8M portfolio? I'd be getting close to FIRE at that point.

On the other hand, OP has a NW over 2M. Even if he pays cash for med school and saves nothing, his investments will continue to grow. He could go into a low paid specialty and can still FIRE just with compound interest. There is more to life than money and this has always been his dream.

Hate to be this way, but a "dream" is just not enough. I always dreamed of becoming an astronaut. Its not gonna happen for me. I never dreamed of becoming a surgeon, but here I am.

Dreams don't pay the bills. Dreams don't help when you're up all night operating for 3 days. Dreams don't help when you miss your kids baseball games, birthdays, graduations. They don't help when you're arguing with your spouse because your program director gave you 1 week off for paternity leave (it used to be less). They don't help with words like "forbearance" and "default". Don't help when you get assaulted by a patient, or when one dies with your hands in their chest.

This is a financial forum. For OP this is a very bad financial decision.

There I said it.

I feel your pain. I am a surgeon and work long hours. I took off Fri/Sat/Sun when one of my kids was born. Back at work at 6 Monday morning. Another kid, I left a few days after birth for cross country residency interviews. I try to get home for dinner, but I sometimes don’t get home until my kids are asleep.

Still, I make very good money. I should be FI about 8 years after finishing fellowship, before I am 45.

But, I would have been FI much earlier if I had not spent 13 years after college in training, and gone into tech or finance like many of my college buddies.

OP is already approaching FI (not sure about their expenses but presumably low to have accumulated 1.8M and a paid off house at age 30). He can afford to make decisions that are not financially optimal. Flying planes probably gets boring after a while. This path will certainly not be boring, at least for the next 15 years. Eventually even saving lives and cutting into the chest gets routine…

[yankees60]

Eventually even saving lives and cutting into the chest gets routine…

!!!!!!!!!!!!!!!!!!!!!!

[Amanda999]

... And you mentioned having no interest in ever marrying or even dating...

OP's married.

I don't particularly like my spouse to begin with, so I couldn't imagine sleeping next to her. Separate beds are the way to go, especially if you are on different schedules or one is a morning person vs night owl.

posting.php?mode=quote&p=7696317

[folkher0]

I think this thread ought to be locked. OPs question is answered every conceivable way.

Good luck OP.

[SpaghettiLegs]

I wouldn’t worry too much, OP, about starting medical school at age early 30’s. I started medical school age 31, served time after a medicine internship as a Navy GP, then went back and did emergency medicine residency (including yes, a second internship!) at age 40. Having lived a real life and worked a real job will make you a better medical student and probably, as you start out, a better doctor. Physically I don’t think the age was an issue, but I had worked quite a bit beforehand in stressful situations and no sleep as a shipboard naval officer and firefighter/paramedic. One challenge for me, however, as a late bloomer, was just being different stage of life than my peer group, especially as a 40 year old intern.

I do worry however that maybe you need more exposure and knowledge of what you’re getting into. In your shoes I would, while working on prereq courses, try to get involved in some aspect of medicine. Maybe work as a scribe for an ER doc on weekends. You’re going to need to show an admissions committee some type of experience like that anyway.

I don’t have a strong opinion on method of paying for medical school, except for I would be hesitant to self pay. Many post residency jobs will include some level of loan repayment.

[ResearchMed]

... And you mentioned having no interest in ever marrying or even dating...

OP's married.

I don't particularly like my spouse to begin with, so I couldn't imagine sleeping next to her. Separate beds are the way to go, especially if you are on different schedules or one is a morning person vs night owl.

posting.php?mode=quote&p=7696317

Previous posts make all of that much less clear, including any future plans (and I started my post with "From your previous posts...).

So aside from the "I don't particularly like my spouse to begin with, so I couldn't imagine sleeping next to her."
(And it's not necessarily clear if that is the child's mother, so in the longer term...?)

Hi all,

I often read threads on BH regarding financial planning for married couples with or without children, and not as many for single folks.

I am a single guy (26) who will likely never marry or even engage in dating; it's just not my thing and I get very uncomfortable when thinking of doing so. Are there any considerations for a single person when it comes to investing/saving that's different than for married people? Perhaps paying for LTD insurance since I won't have a spouse's income to rely on? Or taking some larger risks with investments since I could afford to lose more? Or even just investing less than what I have been doing, since I may not need a large nest egg to live off of. I also don't think I will ever need a mortgage for a primary residence (haven't ruled this out yet for rental property).

I have a home in a nice location that has no mortgage that I could move into anytime. So not having to save up for a primary residence is one less thing for me to worry about. I just wanted to get your take on any differences for us single people. Thanks.

Regards,
Austin

Hi everyone. I am making it a goal for the new year to get all my estate planning done and need some advice with it, specifically term life insurance and trusts.

I am 28 y/o and have a 4 y/o child. I am separated from the child's mother. My NW is ~$1.6m. I am shopping for term life insurance based on some recommendations from the forum as well as people I have spoken to. I am thinking of getting between $6-8 million in a 20-year term life policy intended for my daughter. I am planning on a trust that the policy will pay out and once she is older, she can have full access to the funds. I do not trust my ex's ability to manage this money for her.
...

So I included a query about whether there was a partner who might be affected or give input, as it wasn't at all clear about the current status or even long-term plans (marital or otherwise).

If OP really has heart set on becoming a physician AND has as good an understanding as possible of the pros and cons, then I absolutely wish them well!
But IF there is a significant other long term, that person is, well, significant!

RM

[PeninsulaPerson]

From your previous posts, it seems that you might be uncertain about just what you want to do with your life, so starting a multi-year - and expensive - commitment starting with prep, med school, residencies, etc., might be premature.

You've expressed interest in becoming a master plumber and, separately, an attorney. And also becoming a partner at something, perhaps "a law firm or big accounting"...

And elsewhere, you express concern more generally about where your life is going, or feeling like a loser. (Note: We all tend to have our moments, so please don't misunderstand my comment. It's just that you may still be pretty unsure about just what you want to do...)

And then there is some issue about possibly buying your parents' home for a *very* steep discount [$1.00?] without seeming to understand some of their future health care costs (Medicaid if needed within 5 years) OR... how one would need to structure the purchase so as not to run afoul of tax laws. Some of your ideas seem very close to tax fraud, even if you are not intending it that way. My point here is, again, that you still need to do some serious exploring and thinking about what you are going to be doing.
However, if you are seriously considering med school, residencies, etc., this might not be a good time to buy a house at all. You may not have a lot of choice about just where you spend quite a few years in the coming decade or so.

And you mentioned having no interest in ever marrying or even dating, but then you have a child and are separated from the mother... and then you'd be living with a family (partner and child?). It's not very clear, except your understandable concern about care of a young child in an uncertain world, etc.

And then there is the airplane you were considering purchasing only a few months ago. Are you already a pilot, or would you be starting at ground zero?
And what about your concern about feeling behind with savings? Did that situation resolve in just a few years such that an expensive hobby is also in the cards?

Is it possible that you are having a bit of an early mid-life crisis?
Nothing wrong with that, of course (and you certainly wouldn't be the first!), but you probably should make some decisions before heading off on any of the potentially long-term and expensive trajectories.

Apologies if I've misunderstood your situation. "You know you" much better than any of us can from a few hundred posts on many topics, and there's no surprise there. But it could make it difficult for us to understand your actual situation such that we could make useful suggestions.

If your planning has solidified, perhaps you could add that information?
Some of this could be *very* relevant and important. For example, do you have a spouse/long-term partner and family? If so, how does your partner feel about what life may be like while you get prepared for medical school and then go through that multi-year, stressful process? It's likely tough even with the best support, but if that's *not* there... I'd think long and hard, and have some long and hard discussions.

Good luck with your decision, and I wish you well, regardless of the path you take!

RM

OP, you have gotten wise counsel here.

[Tundrama]

Is this a joke? You are a 30 y/o pilot making $250k. A year or two ago it was in the news that wide body top pay was near $500k….Waaaaay cooler profession than a healthcare provider IMO. I enjoy helping people but think how things would/could be if I did what I really wanted instead of dental school….fly professionally. I remember when I was in undergrad there was an airline pilot in one of my biology classes going back to be a nurse..I couldn’t help but think how baffling that was to me.

For a long time, pilot pay was abysmal. Terrible working conditions and furloughs, bankruptcies, etc. Maybe the guy in your class had to get another job to pay the bills. Thankfully these conditions have improved and I am comfortable financially, but they could also go downhill again. For me, I enjoy the flying, but am always wanting to try something new.

…Four words my friend and problem solved… ‘Bush Pilot in Alaska.’

The flying is the best in the world. Requires some of the most flying skill, other than military, on the planet. Weather, terrain, it’s all there to stimulate the innermost creature that is screaming in your head. There is nothing like flying through a mountain pass with the wind so erratic, you’d rather be anywhere else on earth, than where you are. That feeling will cleanse your boredom pallet.

…and the path there, become an agricultural pilot. And guess what, the questions isn’t whether you’ll crash or not. The only question is the date on the calendar when you will crash.

Ya may think I’m joking but I’m absolutely serious.

It seems to me your looking for a career that will challenge you and make the hair between your toes curl a bit. Alaska bush pilot flying will check the box. Also, lots of these jobs available. You’ll also meet some of the most interesting folks on the planet.

Alaska Bush Pilot or medical school beginning in your 30’s???

You are welcome and Ya owe me a coffee!

[austin757]

... And you mentioned having no interest in ever marrying or even dating...

OP's married.

I don't particularly like my spouse to begin with, so I couldn't imagine sleeping next to her. Separate beds are the way to go, especially if you are on different schedules or one is a morning person vs night owl.

posting.php?mode=quote&p=7696317

Previous posts make all of that much less clear, including any future plans (and I started my post with "From your previous posts...).

So aside from the "I don't particularly like my spouse to begin with, so I couldn't imagine sleeping next to her."
(And it's not necessarily clear if that is the child's mother, so in the longer term...?)

Hi all,

I often read threads on BH regarding financial planning for married couples with or without children, and not as many for single folks.

I am a single guy (26) who will likely never marry or even engage in dating; it's just not my thing and I get very uncomfortable when thinking of doing so. Are there any considerations for a single person when it comes to investing/saving that's different than for married people? Perhaps paying for LTD insurance since I won't have a spouse's income to rely on? Or taking some larger risks with investments since I could afford to lose more? Or even just investing less than what I have been doing, since I may not need a large nest egg to live off of. I also don't think I will ever need a mortgage for a primary residence (haven't ruled this out yet for rental property).

I have a home in a nice location that has no mortgage that I could move into anytime. So not having to save up for a primary residence is one less thing for me to worry about. I just wanted to get your take on any differences for us single people. Thanks.

Regards,
Austin

Hi everyone. I am making it a goal for the new year to get all my estate planning done and need some advice with it, specifically term life insurance and trusts.

I am 28 y/o and have a 4 y/o child. I am separated from the child's mother. My NW is ~$1.6m. I am shopping for term life insurance based on some recommendations from the forum as well as people I have spoken to. I am thinking of getting between $6-8 million in a 20-year term life policy intended for my daughter. I am planning on a trust that the policy will pay out and once she is older, she can have full access to the funds. I do not trust my ex's ability to manage this money for her.
...

So I included a query about whether there was a partner who might be affected or give input, as it wasn't at all clear about the current status or even long-term plans (marital or otherwise).

If OP really has heart set on becoming a physician AND has as good an understanding as possible of the pros and cons, then I absolutely wish them well!
But IF there is a significant other long term, that person is, well, significant!

RM

I did not include the spousal details in the OP. This is my ex-spouse and I have primary custody of our child. So things are not as easy as just get up and move across the country at this point. I know medical school would be going on when my child is in school, so the schedules wouldn’t interfere that much initially. Comes residency, I would really have to do some serious thinking on how to make everything work. Perhaps this makes my plan to become a doctor unrealistic?

In any case, I received great advice on at least getting solid grades on the postbac and doing some medical volunteering to show the admission folks that I am a good candidate.

I would be happy with many of the specialities; cardiology was just one that I have more interest and an inside look into. Or I can stay a pilot and retire pretty early like someone else said. Not really sure what is best for me right now.

[YeahBuddy]

Making $250K a year now, with your savings, you can work for 10-20 more years and do whatever you want in life, totally free and independent. Why blow that?

Exactly my thought. No mortgage, $1.8M portfolio? I'd be getting close to FIRE at that point.

On the other hand, OP has a NW over 2M. Even if he pays cash for med school and saves nothing, his investments will continue to grow. He could go into a low paid specialty and can still FIRE just with compound interest. There is more to life than money and this has always been his dream.

True. Then again, he could find out that medicine isn't what he thought it would be. Many doctors are leaving the profession. Burnout, etc. His dream could become a nightmare. Then OP is out $500k+ plus years of income lost, with nothing to show for it. I guess OP would still be in a very favorable position. But I'll just say this. Medicine isn't what it used to be. It's all big business now. Many are stressed. Hospital boards are changing from doctors/healthcare providers to business people that try to operate hospitals strictly as businesses only. Dollars and cents. Selling off property just to lease it from the new owners, then they run into financial hardships. Primary care and other avenues also pinching pennies and trying to squeeze everything out of their workers. Urgent care and ERs have become primary care for many. But I digress. Best of luck in whatever your decision is, OP!

[bltn]

My daughter finished a surgery sub specialty training after getting an md/phd degree. She was 38 years old when she started practice. She s working 70-80 hours a week on average. Maybe more with her research lab. Fifteen years of training after college. She worked harder during her training than she now works.

My son is applying for a subspecialty program in cardiology after he finishes his cardiology fellowship. Should he get one of the extremely few spots nationwide, he ll finish training at 35. He s also working very long hours.

From my experience with my family, I think that you might do some medically related work while you take the courses needed for medical school application. And continue your present job. That will allow you to continue to accumulate money while giving you an idea about medicine and an idea about the work load you ll face for 7-10 years. In the 2-3 years of preparation for medical school, you may change your mind about continuing on that path.

[yankees60]

My daughter finished a surgery sub specialty training after getting an md/phd degree. She was 38 years old when she started practice. She s working 70-80 hours a week on average. Maybe more with her research lab. Fifteen years of training after college. She worked harder during her training than she now works.

My son is applying for a subspecialty program in cardiology after he finishes his cardiology fellowship. Should he get one of the extremely few spots nationwide, he ll finish training at 35. He s also working very long hours.

From my experience with my family, I think that you might do some medically related work while you take the courses needed for medical school application. And continue your present job. That will allow you to continue to accumulate money while giving you an idea about medicine and an idea about the work load you ll face for 7-10 years. In the 2-3 years of preparation for medical school, you may change your mind about continuing on that path.

It takes a certain type person beyond the obvious intelligence to go through all of that.

I've worked in a CPA firm during tax season but that is only from about early February to mid-April. This seems likes it non-stop tax season plus for 10, 12, 15 years?

[folkher0]

My daughter finished a surgery sub specialty training after getting an md/phd degree. She was 38 years old when she started practice. She s working 70-80 hours a week on average. Maybe more with her research lab. Fifteen years of training after college. She worked harder during her training than she now works.

My son is applying for a subspecialty program in cardiology after he finishes his cardiology fellowship. Should he get one of the extremely few spots nationwide, he ll finish training at 35. He s also working very long hours.

From my experience with my family, I think that you might do some medically related work while you take the courses needed for medical school application. And continue your present job. That will allow you to continue to accumulate money while giving you an idea about medicine and an idea about the work load you ll face for 7-10 years. In the 2-3 years of preparation for medical school, you may change your mind about continuing on that path.

It takes a certain type person beyond the obvious intelligence to go through all of that.

I've worked in a CPA firm during tax season but that is only from about early February to mid-April. This seems likes it non-stop tax season plus for 10, 12, 15 years?

Worse. No one expects you to pick up the phone at 1 am on Sunday with a life or death tax emergency. Not to mention the liability.

[yankees60]

My daughter finished a surgery sub specialty training after getting an md/phd degree. She was 38 years old when she started practice. She s working 70-80 hours a week on average. Maybe more with her research lab. Fifteen years of training after college. She worked harder during her training than she now works.

My son is applying for a subspecialty program in cardiology after he finishes his cardiology fellowship. Should he get one of the extremely few spots nationwide, he ll finish training at 35. He s also working very long hours.

From my experience with my family, I think that you might do some medically related work while you take the courses needed for medical school application. And continue your present job. That will allow you to continue to accumulate money while giving you an idea about medicine and an idea about the work load you ll face for 7-10 years. In the 2-3 years of preparation for medical school, you may change your mind about continuing on that path.

It takes a certain type person beyond the obvious intelligence to go through all of that.

I've worked in a CPA firm during tax season but that is only from about early February to mid-April. This seems likes it non-stop tax season plus for 10, 12, 15 years?

Worse. Youre not routinely getting called at 1 am on Sunday with a life or death tax emergency. Not to mention the liability.

I did say: "non-stop tax season plus" referring to the hours. But good addition on your part. Takes a unique person to go through all of that. That is why I bristle when people complain about how much doctors charge. Those same people would not be able to put up with 1/1000th of what a doctor has to go through to become a doctor.

[folkher0]

My daughter finished a surgery sub specialty training after getting an md/phd degree. She was 38 years old when she started practice. She s working 70-80 hours a week on average. Maybe more with her research lab. Fifteen years of training after college. She worked harder during her training than she now works.

My son is applying for a subspecialty program in cardiology after he finishes his cardiology fellowship. Should he get one of the extremely few spots nationwide, he ll finish training at 35. He s also working very long hours.

From my experience with my family, I think that you might do some medically related work while you take the courses needed for medical school application. And continue your present job. That will allow you to continue to accumulate money while giving you an idea about medicine and an idea about the work load you ll face for 7-10 years. In the 2-3 years of preparation for medical school, you may change your mind about continuing on that path.

It takes a certain type person beyond the obvious intelligence to go through all of that.

I've worked in a CPA firm during tax season but that is only from about early February to mid-April. This seems likes it non-stop tax season plus for 10, 12, 15 years?

Worse. Youre not routinely getting called at 1 am on Sunday with a life or death tax emergency. Not to mention the liability.

I did say: "non-stop tax season plus" referring to the hours. But good addition on your part. Takes a unique person to go through all of that. That is why I bristle when people complain about how much doctors charge. Those same people would not be able to put up with 1/1000th of what a doctor has to go through to become a doctor.

Like I think you said up thread. Doctors get paid what insurance dictates they get paid. Not more not less. Well actually less because that revenue stream supports doctors, nurses, admin, infrastructure, EPIC, etc.

Believe it or not, underbilling is a problem.

Lots of hospitals closing because they are not financially viable.

https://www.bloomberg.com/news/articles ... -of-losses

[austin757]

I'm a physician, a pediatric sub-specialist. Growing up, all I wanted to do was to become a physician. It was my dream during my whole childhood.

If you don't take ANY of the rest of my advice and you wind up in medical school, for the love of all that is sacred please at least follow this advice: do NOT go into pediatrics. You will be working until you are 75 years old and have very little savings to retire.

The loans vs pay out of pocket is a bit tough to decide but the loans really add up quickly and that debt gnaws at your heart.

I am late 50's now, hoping to get out as soon as possible. I am glad I went through the process of becoming a physician but I am also glad to be close to getting out of there because it is not even remotely what I thought a career as a physician would be.
I worked for two years after college in a research lab and took grad school courses to enhance admissions chances. Got into my top pick medical school, worked harder for four years than I ever did before, or after in my life, graduated mid-1990s. Let me assure you of a few things so far: No, you definitely will not be able to work at all during medical school; you will need a lot of money for tuition and fees; you will need a lot of money for living expenses during medical school and a minimum of three additional years of residency. That's seven years where your $250K income will not be earned.

You are already 30 which probably feels pretty close to 20 for you, but you are not even there yet for applying to medical school because of the coursework you need to complete before starting medical school. By the time you get done pre-application coursework, medical school, and at least three years of residency you will be about 40. Maybe you are in great shape and have great physical stamina. Life changes for all of us around 40. The energy level starts to drop off, the on-call nights get harder, and you missed out on the financial (and career) freedom of 7-10 years of earnings that would make those long work weeks and longer work nights on call seem OK. Then when you have to keep working through your 50s and 60s because of your lost savings into medical school tuition and supporting your life for those years of training, you are going to be one really bitter, burned out middle aged guy who feels like you made a giant mistake.

Best case scenario is you somehow get to be a cardiac or neurosurgeon, although entering those residencies in your late 30s is going to be a hellish experience, but you get through it somehow and make a million dollars a year until you are 55 and you retire (if you had the discipline to live the whole time like a guy making $250K instead of a million) and then you go find this thread on the Internet and send me a private message telling me what an idiot I was. That's the best case. I guess I would have to quote Clint Eastwood here: How luck do you feel....?

Making $250K a year now, with your savings, you can work for 10-20 more years and do whatever you want in life, totally free and independent. Why blow that?

Let me lastly state for the record that as I said, becoming a physician was my dream when growing up, but if I somehow wound up in your shoes, age 30, your income, no medical career so far, there is no way in any universe or set of circumstances that I'd NOW try to go to medical school. And, like I said, please whatever you do, please do not go into pediatrics. You will work as hard or harder than any adult physician and make 50% of what they make. Best wishes to you for whatever you decide.

If money wasn’t my driving factor, would you consider any pediatric sub-specialty? I could see myself doing pediatric cardiology or heme/onc. Are there any positive things about your speciality?

[grok87]

Since you have $1,200,000 available for this expense, I would recommend you use it and not take out loans.

Also read IRS Publication 970 especially about the Lifetime Learning Credit. Your income appears to be too high, but maybe with knowledge you can financially engineer your income to your benefit.

https://www.irs.gov/pub/irs-pdf/p970.pdf

Modified adjusted gross income (MAGI) limits. For2023, the amount of your lifetime learning credit is gradually reduced (phased out) if your MAGI is between $80,000 and $90,000 ($160,000 and $180,000 if you file a joint return).
...
What is the tax benefit of the lifetime learning credit?
For the tax year, you may be able to claim a lifetime learning credit of up to $2,000 for qualified education expenses paid for all eligible students. There is no limit on the number of years the lifetime learning credit can be claimed for each student

[Rex66]

Medicare does provide the standard by which all insurances base their rates.

Not a lot of kids on Medicare but what Medicare pays affects everything

The Managing Partner of that pediatric practice once told me that their gross billings were "funny money" as all that mattered was what insurance paid them.

Yes but what insurance pays them is directly related to Medicare rates

[yankees60]

Medicare does provide the standard by which all insurances base their rates.

Not a lot of kids on Medicare but what Medicare pays affects everything

The Managing Partner of that pediatric practice once told me that their gross billings were "funny money" as all that mattered was what insurance paid them.

Yes but what insurance pays them is directly related to Medicare rates

Just to throw in here tangentially related that last night I did drive by that pediatric practice. I last worked for them about 15 years ago.

[momopi]

I am 30 y/o and am in a position where I would like to leave my current role and become a physician. I wanted to get opinions on if I should just pay out of pocket or get some type of loans.
I am in the early stages so haven’t figured out where and when I will be going, or if I can even get into medical school yet. I need to take prereq classes or do a postbac to get my GPA up as well.
-$1.8m investments ($1.2m in taxable in Vanguard ETFs, $600k in 401k, IRA, HSA. $250k in AAPL.
-House is paid off
-Make ~$250k/yr and plan on working while obtaining my postbac/prereq classes to save up more money. Would likely not work at all during medical school.
I know I likely would not come out ahead financially doing this, but it is something I would like to try. How would you go about paying for all this and any other tips?

Here in California our CSU have "pre-health" programs that may interest you: https://extension.fullerton.edu/info/prehealth.aspx

For med school, leave your investments in investment accounts and seek student loans.

Talk to doctors and ask which specialty has the most job offers that will also payoff your student loans if you agree to a multi year contract. Psychiatry seem to have such offers from employers.

[savings_maxer]

...........

[flyhalf]

I am definitely going through a mid life crisis if some sort, that is true. I feel like I have reached the peak of my current career as an airline pilot. I have low expenses and hobbies that are mostly free.

I can use my savings and still have long enough to catch up if I don’t want to retire early.

FWIW I'm a physician on the downslope of my career and my neighbor is a pilot for Alaska Airlines. I often think "How cool would it be if I were on the Hawaii route every other week!". The grass is always greener...

[JPM]

When high school kids ask me about becoming a doctor, I tell them that if they love science and are sincere (and I really do mean sincere) humanitarians that they will be happy in the work. You have to be the kind of kid who got as big a charge out of having your high school or undergrad chem and physics experiments come out as you do when you make a double play or a good fast break in your sports. You have to really like your volunteer work and to like and admire the people you work with in your volunteering. If that sounds like you, go for it, you'll probably love it. If it doesn't sound like you, forget it.

Embarking on physician training is not something to do for the money, there are easier and faster ways to become rich, and it is not something to do to scratch an itch or as therapy for a midlife (is that all there is?) type of crisis. For the OP, this is post-bac + 4 years med school+3-5 years residency+2-3 years of fellowship. That is a lot of time out of your 30s and 40s and doing it while divorced and raising a kid is a daunting prospect.

As for paying the cost, 5% of your $2MM per year should do it for you. Or you could borrow the money.

You may have to give your kid to your spouse during the clinical years of med school, residency and fellowship as those all entail night and weekend duty hours. Eighty hours is often not enough and you may bend the rules in order to work more hours off the books to get your numbers up to what you need to qualify for your board exams.

[savings_maxer]

...........

[yankees60]

Medicare does provide the standard by which all insurances base their rates.

Not a lot of kids on Medicare but what Medicare pays affects everything

The Managing Partner of that pediatric practice once told me that their gross billings were "funny money" as all that mattered was what insurance paid them.

This is a really out of touch comment as the uninsured are charged the gross amount and have to pay it or be sent to collections.

Glad to see the person running that practice doesn't consider uninsured people important.

You are reading way too much into that 1 sentence.

I once asked the practice manager how that managing partner was able to have billings So much higher than all the other doctors. She replied and that he was gifted And being able to see a lot of patients yet making each patient think He was giving them all the time that they needed And not feeling rushed.

Plus this practice is in Massachusetts where Health insurance Has been mandatory for decades And anyone who could not afford it Generally easyily fits on a state health program. So these not being adults I would think that few of them were not having their bills paid in some way.

[JPM]

Pediatrics (and obstetrics?) are increasingly dependent on Medicaid payment rates. About 40% of babies born in the US have been born on Medicaid in recent years. Payments vary from state to state and tend to be more generous to the doctors of mothers and their children than to the doctors of other adults, otherwise many OB and pediatric practices would be uneconomical. In the 1970s I worked in a Medicaid clinic where the Medicaid payment was 75% of the private insurance payments for our routine primary care services. By the time I left practice almost fifty years later, for adult medicine it was about 12% of the usual Medicare charge in Illinois. Medicaid is a state-by-state program and how generous its payments are varies state to state. Wisconsin, though a poorer state, pays better than Illinois a richer adjacent state. The percentage of babies born on Medicaid varies state to state as well, being highest in Louisiana at 60% and lowest in Utah at about 20%. Wisconsin is at about 35%. I would not advise a young doc to consider pediatrics unless he/she was dedicated to children's wellbeing. One of my classmates spent her entire 45 year career in pediatric oncology, bless her soul. Wonderful woman to say the least.

[savings_maxer]

...........

[folkher0]

Medicare does provide the standard by which all insurances base their rates.

Not a lot of kids on Medicare but what Medicare pays affects everything

The Managing Partner of that pediatric practice once told me that their gross billings were "funny money" as all that mattered was what insurance paid them.

This is a really out of touch comment as the uninsured are charged the gross amount and have to pay it or be sent to collections.

Glad to see the person running that practice doesn't consider uninsured people important.

You are reading way too much into that 1 sentence.

I once asked the practice manager how that managing partner was able to have billings So much higher than all the other doctors. She replied and that he was gifted And being able to see a lot of patients yet making each patient think He was giving them all the time that they needed And not feeling rushed.

Plus this practice is in Massachusetts where Health insurance Has been mandatory for decades And anyone who could not afford it Generally easyily fits on a state health program. So these not being adults I would think that few of them were not having their bills paid in some way.

Or you're being naive.

Gross billed amounts are passed onto patients in the case of denied OON charges and used to distort pricing. Just because most people have insurance doesn't mean all claims are covered by insurance (and I'm not talking about copay/coinsurance, I'm talking about denials).

https://www.ajmc.com/view/battling-the- ... twork-care

"Conclusions: Chargemaster rates on uninsured and OON patients impose significant financial burdens on the vulnerable, distort medical prices, and inflate healthcare costs."

Fancy private practice pediatricians in an affluent area may get private pay patients. Probably more common 20 years ago. Nowadays still possible, but most offices rely on insurance payments. Most kids are insurable through one mechanism or another. If a practice doesn't accept medicaid, families are usually told this at the outset when presenting their insurance. Believe me, practices don't want to deal with out of network charges. They rarely get paid.

So was this group getting rich by charging high rates for vulnerable out of network pediatrics patients who didn't expect it? Conceivably. Is it more likely that those charges were never collected or at best collected at pennies on the dollar? Probably more likely.

But I don't know I wasn't there. Neither were you. A little presumptive to try to apply a blanket statement about OON charges to a specific situation you (or I) know nothing about.

[yankees60]

The Managing Partner of that pediatric practice once told me that their gross billings were "funny money" as all that mattered was what insurance paid them.

This is a really out of touch comment as the uninsured are charged the gross amount and have to pay it or be sent to collections.

Glad to see the person running that practice doesn't consider uninsured people important.

You are reading way too much into that 1 sentence.

I once asked the practice manager how that managing partner was able to have billings So much higher than all the other doctors. She replied and that he was gifted And being able to see a lot of patients yet making each patient think He was giving them all the time that they needed And not feeling rushed.

Plus this practice is in Massachusetts where Health insurance Has been mandatory for decades And anyone who could not afford it Generally easyily fits on a state health program. So these not being adults I would think that few of them were not having their bills paid in some way.

Or you're being naive.

Gross billed amounts are passed onto patients in the case of denied OON charges and used to distort pricing. Just because most people have insurance doesn't mean all claims are covered by insurance (and I'm not talking about copay/coinsurance, I'm talking about denials).

https://www.ajmc.com/view/battling-the- ... twork-care

"Conclusions: Chargemaster rates on uninsured and OON patients impose significant financial burdens on the vulnerable, distort medical prices, and inflate healthcare costs."

Fancy private practice pediatricians in an affluent area may get private pay patients. Probably more common 20 years ago. Nowadays still possible, but most offices rely on insurance payments. Most kids are insurable through one mechanism or another. If a practice doesn't accept medicaid, families are usually told this at the outset when presenting their insurance. Believe me, practices don't want to deal with out of network charges. They rarely get paid.

So was this group getting rich by charging high rates for vulnerable out of network pediatrics patients who didn't expect it? Conceivably. Is it more likely that those charges were never collected or at best collected at pennies on the dollar? Probably more likely.

But I don't know I wasn't there. Neither were you. A little presumptive to try to apply a blanket statement about OON charges to a specific situation you (or I) know nothing about.

Thank you. As I said early above ... I've had nothing to do with them for 15 years. Memory is not that great on all the details I'd deal with each month. But I think you have the correct assessment of what was going on.

[HighC]

Went to med school at 40 at a fancy school after having a full first career. Picked a chill specialty and residency in the community (no overnight call, no super long hours) that fit my stage of life. Main keys to success: supportive family, financial stability, high motivation. I enjoy my work a lot. No regrets.

PS- stay away from primary care!

[austin757]

Went to med school at 40 at a fancy school after having a full first career. Picked a chill specialty and residency in the community (no overnight call, no super long hours) that fit my stage of life. Main keys to success: supportive family, financial stability, high motivation. I enjoy my work a lot. No regrets.

PS- stay away from primary care!

Very cool. Mind giving us an idea of your specialty? It seems that a "chill" specialty without long hours or overnight suggests primary care based on what I have researched.

[HighC]

Psychiatry. Very balanced lifestyle if desired. In HCOL areas can pretty much make as much as a neurosurgeon if you want as supply-demand mismatch is profound and you don’t have to deal with overhead, insurance companies or the like.

[sketchy9]

It's a brave new world with residency. In some institutions residents are unionized and salaries have been negotiated upwards as a result. The major university near me has senior residents in the low 6 figure salary range, so the idea that you would need to subsidize your living expenses as a resident may or may not be true, depending on where you would match.