Specialties with good loan paying options

Pre-Med & Medical School
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As regulars on here know, my guy is just in his second year of residency as a neurologist and has two years to go, plus probably another couple of years doing a fellowship. He has 6 figures in med school debt which worried me prior to his going that route, but it’s what he’s wanted to do since he was 8 years old and he’s still loving it, so no regrets.

Both last year and this he’s shown me some impressive offers for employment he’s received - offering to pay off up to 200K in loans, 100K in a sign on bonus, competitive salary (whatever that means), regular hours - one place only required 26 weeks per year, others have about 6 weeks paid time off annually, etc. I’m far less worried right now. Barring some major change between now and when he’s actually looking, he should have terrific options, esp since he’s open to various locations. It’s not like he’s just had one and “everyone” is clamoring to get it.

So… now that I’m back in high school, albeit occasionally, if I get talking with pre-med wannabes, I’m less concerned with their taking on high debt, at least for some specialties. Are there others I should offer as paths to consider? I already know full well that specialties are competitive to get into, etc, just as med school is. I just want to add “more” to knowledge I can pass on, both options and cautions.

The military has been one option I’ve known about. My guy’s roommate took that option. He’s less than thrilled about it now TBH since he got where they put him vs what he wanted, so that’s a caution.

It’s super common around me for kids to need high loans if heading to med school. Few parents are full pay for anything.

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The problem is that a high school or college pre-med does not know which medical specialty they will get into. Taking on debt based on a higher paid specialty is like a high school student taking on college debt based on future employment in something high paid like elite investment banking or management consulting.

In addition, while in medical school, a medical student may find a calling to some specialty that is not one of the higher paid ones. Taking on a level of debt that requires elite level pay can be a trap if the person decides that their true interest is in something that is paid somewhat less.

Granted, there may be some situations (e.g. poor family in rural Pennsylvania) where college may require a choice between high debt and higher debt, but the higher debt choices do still increase the financial risks.

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I admitted to already knowing this. :wink:

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Not sure I understand your question. I know pediatricians (low paying specialty) who are easily paying off their loans, and cardiologists (high paying specialty) who claim they’ll make their last loan payment the month their first kid graduates from HS.

it’s all about lifestyle in my view. You want the Mercedes with MD plates? That’s going to cost money. One of my neighbors is a hospitalist- she’s got undergrad loans, med school loans, has found time to have four kids (all under the age of 6- yes, there were multiples) and has a great quality of life. But as a casual observer- they seem to live the same lifestyle as the school teacher and all the other neighbors with “regular jobs”, all of whom are dual income (as is the hospitalist with loans). She has told me (I didn’t ask) that she and her husband are on a rigid budget to get out from under the loans- but they own a house and clearly qualified for a mortgage (nice house, nothing special), two cars, and the kids don’t look malnourished.

So ANYONE can pay off med school loans IMHO. (and yes, this is a high cost of living area). But you need a plan…the caution is that lifestyle comes in many flavors- affordable, less affordable, and “blow the budget” and that will impact how quickly you can pay down the debt!

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Maybe that’s the info I needed to know - essentially if they make it through to becoming a doctor, loans can be paid off regardless of specialty as long as they budget to do so.

In our area, finances are the most important consideration for most kids heading to school and those wanting to become doctors will have a lot of loans. We Creeklanders spent some time discussing finances with our guy, so I’m relieved to know his should work out just fine. I suspect it’s why he’s showed me the offers. He’s probably relieved too.

If that happens with everyone (who makes it), I can certainly relay that info.

Thanks for your thoughts.

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The highlighted is key. Lower debt (even if the choice is between high and higher) and lower cost lifestyle will mean more career and life choices, as opposed to finding some choices (e.g. a lower paying medical specialty) to be unaffordable on higher debt and higher cost lifestyle.

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I agree with those above who say it is all about budget and lifestyle. ALL physician specialties get paid well, just some more than others. The only ones of my class to have problems are those who started living the rich life as residents (or even in medical school!) Yes, if you graduate $500,000 in debt, and then live a $250,000/yr lifestyle on top of that, you are going to have problems.

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Yes. As long as they get a real job!

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White Coat Investor is great website that has a ton of information about the financial side of medicine. It explains the options for federal loan repayment.

You can also mention the service for scholarship options to your students. Besides the military route, there is NHSC (National Healthcare Service Corps). There are scholarships for physicians, dentists, physician assistants nurse midwives, and nurse practitioners. Physicians are required to enter a primary care field (family medicine, internal medicine, geriatrics, pediatrics or OB/GYN.)

The scholarship covers tuition, fees, books, standardized exam fees and pays a reasonable living expenses stipend. Scholarships are awarded for 2, 3 or 4 years. For every year of scholarship received, the student will owe one year of employment in federally designated healthcare shortage area and earns $40K in loan repayments beside a competitive salary.

The VA offers its own VA HPSP Scholarship program for physicians, physician assistants, clinical psychologists, nurses (including advance practice nurses), medical technologists (MT), and diagnostic radiological technologists (DRT). Service payback requirement varies by profession. Physicians owe 18 months of service at a VA Hospital for each year of scholarship received. Unlike the NHSC, the VA HPSP places no restrictions of the choice of specialty.

The IHS (Indian Health Service) and federal prison system also offer loan repayment as part of their compensation packages for physicians who work for either organization. $40K/year with a minimum of a 2 year commitment.

Many rural area hospitals/clinics offer loan repayment as part of their compensation packages. However, the repayment Is only given after the physicians completes their employment contract with the hospital. (Varies, but 3-5 year contracts are common.)

However, your students need to be aware that medical jobs may not necessarily be located where they want to live. It’s a myth that a physician can find employment wherever they want.

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New attending physicians can get special “doctor loans” to buy a house where no down payment or employment history is required, and education debt is not considered when determining the amount of loan they qualify for. And these loans do not require PMI.

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Great to know!

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Edited to add:

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Page 7 shows that many pediatric specialties are among the lowest paying. So if a physician wants to work with children, the physician has less financial safety margin than in other specialties.

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Thank you for this and for the links. I’ve copied what you’ve written and bookmarked the links. There are students I have in mind who will likely find them useful. It’s much appreciated information.

I can give them ideas about the locations of places searching from my guy’s offers. I just don’t want to post specifics here. Rural areas aren’t likely to be a turn off - one of the offers is within commuting distance from our school.

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Yeah, unfortunately American medicine devalues the specialties that deal primarily with children’s and women’s health.

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Nurse practitioners (and to a lesser extent, PAs) are eating primary care doctors’ lunch - pediatricians, internal medicine, psychiatry, too, even specialties like derm, since an NP can call themselves any specialty they like, without any official training or specific board certification. Seriously - whereas 30 years ago, a busy practice would look to hire another doc or two, now they’ll hire PAs or NPs at lower pay, or a solo MD will hire a number of NPs or PAs to work for him. Or NPs will just hang out a shingle on their own in one of the many states that allow them to practice unsupervised.

It’s really tough for some areas to get enough neurologists or rheumatologists or endocrinologists. These are specialties which can require extra years of training, but aren’t very remunerative, since they require thinking, not much in the way of procedures. Insurance companies compensate procedures much more highly than they do thinking. Hence, fewer MDs tend to go into these low paying, thinking rather than procedure-heavy specialties.

I will be counseling my own kid who plans on MD school to go to the school which will require the least borrowing, since they’re planning on one of the low-paying specialties. I’m hoping that kid can parlay high academic achievement at a tippy-top into a spot at one of the increasing number of med schools offering tuition scholarships.

Assuming that one should borrow heavily for med school and just trust that the money will come is a very bad idea.

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It does come back to lifestyle. My wife is a CRNA. I know the heart surgeons and anesthetists my wife works with do very well.

Her best friend is an OB/Gyn. Does very well too but getting an appointment with her is like getting an audience with the Pope. I wouldn’t want her job. She’s retiring soon. Had enough. Shame because she really is that good. We know several kids and moms that probably wouldn’t be here if not for her intuition.

I would think underrepresented areas would offer paybacks. Rural, inner city, Reservation.

I wonder how psychiatrists will fare? Such a need.

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They do, although these clinics typically pay less. I paid off my school loans at an inner city clinic where the government gave me $20,000/yr in loan repayment. But the clinic paid me only about 60% of what I would have been paid at a regular clinic. I loved that clinic, though…

ETA: Now that I am semi-retired, I am working part time in a rural clinic where I am paid 65% per hour of what I was paid at the suburban clinic where I spent most of my career…and no benefits either. Again, you have to do it for the love of it.

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And yet, that’s what many kids need to do to get there. It’s often a default around me that kids will pick the least expensive school to them. Kids/parents rarely go for prestige here, esp if it’s costly. Sometimes the higher ranked school is actually cheaper (as it was for my son).

We have kids from our school who go into all sorts of medical professions including those you listed and more (techs, etc). They have that info to contemplate.

It’s mainly the money - the amount of loans needed and if that truly works out. It will for my guy. I’m glad to hear of the other options to share too.

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I know kids who do more research on their shampoo and conditioner than they do on their educational loans. They can check ratings, watch videos, invest hours in making sure that their favorite influencer approves of their hair care routine- and when it comes time for loans it’s “What’s a few more thousand dollars, I’ll be in debt forever anyway”.

No. Someone is in debt “forever” because they didn’t have a plan, didn’t understand the terms of their loans, didn’t evaluate other options (It’s amazing how bright young people assume that the federal programs only work if you’re willing to staff a Tribal clinic in North Dakota… not realizing how many urban areas qualify as well. And many inner city clinics are fantastic places to learn primary care because you literally see EVERYTHING and EVERYONE.)

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