Just adding my two cents:
Merit aid at med schools is a moving target and may very well change by the time yours applies. 80% of my peers (med school grads 2000-2005) took out loans(rest had parent help–my husband and I did not), and almost all of us have paid them off by now. My husband and I both had loans. Many medical schools that are public are cheaper if you are a state resident, so that is huge savings. Proving state residency can be tough, as some look all the way back to where you lived in HS. My final decision was between my “state” med school and a private top-3 med school . I did my homework and asked a lot of questions about med student research awards as funding, which is available at some med schools. The top-3 school had fellowships that completely covered tuition and books plus a small stipend for one of the four years, less than half of the students usually applied, and over half got one of the awards. Doing the math, I knew that if I got one of the fellowships, the "top 3 " school would mean a lower 4-year cost than the state school . I took a chance, put a huge amount of time and effort into my application when the time came, and it worked out–I got a year of med school almost free. My husband got into an out of state med school so his was as expensive as my private one. However, by the time he was a 3rd year, we were married and already had purchased a home in the state (I was already done), so he applied for in-state tuition. He was denied, but encouraged to try again the next year. He did, and still had to appeal it again, but eventually he got in-state tuition for his final year. He had a few classmates who got research awards at his school(they were rare at his school, and mostly all for the surgeons, which he is not , so he did not try for those). There are also some fields and some schools which offer full tuition repayment if you work in an underserved area after residency, usually for 2 yrs. Basically, in summary, there are ways to cut costs, but even if you cannot cut costs, the majority of med students have no parental help and pay off their loans just fine in 12-15years.
Of course if one actually wants to be a physician scientist an md/PhD is worth doing. I assume we are not talking about such people like myself. Being a physician scientist also comes with a pay cut regardless of specialty since research makes less money than clinical. That’s why the MSTP exists. It would be impossible for anyone outside of the upper class to do md/PhD without it.
Even if with interest, the loans come out to 400k (because if you are talking about 400k pre interest you are using a small minority of students to make your argument since 85% of students have <300k in debt including UG when they graduate so the number <400k is probably over 95% https://members.aamc.org/iweb/upload/2017%20Debt%20Fact%20Card.pdf).
You really don’t need a high paying specialty to easily eclipse that with 4 years of salary, and fine, we’ll throw in the fact that the md/PhD student made 200k total over the 8 years. The LOWEST paid specialty has an AVERAGE salary of 200k/yr https://www.medscape.com/slideshow/2018-compensation-overview-6009667 so in one year the lowest paid specialty will make as much as the MD/PhD student does over their entire training and then the next 2 years they make the 400k in debt and then there’s and extra year to come out 200k ahead. It only goes up from there.
I wanna be brown, I don’t disagree that md PHD are often a bad financial decision, I disagree that they always are. I think your numbers are off in two, maybe three significant ways. First, I am using the 400,000 because people on this forum are not going to medical school for four, five or six years. So, I am anticipating continued increase in costs and not the costs from when people borrowed five six seven or ten years ago. Second, you are comparing tax free and taxed benefits. If you make 200,000 you take home a lot less. Third, more and more doctors are taking salaried positions. If you want to be a cardiac surgeon or dermatologist in Los Angeles then md PhD is a bad investment. If you enjoy research, may want an academic career, and have no interest in a big money job as a specialist, i am not
Convinced that coming out debt free with the freedom to take a research or low paying but rewarding position is a bad financial decision. Either way, you make a great point that needs to be considered seriously.
Md/PhD stipends are taxed and we came dangerously close to having our tuition waivers taxed too. Clinical medicine will always pay better and have greater job security than a research position. I think you are vastly underestimating the proportion of clinical careers that will easily recoup the losses and come out on top.
And we still haven’t addressed the fact that getting into md/PhD programs and getting out of them are much harder than straight MD. It’s a far simpler money saving process to just choose cheaper schools or one of the other money saving options than try to do an md/PhD.
I dont know if it is still true, but when my kiddo was applying to med school, she got a 40k per year scholarship to U Chicago, Pritzger. The thing was, their COA was so high with 4th year to be over 91k, it would have still been more expensive than the school she eventually chose because of her schools generous need based aid.
ETA. Daughter’s state school did offer her a $10k per year “diversity” scholarship, but they said they couldn’t guarantee the funds would be there every year for it. Huh? No thanks.
I’m not underestimating anything. Tuition waivers are not taxed and stipend tax rate would not be same as high earner physician. I understand how hard it is to get md PhD but I do think it is simply wrong to say that it is always a poor financial move with tuition going up and more doctors on salary, particularly if you like research. A top applicant should consider that option if they like research and should not pass because of generalizations that suggest it is always a money loser. We can agree to disagree.
I’m not talking about people interested in research. I don’t know how many times I need to say that. It’s an apples and oranges discussion to discuss whether md/PhD is a good financial choice for someone who wants a significant research career vs someone who doesn’t.
You’re right, a 25k income has less tax collected than a 200k one, but MSTP stipends are taxed the same as any other job that pays 25k.
You are correct that currently tuition waivers are not taxed but Congress was considering reversing that this past academic year and mstp students would then start having to pay taxes on their md and PhD tuitions. https://www.npr.org/2017/12/18/570941259/grad-students-tuition-waivers-will-remain-untaxed-after-all
The fact is this conversation is mostly a moot point anyway. MSTP adcoms spend significant energy sniffing for people looking for “the free MD” and very consciously make sure they are accepting people “committed to the goals of MD/PhD training.”
Let’s be clear, for the overwhelming majority of medical school applicants (exceptional or otherwise), going the MD/PhD route in order to make medical school less expensive is putting the cart before the horse. Anyone who does not anticipate a research forward career is wasting everyone’s time, and their own, going that route.
Current best practice for those looking to limit their medical school costs should be the following:
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if accepted at multiple schools, go to the cheapest one, unless there are extenuating factors that severely favor the more expensive school. I would have strongly advised the HMS vs full COA scholarship recipient to use the intellect that got them to that spot and go with the scholarship, but HMS vs normal state school would tip towards HMS.
**Given how few people get multiple acceptances though, many students have zero choice and have to make do with what they have. -
consider military options, but do your research as to what that entails.
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live as cheaply as possible as a student. If you can live a home, do so. At least have roommates to defray costs.
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Read the White Coat Investor website thoroughly. Lots of tips and tricks on how to manage loans there.
Missed my edit window, but wanted to add the following:
Simply put, most people looking to limit their medical school costs are doing so (rightly, I might add) as to improve their financial status AS AN ATTENDING. The time and opportunity costs associated with the MD/PhD route do not achieve that circumstance reliably. MSTP is a direct counter response to that reality in which there are severe financial disincentives for students to become physician scientists The comparison isn’t the person looking to become the LA dermatologist who never would have been the person looking to do MD/PhD. It’s not even the typical pediatric subspecialist who is resigned to academic medicine because their clinical practice can’t support their own salary were they to go it alone. MD/Phd and MSTP really should be only considered by those who might otherwise go get their PhD anyways but their research interests benefit by the access an MD degree provides (to patients/research subjects, to specific fields like cancer or drug development, etc).