Lauren Delana, OMS III, will accumulate roughly $275,000 in education debt by the time she finishes medical school. This ulcer-inducing figure has been at the forefront of her thoughts this year.
Like Delana, many medical students faced with choosing a specialty find themselves torn between pursuing their passions or following the most lucrative path toward medical school debt repayment.
“With the amount of debt I will have, I need to make sure I have a career that allows me to pay back those loans,” Delana says.
Financial planners often advise students not to borrow more than they expect to earn in their first year on the job. If Delana wants to follow this advice, she’ll have to forgo lower-paying specialties such as psychiatry and internal medicine and try to land a residency in a more lucrative field, such as urology or pulmonary medicine.
Alternately, Delana could opt for a loan repayment program such as the Public Service Loan Forgiveness (PSLF) program or the National Health Service Corps (NHSC). But the PSLF program is only available to physicians in certain public-service positions, and the NHSC is highly competitive.
Ten years ago, Matt Pflieger, DO, was facing the same choices Delana is now. Dr. Pflieger and his wife, Janelle Maxwell, DO, graduated from medical school with $450,000 of debt in total.
Determined to pursue family medicine despite their debt, the pair moved to Denver, where Dr. Pflieger joined the NHSC and Dr. Maxwell received loan repayment via a Colorado state program. The programs repaid $280,000 of their debt, and the couple paid off the rest by moonlighting and living frugally.
Dr. Pflieger says they would have made the same decisions even if they didn’t obtain loan repayment.
“I was always committed to family medicine,” he says. “If you are committed to something you love, you are going to make it work.”
On the flip side, Hamad Husainy, DO, says his debt load—$263,000 when he graduated—weighed heavily on him when he planned his future.
“There was a time when I wanted to be a family physician or a pediatrician,” he says. “Unfortunately, after having some candid discussions with a few people I trusted, I realized that obtaining financial solvency in those specialties would be very difficult.”
Dr. Husainy eventually chose emergency medicine. After residency, his debt also influenced his decision to work for a rural hospital.
“Your dollar takes you a lot further in rural areas,” says Dr. Husainy, who practices in Florence, Alabama. “And as an emergency physician, you can often get a pay raise to work in a more remote area.”
Similarly, emergency physician Chadd Kraus, DO, accepted a job this year in Columbia, Missouri, partially because the area’s low cost of living will enable him to pay off his loans quickly. Dr. Kraus’ new position is in academic medicine, which he says is a better fit for him than the job he held at a community hospital just after residency. He chose that position to get experience in community medicine, but also to get a head start in paying down his loans, as community hospitals tend to pay more than teaching hospitals.
Whenever possible, medical students should prioritize finances alongside, rather than before, career satisfaction, Dr. Kraus advises.
“While it’s something you need to consider, your debt should not be the driving choice for which specialty you select,” he says.