¶ The Financial Implications of Medical Education
Education in general . There has to be a barrier , because if everyone could go to med school , everyone would go to med school , right ? First it's prereqs , then there's the MCAT , then there's cost , right , they're going to put that in there .
But why does the cost have to exponentially increase ? The body ain't mutating .
Everybody out there right now . You know , with your scrubs or backpack or shoes or car , you know the price tag of those things and if the value was lower you may not be as interested . When you attach a cost to something , it looks better to everybody else and I think people still attach that cost to medical school .
So that's why these medical schools continue to adjust the cost as they're moving forward . So , yes , the body's not mutating , but society is . Interest rates are . They're gonna continue to go up .
Hey , we talk about locum tenants a lot on this show , renee and I . We've been doing it for well over 10 years now . So if you're curious about locum tenants and how it might fit into your career , check out locumstorycom . That's locumstorycom , and you'll see all the different reasons why physicians choose locums and how it works for them .
Find out about jobs , taxes , travel and , to me , most importantly pay . Visit locumstorycom to learn more . What's good everyone . This is Dr Nii , host of Docs Outside the Box . Listen , this is a special episode .
This is a collaboration between Docs Outside the Box and my favorite organization , the organization that got me through medical school socially as well as academically , the one , the only the Student National Medical Association . And guess what ?
Next year will be 60 years of the amazing work of the Student National Medical Association , and we are joined by the one , the only , dr Love . Anani , dr Love , tell them who you are and then we're going to jump right into this .
Hello everybody . It's the Docs Outside the Box family . This is crazy to be on the podcast on this side . My name is Dr Love Anani . I am the professional board member to the EC for S&MA year 23 to 24 . We're hype about the 60th . I'm hyped to be here 23 to 24 . We're hype about the 60th . I'm hyped to be here .
For anyone who listens to the podcast , yes , I am the Doc with the Lucid that need be talking about .
It's me . I will throw it out there . It's me . I got to give you props for not being anonymous because a lot of people you know , once they get to that point , you know they're like I'm going to come on as Dr X or you know . Just don't say my name .
But yes , you do drive a Lucid , which is higher in cost than a Model X Plaid , but it's dope and I've seen it driving around .
It's amazing .
Yours is white or black , black black black everything .
Go ahead , go ahead . I feel like the car is flashy , it's out there . I can't hide it anymore . You know , you know . I just I need the world to know . The secret was weighing on me heavily and I feel like I had to step up for the lucid owners who listen to the podcast and hear you talk now it's not that many .
There's not that many , it's very infinitesimal how many lucid owners there are it's real small so how many years in before you got your lucid which anybody who doesn't know lucid is , is EV is out there how many years in before you decided , hey , I'm going to purchase this car ?
Years is . I became an attending 2015 , and I did not buy it until 2021 . No , 2022 . It's only like a year and some change . Basically , once our cars were fully paid off , we got my wife a new car . The kids started to grow . I decided , hey , I need a electric vehicle now . It's about time . We're stable on everything . And I actually Googled Tesla .
I was going to go the Tesla route and I was like , no , no , no , I've been saying I want a luxury car . I thought I was going Lexus my whole life . And then I looked up luxury EV and Lucid popped up . I looked into the whole company and what they were doing , Found out they're one motor trend car of the year . I was sold right there .
Oh my God , here we go . I was sold . That was me . I was sold , All right .
I'll be really honest At every point . The car is better than a Tesla . I'll be very honest with you . It's nice . The question is is are y'all gonna be there in five years ? So I'm teasing it's real talk .
I can't even hang on that like it's real day the way how these EV companies are like .
They come out but you don't know if they gonna finish , but they at least they deliver for you . I've seen the car , I've been in a car . It is amazing , it's great .
The reason I asked you that question , y'all , is because I just want y'all to know that , like , like dr , is the specific um is doing the things that specifically I'm talking about , which is , you know , he can afford anything he wants , but he can't afford everything , right ? So you wait until you get to a certain point in your career .
Maybe your loans are paid off , or maybe you reached a certain um career trajectory , maybe you've gotten a certain promotion , um , or just maybe you just reached a certain net worth , right , but you put in the hard work first and then you said , okay , listen , this is the card that I've always wanted , or this is the card that I want .
Let's go ahead and make it happen . And , if I understand you correctly also , isn't this car specifically for business only ? So you , you've put in a part of an llc also .
I did do that part of the llc , because my hospital where I work from where I live is 40 minutes just about , so I felt like I was polluting the environment every day , and at the hospital I'm also the medical director . So I was going for meetings multiple times a week , driving home to work , and I just felt like I was going oh poor earth , poor earth .
Right , keep going . I'm listening . Hey look y'all . I'm one of those conscious people I'll be looking like look when it's 50 degrees , when it's 60 degrees in .
December . You know there's a Prius . You know there's Prius . Right , that's far cheaper , but keep going .
But if I'm going to not pollute the earth , I'm going to not pollute the earth in style , so other people can say you know what I'm not going to pollute the earth , either there's a Nissan Leaf . No one looks at an Leaf and says , yeah , I'm going to do that to better the earth and then that's what I'm doing now and I'm doing that through my business .
That covers all those miles . I use Stride for my app . I was into the other apps Y'all suggest . Stride was free and keeps track of the miles .
I love it . So basically , the mileage that you use to drive back and forth , that all of that stuff gets accumulated and becomes a tax write-off , it makes sure the total amount of taxes that you have to pay , that decreases your taxes by a certain amount . That car , the payments , a certain portion of that is decreased by a certain amount .
You're doing it the right way .
I think , yeah , y'all do it better though . I heard y'all last podcast because I'm an avid listener Y'all are 100% like not touching the Tesla unless you're going somewhere . I'm not 100% , but I make sure that when I do my taxes I'm honest . I'm not a hundred percent , but I make sure that when I do my taxes I'm honest .
You know I'm not going to write off a hundred percent . I will say for personal use , it was used 20 , 30% of the time , whatever , and subtract that amount .
I still think it's the smarter way to do it right , which is let your business pay a certain part of your car because you need to use it . These are the things that I just think like we don't get those lessons . When we're younger , right , and we learned through the School of Hard Knocks .
You may find out 10 years , in 15 years , from one of your partners in the surgeons and I was like , but you was doing what all along ?
Why did you tell me , right , so you found out pretty early in your career and I really applaud you for that , because that's really smart and like the reason why I started off there is because , like this episode is about really the financial implications of going to medical school or even any type of health professional school , and what that means for you while
you're training , after you're training and then while you're working , because whether you're in nursing school or you're in medical school or you're in respiratory therapy school , like the cost of the cost of admission is like exponentially on a yearly basis , getting worse . And I'm just going to start off with some stats . Hold on a second .
Let me get some stats up in here , because I'm a stat person . If you look at the stats right now , medical school graduates owe a medium average of $215,000 in total educational debt . So that's pre-medical debt included , right ? So that's college and med school , right educational debt . So that's pre-medical debt included , right .
So that's college and med school right Now . If you're talking about just debt in general by itself , people in medical school , if you don't include medical school , if you just include sorry , if you don't include undergrad ,
¶ Debt's Impact on Medical Career Choices
it's $200,000 of just debt , right . And then what we're finding out from these stats is that that debt , that financial burden , is actually playing into what medical students decide to do in terms of where they're going to practice , like if they're going to go to a rural neighborhood or if they want to go practice in an inner city right , like me I was .
I grew up in Irvington , newark , inner city areas and I made the tough decision that when I finished training , I can't go back there because I can't afford to live there and still pay off loans . So I went to a rural area which wasn't in my plans . It was a great experience , but finances played a part , right .
It may even affect what specialty you go into , right , if you're going to go into family medicine versus a subspecialty it's going to affect that . It may affect how quickly you get married .
Oh yeah , oh yeah , and how quickly you have kids . And definitely listening to those numbers , A lot of the people listening to this episode right here right now . A lot of people on the SNMA side heard those numbers and two words popped in my head Light work , 215K . That's it For undergrad and med school combined Light work 215K .
That's it For undergrad and med school combined Light work . I mean , I'm just What'd you graduate with ? Undergrad was 100 and med school was 300K . 400 for you just alone . Yeah , yeah , 215 , light work . That's back in the day . So I know folks now are like really feeling it .
So yeah , that's and if you think about it to me , all right , undergrad , and if you know my undergrad , I'm going to save my undergrad because I sit on the board . I don't need y'all blowing them up on like the socials .
I've known you since undergrad Everybody , just so y'all know region two . That's how we do . I can't name the school . You don't want me to name the school right ?
Nah , nah , because I don't need y'all . If y'all know me , you know the school , you can Google it , you can look me up , you can find it easily . But I need y'all to do some work . I can't give y'all all the answers to the text . Expensive private schools . Leave it to you , like that .
They annual medical education conference , but 25 a k a year for that school is great if you can come out after that . So that's why the 100 didn't like phase me . Uh , and then med school again 300 is light work .
So let me . Let me ask you a question , right ? Um so , going through college , what role did your parents play in your in finances ? Like , did they ? Did they contribute , or were they just kind of like you going to college ? That's amazing . I'll drop you off . See you later , because that's what my mom Like you're not going to sign here .
Mom and dad , no , no ,
¶ Financial Considerations in Pursuing Medical School
my mom , full Nigerian immigrant . Her role was let me get you to college , but we got to figure out how to pay for it later . So when the FAFSA came in , you know I'm one of those immigrant children . Hey , mommy , how much you make this year ? All right . What'd you do this year ? How much you donate ? All right . Hey , sign here .
Like , that was me , right , like .
I did everything , so you do it for your parents .
Oh yeah , same here , oh yeah , and then when it came out , like you know , the school had to make you pay something based on what you submitted . And she was like this it can't be less . I'm like my school said , so she did have to pay something .
Right , you always have to pay that minimum , like maybe 2K a year or 4K a year , and then the school would fast for the rest of it . But , yeah , no , that was her involvement throughout the entire thing .
And then med school was so did what ? So obviously you tell your parents yeah , or you tell your mom I got into medical school mm-hmm what .
So when you're doing the whole thing , it's it's like you don't even mention the finances here to your mom at that point , right you're just like I'm going to medical school and that's it no , I mean , she told me that was the same conversation same difference .
Yeah , you're going , you're going she had , and she had no clue .
She had no clue . Is she in medicine at all or Nurse , nurse , nurse . She's a nurse , Okay , so she kind of knows that it's expensive , but she doesn't know the exact finances and so forth .
And I feel like no one knows , because lots of room and board in there cost of living , things that the school has to help you supplement . Because you ain't got no job you can use a little Tony or Albert , you can use a little Tommy thing in there if you want to . You ain't got no job .
Why are you talking to Alfred ? That's my job .
I've always wanted to do that , Keep it moving . But yeah , they have to supplement those things . So if you're like me in the Washington DC area , a little heavier than if I did do med school out in Idaho . No shade to Idaho . Y'all cost of living just low . That's all . That's all .
And you went to medical school at the Howard University .
Amazing , amazing history .
Amazing amazing history , amazing medical school in Washington DC . So you know the reason I asked that question is very similar . I did the FAFSA paperwork for my family . My parents didn't really understand that stuff , right , both my parents are blue collar . My mother's a nursing assistant .
My dad was like in , he was in like electronics , he would fix like the big computer sorting machines at banks , right , so you know the check sorters . So if they would break he would go and be on call and fix those machines and stuff , you know .
But I did the FAFSA paperwork , like you said , for my parents , and then sign here and I graduated from college with $25,000 in debt . So this is in 2000 . And I was like I thought that was the end of the world . And then you know my parents would contribute a little bit to it . But that was it right .
Because when you look at the FAFSA form you realize how little or how much your parents make . Right , and it's either . It's a very sobering conversation , particularly when you are , you know , at a very , at a private institution .
You find out like how much you know your colleagues or your , you know your coworkers or your , you know how much you're the people in your school , how much their parents are making , right . And when I graduated , I was like , oh man , like $25,000 , a lot , until I went to medical school just the same way . I told my parents I'm going to medical school .
There was no discussion about finances . They had no clue . They didn't ask . It's not like they didn't care , but I'm sure they were just like , well , what are we going to contribute ? We'll be there , we'll be there for you , We'll help you get there and all those different things .
But you know , and I remember , like taking out the first semester or the first year , like it was like almost 40 K , you know , and it was just like it took me four years to accumulate $25,000 . And just like that , I just doubled that , if not Right , and that was crazy and I just I didn't know the implications of it .
I just knew that this is what it takes to graduate , that's it .
Yeah , you know and I'll be , you go ahead . And that's why when people always ask me like , oh , when in residency , if we ever get to that portion , like , oh , slave labor , you're getting , you're getting , you don't get paid enough , blah , blah , blah . I remember when I got my residency you know those annual , how much you get paid .
I remember filling out those FAFSAs as a pre-med . I remember telling myself I'm going to be paid more than my mother in my first job annually and that's why I never complained about my residency salary . I was like all right , we're going to make it work . She made it work , me and my sister and her . Can you say that again ?
Say that again Because I think sometimes people don't understand , because there is also a section on the socioeconomics of medical school . Yes , right , and the majority .
This thing keeps you want to get Apple , there you go .
Apple , yeah , oh man . But the socioeconomics guys I want y'all to hear that like first-year residents , if you think about how much money a first-year resident makes in comparison to what an attending makes , or even comparison to what , yeah , just someone in general public makes , it's not that much .
And the fact that that there is , it makes more money than your mother's annual salary . That speaks to the social economics Right of where you come from and stuff .
Yes , and when I qualified because I was a resident , I definitely understand the hard work it's when you factor in the hours for how much you get paid . But if you just look at base salary , off-rip for a year , I was making about I think it was like 5K my first year , more than my mother did annually . And you know your residency salary goes up .
So by the end I think I was like nearly 10K more than she was annually and I was just like you know , yes , I'm putting in 70 , 80 hour work weeks , yes , but I'm not going to complain about it , because who am I complaining to ? The person making less than me annually ? So , yeah , you had to shift . I shifted my mindset to . This is where we are now .
You've already ascended to that place you were talking about to make more than your , than your mother . Now you can continue to go up that mountain .
That's why I kind of push myself there . I'm sure you did exit interviews Right ? So like as , or how about this ?
Even before exit interview , right , like you have to be like thinking , ok , listen , like like I'm accumulating a ton of debt , did there was there any thought process of like I just want to do maybe primary care or maybe I want to go into , I want to subspecialize ?
And if you did think that , did it have anything to do with your debt or your , like your economic status growing up ? Tell me about that , those decisions to go into ER or your economic status growing up .
Tell me about that , those decisions to go into ER . So you do have those exit interviews where you know every school , I think your fourth year in med school they have to sit you down .
I think even having an undergrad if you take federal loans , you got to have an exit and you're like , hey , you owe this much , don't default , please , this is your interest , you know , this is how you pay , et cetera , et cetera . When I chose ER and I tell people this , hand to God , every time I had zero clue of the annual salary .
Zero , zero clue of the annual salary . All right , I chose ER . One I wanted to be the Jack of all trades , master of none . I love that aspect . Two , I swear it , you can ask anyone . Two , it is the only specialty that I know where I can see 100% of the patients who come to me and not ask them directly to their face how much money you got on you .
You know what I'm saying , so I never have to do that and that was my thing .
That's the reason why you went into it .
That was me , and then number three , the show was dope . Hey , you can go look at every personal statement . The show was dope . Hey , you can go look at every personal statement . Like in my life , the only time my family never got stopped by the little lady at the . Excuse me , miss Angel , for a little how much money you got today your co-pays .
The ER is the only place where it's like all right , thank you for coming in . You know your bill will be sent to you and you can get full care . Even yesterday I saw a man . You know all he needed . He told me straight up , trying to get to Wisconsin . It's cold outside , all right , you know how much I charged him . I don't know .
Here's your turkey sandwich . Sit here . You're medically checked out . You're good to go . So when I found out what the salary was , I definitely was like dope . But to me going into medicine , I assumed which is a bad assumption , y'all , because I know now different every doc at minimum made 100K at minimum . I thought that was the floor .
Going into medicine was 100K . So I knew where my loans were and I kind of told myself all right , if I live like a resident , 10 years should be paid off or five years be paid off . I did terrible math , not factoring other things , but I assumed it would be paid off . I have never met a doctor 20 years into their job , regardless of specialty , say .
Man , these loans are still kicking my butt . So I knew it was going to be paid off . So I just chose specialty I wanted to do and not the one that was going to get paid off the fastest .
Fair enough . And when I was saying cap , you know I'm just teasing you and everything . Oh yeah yeah , yeah , you know . Do you think that's a disadvantage though , for people like particularly , you know , students who may come from a similar background , where , immediately as soon as you graduate from medical school , you're making more than your family members ?
Right ? And that's like , for example , like me , when I first started at Morehouse , I was making what my first year was like thirty nine thousand dollars a year . You know , I was literally at what my dad was making , maybe a little bit higher , and stuff like that .
And you know , it was just , I was fine , but I also knew that I was ducking calls from Sally May , like they were calling me like yo , you know your grace period is up , right , like , and you know , we know you got the coupon book .
We haven't gotten any of the coupon pages back when you paying , and I'm like yo , I can't afford to pay this right now , so I'm gonna call you back right . And you just keep doing it over and over and over again .
Do you think that kind of going into medical school or going to health professional schools is just kind of like listen , I got the grit , I got the determination and this is what I've always wanted to do , Never mind what the financials of what this is going to be ?
Do you think that you should still have that type of mindset which is like , don't worry about the money , It'll take care of itself , you just try to get in and you graduate and you'll be all right ? Do you think that's the wise choice to do ?
I think it's the lifelong choice to do .
If you , at the end of your day , want to be happy with the specialty you're in , how much you're making in the life you're living , I think that's the decision you have to make , because you may make a decision that will make you not happy in the long run and I know there's someone out there listening like I hate when you're all positive about things , man .
Keep going , though . Move on . I know there's someone out there listening like You're getting all nice and stuff I hate when you write Go on .
Look , I'm just saying Someone out there is going to be like man , I don't care , as long as get that 400K . And I'll tell you right now this is not cap . I don't care what your specialty is , we're not calling all these five figures , six figures , specialties . At three o'clock in the morning they don't still sound happy anymore .
So I'm just saying it doesn't matter .
Trying to get a hand surgeon in to come in for a hand injury at two o'clock in the morning . It's like that's pulling teeth .
I've had tips of fingers hanging off . You know they say just sew that up and wrap it up , send it to the office . I'm like it's hanging , he cannot extend it . You know what you said . So you got a hand , you got it . Document .
Hand surgeon told me to do da , da , da , da , da , da da . Yeah , yes , Y'all know who you are .
Y'all know who you are . You need to get up and be happy and you know I've talked to every specialty at three o'clock in the morning because I need you for something and it's rare that that person is happy every single time I call them and you know it may just be call Right , but do something that's going to fulfill you .
That's gonna make you smile , that you can write a book about that . You could be on a podcast on after you were up 12 hours afterwards to talk about it because you're so happy . That's what you should do .
¶ Paying Off Student Loans and Strategies
I have this joke . I tell all my mentees and I'm going to ask you the same question Amy or Dr Ne , when are you going to pay your light bill off ? At the end of the month ? No , no , no , no , no . When is your light bill going to be zero and you're not going to owe any more on your light bill ? When is it going to be zero ?
It never is basically Exactly that's how .
I treated student loans . Hey man , it's bill of credit , I pay it , I put it away .
Like some people , like you know calendars , five more years , three more years , anxious . But if you think about it as like do you have enough to pay it ? Yes , can you pay it ? Yes , did you pay it ? Yes , that's it . At some point it will disappear , it will dwindle down , it will go away .
You know , we do pay so many bills in our life every month and I'm thinking twice and I'll pay for the rest of my life like so your girl , your family's goal , cuz your wife is also a doctor , y'all make sure he understand that his wife is also a doctor , yo . So y'all got debt right ? We do .
The goal is not to get it paid off Like you don't have like a timeline in terms of trying to pay it off early .
So we had an estimate but we didn't aim for early . So we sat down and we're like all right , my wife's a doctor too , but she had the BSMD at Howard's . Look up that program . Two years of undergrad , four years in med school . So her first two years of med school was undergrad rate right , so hers was lower .
So we basically said , all right , boom , yours paid off . Let's try it in five years because it was way lower . If we can aim mine for 10 years post-attendingship , right . I think everyone should know that . I don't think you should be counting your years of residency as paying off your loans . That's minimum .
Don't let Sally Mae come find you or make phone calls , payments . They come Post attending ship . Yeah , they come 10 years post . That was it and it was like that's when we think we should do it . We weren't rushing . 10 years seemed appropriate . We did the calculations , that's fact and we're on track .
That's the standard plan , right ? Yeah , oh , no .
We did income-based , income-based .
You ain't say all that .
All right , good , okay , but don't they change it based off of your ? Combined income now yes , and so when the income skyrocketed , let's just say my current payment has multiple more than my residency payment , multiple more than my residency payment .
However , remember y'all , your income base is based off your income , not your business income or the dividends you get from your business .
So it Iris , come get this guy , come get this guy right now .
I see , I see , but we inflated it . So I think we're going to be done at eight years now , because 10 years post resident uh , intern , uh , attending we 2025 . And I think I're going to be done in eight years now because 10 years post resident attending we 2025 . And I think I'm going to end in 24 . So we did it right on time .
I do pay way over what they want to pay , because they will hand you 20 and 30 year plans everyone , because they need that interest payment . That's yo . Let me tell you something right now .
So when me and Renee got married , we combined our finances almost $700,000 in debt . They both have each each of us on the 20-year plan . So we went into a calculator and we put in all our debt and we had similar interest rates and everything yo .
By the time 20 years was done we would have been at like 1.2 million dollars of principal and interest and watch them .
Watch them . You know what they did to me Because I'll be paid off by , hopefully , june next year . Why did my minimum payment amount drop suddenly , like it was auto-drafted .
They try to entice you Like . We know you want that lucid Could just drop that payment a little bit long . We'll extend you out to 2057 .
I was like I see y'all , I am not . This amount is locked in the Anani finances . I'm not decreasing this amount . It's going to be knocked out but like they want that interest , that's how they make money . Capitalism , I love it .
All right , y'all , this is Dr Ne . I've been doing locum tenants trauma surgery for well over 10 years and I haven't looked back since Best combination of lifestyle and income that I could ask for . Now , for you , your needs , your wants , that's gonna be different than mine .
Maybe you want more control over when you work or even how much you work , or , look , you're just trying to make more money to pay off those damn student loans . Now the other thing is pay attention . The average locum's doc gets paid at least 33% more than your average employed doc . You got your attention now so look , I get it .
Sometimes the hardest part is where do I start ? You start your research at locumstorycom . Once again . That's locumstorycom . It's an unbiased educational resource about locum tenants . There you're going to find stories about the different reasons why doctors choose locums and how it works for them .
Locumstorycom has tools that let you explore locum's pay demand for your specialty and even compare different locum tenants agencies . So , look , stop sitting on a fence or just thinking about it . Start doing on the fence or just thinking about it . Start doing . Do your own research at locumstorycom . Once again , that's locumstorycom . It's easy .
So I think you definitely have a different perspective on things because it looks like you knew the money was going to be there . But for you the goal was I want to be a doctor .
I'm going to be a doctor Financial wise because , like I think there's something to be said for if you gonna be a doctor financial wise because , like I think there's something to be said for if you didn't spend that that much , if you didn't spend a lot of money growing up , or if you didn't spend a lot of money while you were trying to get into medical
school . Usually when you jump into new money , it's not that big of an issue afterwards , right ? that's kind of like me and Renee , like we didn't spend much money . So now that we got a lot of money , budgeting is actually easy for us because we don't really spend money at all .
So you but for you , you look at it as the money will take care of the loans eventually yeah , not stress about it . Whereas for me , I think there was like a very visceral pain point , which was I don't want to live in royal rule america . I want to be close to my family , um , and I feel like it's in cr .
It's impinging on the way how I wanted to live . So I just knew that that was the pain point . I needed to pay that off . For the folks that are listening right now , you're starting to see more tweets .
You're starting to see people on social media talk about like yeah , I'm getting towards the end of my fourth year of medical school and I didn't realize the implications of what I got into . I may have some regret , but I'm still going to keep moving forward .
Or you have some people who are in residency and they're like yo why don't they just increase our pay ? They got the money to do it . Why don't they increase our pay ? To those who say things like that it can't just be like yo , don't worry about that , just graduate .
What are your thoughts on the current situation where , like , literally , there's a study that says that next year the average we're at 240 or 250 for average student loan debt which is graduating , medical school and undergrad , but they're saying it's going to jump to $300,000 in a year . What are your thoughts on that ?
Because you had a lot of student loan debt , but during that time the average was a lot lower . Same thing with me . I had a lot of student loan debt , but during that time the average was a lot lower . Same thing with me . I had a lot of student loan debt . I borrowed way more than what the average was , just because of the socioeconomic type stuff .
¶ Rising Cost of Medical School
What do you say for people like that , who are just like yo , like bing , bing , bing . It's a problem for me . I'm thinking about it , I'm thinking about it . What do you say for them ?
You're right to . You should think about it . But I guarantee you every not guarantee my thought process and why I didn't think about it too much is every answer you have is going to move the needle on something else , right ? So let's use what you just said . Right , we were talking about our salaries in residency .
You said your salary I'm just using numbers you've already thrown out there is about $39,000 . Right , my salary in residency was 48,000 . So I'm already 9K ahead of you , right ? So someone would say , hey , look , we increased the salaries of residency 9K in what five , 10 years ? I'm like okay , but what happens to the cost of living ? That also went up .
So I guarantee you , like our cost , they're going to keep moving the needle . But when they move that needle of like like all right , we're paying you more as a resident everything else in society will probably go up . So then that person's probably saying , well , why not match ? Or why not match ? I think it's possible .
You know a lot of the residents you've been talking on this podcast as well . Uh , unionizing out here . Uh , someone on the west coast did it with britain , britain or uk residents did it . Yeah , so it's possible . That can get us more , but you always have to .
I'm the type of person that believes your salary must always depend on where you want on the totem , right . So , all right , there is someone attending out there who's at 100K right now . Right , they're in family medicine or P's or something , because they are the salt of the earth and they're going to have their wings immediately .
Right , they're at 100K right now . A resident can't pass that , so that has to be our ceiling , right . So what is that ? 80 , 70 , 60 ? I mean , some residencies out there are already paying 70 .
We had Steven Bradley on . He was saying as a fellow he was at 77 . I was like what ? That's what I'm saying . I didn't even know that .
So there has to be a ceiling and it has to be under 100K . So can it move up ? Yes . Can it pay people more ? Yes , I was always in the camp of my pay good , because , again , I was thinking about what my mama made my pay is good . Make me work less .
I was never in the camp of you should be in the hospital 20 hours a day each day and only have one day off , and then on your day off you should be reading . I never understood that , because I feel like you get more learning as you do . So tell me enough to not harm people , and I will continue to learn for the rest of my life .
So trust the people , trust the lessons that you teach people and they will become lifelong learners , as opposed to forcing them . Basically .
Yes and right and like , especially for like y'all surgeons , if you're not in the hospital , how many , you're not going to get your number of appies . Like I talked to all these mentees who are in the surgical specialties counting cases oh , I need a couple more C-sections , I need a couple more of this . And it's like , like , what is that ?
Is that number found in something I know thousand times ? You're a expert or whatever . Yeah 10,000 hours or something like that . Yeah , and I get that , but you only need 10,000 hours of residency . You know what I'm saying ? That's what like . So instead of chasing the pay , I say let's chase the hours . That's where I am on the residency lifestyle .
Here's my fear and we're going to get into why is medical school this expensive ? Which is where you understand that better than me . But I just want to know , like why is medical school so expensive ? Why is medical school expense exponentially getting better ?
If we notice statistics show that the majority of people who are in medical school come from you know well-to-do families and so forth , when we continue to make the price of medical school really high , it's going to continue to be a barrier for people who one can't afford it and have to take out more loans . They're going to get intimidated by that .
But then also , at the same time , not only are those people who might be able to get through and they will get through it's still going to be a major situation once they actually become attendings , because now you've taken someone out of a certain socioeconomic status . We know . You know what I'm talking about , right .
But , then when you become the beacon of light , light , the Statue of Liberty for your family and now , not only are you , do you have to support mom and dad and possibly even family members it's like okay if salaries aren't keeping up with the exponential rate of how medical school is going . It's like okay .
So before I was poor , now I'm really poor and now I'm starting to make money , but it's not keeping up with what my student loans are like . What are we really creating ?
Like , are we kind of forcing people who don't make money to be like sit down and you stay there and this is gonna can be , this is gonna continue to be a lifestyle or an educational path for those who have the money and are willing to spend it and sacrifice ?
That's my fear , right , it's like you look at people who are gonna have to do a lot of sacrifice to get up to this point . Say , now you sit down , because now it's gonna be worth four hundred thousand and we know damn sure you're not going to be able to pay for that . What you're going to do then . That's my fear .
I think your fear is right , but I think that's what society wants . I think one when it comes to education- .
Well , that's what United States wants , because in other countries it's subsidized .
Yes , but then the whole system is subsidized . Yes , but then the whole system is subsidized , right . So whenever people hit me with the other country subsidized , I'm like you're darn right , the whole healthcare system is subsidized .
But I'll guarantee you right now , all you orthopods out here and in the US are not making orthopod money in the UK , right , right , right . Because healthcare is subsidized when your government controls the money . And first off , let me just say this out here , if anyone can attack me , I'm not pro these things .
I just like pointing out these things to people , right ?
Dr Love , you're going to have to take a stance and you're going to have to live in it . This is what this show is about . Stop trying to play both sides . Thank you , let's move on .
I will throw my stance at the end , but I'm going to throw this
¶ Education Barriers and Rising Tuition
out there . General has to be , there has to be a barrier , because to be a barrier if there was no barrier , everyone would do it . That's one thing all the people who control the education knobs understand , right , that's not Shouldn't it be that way ?
Because I actually kind of think everybody it should be easy to get into medical school but hard to get out . But that's another conversation .
Oh see , but so oh . So y'all heard that want to give y'all the debt he wants . But I think they want there has to be a barrier , because when there is no barrier things don't look as good and our society is like that .
I'm not sure you know , people can blame the internet whatever they want , but when you walk on a plane and you walk through first class , it's like what ? 12 seats in first class , sometimes maybe 16 , right , they've already buried the number of people that can get in that immediately off-rep .
Exclusivity .
Exclusivity , right . If everyone could go to med school , everyone would go to med school , right ? So they have to have that barrier . There's the MCAT versus prereqs . Then there's the MCAT , then there's cost right , they're going to put that in there .
But why does the cost have to exponentially increase ? The body ain't mutating Like I don't understand , Society is .
Society is all right , you know I'm not going to say the brand name of what I'm drinking right here , because they don't sponsor y'all . But this is cheaper , is more expensive than it used to be . Right , you and I corner store and I want to store four bags of chips a dollar and a quarter water . Right , it's a dollar a bag .
Now for the one like cost goes up . So then they keep moving things every single time .
If you look at your undergrad right now and I've worked with undergrads , right , I said that earlier every year you got to sit and adjust your tuition to move up because there's a slider between who's gonna pay it , how are they gonna pay it and how are they gonna look at us when they pay it .
Right , everybody out there right now , you know , with your scrubs or backpack or shoes or car , you know the price tag of those things and if the value was lower you may not be as interested . It'd be the exact same product you can look up . Um , I think payless did this before they went out of business .
Rip , uh , they madea shoe store and they called it like pele , like they changed the name on it , but all the shoes inside were still payless shoes and they like changed the price tag . People are coming on these shoes are awesome . They're amazing . Blah blah . They were all Payless shoes and they exposed it to everyone . They're like oh , you're kidding .
Blah , blah , blah , but Payless is gone now . But Nike's still out here collecting all them checks on sneakers . I still can't get on the sneaker app . I'm buying off of whatever StockX for 200% , because when you bought my fake shoes .
I need that .
Shout out to all people who rocking the Grinches out there . I tried to get the reverse Grinches on Christmas . It didn't work . It didn't work . But when you attach a cost to something , it looks better to everybody else . And I think people still attach that cost to medical school .
So that's why these medical schools continue to adjust the cost as they're moving forward . So , yes , the body's not mutating , but society is Inter forward . So , yes , the body's not mutating , but society is . Interest rates are . They're going to continue to go up and that's what's sliding . Everyone and students are already doing it .
The numbers show primary care is dropping and I think , if we want to get that number up , student loan forgiveness ain't it , because , again , student loan forgiveness is finite . That is , oh yeah , I'll give you $300K right now . Boom . You don't earn it for the rest of your life . If you want to keep people going , the cost of primary care has to go up .
But the problem there is most of their funding comes from government , because kids all have insurance . They all have state insurance . These wellness visits don't pay as much as a post-op visit .
And when we start to adjust that , then I think we'll start getting more primary care doctors .
For the most part , when you really do an investigation and you go through the red tape and all of that stuff , rarely is that stuff equating to an increase in pay for professors or an improvement in the education , like an improvement in like facilities specifically for education .
But a lot of times it goes into improving , maybe , the gymnasium , improving , you know , the sleeping facilities , the dormitories , or making a really nice cafeteria .
Because what we're seeing now is that there's a steady state in terms of the competition between colleges and there's only so much you can say well , professor A is going to be able to recruit people to know school A and professor B . It's really about , well , how nice do you really want it in college ? Right , and that is ultimately becoming the .
That's ultimately becoming the . You know the deciding factors what kind of amenities do you have ? And in medical school it's like , yeah , like I get it , like I know I got to go through this . I know I got to walk through the desert and I got to have cups of water in my hands . I got to go through this . Yes , sir , may I have more ?
Yes , ma'am , can I have more like that ? But like damn , like , does tuition really have to exponentially increase on a yearly basis just to prove that I want to be a doctor and I get it ? We're never going to answer that question , but I got your point , but that's just .
That's just my mindset , which is like this is crazy , but like let's , let's , let's get to the go ahead , go ahead what you want to say when it comes to tuitions , you are correct .
Professors who are on staff on , often just like everybody else , has a contract , so it doesn't go up yearly . But the new professor getting recruited usually has an increased base . So and then that , then that doctor , that professor was there before , or a doctor or teacher comes back in a couple of years and asks for more money .
So salary for any school is the number one driver of tuition . Every professor may not get a increase in pay because the tuition went up , but it is the number one driver Inside knowledge .
All right , what's the Student National Medical Association doing about this , like , what are some initiatives that they have ? And then also , you said pre-medical board member or , sorry , professional board member to the EC . What does that mean ? What does that do ? And then tell us what SNMA is doing about this , the financial issues that are facing the students .
So I'll start with the second one Professional professional board member to the EC . The SNMA wisely , on their national board of directors , have four professional board members because they need someone in the room to say , uh-uh , don't do that .
Because they need us to kind of say , hey , look , on the far end spectrum , this is how things are done in the medical field . Or we were sitting in your chairs and this is the mistakes we made . Here's how we're going to guide you , here's how we're going to help you .
One of those board members also sits on the executive committee , which is basically in function monthly , whereas the board meets quarterly . So I have to go to the monthly meetings and again be that same professional board member in the room and say , yeah , do that , don't do that . That's a smart idea , great idea .
Or let me think about that , or let me bring you guys some resources that you may not have on this . So , the professional board members of the EC I'm up there with the chair , the president monthly , and the executive director and the whole executive committee staff .
So just to be clear , so everybody understands this SNMA is run by students , so it's run by medical students , Like they are actually studying for boards while they're running this organization and then you , as an alumni of medical school , as an alumni , more than likely , of the student medical association , you sit on the board and you make sure that these students
don't do crazy stuff and run amok .
Basically , we are there to be the wise sages in the room . I'm supposed to be their Yoda . I'm supposed to be their . You know , anakin , I'm not Anakin , you went crazy . I'm supposed to be their Yoda . I'm supposed to be their Obi-Wan . I'm supposed to be there guiding them .
So that's what we're out there doing on a monthly basis on the EC quarterly for my other colleagues , but you on the EC quarterly for my other colleagues , but you still work with students on the whole board as a whole . So SMA as a whole . Student National Medical Association understands these costs of livings and everything else .
Right now I feel like a lot of what they're doing is pushing the policy , because they know the numbers is driven by so many knobs , it's a lot harder . So the National Medical Association does have their HPLA Health Policy and Legislative Advocacy Committee . We're out there on the Hill , they're going to the Capitol , they're talking about these things all the time .
They make they write letters , we publish them , we meet with people and we also have relationships with certain businesses and medical schools , right . So SNMA partners with AstraZeneca . We have grants from them , we talk with them , we send them what we do as an organization and they help do some of our funding , right , you know tit for tat .
We're here , we're together now Big business nonprofit organization let's change the world . Snma has their president sit on the NMA , which is the National Medical Association . They're part of their board . It's like a student member , right .
So now they're on a bigger platform , bigger advocacy , going out there , working directly with physicians in those roles to do different things and , of course , we have several relationships with med schools around the countries .
I like to believe that the partnership SNMA has with a lot of the institutions has sponsored a lot of things to help with that debt that we talk about so much , right , okay ?
give me an example .
Pipeline program like pipeline programs right SNMA , right now with the American Board of Emergency Medicine , abim .
There is a scholarship out there right now , In terms of you just need to be a spokesperson , that's your thing be a spokesperson for your private college and be a spokesperson for damn , keep going .
I'm just saying I know where the plugs are . The American Board of Emergency Medicine is helping with a diversity scholarship for those who want to go into emergency medicine . Let's lower that cost , let's lower that barrier of entry . So ABIM sent SNMA like a bunch of stuff for this scholarship they're having .
They said help us publish this , help us do this , let's partner together . Boom , we're going to take that . Put it to our student interest group , send that out there , make sure people know that these things exist .
And I feel like the cost of applications in residency for , like ER or for any specialties . A lot of money we're talking like $5,000 to apply for these residencies at least .
And it's flat for everybody . But because for the more competitive ones which hopefully ER is this year my chest hurts already thinking about it For the more competitive ones , people are increasing the number of applications . There's someone on the board right now who is applying to a specific skin related specialty , talking about dropping 80 apps .
You know , and it just goes up . But that's what you have to do . I know no one applying to ortho , applying less than 20 programs . You know like that's like the base , so you have to have your money up for all these things and they don't want no one wants these bears of entry anymore . A
¶ Reducing Medical Student Debt With S&M
lot of our student national medical association chapters again work with other residency programs . They have interest group meetings , they have Zoom meetings . We have all these diversity initiatives now at these organizations and I like to feel like S&M is a little kindling fire to keep those things going .
Yeah , I think it's really important to let people know that there's some active work on Student National Medical Association to at least do their part in making sure that you can defray the cost , whether that's getting into residency or defray the cost Maybe we're trying to get into like doing a sub I that may be subsidized , like any bit counts , bit counts .
And I think , from my perspective , I always look at SNMA in terms of the social kind of bailout that I needed , right , because a lot of times you feel like you're on an island at your medical school or you may feel like you're in a silo and it's great to kind of come back and meet with like-minded people who come from maybe similar backgrounds , who maybe
have similar struggles , who can give you great similar ideas on how to kind of make it your way through financially , socially or even just career-wise . I think that's really for me the key thing as to why we're giving back , at least from my perspective .
Now , renee , obviously as a chairperson emeritus , obviously you know SNMA means that much more to her because you know she is , that's in her blood , it's in my blood , but it's really in her blood and stuff . So that's in her blood , it's in my blood , but it's really in her blood and stuff . So that's really important .
I want people listening to really understand that there's some work being done by SNMA to really help students get through this process with as little debt as possible , and I think that's ultimately .
My message to people is that , listen , when I did it , I remember when I looked at my application I'll end it like this when I looked at my application to apply for financial aid my first year , there's a space there that says that you know this is even before that there's like a schedule that says OK , you know you're going to need this much for books and
it'll give you like an approximate . You'll need this much for . You know supplies , you'll need this much for an apartment in Kansas City . You , you know supplies , you'll need this much for an apartment in Kansas City . You may didn't need this much for transportation and it'll . It will give you like the total amount that you need , right .
And then underneath it it says how much do you want to ask for ? And it's blank and it literally said you could put in like zero up to whatever you want and I put in maximum . Right , that's what I wrote . I'd even write at a dollar amount . I wrote maximum , give me everything .
Right , even though I was living in a place where I was paying 270 bucks a month for a rent . Um , you know , I had a used car and I was paying my dad back in the loans and stuff like . I was able to keep my finances low . But I just always had the mindset of I don't want to have to ask my parents for anything .
Right , like I told my parents I was going to become a doctor and , god damn it , I'm going to be a doctor and I'm never going to ask them for anything . Not because they would throw it in my face , but if I knew if I asked them for something , they would worry , and I didn't want them to worry . I wanted them to know that Nii had this .
But in response to that , I ended up taking way more debt than I should have . Right , I graduated 2006 with $240,000 , which is way ahead than what the average medical student at that time is taking similar to you . Right , like you are way ahead than what the average medical student should be taking in 2015, .
Right , but it just so happens like we come from backgrounds where we're just like look , I ain't asking my parents for nothing because they ain't got nothing .
I don't want them to worry and I'm going to figure this out , and I sometimes want to craft a message for them to let people know like , listen , try to decrease the amount of debt that you're taking out maximum on a yearly basis . Try to decrease that , and just also know that you're going to make enough , like you said after residency .
You're going to make enough to pay it back . The question is is how fast do you want to pay it back ? The question is is where do you want to be in your career ? And how much is debt ? How much is how much you make financial implications ? How much is that going to play into your career trajectory ? And that's all I'm saying
¶ Financial Support for Medical Students
.
You know there's there's a Nigerian slang out there I'll call it African slang out there right now that I think I applied in med school when I was filling out that same application and I think , even though I know better now , I probably would still apply it now .
I can't come and kill myself , which means I wasn't made for this life to suffer , you know like you guys hear that accent coming out , yeah , that maximum out . Would I have owed Sally Mae $20,000 less if I didn't take it For sure ?
But would it have changed a granular thing on the trajectory of residency to where I am now as an attending Again , I'd have $20,000 more that I would have paid somebody else . I feel like right . So you know I come in to the students a lot . You know don't go out there and buy a bottle every weekend after a test . You know that's crazy .
But if after one semester you need a little extra cash to just sit down with the friends and toast , I mean enjoy life .
It's shorts , guys , remember he's Nigerian , so just remember that he Nigerian .
You take an advice from a Nigerian , okay which people have you never seen struggle for money ?
guys check . The question is guys check your Yahoo emails , your junk mail . Okay , there's a reason why , exactly , prince love , exactly , I can't kill myself .
I'll go and take it from you before I kill myself . So , yes , should you write maximum ? No , probably not . Don't write maximum . But should you write zero Hell ? No , I get it . Write zero Hell , no , like you know . Like you , I get it . Yeah , halfway . Just sit and tabulate your life .
You know we all play that little game house or a little thing where you move and everything and you've already planned when you want to have kids , what type of house you want to live in , what city you want to live in .
You can Google the average for all those things right now and determine how much you're going to need to make and whatever , whatever , and your loans are going to be there . When people do a credit check , they separate your education based loans from your car loan , your unpaid city circuit , city credit card .
You know a lot of people don't know it's like a city out there . They can separate that debt and you know , even when we talk to people in finances , there's good debt and there's bad debt . Education has never been considered bad debt and they always know you're going to get it all Look , hey , now , if you don't finish , you've killed yourself .
You better start picking up sneaker collection and start selling sneakers , selling fake sneakers to Dr Love , because you'll buy it .
I check my stuff . I need the certification . But if you don't finish , you know , should you open up that Yahoo email and start emailing people ? You might have to consider it . But you have to know what you're getting into and so if you don't finish it , you need to find a job that's going to supplement those minimum payments .
That's why income-based exists , so you can kind of like live through it . But just know , when you do income-based you're usually stretching it a little longer because they want all of that interest . So choose an amount that you can live off of that you'll be happy with that .
Maybe one New Year's you can say hey guys , we're going to Colorado , you know something like that and enjoy life . Or maybe you decide you want to come to the 60th annual medical education conference for snma I was wondering when you're going to segue into that man .
You're leaving them out in the cold I'm supposed to come into it in new orleans easter weekend . Right , maybe you want to use a couple of your loan dollars on that meter to come down there get your battery Reach or your office of diversity affairs should be paying for this already .
They should have what do you call earmarked money for this they should have .
You know , certain states right now will not let and I will not name , may not have those offices no more .
Get downloaded in Texas . Hey Apple , you know you need to do something . Make sure that people in Texas can download this podcast . Yo Damn , bypass the diversity filters .
Shout out to people who listen to me , like on Google . Apparently , google podcast is going away . We have to use YouTube music come April .
I'll switch . It's better , though it's better , it's better , I'll switch .
But like , yeah , earmark that , calm down , enjoy we . But like , yeah , earmark that , come down , enjoy . We . Started off talking about evs . This is where you get your battery recharged . Every conference I would .
I would go there and be like I'm ready for the year , like I'd be hyped up , I'd be studying again , I'd be pushing myself , you'd ready to run through a wall when you leave amec and for all those old heads who are listening , attendings who are like , oh , I don't go to amec , no more , I don't have the hours , my battery's full , you're missing out or you
can help . We do a lot of talking about money . A lot of y'all have a little extra pocket change $5 , $10 a year . Sma is trying to do a campaign 600 for the 60th , 600k for 60 years . Price just went up y'all . You can donate . You can go to snmaorg right now . Leave a donation . $5 helps I know it sounds corny and you always listen to those things .
$5 ain't going to help y'all at 600K . What if 600,000 people gave $5 ? Boom , we're already there , right ? And we know how many people listen to Docs Outside the Box podcast . We know how many people need them . Tax write-offs we know people know the game . Just do a little write-off to the business Five $10 . I know people got more than that .
You're probably holding your Starbucks coffee right now with the extra espresso in it . You can go one Lex Espresso donate to S&MA . Boom . Now you've done a good deed . Now you can feel good about yourself . Please help us . Please help us .
And there it is everyone . This is the reason why , whatever event it is across the United States , you want to have a Nigerian as the emcee for that event , because they will get that money out of you . Yo , they can convince . What did it say ? You can pinch what was it , you can get water out of a turnip , or something like that .
Yeah , I can sell water to a whale . You know what I'm saying ? Like , hey , well , these other wells outdoing you right now . Your reserve is low , don't you want to be the top ? Well , the well that all the maidens and all the men come to . First , get this extra water right here . Boom , there you go .
Boom . Listen , guys , this is a message for everyone . But this you know , I know sometimes people will be like , oh , this message is just for minority . No , this is a message for everyone .
This is important , right , because more than likely , the studies show that that student who comes from minority background is going to come into a rural neighborhood and practice with a rural population or a suburban population . I practice trauma surgery mainly in rural neighborhoods and stuff , right , and I'm the only African-American doctor there and stuff .
I don't have any qualms about that at all . I take care of them like they were my family and so forth . So it affects everybody in so many different ways and stuff . So it's very important that everybody take a listen to this .
It's very important that we all decide that we're going to support this organization because it really does great things and it's very inclusive . I'll just leave it at that . So listen , dr Love . Where can people go to learn more about the 60th anniversary SMA , amac and maybe even get in touch with you ?
Tell them all of that before we end the show , all right ?
So for the SMA tip , they're everywhere Twitter , instagram . Sma is the hashtag SMA underscore official . I believe All the information is there . If you're not on the socials , straight up internet SMAorg , go on the website . Go under conferences . Amec is right there . You can look to the right . You'll see all the donations . You'll see all the links .
We have business partnerships with Delta for lower costs to fly to New Orleans for all the Delta people who need the medallions points and SkyMiles . Now you know those went up too , so you can use that link if you want to . All the information's there . If you want to get in contact with me , I'm also on the socials .
You can use the professional tag first , t4d underscore . Dr Donnie , I do work with Tour for Diversity as well , and that's kind of the IG I post most of my information on . You can also find me on Twitter Evil , which is just love backwards underscore thoughts . I don't post as much anymore . Are we allowed to call it Twitter , is it ?
X now you can find me there , but my main goal between now and Easter is hustle up AMEC . Everything you're going to hear from me is going to have SMA attached to it in some way , shape or form , so keep your eyes open .
¶ Financial Implications of Medical School Debt
And there it is , guys . Dr Love Anani , professional board member to the executive board with the Student National Medical Association , and here we're talking about the financial implications of all of this debt in medical school . Listen , make sure you check the show notes below You'll find all the links to everything that Dr Love mentioned .
And also check out our previous episode , where you'll find out what me , or how much me and Dr Renee are contributing to the Student National Medical Association . This stuff is important for everybody from every walk of life to understand the cost of medical school and what it means for people who are going to come into your respective neighborhoods .
Make sure you guys check those out . We're going to catch you guys on the next episode of Docs Outside the Box , y'all , peace , peace .