Medical School at $278,000 Means Even Bernanke Son Has Debt | Hacker News Reader

Medical School at $278,000 Means Even Bernanke Son Has Debt

bloomberg.com

23 pointssimonreed50 comments

I'm caught in an interesting trap where a third of my friends are set to become doctors, a third investment bankers/consultants, and another third will be going into tech. I'm also in Canada.

When our medical school friends explain their debt, my IB friends get really excited and start cursing them for their luck. Here, apparently, in addition to student loans that don't accrue interest until 6 months after graduation, all medical students are apparently eligible for a $250,000 line of credit at PRIME. Yes, you heard me--PRIME. At this point, my tech friends start to ask why anyone would take debt.

Here in Canada, an emergency doctor would make about $250,000/year in Ontario for working what works out (in shifts) to be about 25 hours per week, after he has finished his residency. Assuming this is a similar situation in the states, I don't see why this is so outrageous at all.

Oh, and Doctor shortage? Really? It's medical schools that cap entrants, not the price. Take a look at all the qualified students who are rejected each year. I know a bunch.

In the states, federal graduate student loans are 8%.

Are you sure? When I did my MBA a few years ago, student loans were about 6.5%, and I thought I heard that rates were lower today.

There are Stafford loans at 6.5% but they only go up to like $20k/year. GradPLUS covers the bulk of the cost and is at 7.9%.

The reason medical schools cap the number of entrants is the same reason they raise tuition exponentially - it's expensive to run a medical school. It has nothing to do with the number of applicants.

Also, 25 hours per week? My wife is a physician. Nobody at her hospital works less than 60. Most work 80 or more. Surgeons are close to 100. For many full time primary care physicians, it works out to about $10 / hour when first starting out.

But that $10/hr is gone once you are out of residency. And particularly for the Surgeons - who are still working 100 hours - the real money starts. Med Schools is a fine financial decision at this point in history. Lots of debt - but lots of jobs, with good pay as well.

I may have to reexamine my chosen career path, and my nationality. :p

In all honesty, this seems almost too good to be true, especially given the state of healthcare in America. At 25 hours per week, it would take three Canadian doctors to perform the labor done by a single American doctor at a significant markup. (At least right out of a residency. I am not entirely aware of salaries, but I've heard on multiple occasions that a new doctor will make between $100k-$150k.) I'm curious as to why Canadian hospitals choose to emplace such short shifts, and why there is such a massive price disparity between nations of similar prosperity and social norms.

> Here in Canada, an emergency doctor would make about $250,000/year in Ontario for working what works out (in shifts) to be about 25 hours per week, after he has finished his residency.

Ya, not even sure if this is true in Canada, but it's not true in the U.S. That would be 2 days a week of typical ER shift work here (12 hour shifts). Schedules vary, but that's a very light schedule.

I'm pretty sure your 25 hour quote is definitely wrong and that the true number for many surgeons is higher by a factor of around four.

That said, it's true that doctors in specialties outside of family practice make an absolutely staggering amount of money, far more than anyone can hope to make in technology outside of an executive career path.

As a physician (with a BS EE/CS degree which is why I frequent HN), I tire of this argument. If one reads the article carefully, they find that the father Dr. Mark Moy attended excellent public medical school (and lower cost) Univ. of Illinois in Chicago while his son is attending the very expensive (and lower quality) Chicago Medical School (not to be confused with Univ of Chicago School of Medicine).

Many graduating doctors get into big debt because they choose to attend private undergraduate and private medical school. Instead of getting into such huge debt, a fiscally responsible medical student should attend a lower cost, quality public undergraduate school and a public medical school.

For example, in New York State, one could attend one of the SUNY schools or the public part of Cornell (the Agriculture school for instance) undergrad and then SUNY Downstate Medical School where they would get outstanding clinical experience for the approx cost of private undergraduate tuition alone.

It seems odd that Berknanke's son would still be in debt if he had attended both public undergraduate and medical schools and does seem so fiscally prudent on the part of the Fed Chairman and his son.

In addition, IIRC, you can have the military pay for full medical school if you serve for four years as a doctor after you graduate if you are not good enough to get into public medical school.

In summary, for most people who complain of medical school debt in this country, it is really a sign of not being fiscally prudent on their part or of those of their parents.

Sure you can save plenty of money going to a public school. But even though $100,000 is less than $350,000, it is still a huge amount of money. Even more once you consider that doctor's have to undergo a residency after med school in which they barely earn minimum wage.

> doctor's have to undergo a residency after med school in which they barely earn minimum wage.

Residents earn between $45k and $60k a year. While they do work long hours (my wife is a neurosurgical resident, so I am quite familiar with the hours), and are grossly underpaid compared to their skills, comparing a resident's salary to "minimum wage" is absurd.

$45k/year and working 80 hours per week works out to $10.82/hour. This may be where the 'minimum wage' figure comes from. I feel like talking about them working for "minimum wage" implies that their yearly salary is much lower than $45k+ per year, which is a bit disingenuous.

That's pretty much where the minimum wage comment comes from. I admit that it is a bit hyperbolic, but they are still ridiculously overworked and underpaid.

"The median four-year cost to attend medical school -- which includes outlays like living expenses and books -- for the class of 2013 is $278,455 at private schools and $207,868 at public ones."

Whether the median is $278K (private) or $207K (public), that's a lot of debt with which to start your residency before starting to practice.

I'd also dispute the "military...if you are not good enough" assertion.

And that's not even considering the interest that accues while you are in residency.

Also, I'm fairly certain that the military (Army?) will pay for your medical school costs, but you still have to go (and be admitted) to a normal medical school.

There are two military options - you can have the military pay your medical costs at a non-military (public/private) school, after which you owe the military x years of service as a doctor in the military. The other option is to go to the military medical school - you're paid standard officer salary to go to school for the y years it takes, and then owe the military x more years service as a doctor.

If you look at it as "getting paid to go to medical school" + "guaranteed employment for x years following medical school" it looks like a pretty sweet gig.

I don't know how much value that "guarateed employment for x years following medical school" is. From what I can tell there aren't a lot of doctors out there hustling for a position.

The military will do so, but you are obliged to work as a military doctor afterwards, and the pay is considerably lower.

The dig on military doctors was unwarranted.

It wasn't a dig. He was simply stating a fact.

On my part, did not mean a dig on military doctors, rather that if one is not good enough to attend a public medical school and instead attend the expensive lower tier private schools one has the option of going to medical school and serve as a military doctor for four years instead. Sorry for the confusion.

I hope what you're trying to say is that you can avoid debt by opting to serve in the military, including 4 years as a doctor after med school.

Any assocation between serving in the military and being "not good enough to attend a public medical school" is offensive and unwarranted.

> Many graduating doctors get into big debt because they choose to attend private undergraduate and private medical school. Instead of getting into such huge debt, a fiscally responsible medical student should attend a lower cost, quality public undergraduate school and a public medical school.

Would it be because the public med schools are incredibly impacted and the private ones are slightly easier, albeit more expensive, to get into?

That's being a little disingenuous. From the article, the expected costs of private schools was ~ $278K, but still $207K for public schools.

I accrued nearly $40K from one year of medical school before I switched to a straight PhD (I was in an MD/PhD program that didn't cover tuition). And that was over 10 years ago. Oh, and I was at Indiana University, a public school (and the only MD school in the state).

My wife, however, did finish her MD (and PhD). She decided to go into a specialty, partially because the salary for general practice physicians (she's a pediatrician) is just too low.

So, yes, medical school costs - public and private - are ridiculously high. Because of this, the number of doctors is just going to decrease. The only ones who are left will be a) those who can afford it, b) those who really want to be doctors - costs be damned. And all of them are going to be overworked. Now, couple that to the fact that GP's don't get paid very much in comparison to specialists, and you have a worse problem.

Summary: the article is right - it doesn't pay to be a doctor.

(Then again, I'm an academic, so I still made a bad choice!)

It's an interesting question - is this in fact a good thing, because we are left with only those who really want to be doctors regardless of how much money they make (and some people from really rich families)? Medicine seems like a field where you wouldn't want people that are motivated by money.

The problem is that large scale debt makes you interested in money AFTER you get the degree. While getting it, the debts on hold, and there is no pressure.

If you want a class of Doctors that don't care about money, have them accumulate moderate debt, and get a nice but not extravagant income. But Huge debt with a just large enough income to pay it off, just makes people who otherwise wouldn't care about cash, start caring about cash.

(This is exacerbated by the fact that many Doc's go straight through and have never had a job until Residency, where they have to pay off the debt - but are not (yet) making enough money to do so. That'll focus your mind on money fast.)

That's predicated on the false premise that being motivated by money is in any way correlated (positively or negatively) with the qualities we want in doctors. Lots (most?) brilliant people are motivated by money.

Brilliance isn't the only thing I'd look for in a doctor... most of the time, you have a very common issue and don't need brilliance. Having several family members who are doctors, I would say the most important thing to me would be compassion.

The median public med school of $207K might be including out of state residents. For in New York State: Public SUNY Downstate tuition: $30K x 4 = $120K Dorm room $5500/yr Other living expenses $12K per year Total $188K http://sls.downstate.edu/financial_aid/costs/CollegeofMedici...

SUNY Undergrad (in-state) About $22K x 4 = $88K http://sls.downstate.edu/financial_aid/costs/CollegeofMedici...

Total (without any financial aid) $188K (medical) + 88K (undergrad) = $276K

This is approximately the same cost as a private undergraduate education including on-campus living expenses (about $250K). Example: Columbia College at Columbia University is approx $62K per year + travel or $248K total + travel. http://www.college.columbia.edu/bulletin/feesandexpenses.php

Instead of attending pricey private undergrad and then medical school attend public undergrad and public medical school for about the same price.

There should be a study of median debt for those who attend both in-state public undergrad and public medical school vs. those who did not make that choice.

(Your SUNY undergrad link is the same as your medical school link.)

The tuition indicated for Columbia is the maximum one could pay, which is significantly decreased by financial aid depending on need -- presumably much more so than at SUNY. Columbia's financial aid includes no loans and the average aid award is about $40k (of those with need, so presumably about $20k over all students).

In addition to Columbia being considered a much better school than SUNY, for many students it may actually be cheaper to go to Columbia ... if they can get in.

I'd say given the salary data, the fact that medicine is a stable and growing field, and the amount of high level training required , these numbers are not really crazy or out of line.

http://www.profilesdatabase.com/resources/2011-2012-physicia...

After six years of practicing, even a non specialized doctor will be at 200K with the lowest starting salaries around 140K. That is a fantastic amount of money when you consider that it is the lower end of the pay scale for doctors and that it will be a completely secure position in which you can work until death or retirement.

250K is a small price to entry into 8Million+ lifetime earnings.

Being highly successful in most fields is equated with 150K and beyond salary point, which comes with increased competition and no job security as you move up the ladder...I don't see this as being a bad deal at all, even for those totally self/debt funding.

Indeed, the salaries in medicine can be so absurdly high that $250k of debt is truly not as much as it sounds.

If a dermatologist starts at $234k, then you could easily pay back $100k/year and still have a very comfortable chunk of change left over. And that's ignoring salary increases. In a few years, you'll be debt free making $350k. And you could see numbers of that magnitude even in cheaper rural areas where you'll live like a king.

And I completely agree with you on job security as well. Once you start practicing, you're pretty much made for life.

And to add to this we are heading into an era of what appears to be declining reimbursements. If not declining, then there certainly have not been increases commensurate with increases in the cost of training. Students are always told there will be a shortage of primary care physicians. I was told the same in the mid 90's as a student. Just because there's a shortage, however, it does not mean that "increased" demand has resulted in increase reimbursements for primary care physicians. Instead, the trend has been the growth of nurse practicioners and physicians assistants assuming greater responsibilities for care, at a much lower cost.

So if you are medical student now, my advice would to practice, of course, whatever specialty makes you happy, but don't fall for the shortage of primary care providers schtick - if that's the reason you choose primary care, you will be disappointed.

Bernanke is a career academic. What would make you think he's particularly wealthy?

My thought too. Even Ben Bernanke. His salary is 180k. Good but not enough to spend 50k a year on med school most likely.

That's something like 1.6 years salary (assuming 6 years of med school)? Seems quite cheap, compared to something like an apartment...

Med school is 4 years at around $65,000 per year (post tax obviously). $180,000 per year post tax is $105,000. So that's 60% of his after-tax income for four years.

But Bernanke can print money for him and for his friends.

You can't.

Of course - you've got to be a True Believer to get that kind of leadership position, and he would have of course taught that to his son. These people actually believe that having any non-monthly expense able to be financed is a good thing, as it is then more "affordable", where affordable means not requiring any sort of planning or saving for the future. Of course this really just causes prices to shoot up, with positive feedback if the good can serve as collateral, which exacerbates the problem causing more people to finance. Essentially they are working to erode the utility of money itself, and revert us back to a social reputation based system where your stature in life depends on your creditworthiness and obedience to your job (stability required to make all those continuing monthly payments).

Maybe, but they also have a stable guarantee of income. They certainly don't live in poverty and fear.

What about the people that drop out of school or residency? Not everyone is going to make it through.

Very very few people drop out or fail out of medical schools. Whether the huge debt load is the reason is another issue.

You'd be surprised how many doctors struggle to get by while paying their debts off. Starting doctors don't get paid very much (considering their debt load).

It's even worse when you factor in their opportunity losses by spending 4 years more in school and 3-5 years more in residency (where you don't get paid much). And if you add in a specialized fellowship? That's 3-4 more years. It's 7-13 years before you actually get to start making real money. And if you're a GP, you're still only making a fraction of what you could be making elsewhere.

This. Becoming a GP in the US by any route other than the military is going to put you way behind just about any of your undergrad classmates with a marketable degree if you consider lost opportunity.

There's also something else to consider. 7-13 years is a long time, and lots of things in your life will change. You may not be able to or want to practice medicine (I know one of each), but that debt isn't going anywhere.

A couple advantages to medicine are that you can keep working consistently until retirement age, and you can essentially work anywhere in the country for a the same salary. A GP may "only" make $150K in Westchester but they can also make $150K in rural Maine.

I disagree, many physician jobs offer loan repayment (of up to $200k) while offering salaries in the upper 300-400s (for many specialties). Surgeons can easily make seven figures depending on what they are doing.

You also have to factor in the job security, the fact that transitions to other roles does not entail a pay cut (as in law or finance) and the potential to be your own boss (run your own practice).

Doctors who make little money (the reason the average is so low) is because they choose to work less hours and spend time with family and friends. It's not as bleak as you think.

> Surgeons can easily make seven figures depending on what they are doing.

That seems like quite an exaggeration to me. Surgeons are highly paid, but in the grand scheme of things very few of them make $1m+/year. And the ones who do so generally do not do so easily. Neurosurgeons and orthopedic surgeons are generally the highest paid of all doctors, but both rarely crack seven figures, and they work horrendous hours in many cases. And becoming a neurosurgeon is simply beyond the ability of most medical students anyway.

Perhaps if you set up a plastic surgery shop in Beverly Hills and hired other doctors under you.

I knew two people in their residency, their problems were a lack of sleep not lack of money. They lived off loans, but they had enough money to eat out everyday. I am not sure about the weight of their loans. The only thing thing I recall it stopping them from doing was buying a fancier house. This isn't poverty!

They didn't eat out because they could afford it. They ate out because they didn't have time to cook or because that's the only real meal they have time to eat.

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