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Musings of an Infectious Disease Specialist

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Dark Clouds A Lifting

27 July, 2014 by GAggreyMD 2 Comments

debtI rarely discuss finances but have been disturbed by the many stories of student loan debt in recent years. Most people realize that a medical education comes with great financial undertaking and indebtedness though I doubt most understand the delayed gratification required. After all, doctors are inherently rich!

Are Student Loans Good Debt?

I realize that are many people way too deep with their student loan debt taken out for other professional degrees, master degrees, undergraduate degrees, and let’s not even talk about all the online degrees. I at least have a practical chance of repaying my student loan debt. We all though have drunk the Kool-Aid that “student loan debt is good debt” for much too long. How can a debt that can never be written off when you are otherwise bankrupt be good debt?

My own personal story with debt I think reflects my naïveté but I suspect I am not alone. It should be understood that I have never liked being in a position to owe anybody anything. I have never wanted to be held hostage by somebody else’s whims, real or imagined on my part. This fiercely independent spirit has not served me best, I’ll admit. I am after all human and as humans we are supposed to have faith in each other and be interdependent, I know, but that’s another story. My point is, the very American concept of borrowing large amounts of money to go to school with or to live life on does not sit well with me.

Luckily for me, my undergraduate education came at minimal cost to me and my family. Even so, the few thousands that my parents were responsible for made me feel so guilty that I made it a point to work during school and during the summers to put some money towards my tuition. Of course, having African parents meant that they saw it as their duty to pay for their children’s university education. In hindsight I realize that whether I had saved or splurged my hard-earned pennies my college tuition would have been paid all the same. Medical school was another story. Graduate university school was our own responsibility.

Being an International Student at an American Medical School

As an international student in America, I had been told by the premed advisor in college that it would be damn near impossible to get into an American medical school because of the extreme competitiveness even among the American students. On top of that, unlike for undergraduate degrees, there was little in the way of scholarships and grants I was told. I was encouraged to find other interests.

I took the advice as a personal affront. I assumed the advisor saw a Black girl, an African at that, before her and concluded that I didn’t have what it took to get into medical school. What other explanation could there have been? It was early in the first semester of my first year. So, I never went back to her and I didn’t seek out any other professor in the sciences for my career-decision making qualms. I proclaimed myself pre-health and pursued both biology and anthropology studies.

My fourth year of college begun on such a high. In each class year ahead of me, one or two international students, African may I add, had managed to gain admission into an American medical school and had actually enrolled. Surely, I could too. When my turn came around, I was called for interviews almost everywhere that I had applied. It was such a rush. But the winter progressed into spring with receipt of either rejected or wait-listed statuses from these schools and I became crushed.

On the other hand, I had been accepted into excellent schools of public health but now I wanted to go into medicine that much more. I could not envision doing what I wanted to do with my life with just a public health degree. Who would take me seriously? No, I told myself that I needed the M.D. Clearly, I don’t think so anymore. In either case, when I did eventually start getting off the wait-list at various medical schools during the spring I was already so dejected that I refused the schools that offered partial scholarships to me. Can you imagine? I was stubbornly going to go where I wanted to go out of my remaining choices after having already been rejected from the one I truly desired to attend.

Taking Out Private Bank Loans for Medical School

My medical school was known to be expensive even at that time. As a foreigner I had to show proof of funds to be able to matriculate. As an international student I was not eligible for federal student loan programs. Out of the woodwork, a close friend of my father offered to co-sign my first year loan. At the end of each year, he co-signed the next year’s loan, and then the next. Each was a private bank loan. Each was at 6-8% interest. I took out loans to cover the full tuition plus living expenses. Loans that were approved in time to allow my medical school to grant me student status, so I could stay in legal F1 student non-immigrant status. Loans that started to gain interest the minute they were disbursed.

To this day, when I start to vent about how miserable my life is because I chose to be a doctor I have to remember how badly I wanted this for myself, and how much faith and investment others had put in me. I suppose to be honest though I could claim that the idea of being a physician was planted in me by others earlier in life, and that I just accepted it. There is a personal truth in claiming to be pre-health and not pre-med but I guess I wanted to prove that I could become a doctor. I was good in the sciences but my heart lay in the arts and humanities. But it is now what it is. The bed has been made.

I took out only the bare minimum to cover tuition and basic living expenses that first year. I flew to medical school with my two suitcases of life belongings and rented a room that was furnished with a twin mattress that lay directly on the floor. I shake my head now at the vision of my toiletries carefully lined up on the floor next to the mattress. Next to that a growing pile of used textbooks. One of my suitcases served as a table, the mattress my chair for when I had to study at home. I spent most of my time in the school, staying behind after class, only returning to my room to sleep. I didn’t have a car then. Didn’t even know how to drive. The apartment was not in the best of neighbourhoods so I would only stay in school as late as which ever kind class-mate who would give me a ride home did.

When it came time to apply for a loan for the second year of school, I upped my living allowances, debt be damned, moved out of that room into a one bedroom apartment in a safer neighbourhood and bought myself furniture. Third year came around with the requirement to drive to the different hospital sites for my clinical rotations. My parents purchased my car for me which is still going strong twelve years later. Back then, it took about twenty dollars to fill my tank every two weeks, and that was carefully budgeted out of school loans.

Deferring Student Loan Repayment

I completed medical school with about $190,000 owed to the bank in principal and accrued interest. In addition, I owed $12,000 to my undergraduate college, which had gained ZERO interest in the 4 years of deferral. Is it any wonder that I love Wellesley College and will forever send in to them my alumnae donations?

Not so for my medical school. Actually, after receiving one too many email requests talking about how tuition was now $51,000 per year and 40% of the Class of 2012 had debt over $200,000, excluding their undergraduate debt, and we the alumni community and the school itself were falling short in providing scholarship support blah blah blah … I shot them back a terse email detailing how I of the Class of 2004 had my own debt of over $200,000, excluding my undergraduate debt, to worry about. Humph! That should teach them to clutter my mailboxes.

I don’t think anybody was more shocked though than my benevolent co-signers when I revealed my intern year salary of just about $40,000.  I sensed that they thought I was lying because yeah-yeah interns and residents make less than full-fledged doctors but surely it had to be more than that?! I recall being told, “but I know a nurse at that hospital who makes more than $60,000”.

Internship, residency, and fellowship proved to be as tough as I was forewarned. They were horribly demanding of my time and sanity. Add on the feeling of being buried and trapped by a humongous financial burden. Of knowing how hard you worked for pennies that wouldn’t even cover the minimum monthly payment of the collective loan were you to send your entire paycheck directly to the bank. Then add  the realization that society at large thinks your profession is one of greedy incompetent liars. It was a downright miserable existence. Now add all the hoops I had to jump through to make sure I was maintaining proper legal status in the US post 9/11. I was perpetually stressed, overwhelmed, and anxious.

Student Loans Dictate My Career Path

Student loan debt tied me down and constricted my options in so many ways unimaginable to me when I decided to take them out. They probably affected my career choices more than my status as a legal non-immigrant alien did. I did try to pursue a public health degree both in medical school and during fellowship and both times had to talk some financial sense to myself. I couldn’t afford to forbear repayment on the bulk of my loans for yet another year.Furthermore, I realized during my fellowship training that the world of infectious disease academia would leave me feeling like a caged bird still burdened with all this debt for decades to come. I didn’t want that. Far more than wanting to be the expert on a specific tropical illness, or one of many expert contributors to the world of HIV/AIDS care, or an official in the World Health Organization, I wanted to be free of the burden that had imprisoned my thoughts, hopes, and desires and had made me a bitter person. I wanted to be the bird that sings in the forest. That girl who skips in the rain. I just wanted the chains of bondage off.

During training, I paid the little I could towards one loan which could not be deferred though all it did was keep my account current. I would endure what I endured in the hospital then come home to battle roaches, mice, and at one point a murder in my apartment complex, all the while receiving lectures from disappointed or well-meaning family who found me to be selfish with my time and opined on my expiration date as a woman and the necessity for me to get married and have children.

Tackling Student Loan Repayment

When I finally came off the residency and fellowship conveyor belt, five years after graduating medical school, and nine years from the disbursement of my first medical school student loan, I owed $232,000 to the bank. I never acquired credit card debt because I was that diligent with my budget. I was 30. I had lost my twenties and with it the ability to truly save and invest money to earn compounding interest. It’s of no comfort to me that most people in their twenties don’t save towards retirement or general savings for I know that if I had the luxury of time, I most certainly would have made use of it.
But, I was beginning my career in my thirties with over a quarter million dollars in debt.  Worse, the financial crash of 2008 had occurred and my loan co-signers were stuck with me and this quarter million dollar debt. Thus continued my miserable years. Into my thirties the dark cloud of despair came. On paper, I made the right decisions, accepting a job that would help me tackle that debt head on and with max speed knowing all along that signing that contract was akin to signing away my social life, one that I had promised myself I would make my focus once I was done with training.  Ha ha. Bitter laugh.

I was finally a real doctor making the big bucks. Six figures, sure, but dwarfed by far by my student loan debt. I recalled years earlier reading not to take out more in student loans than your expected first year salary. Well, I was one of the fools who did. I went into medicine where the options were many but chose to become an infectious disease physician, one of the lowest paid specialties, despite advice from people who tried to dissuade me for exactly that reason. However, I’m glad I stuck to my guns. Though my current stint in private practice leaves much to be desired, I can’t imagine being anything else in the field of medicine. These days, I can smell the jasmine blooms  and hear the birds sing. I see angry people and wonder why they are so upset, because for me, being grateful and happy is easy now. I have lived on the equivalent of a fellow’s salary and putting all that I can towards repaying my student loan debt and relieving my cosigners of my debt. I finally have a positive net worth, and I trust it’s only going to get better. In fact, I still remember the day that my net worth was ZERO. It felt marvelous. Who knew ZERO could be such a beautiful number? ZERO! Swoon.

Socially, in hindsight, I can see that the dark clouds blindsided me. I never imagined that I would be alone at this stage. I get upset not because I am single though but because family members seem to think I’m wasting time on purpose disillusioned by my youth. Okay.

Medicine is a Lifestyle

No one ever said being a doctor is easy. I just didn’t expect it to be this hard. I didn’t think medicine would take over my life and disrupt plans I had for myself. I now know that medicine is a life choice not just a career. I had been ready to endure medical school and medical training but I admit that I expected some semblance of normalcy afterwards. I didn’t expect to endure a lifetime of being a doctor.
All around me I see that the autonomy, respect, and big bucks generally thought to be some of the outward rewards of the profession are quickly fading away. Every year insurance reimbursement rates fall and practice and malpractice costs rise. Each year for the last decade, physicians who accept patients covered by Medicare, are threatened with pay cuts of 20 – 30% only to have the Senate stall decision-making for yet another year. The media blames us for the country’s ills, the sick patients and their families take out their frustration with the healthcare system upon us, and the insurance companies try to dictate to us what we can and cannot do while our professional organizations stiff us for more and more fees in the guise of making sure we are up-to-date with our medical knowledge and skills.

I feel like I’m in a maze of a minefield trying to get to the exit with as few battle scars as possible. We don’t know what the future holds yet I am disturbed that when I sometimes ask myself why I wake up in the morning to go to work the answer is “to pay off my loans”. That’s rather awful don’t you think? Soon though that will no longer be the case. Thank goodness!

ere
she couldn’t afford to make payments and had to place her loans in
deferment, but this is one of the worst things you can do when it comes
to student loans since the balance and the interest are growing in
tandem. – See more at:
http://madamenoire.com/279941/woman-says-she-never-plans-to-pay-off-her-186k-student-loan-debt-will-this-be-the-new-normal/#sthash.tJgcpx92.dpuf
ere
she couldn’t afford to make payments and had to place her loans in
deferment, but this is one of the worst things you can do when it comes
to student loans since the balance and the interest are growing in
tandem. – See more at:
http://madamenoire.com/279941/woman-says-she-never-plans-to-pay-off-her-186k-student-loan-debt-will-this-be-the-new-normal/#sthash.tJgcpx92.dpuf
ere
she couldn’t afford to make payments and had to place her loans in
deferment, but this is one of the worst things you can do when it comes
to student loans since the balance and the interest are growing in
tandem. – See more at:
http://madamenoire.com/279941/woman-says-she-never-plans-to-pay-off-her-186k-student-loan-debt-will-this-be-the-new-normal/#sthash.tJgcpx92.dpuf

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Filed Under: Musings Tagged With: Angry Patients, Bureaucracy, In The News, Medical Residency, Student Loans, Why ID

Comments

  1. Shopaholic says

    28 July, 2014 at 00:44

    I enjoyed this piece.

    Reply
  2. Anonymous says

    27 October, 2014 at 11:18

    Really enjoyable. It was something for me to think about since my daughter just took a second loan to pursue a masters degree outside the US.

    Reply

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