Student Loan Debt

The start of our last block sure feels good. Soon enough we will be seeing patients and interacting with physicians in the community, unfortunately that comes with a price.

Student Loan Repayment Options

Just as we are preparing to file our FAFSA for the next year we received the bad news that there will be a 5% tuition increase! Apparently this figure is low, but it still adds up. The AMA reports that the majority of medical students have more than $100,000 of debt. Ask a student and after performing the math they will tell you that their debt is closer to $200,000 or more. We have no idea how the health care reform will affect future medicine and the financial concerns it carries. From my understanding, it is difficult to be a physician and not be bothered by the monetary repercussions of business. In fact, many practicing doctors are still paying off student loans.

A growing concern is the dwindling number of family practice physicians. For many students the pay alone is a deterrent that promotes interest in medical specialties. Fortunately, there are some specialties that are eligible for loan repayment opportunities. Here are a couple resources worth investigating if you are looking to get that student loan monkey off your back and you are not interested in the military scholarship:

• National Health Service Corps - Family Medicine, Obstetrics/Gynecology, General Internal Medicine, Gerontology, General Pediatrics, General Psychiatry
• AAMC - Loan repayment/forgiveness and scholarship opportunities by state

Board Prep Question of the Week

A 6-year-old child is brought by ambulance to the emergency room following an automobile accident. She is covered with blood and unconscious secondary to hemorrhagic shock. Her parents urge the physician to do everything possible, but implore that no blood products be used to treat their daughter. What is the best course of action for the physician to take?

A. Administer blood without delay and contact child protective services
B. Convene an urgent meeting of the hospital ethics board
C. Engage the parents in a discussion of why they hold these beliefs
D. Transfuse blood as needed, explaining the situation to the parents
E. Treat the patient without using blood products, per the request of her parents

Answer & Explanation 

Federal Student

Although I never really imagined having time to be employed anywhere as a medical student, I was happily surprised when the opportunity presented itself. This is the cadaver lab where we dissected cadavers and where I participate in the federal work-study program.

Federal Student Work

No longer a run-of-the-mill student, but a federally paid student, I reduce some of the hefty student loan I borrowed and learn at the same time. Nationally, students at more than 3,000 institutions are hired part-time to help in various operations and other positions. Almost two-thirds of the pay comes from federal funds geared towards students in financial need...for which most medical students qualify. The remaining third comes from the institution and all remuneration is tax free.

Once first year ended, I gained employment as a laboratory assistant in the bioskills and anatomy labs at Touro University-Nevada. Currently, the labs are home to 47 cadavers, the majority of which coworkers and I are preparing for the incoming DO class of 2013. Some are being prosected in preparation for allied health students within TUN's other colleges. I must admit that my job is probably one of the more unique federal student positions available.

In addition to earning a little extra among the cadavers, I will be able to brush up on anatomical landmarks and terms. This should bolster some of the already fading memories of structures once learned. Although impossible to work off my student loans in this position, if it helps when boards come around, I will be one step closer to graduating as a doctor. When that happens, no more federal student for me, instead my tax dollars will be feeding into the next generation of federally paid student employees.

Clinical Corner

Willed Body Program

The cadavers that are provided for students are obtained via willed body programs. A number of these programs exist around the country which are often associated with medical universities. An individual can specify that they would like their bodies to be used for the purpose of medical research by filing a donor form before dying. This gift to science has benefited the medical community in ways that the common public is not aware. In the university setting, these individuals are often considered a student's first patient.

Rationed Time

The long days that never seem to end are certainly anticipated experiences. Only in the beginning of the whole process, I am learning to ration my time to the many tasks that demand my attention.

New Home

We finally closed on our new home and moved in last week (hence the missed post). It took our mortgage broker a long time to finalize the transactions and was more than a headache with a new problem or delay every day. Being first time home buyers has been quite the hassle and I know many medical students wrestle with the decision to become home buyers or simply rent.

In making our decision we had learned that renting a unit in Las Vegas would cost nearly the same as a mortgage. Our struggle was mostly with the mortgage lenders being flexible once we found the house we wanted. We waited until the very last minute before making the deal official.

All I can say is that if you are entertaining the thought of home buying, start well before matriculating. We ended up staying with family for almost a month. It was great to spend time with them, and we will forever be grateful for their hospitality. We just hate to have out-stayed our welcome. Renting sure sounded tempting on occasion, but our new home was worth the effort.

Student Loan

Reimbursement for the expenses of medical school cannot come too soon. With all the costs of living increasing and becoming more abundant, staying financially afloat is a rather fancy dance. I can come up with a lengthy list of debts, but if you are reading this you could name them just as well.

My financial institution is finally funding my tuition and reimbursement checks. It is a huge relief to know we will be able to buy groceries next month and have a roof over our heads. Visit the past post for more student loan info.

Exams

I knew medical school would move quick, but I had no idea we would cover an entire book in less than a couple months. Midterms were only one month in and next week will be our first week of exams. "Block week" as they call it, occurs three times a semester, testing our memory and endurance skills. With 24 credits this semester, I should start having nightmares any night now.

Somehow I managed to make it through my first couple tests despite the late...late nights of studying. This method is not recommended for two reasons: 1)Taking a test while fatigued makes information recall ineffective and 2)It's bad for your physical health. Of course I would like to have performed better, but the information was spilling out of my head by the time I took the test. I think I need to reformat my cerebral hard drive and free up a little space.

Student Organizations

I have been blown away and slightly annoyed by all the organizations vying for my money. Who knew there were so many student medical associations? Each one asks for membership money but none really have a significant impact that seems evident. The benefits they have expressed usually include free meals, discount suture clinics, and the ever popular screen printed tee-shirt.

I may be new to this medical school thing, but I'm not an idiot. My intention is to pass and earn a degree. If that means I cannot join an organization my first week of school, please support me in that decision. Perhaps down the road I will share a portion of my student loan with you so I can say I belong to your club. Maybe in the meantime you could come up with better reasons than a free lunch to be a member of your organization.

Back to School

Would you believe I made it through the second day of medical school and still had a smile on my face?! So, I had to force it a little. The first week is behind me and classes are under way.

Orientation

Touro University has chosen to start the school year with a two day orientation that gives the new medical students an opportunity to meet administrators, professors, and the other students. We worked out technological kinks, signed a lot of paperwork, and learned a little about the background of our new school.

As TUNCOM is still rather young, there has been a lot of change from year to year. Each professor has been assigned four or five students whom they mentor. Mine happens to be one of our biochemistry professors. A large portion of our teachers have foreign backgrounds; my mentor hails from Russia.

What did I take away from orientation you may wonder? Medical school is going to be really...really hard and keep us extremely busy. However, they want us to succeed and will help us get there (I wish I could say, "or my money back.") I really believe they are looking out for our best interest. On top of all that, we received our ID badges and multiple kosher meals. When was the last time you had kosher pizza?

First Day of School

Bright and early, we all filed into our lecture hall (for the next year), turned the room into what looked like a laptop convention, and received a two hour orientation to anatomy procedures. As creepy as it may seem, a room with 40 cadaveric patients is an awesome sight. It was soon time for our first lecture...biochemistry.

Anyone who has taken a course in biochemistry knows that there is a lot of information to absorb learn in an hours time. Fortunately, we only have a little more than a month of biochemistry, and I am sure they will cover everything. That being the case, they sure have started us on the right foot. After six hours of biochemistry, I think we were all ready to go home and catch up.

All the Rest

We had full days of school from 8 in the morning until 5 at night. A break for lunch and dinner were followed by more intellectual feedings. I don't know about my counterparts, but I was studying until 11:00 or later each night and trying to get up early enough to exercise before classes. The days are full; what else could I have expected?

Our first quiz was this week and we have already started dissecting our cadavers quite extensively. They want us to finish anatomy early on so we have a good understanding of human geography for the remainder of our education.

Murphy's Law

You know, 'if anything can go wrong, it will.' These are not problems with the school, but issues none the less. I am reconsidering my decision to save $400 by not purchasing a laptop protection plan. The girl next to me spilled her soda on her laptop only two days into the year. At least it wasn't a month later, but she still had to purchase a new one and this time she bought the protection plan. This warranty will usually cover everything from spills to running over your computer with a car. Unfortunately, you still run the risk of losing stored information.

When I chose my lender, I thought I was getting a great deal and saving quite a bit in the long run. Perhaps I should have gone with a well known lender. Only a few days into the year and they called to let me know they were changing their company organization and would not be able to guarantee when my loan would be available. That is bad news when your bank account cannot afford a $40,000 tuition cost. With my new lender, I think things are now moving in the right direction.

And with that I would say to anyone who has gotten this far, enjoy your free time. At least do it for those of us who don't get much.

Housing

Finding housing can be one of the most exciting and stressful experiences of the pre-matriculated medical student. While obtaining all the necessary documentation, supplies, and loans it is crucial not forget that you have to live somewhere. I was actually surprised to learn that my wife and I could afford more than a one bedroom home from Monopoly.

Studies have shown that individuals who buy a home tend to have more money saved than those who continue to rent. In our case we had to choose between paying $1200 for rent every month or paying a mortgage of $900-1100. Obviously the former choice would be throwing money to the wind whereas the later would ultimately build equity in our name. The decision was not hard to make as you could imagine. With that in mind, this blog will concentrate more on the purchase of a new home rather than renting a unit.

Home Loan
Many of us who are entering medical school have never purchased a home and likely do not have the money to afford paying cash for one. Currently, we are in a 'buyers' market which means it is easier and cheaper for buyers to get a home. Certainly my wife and I would love to have a lavish home with furnishings and the like, but neither of us make the kind of money that would be required for this to happen.

Our first task was to find a mortgage lender, someone who could determine how much home we could afford. Through a careful review of our expenses, debts owed, savings, and salary we could determine a monthly mortgage payment that would not be too expensive for our budget. In our case, I do not plan to work as I will be a student. This means one salary will be figured into the equation, which is usually a safe way to avoid foreclosure.

The goal here was to become pre-qualified and pre-approved. Qualified simply means you are eligible for a loan where approved means you have the loan waiting to be used. Sellers prefer an approved buyer as they will not have problems receiving their money. Thus pre-approved buyers have a greater chance of purchasing the home they want sooner than a buyer that is only pre-qualified.

Now that my wife and I knew how much our monthly payments would be, we also knew the price range in homes that we should be seeking. This significantly reduces the amount of homes in our search and allows for a more focused house hunt.

Location
Knowing where your school is located and the neighborhoods in the area helps greatly when looking for a new home. In my case, I would like to be able to live close enough that I could bike to and from school. Not only to economize with rising gas prices, but for the sake of exercise and proximity. If you are fortunate, Google will have your neighborhood on their street view allowing you to see it online before visiting in person.

Safety, climate, populations and other information may be useful as you look for the perfect place to call home. Consider your city's reported values and how they compare to national averages. After all, a purchase suggests you will be there for an extended period and you want to be certain it is the right place for you.

Realtor
Let's face it, you are strapped for time and orientation is just around the corner. Looking for all the available homes would be impossible without a realtor who's job is to help you find the right place. Our lender helped us find a realtor and we have been running ever since.

Know what your home must have so your realtor can narrow down the listings. We chose to have at least three bedrooms and two baths. The garage was not mandatory, but it would be nice for storage purposes. Having the proper hook-ups for a washer and dryer were the other must as the coin laundry gets really expensive. Other things to consider would be cabinetry, appliances, basement, landscaping, backyard and remodeled features.

Walk Through
Since you will be eating, sleeping and studying in your new home, you had better like it. Take time to actually walk through the home yourself or have someone you know do it in your place. If you are out of town, the realtor could take pictures of the home and email them for your approval.

We drove to Las Vegas and stayed with family over Memorial Day weekend. Our realtor sought out homes to visit and we spent a couple days looking at various locations, properties and options (condominiums and houses). This visit was valuable as we could see the homes and their respective neighborhoods. Unfortunately, the real estate market is moving fast and the homes we tried to obtain were already sold by the end of the weekend. This only emphasizes the need to start early.

Many of the homes on the market today are repossessed by banks as foreclosures. The savings can be extremely valuable. In fact, the only homes that we visited were foreclosed as they were in good condition, newer models, and most importantly in our price range. For example the home we are currently looking to buy has been reduced in price by more than $100,000 in less than three years!

Buying Your New Home
So you have finally found the home you like. Your realtor and lender will do most of the difficult paperwork and organizing your offers to the seller. Once accepted they work out the details necessary to close in a timely manner and you make your move into your new home.

Any day now we will be hearing back from the bank as to whether our offer was accepted. It is stressful not knowing if we need to keep looking for other homes or if we can start planning our move in its entirety. In the meantime, wish us luck and happy hunting!

Student Loan

There are a few ways to pay for that expensive medical school education. Unless you have a great inheritance, win the lottery, or find a sac of hidden cash, it is likely that student loans are the only way to pay. I never found the pot of gold at the end of a rainbow and now must look for other financial options.

Scholarships and Grants
If you have the grades, the time, and the will power, it is wise to search for a little free money. Grants and academic scholarships helped fund a large portion of my undergraduate studies leaving me debt free upon graduation.

The hardest part is sitting down and looking for matches that meet your personal qualifications. FastWeb is a great place to start as it does the sorting for you. With the right grant or scholarships, the medical school expenses can be significantly buffered.

Student Loans
Once scholarship opportunities are exhausted, the most common method for payment comes from borrowed money in the form of a loan. With rising costs for medical school, loans are becoming more substantial all the time. Loans to consider: Stafford, Grad PLUS, Perkins, and private.

Stafford Loans
Stafford loans come in two forms, unsubsidized and subsidized. $32,000 and $8,500 can be borrowed from these loans respectively, totaling $40,500. This will satisfy tuition, but not easily the other expenses of room, board and supplies. Interest is paid by the US department of Education for subsidized loans while in school where unsubsidized loans require the interest to be paid by the student from the time of disbursement. Obviously subsidized loans are preferred in this regard. Interest rates may be high, but some lenders offer benefits to curb the overall expense.

Grad PLUS Loan
These loans are backed by the government and come with a fixed interest rate of 8.5%. As these are usually supplementing the Stafford loans, they are not need based and vary according to the amount of aid already received. You cannot borrow more than the cost of attendance. A good credit history will make this loan easy to obtain.

Perkins Loan
The Perkins loan is a federally funded loan that provides aid to those who are exceptionally needy. It offers a low interest rate to those who qualify.

Private Loans
Should the loans above not provide adequate funding, private loans are available to supplement your resources. Do not over-borrow as it will one day have to be repaid. Interest rates are not fixed and other requirements may apply.

Lenders
Finding the right lender can be difficult. Compare the terms of service and special offerings before selecting your lender. Some will offer all or a couple of the loans listed above. Use one lender for all your loans. Once the time comes to repay your loans, the process of loan consolidation will be made easier offering a lower interest rate.

I chose to use MedInvest as they offered greater discounts than the other lenders I researched. With on-time payments and direct withdrawal, similar sized loans save almost $2,000-3,000 over the lifetime of the loan.

Application
I have chosen to apply for the Stafford loans and some Grad PLUS loan money. TUNCOM has a loan application form that is filed once a lender is chosen. The financial aid office applies for Stafford loans on my behalf. In order to obtain Grad PLUS money, I must apply with my lender of choice for the amount of desired money on my own. Since my wife will be able to work during my time in school, it is not requisite that I borrow the full amount available. Since I would like to buffer some of the expenses, I will obtain a small Grad PLUS loan to help cover living expenses.

In every case, it is necessary to fill out a FAFSA application as this is how lenders approve your loan request. Never incurring debt until this point in my life has been a great accomplishment. Now that I must borrow money to thrive, the natural fear that is associated with owing something to someone else is very daunting.

One physician I spoke with said that students are poor and doctors are rich. Borrow a little extra during school in order to live moderately so that the transition is not too drastic. Good advice, I hope that is still the case when I graduate.