{"id":1958,"date":"2016-04-08T17:07:07","date_gmt":"2016-04-08T21:07:07","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=1958"},"modified":"2016-04-08T17:07:07","modified_gmt":"2016-04-08T21:07:07","slug":"the-costs-of-being-a-doctor","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/04\/the-costs-of-being-a-doctor\/","title":{"rendered":"The Costs of Being a Doctor"},"content":{"rendered":"
\"Ahmad<\/a>

Ahmad Yousaf, MD, is the 2015-16 Ambulatory Chief Resident in Internal Medicine at Rutgers New Jersey Medical School.<\/p><\/div>\n

I start this article with a disclaimer: I am not here to comment on the decreasing salaries of physicians or the knowledge that I will never get paid the way the prior generation of doctors got paid. It is hard for me (and the American public) to feel bad for anybody making more than $200K a year when the median household income is in the mid-$40K range.<\/p>\n

\"median<\/a>

BrendelSignature (https:\/\/en.wikipedia.org\/wiki\/File:Median_Incomes_US.png), CC BY-SA 3.0<\/p><\/div>\n

What this article is about is the absurd costs of becoming a doctor (both in medical school and residency)! Let me tell you my story to put things in perspective:<\/p>\n

I went to a state undergraduate university\u00a0and, thankfully, left that school with no debt. I then entered a public medical school, with no way of paying the tuition on my own.\u00a0I\u00a0faced the decision\u00a0of taking out loans or dropping medicine and doing something else. I stuck with it \u2014\u00a0like many of my colleagues \u2014 because I could not imagine NOT\u00a0being a doctor\u2026 and honestly, I was\u00a0naive about the financial hardships I would undergo. \u00a0I lived at home for 2 of the 4 years of med school, was single for 3 of those 4 years, had no kids, and had amazing parents that subsidized my living arrangement with home cooked meals and car insurance payments.<\/p>\n

\"empty<\/p>\n

Despite that, at the end of my med school education, I had acquired $180,000 in loans (close to the national average), almost all of them with an interest rate of 6.8%. To put that into perspective: My monthly interest accrual was ~$1020 a month, and good old Aunty Sallie would capitalize the interest into the principal at the end of every year! Then came residency. Finally a salary of my own\u2026 or so I thought.\u00a0The average resident’s salary starts between $40K and $50K a year. At 70 to 80 hours a week of work, that comes out to $9.50 to $12\u00a0an hour. Most residencies prohibit moonlighting (for\u00a0reasons beyond my comprehension),\u00a0so the money you get from your institution is the ONLY money you get.<\/p>\n

I live in northern Jersey, where monthly rent for a 1-bedroom apartment is around $1000-$1400\u2026 a\u00a02-bedroom ranges between $1500 and $2400. I\u2026 lived in a 1-bedroom. I cleared about $3000 a month after taxes. $1000 went to paying just\u00a0the interest on my loans and never touching the principal,\u00a0and\u00a0$1200 went to paying rent. I was left with $800 to spend on food ($100-$300, thank God for a mother and mother-in-law who have phenomenal cooking skills), gas ($160), car payments ($200) because you cannot move between three hospitals on public transportation, insurance payments ($200), cell phones ($80) with no landline, internet ($50), and, well\u2026 there is no money left. So, I guess I could have just paid the minimum on my loans and\u00a0have had money for heat and electricity. Problem is, that after 5 years of residency,\u00a0I would have\u00a0owed Ms. Mae close to ~$250,000.<\/p>\n

\"borrowing-repayment<\/p>\n

This is the thing\u2026 I was better off than many residents. I had parents who gave me money when I was short and paid my EZPass bills. I went to a public undergrad school(many people I know have debts in the $350K range when starting<\/em> residency). I never had any large unexpected costs during my training (e.g., medical bills, big car bills\/accidents). For much of my training, I was not yet a parent. Residency sucks\u2026 and not just because of the intensity of the training and the stress of trying your best to become a decent physician.<\/p>\n

This article is not over yet. The real impetus for me to write this has to do with the loads of money I recently dumped to fulfill the next step of my “training.” What many people outside of medicine might not know about are the enormous costs of tests\/licensing that doctors are REQUIRED to complete\/obtain\/maintain to practice medicine. USMLE Step 1,2,3 tests cost about $2200. The American Board of Internal Medicine exam costs about $1200, and the American Academy of Pediatrics board exam costs a whopping $2250. Most residents spend about $1000 to $2000 on prep courses and materials for each<\/em> of these exams WHILE IN\u00a0residency.\u00a0 And then, there is licensing: NJ state license is about $1100, the DEA\/CDS licenses cost another $760, and\u00a0there are others, depending on your practice. All of this occurs BEFORE you make \u2018doctor money,\u2019 all while your student loans continue to grow.<\/p>\n

\"government<\/p>\n

My concern\u00a0is not for my own misery…. that time has passed. My concern has to do with the next generation of physicians who have already started pre-med tracks in their undergrad colleges.\u00a0 What type of candidates will medicine attract when the associated costs of becoming a doctor are no longer the extreme intellectual rigor and high academic expectations of the training\u2026 but instead, financial suffering?\u00a0 To put it in plain English\u2026 Who in their right mind would do this when you know you are putting yourself, and potentially your family, in great financial peril?<\/p>\n

My inner optimist\u00a0tells me that there will always be a group of highly motivated people who will bear the\u00a0difficulties, because the goal is lofty and righteous enough to keep their eyes on the prize. But what are we saying as a society when we make an education in healing so difficult to attain?<\/p>\n

~Yousaf<\/p>\n","protected":false},"excerpt":{"rendered":"

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