These questions are from a recent Q&A with the fantastic pre-med society at BYU-Idaho. We wanted to be sure to give each question its due attention for their benefit and for any others with similar questions.
How much do residents make in residency?
I remember when I was in undergrad and people would tell me that residents barely made enough to live on and then occasionally, I would hear about “somebody’s friend’s brother-in-law” who is making $300K in his residency.
I now realize that this person was mistaken. Either that brother-in-law is cooking meth in his basement, or he is not a resident.
The good news is that if you know how to work the google button on any internet machine, you can find out exactly how much every resident in the country makes. Medicare funds all the residency positions in the US so they require transparency about salary. It might take a little digging, but they are available.
I can also tell you that there is little variation in pay program to program. The highest paid residents reside in the highest cost of living areas. Therefore, you have to take into account many variables when comparing residency salaries. Also, other perks can make a big impact. Such as free parking, free meals/meal allowance, book/education funds, paying for licensing exams, etc.
A trend you will notice is that big name institutions really cut down on perks because they know they will fill their cohorts regardless of what they offer. Smaller community programs will typically load you up with free food, free parking, and book funds to try and entice you away from the Ivory Towers.
Residents’ salaries start around an average of $52K-$63K (PGY-1). Each year you get a small, predetermined bump in pay with an inflation adjustment built in. They don’t actually care about keeping up with inflation and it’s set at a baseline of 2%. So, when inflation is 8%, like now, you are actually earning 6% less than residents in your shoes last year. Cheers.
If you are interested in finding exact figures and other perks for specific programs, I’ve compiled a list of resources to use to research residency programs here.
What are the options for paying for medical school? How are you paying for medical school?
There are a couple of strategies for getting through medical school with either zero debt or less than average debt. And a few strategies for getting debt forgiven afterwards (if that sort of thing continues).
These are competitive programs that allow you to complete the first two years of medical school, then transition to graduate work for 3-4 years to earn a PhD, and then come back to complete your final 2 years of medical school. Your education will be free, and you typically get a small stipend to live on. But you spend 7+ years just to get your MD. That’s a long time. You’ll be starting residency when all your classmates are getting real attending jobs.
Just had a chat with an MD/PhD who said he definitely regretted trading time for debt. He is going into an incredibly high earning specialty and could’ve paid his loans off in a year if he wanted. He also doesn’t plan on using his PhD, which probably further exacerbates his regret.
I went through all the steps of joining the HPSP scholarship program through the Airforce. Decided against it at the last second.
Every branch of the military has a program where they agree to pay for your education in return for service after completing training. It’s typically 4 years of active-duty payback. You can always elect to stay in as well.
You get tuition, books, and fees covered. They also give you a small living stipend while in school. Sounds really good, especially if you talk to recruiters. Some branches will have special recruiting campaigns where they offer signing bonuses to sweeten the deal (usually in exchange for extra pay-back time).
There are drawbacks though…Particularly if you plan on doing a competitive, high paying specialty. Military matching has some nuance to it and can sometimes make it more difficult to get what you want. If the military has no need for orthopedic surgeons one year, well looks like you’re doing something else for a while until you can re-apply. Sometimes you have to serve as a primary care doctor for 1-3 years as a “flight surgeon” or doing a “general medical officer” tour before you can reapply for the match.
Ultimately, I decided against it because I knew I was looking at competitive specialties with historically higher than average salaries. The math worked out in favor of just pursuing civilian residency and paying loans back quickly.
I can’t explain all the options here in this paragraph, but if you really want an exhaustive rundown that is a quick read and beautifully written, then I would suggest checking out Ben White’s book on student loans. You just enter your email, and he sends it to you. For free. Also, this White Coat Investor post about student loan basics.
The vast majority of you will pay for medical school through federal student loans. And all of you will ignore them until you get to the end of your MS4 year. That’s when you will finally check the total and say “holy crap”.
If you have a desire to serve the underserved, and you plan on practicing a primary care specialty, you can get up to $100K in loans forgiven just by practicing in predetermined health professional shortage areas. There are many of these positions in Idaho, for example. I paid like $6K a year as a medical student to fund the program.
If you plan on working for the government or a non-profit organization, you can make minimum monthly payments for 10 years and have the remaining balance forgiven by the federal government via the Public Service Loan Forgiveness program (PSLF). The process is somewhat convoluted and annoying, but thousands of people are getting their loans forgiven each year. Ben White talks you through the specifics of how to navigate it effectively and how to minimize your payments each month to maximize forgiveness (with several example cases.) Of note, only federal student loans are eligible, so don’t take out private loans or consolidate with a private loan servicer if you want to remain eligible.
Income driven repayment plans are also available. These are plans you will enroll in even if you are shooting for PSLF because they cut down your minimum monthly payment while in training. You make these payments for 25 years and then the remaining balance is forgiven. *This forgiveness is counted as income in the year you receive it, so watch out for a huge tax bill if you go for this option.
This is an option where you continue to ignore your student loans until you graduate from residency training. It may sound good at first, but it is usually the wrong decision for everyone. The various income driven repayment plans can keep your monthly payment low and through the REPAYE program you can get up to 50% of your interest paid for by the government. Which could be the difference of thousands and thousands of dollars.
There are tons of scholarships out there and if you have the time and energy to apply to them, they can really help. Some are targeted to the underrepresented in medicine exclusively, but others aren’t. There may be scholarships offered through your school as well.
How do you find scholarships? Back to the google button. Also, check places like White Coat Investor, they have a scholarship they award and will frequently feature blog posts with lists of available scholarships.
Ask your school’s financial aid office if they have any lists of scholarships. My school would send out emails quarterly with a few scholarship opportunities they had heard about.
Perhaps the best thing you can do is to educate yourself about how saving money during medical school pays dividends. Anything you buy with loan money actually carries a heftier price tag than you realize thanks to your eternal training route and the miracle of interest.
Not everyone can avoid the loans. I certainly couldn’t. But you do your best. You stick to a budget and then pray that PSLF survives long enough to set you free. Or you can just live beneath your means and pay down loans quickly. Whichever tickles your fancy.