REPLAY: I was a serial Monogamist with Tons of Student Loan Debt

Locumstorycom is packed with unbiased information and tools to see what the trends are in your specialty and even make a decision if locums is right for you . My advice make locumstorycom the go-to place to learn more about locum tenants . That's locumstorycom . What's good everyone . Welcome to another episode of docs outside the box .

I am your host , dr knee , joined by dr renee oh snap , I love that . That's what I'm talking about . Short , sweet , to the point . Yeah , yeah , I'm trying . You've been watching them videos on social media , realizing that your stuff is too damn long . No , I think the people actually want more .

You know that five to seven in the morning time zone , or a time slot , nothing is going on during that time exactly my phone is on , do not disturb . And everybody's sleeping . I just finished reading the miracle morning , which is a really great book and it's really . I like it because it gives you really great steps to get up and stay up , right .

So you know , if you haven't read the book , I'm just going to give you really quick things , which is one put your phone , which is more than likely going to be your alarm clock , put it on the other side of the bed . Number two when you wake up , you set it for five o'clock or six o'clock . You're going to be tired and it doesn't matter .

The book is right . It says whether or not you know you're waking up at five in the morning , six in the morning or four in the morning , you're going to be tired right . Because you have it in your mind like how much time you need to sleep .

So really the perception of if you're tired or not , if you got enough rest , is really in your mind and what your expectations are .

And then I go downstairs and , according to Atomic Habits , I made the process of studying , personal journaling , doing you know whatever I need to do , very attractive .

So the room that I'm studying in is always warm , the lights are on , everything is set up up , the desk is not messy , so that all I have to do is sit down and get ready to to study and work , and I love it what you studying for I'm studying for boards , but that's the thing that I really I mean , that's see , the thing that I think people don't talk

about a lot , and I think atomic habits really get , and this is not the point of the episode , but the the thing that I think a lot of people don't talk about a lot , and I think atomic habits really get , and this is not the point of the episode .

But the thing that I think a lot of people don't talk about is motivation really is , and we learned that in atomic habits . Atomic like motivation ain't nothing . Motivation is a waste of time .

In my opinion , it really is about the system that you have set up , and how is it that you're going to continue to do this behavior , even when you don't want to do it ? right right , which brings me to you . Let's talk about you what was it ?

So , um , my micro habit is basically I do 10 sit-ups and 10 push-ups before I go to bed . That's it 10 sit-ups , 10 pushes , that's it . So at the end of a week I have done 70 sit-ups and 70 push-ups , that's it Now .

At this point the sit-ups don't matter , it's the doing the sit-ups that is getting your mind to know that right before I go to bed , I'm supposed to be doing some activity .

A second Pause for that one second Because , speaking of you , a surgeon , I actually have a little bit of something that I would like for you to watch and , alfred , I'm going to send you this clip , so if you could play this now , If you need an operation on your knee , do you want the general surgeon or do you want the surgeon who's been doing just knees

for over 20 years ? Expertise matters .

I'm not going anywhere on this , you know , on this treadmill , like I , just for me it doesn't work . That's not , you know , that's not a motivating factor . So what I've decided to do is I actually joined an African dance class . OK so I do it every Saturday , except for , obviously , the Saturdays that I have to work . But I do it every Saturday .

I could literally do this class every single day if it was every single day , I literally could .

I was like I didn't know I was going to get put to work , but she actually passed out the last time because it got really , really hot in the studio . But for me , that's something that I am including as part of my habits . Oh , and one more thing , and walking . I did incorporate walking .

I need to establish a little bit more of a habit with that one , but I did start that . So there's something called Girl Trek . I actually learned about it from Tifta Bajanista and so I joined that movement . If you will , got my T-shirts and everything , so I'll be watching as well .

You can do that . You get a good workout , you feel like you've accomplished something , but also at the same time with girl track . That's something that's keeping you accountable .

We check in , you know every check in , you know every three to six months , but you know , be honest , like it's really been on the six to nine month side . We haven't talked in a minute , um , but it was good connecting with her and you know she's doing really well , I think academically . She's hitting all the milestones . She's hitting all of that yeah .

I think that the way how she's describing how she feels in terms of she's not sure if she should take step of . She's not sure if she should take step a . She's not sure if she should go left . Should she go that left , when everybody's going right ? All of these different things you know , because her residency is four years .

She's not sure if she should do you know , fellowship she's . You know . Should she go into global health ? Should she do ? She's not sure what to do .

She didn't say it , but I got the sense that she's stuck right , like she has so much options available to her that there's a little bit of some analysis paralysis there , and so the first thing I started off by saying is is based off of what your attendings are doing , and you know , by your second year you've gotten a chance to see a good portion of your

attendings . Is there anything from their careers that you want to emulate , emulate ? and then she paused , and then she said no , and I was like all right , well , damn right but . I didn't think that was a bad thing I was right , I wasn't shocked by , but I was because that's how I felt . Right , I felt , like you know , in residency .

I admired my attendings , but their careers were something that I didn't know if I wanted to do . I couldn't put a name . I put that's something to be desired . Well , yeah , I couldn't put a name on it .

I couldn't say it back then , but it was just like that's not what I want to do , right , 100 , and I think that's where she's at and I think she's stuck . She's not gonna say it , but it was really interesting to talk to her . You know , my biggest advice for her was just kind of just let things play out . You still have a lot of time .

There's nothing that's saying that you have to take a step left or go right when , right now , you're in your second year . You don't have to start making decisions until your third year , maybe even your fourth year , and there's plenty of people who have walked away and finished without doing anything and then come back years later and do a fellowship .

Absolutely , you know they do something else . She's got an MBA also prior to coming in . So she's got the administrative things also . So I know you said a couple of words to her also . Do you want to ?

One of the other things that I said to her because I know she revealed to us that she's also in a relationship is you know , if this is a serious relationship like , don't be afraid to put that as part of the consideration in the things that you want to do . You know , and I think a lot of times we , you know , talk to people about their careers .

I'm talking about a relationship , you know , where someone is committed to you , you're committed to that person and you're trying to figure out your future together .

because you got to break up with so many different things .

The saga of our relationship and stuff like we should not have been . We should not have made it , guys , but we have made it All right . We were for real . For real , we had our issues , but we made it . We here . It ain't no going back , but I agree with you . I agree with you to some extent . She needs to incorporate that .

You know , in their career decisions and I think that that's a big part of your career decisions . You know that determines where you're going to be , what you're going to be doing , the amount of time that you're going to have .

It's just in my mind . It was like inception . My mom was Leonardo DiCaprio before I came out and she planted in my head you ain't getting married until you finish all of your studies and that's the way it played out .

It gives you a fresh sense of you know what you expect medicine to be practiced like without you know some of the things that we worry about in the bureaucracy , the red tape , and it has its challenges . But yes , which reminds me , guys , it is 2023 . We are already planning for our trip , our medical humanitarian trip to ghana .

It is going to be august 2023 . It's going to be august 4th to august 18th . We are going to ghana . Usually we take a team of about 30 folks and we go to ghana . So that means that we are flying out of JFK August 4th , we are flying back from Ghana August 18th , and this is literally a medical humanitarian trip where it's bi-directional learning .

We teach them stuff , we learn a lot more with them and we do everything from internal medicine to ER medicine to , obviously , women's health , with mainly urogyne and colonoscopy .

We'll put that link in the notes , but if you go to the website , it's very easy to find that form and it doesn't , you know , commit you to anything . All it does is it just says that you're interested and it puts you along or puts you in our email list so that you can see how plannings are going and things like that .

And , as a matter of fact , this February 3rd we have our first meeting on zoom , where we're going to talk about that , and we'll get there .

So not everybody is selected to go as a volunteer , but we do need GYNs , we need surgeons , we need anesthesiologists , emergency med , im , fourth-year medical students are also welcome on the trip , as well as any junior volunteers who are basically , you know , maybe somebody like a pre-med or whatever .

Backdrop 2012 , finishing my fellowship in Miami and no decision bigger than where and how I was going to start working on my own . And there it was the fork in the road being employed versus something I had never heard of before locum tenants . So I decided to go the locums route and I had a ton of questions .

Then I stumbled a bit , but eventually I was able to stand on my own and I have been working locums over the past 10 years . Now , what about you ? If you're considering locums , you probably have hella questions , just like I did , Like who covers my malpractice , Do I really have control over how often I work , and what are the tax implications ?

Now , lucky for you , locumstorycom has the answers you need . It's packed with unbiased information and advice from docs just like you , and there's nothing to sell here . It's just a simple resource for information , like finding out what's the average pay rate for your specialty . There's even a quiz to see if locums is right for you .

So listen , take my advice Locumstorycom is the perfect place to start if you want to learn more about locums . That's locumstorycom . All right , Spoiler alert there's a study out there that shows that there is a difference in debt among postgraduate medical residents who self-identify by their race and ethnicity , and this is taken from data from 2014 .

Is that a spoiler ? 2019 . It is . I mean like , come on , it's not really a spoiler .

What was this in health affairs , excuse me ? Came out this year , january 2023 . Um , the main author is from yale university school of medicine , and uh , basically just shows that becoming a physician requires significant time and financial investment , and populations that are underrepresented in medicine have also been excluded from building wealth . We know that right .

Yep . So this says understanding the differential burden of debt by race and ethnicity may inform strategies to improve workforce diversity . Okay , you got me hooked there .

2019 on postgraduate resident trainees from the AAMC to examine the association between race and ethnicity and debt , independent of other demographics and residency characteristics .

It says black trainees were significantly more likely to have every type of debt than the overall sample and all other race and ethnic groups 96% of black trainees had any debt versus 83% overall . Right 60% had pre-medical educational loans versus 35% overall , and 50% had consumer debt versus 25% overall .

American , indian , american Native Hispanic and Native Hawaiian Pacific Islander trainees were more likely to have debt compared with white and Asian trainees . Overall , debt prevalence decreased over time we hope so Right and varied by specialty . However , for black trainees , debt decreased minimally over time and was stable across specialties .

So basically , y'all everything that we talked to the NRMP about , but this actually has some more data , actual studies based off of what postgraduate students are doing , and basically , if you want to know why there's two black doctors here talking about money and medicine all the time , if you want to know why we have this show for the past seven years , this

information in here , this is basically the thesis of it , right ? How is it that two black doctors have a total of almost $700,000 of student loan debt ? Now , that's not unique , right ? Because you got two doctor households who are white , who are Asian , and they may have the same amount , but why is it that these two ? Why are we always talking about this ?

You know it's interesting that at the end of the abstract they recommend scholarships . But what we talked about , remember , with the NRMP , was that scholarships are actually distributed pretty evenly across the board , regardless of the fact that you have this gap .

So I don't even know if that would necessarily help , unless there's a change in how the scholarships are actually distributed . So you know , it's really important to understand that the debt , the debt that we go to in medicine , stays with us , but it also has other implications on our lives . Yeah , right .

Right , like there is a support of a family unit that ultimately we're going to be in charge of , right ? So there's this notion . I saw it in the New York Times several weeks ago where they were talking about the sandwich generation .

Right , this is going to be the largest amount of people in generation X and a little bit of millennials , who not only have to pay for debt on their own but they also have to take care of children . But then you throw on top of that , they have to take care of their parents , you know .

So , yes , you may have a multi-generational household , but actually that one , you know , that person in the middle , that doctor , is taking care of grandma and grandpa , but also the kids . So that opportunity to get the wealth that others may be able to get , it's going to be a little tricky , yeah it might be , it's going to be siphoned off .

We can get into that in another episode yeah . We can get it . I think the barrier of entry , which in this case is financial , is too damn high . Right , yeah and not . And you know you could joke around I'm not joking around about it , but it's like it's .

I wonder if that's a major issue and we oftentimes say , well , maybe it's you know academics , or maybe we're not reaching out to certain communities , maybe it's just the price is just too much .

The year before last year , actually , I went to the SMA conference and the workshop that I did for them actually was a pre-med workshop , and it had to do with how much it costs to even apply to medical school and how you might think that your academics are the things that are holding you back from getting into medical school , but it actually may be the amount

of money that you don't have in order to spend .

Depending on the schools that you applied to , you might have actually had to have cast a wider net and their MCAT scores . Right , I'm saying barring any issues with MCAT scores or whatever , or their grades . I'm saying that , you know , sometimes the issue is they just didn't cast a wide enough net of schools that would actually look at them , right ?

So I'll give you an example . Right , I have a student .

She applied I think I want to say 13 schools in the United States . Right , and between money and the understanding of where she might want to be in school , she applied to 13 schools in the United States . Now she's from New Jersey .

So she applied , like right up in that East Coast area New York , new Jersey , pennsylvania , a little bit of Ohio , went to Chicago , skipped what I call the donut hole , skipped and went all the way to California and actually did one in Oregon which I was shocked about .

But oftentimes when I'm talking to students , I'm like well , why did you skip all of these schools that probably would have looked at you in the Midwest ? Right , they would have looked at you , but you didn't apply to those schools . Well , one is the demographic that they're looking at .

But two is also the money , right , the money that they don't have to apply . So she had enough money to apply to 13 schools . So she applied to the school that she was like well , I'm comfortable with the demographics of these areas . So when I got to talking to her , she didn't get any interviews . Well , she got one interview and she wanted more .

I said well , why didn't you apply to the schools in the Midwest ? She was like well , the whole demographic thing . But she was like the other thing is the money . I just don't have enough money to apply to those schools as well .

So , yeah , maybe if she had cast a wide enough net she would have been able to get more interviews , but the cost barrier is real . The cost barrier is real .

Getting dismissed from a program is devastating .

So there's like information from the ACGME that kind of breaks down people getting dismissed from their program based off of specialty , as well as broken down into demographics and race and so forth , and I'll tell you right now whether , whatever background you come from , getting dismissed from a program is a big deal and sometimes getting dismissed is not even getting

dismissed , it's I need to just leave this program and go and do something else . That type of mental math is really affected by . Well , while I'm looking to get into another program , while I'm looking to start this process of getting into someplace else , can I even afford to do that ?

Yeah , and I'm not saying that that should discourage someone from saying , look , you know what , ultimately I don't want to do this anymore , but you can't ignore that as part of you , can't ignore that as part of the decision , right , you really can't .

So you know , like , yeah , the amount of money that we spend in our education when we go through the whole thing , right , when we go through seamlessly , is high enough . But now , when you talk about someone who you know , their , their journey is basically interrupted and they're no longer able to to complete their journey .

Like , what does that look like for that person ?

Use all hurdles and challenges . Overcome divining people by color , gender , religion only tends to ingrain bias and discrimination . Diversity is occurring rapidly . Best metric is simply whether someone does good right as a result , you know this obviously made its way through twitter .

But you know , they put out a statement basically affirming their commitment to diversity , equity and inclusion .

You know , I'm really interested from your standpoint , because you just did a lecture for ICOM and you talked about the relationship where someone is saying , well , you know , this whole notion of you know including people based off of you know socioeconomic status , all that's doing is kind of decreasing the standards of how we normally evaluate people .

It , yeah , it helps with diversity , but we're bringing people in who may not be you know the best and all that stuff . What are your thoughts on that ? Because I have thoughts on it but I want to get your opinion on it ?

And that's not a bad thing , right , Because the standards by which you know we do a lot of things in , not just in medical education but kind of all across the board , the standards by which we pick the best person is usually people who look like you , who you know , do the exact same thing as you and have like it literally , is this country club , you know ,

mentality of . Well , if you're not like me , you don't look like me , you don't make as much money as meeting , you can't play , you know , and I'm glad that that standard is changing .

So we're talking about you know , you're doing a general surgery residency and then you're doing some research .

There's multiple ways you can get to thoracic surgery , but the main way is you're doing residency for about five years and then you do research for maybe for an additional two , three years and then you go and you do additional training in cardiothoracic surgery once someone lets you win , right .

So the reason why I'm tying this all back to what we were talking about earlier , which is , you know , medical residents and the debt that they have , is , you know this is a big deal financially .

If someone is able to get through medical school , they're in a ton of student loan debt and then you know you're trying to make those payments through all of residency . You know , depending on how you're getting paid as a fellow or getting paid as doing research , you know your debt could be going up .

You know , or you know , whatever struggles you may be doing , it may be multiplying and getting really bad . And now we're talking about there's a possibility that you may not get into a residency because someone thinks that you're not as good as the rest of the candidates . You can't play . You can't play .

Well , the problem is that your , your patient load , right , comes from a lot of different backgrounds . Your patient load comes from , you know , places that you are not familiar with . So my question is this standard that is created , right , is actually substandard .

It's an actual substandard , because this standard cannot possibly take care of the gamut of patients that we have in this country , right ? And so that's where the inclusion comes in . You have to include people who understand the actual landscape of patients that you're taking care of .

Other than that , what you're saying is that then you have a standard of patients that you want to take care of , which we already know there's structural racism in medicine . So does that exist ?

Yeah , there's a standard of patience that people just want to take care of , and there's a substandard of patience that they think , eh , I don't really want to take care of those people .

So you know that that's kind of where , like the whole , you know , structural racism comes into play where people are like no , show me the policy where it says that black people can't get into medical school . I'm like dumbass .

Like you don't have to have a policy that says that in order for you to find a loophole or some sort of caveat , to be able to say that there is structural racism Like you're a whole doctor you should be able to understand the complexity of a system and how the complexity of that system can actually foster you know foster biases and racism and all these things

. So for me , I'm like a whole doctor literally gave this president a whole doctor . You so smart , you went to medical school , you did all these things . You went to thorac doctor .

You so smart , you went to medical school , you did all these things , you went to thoracic , you know surgery , residency , you did research and you don't understand the nuances of an entire medical education system that fosters you know these biases .

Instead , you take the opposite , you know , and you say , well , no , if we include all these people , then it's just fostering biases . I'm like , wow , you're a whole doctor , wow .

And there's certain things that affect us that may not affect other groups , but also , at the same time , all of this stuff affects all of us right , finances , debt . All of that stuff affects as this study shows affects so many different people from so many different backgrounds .

It just so happens that there's certain vulnerable populations who constantly see these issues over and over and over and over again , and we just wanted to shed some highlight on that . So I'm very interested in what people think about this . I want you guys to text us at 8-2- . Excuse me , is this 8-2-2 ?

The one thing that I also wanted to mention , also because I did mention that getting dismissed from a program is financially devastating Right . Right , it's more than just career . It's financially devastating for someone . But also , I remember about two years ago , there was a medical student who was graduating from medical school .

She was doing her exit interview and she found out how much debt that she had , right , oh , I remember that . Yeah , she was completely shocked by it , right . And then she put it on Twitter that she just wasn't expecting that and she was just devastated by the consequences of that how she's going to make payments for that , going into residency and so forth .

And there was a famous blogger who said that , well , this is the epitome of financial illiteracy , right ? This goes back to what I'm saying about the barriers of entry being too high , right ?

Yes , not understanding what the effects of signing all of these promissory notes and not knowing , graduating from medical school , how much you're going to get into , how much total that's going to be . Yes , in some regards , you can say that it is financial illiteracy .

It's just like look , in order for me to change I want to do this right and in order for me to change literally my social standing and what I really want to do , I got to take on all this debt . That's a lot of shit to take on right , so I present to you .

I'm going to ask you like , let's say , for example , you found out that going to medical school , by the time you graduated , you'd have $500,000 of debt Seriously , and it may take you 10 years , maybe even longer , to pay it off , would you still do it ?

At the end you'll have $500,000 worth of student loan debt . I would have the end , you'll have , you know , $500,000 worth of student loan debt .

So I'm going to tell you that actually is a different scenario , because if you ask , pre-med Renee right $500,000 in the next eight , maybe 10 years . It goes into the cloud . It goes into the cloud . You ask pre-med Renee $15,000 , which is significantly less than $500,000 .

Right Like this is how much it's going to cost you to go into medical school . Right , like this is how much it's going to cost you to apply . Students don't even have a clue . I'm telling you , when I did that , when I did that presentation even $3,000 , they weren't expecting . I'm like , dude , you don't even expect to spend $3,000 . Like , come on .

I'm like how many of y'all got $ thousand dollars saved , two hands raised in a room ?

It's like well , it's just to me . I think this thing is way too expensive and in some fashion it's a message to certain people that you're not welcome here .

So if I got a small little clutch bag and it cost twelve thousand dollars , guess what ? Not everybody's rocking it , right , you can't play , you , you can't afford this . This is not a store you should even think about walking into .

If you are of a certain socioeconomic status , don't even think about it , right , but everybody could walk into Walmart , yeah , so you know , and that's the thing is , that's where the , the , the financial literacy , could play a huge part .

We could really start at least with premeds , because they're not doing it in most high schools , they're not doing it in most colleges , but at least for people who are going into medicine during their pre-med years , that might be somewhere that we can start .

If you disagree with Renee's take , if you disagree with my take , if you agree with our take , if you agree with the thoracic surgeon's take , with their virtuous ideals , we're very interested to see what you got to say about this . I think that's it . We're going to keep it a buck and end it right here . That's right

, all right , y'all . We will catch you guys on the next episode of Docs Outside the Box .

Listen this is Dr Nii , the doc outside the box . I'll catch you on the next one Peace .