With the promise of abundant job growth and the unwavering need for medical care, physicians are some of the highest paid professionals in the United States. On one hand, medical students have a wealth of lucrative job opportunities waiting in the wings, yet the cost to obtain the education and training necessary to fill these positions continues to escalate. The rising average debt levels of medical school graduates coupled with the personal sacrifices an individual makes to become a doctor might have some students thinking twice about pursing the profession.
Money and time are two constant factors that an aspiring doctor must contend with before, during and after completion of medical school. Since no two journeys are exactly alike, the ROI (Return on Investment) for a medical degree differs for every graduate. The following information will shed light on the total cost versus the rewards of a medical school education:
A number one concern related to pursuing a career as a physician is the cost of education, which according to the Association of American Medical Colleges (AAMC), created a median debt of between $170,000 and $200,000 for 84% of 2014’s graduating class – up 3% from the previous year. The above figures also include premedical education debt, and are based upon the FIRST analysis of the 2014 Medical School Graduation Questionnaire (GQ) data, which the AAMC administers on a national basis.
“Unfortunately, the cost of medical school [and other aspects] are continuing to rise,” says Rick Swenson, MD, owner of Swenson Medical Practice in Yreka, California.
An AAMC survey of 85 public schools and 55 private schools found an overall 3-4% rise in the cost of attendance for medical school, including tuition costs and fees. Preliminary data for the 2014-2015 academic year shows the median cost of a four-year medical school education as $226,447 for public schools and $298,538 for private schools with median tuition/fee costs ranging from $34,540 to $53,714.
“I think nowadays medical school students need to go into medicine because they really want to help people,” says Dr. Swenson. “The financial upside of becoming a doctor is decreasing rapidly.”
Multiple factors play a significant role in either the increase or decrease of a medical school student’s overall debt and return on their investment:
* A School’s ‘Sticker Price’: The cost of a medical school education begins with the starting costs (often referred to as a ‘sticker price’) to attend an institution which fluctuates for an individual student when certain dynamics come into play, such as financial aid, scholarships, grants, the overall prestige of an institution, as well as the residency of an applicant.
For example, with yearly full-time tuition costs of $54,200, the U.S. News & World Report ranks the prestigious Harvard Medical School as the top medical school in the country for research. The top-ranked medical school for primary care is the University of Washington; where in-state students pay $31,992, and out-of-state students are charged $60,978 for full-time tuition.
* Location Matters: Where a student chooses to attend medical school (and ultimately practice as a physician) also affects the ROI of his or her education.
According to an article titled Residents: Will They Ever Pay Off Medical School Debt?, residents in the Southwest and North Central regions of the U.S. tend to face the largest debt levels, as opposed to medical graduates with the least amount of debt who attended schools in the South Central-, Northeast-, and Mid-Atlantic regions, and the West.
Location and tuition costs are also interconnected, as seen in the ranking of medical school costs and medical graduate debt levels by the US News and World Report. For example, Texas is home to a number of medical schools with the lowest tuitions in the United States, which correlates to graduates from that area representing some of the lowest debtors on the list [1].
* Type of Medical School: Overall, the cost to attend public medical schools is generally less than a private school education; the AAMC reports median tuition costs for the 2014-2015 academic year as $34,540 for public schools versus $53,714 for private schools.
* Specialized Training: Although it takes more time and money to become a specialized medical doctor, such as a cardiologist or urologist, the ROI can rise considerably for some who invest in additional training after becoming a licensed physician.
For example, the Medscape Physician Compensation Report (2014) identifies the specialty of orthopedic surgery as paying the highest median salary of $413,000 in 2013, compared to the $188,000 median salary that general internists earned that same year. This higher salary allows a graduate to pay back their overall debt at a faster rate.
In the end, the ROI of a medical school education is dependent on various factors that are unique to an individual student’s circumstances. Additionally, the continuous shifts that take place within the current healthcare, government and education systems, such as repayment incentives and statewide programs, also play a major role in the decision-making process.
The Time Commitment for Medical School
The second greatest concern for an aspiring medical doctor is the number of years it takes to gain the necessary knowledge, skills and experience required to become a physician. Students spend at least 11 years training as a medical doctor, which includes at least three years of an undergraduate education, four years of medical school, and however long it takes to complete internships, residencies and fellowships.
Those who pursue a specialty field of medical care, such as neurosurgery or radiology, complete additional years of education following medical school with surgery-related fellowships facing the most extensive training of five to six years.
“In my opinion, a medical school degree is not worth the cost because by the time the graduate finishes the prolonged period of studies and training, he or she is in the mid-30s,” says Dr. Akram Alashari, MD, who is a Trauma Surgeon/Surgical Intensivist at the University of Florida. “If, for instance, he or she lives to be 100 years old, this is one-third of his or her lifespan.”
In addition to the high cost of education and a lengthy time commitment, there are several additional hardships that a student in medical school generally faces.
Aspiring doctors must consider the following:
Expenses Beyond Medical School Tuition: Medical school costs and debt does not begin and end with the actual four-year education and additional residency training that students undergo to become doctors. Graduates also accumulate expenses related to application fees, lab fees, the cost of living, transportation costs, licensure fees, student loan repayment, malpractice insurance premiums, private practice expenses, and continuing education costs.
For some, the inability to pay off student loans after medical school and during a residency can lead to seriously ballooned debt and added charges in the most extreme cases, which might include deferred loan payment charges, default fees, and compounding interest rates.
The first year out of medical school is generally the most difficult for most graduates. For example, the Cornell Chronicle identified family physicians as being the worst off their first year out of school with a debt in 2010 that equaled about 85 percent of their yearly income – nearly double the ratio faced in 1996. However, physicians who specialize in fields, such as cardiology and orthopedics, did much better with a steady debt-to-income ratio below 35 percent.
Mounting Debt Can Affect Career Decision-Making: According to the American Academy of Family Physicians, many experts believe that some medical students avoid entering the field of primary care or opt to pursue other interests in order to circumvent a larger burden of debt. As a result, students may choose to study certain subspecialties associated with higher-paying salaries instead of follow a ‘true calling’ or their initial interests. Nonetheless, research suggests that primary care remains a worthwhile option for graduates with median levels of debt.
Conversely, some medical students with an interest in a subspecialty may forego the extra time commitment and increasing debt related to receiving additional training in a specific field. For example, Medscape Medical News reports that pediatric residents facing high educational debt might reluctantly enter primary care or pursue a hospitalist career rather than gain fellowship training for a subspecialist career.
A Strained Social Life: “The hardships that medical school students face is the extensive amount of time that is required to be dedicated to lectures, clinical rotations, and studying,” says Dr. Alashari. “This causes less social life, a high degree of uncertainty (as medical students usually have to relocate for residency), and a delay in forming deep meaningful intimate relationships.”
“[Medical students] need to develop relationships with other students who understand what they’re going through,” says Dr. Swenson. “If they’re by themselves, it is going to be a very long 4 years.”
Upon entering the workforce, balancing job responsibilities while maintaining a social life is still an obstacle for most medical doctors to overcome.
“If I could do it all over again, I would not become a doctor because I feel that so much of my time and my life is spent in the hospital, missing opportunities to spend with family and recreation,” says Dr. Alashari. “This may seem like a surprise, but this is the same opinion of the majority of doctors.”
Long Hours of Hard Work: The majority of physicians in the United States work long, irregular, and overnight hours. Many doctors are on-call, which means they must answer questions, consult with other physicians, and make medical decisions if one of their patients is in need. While the average full-time employee works 35 to 40 hours per week, doctors average a 50- to 55-hour workweek (depending on their field or specialty). Residents attending accredited residency programs work up to 80 hours weekly.
“…the extensive hours of medical school don’t necessarily improve once one is working, so this causes a significantly reduced quality of life,’ adds Dr. Alashari.”In fact, it has been shown that doctors have a higher rate of prescription drug abuse, suicide, burnout, and divorce than the general population.”
Lots of Responsibility: A medical doctor is responsible for the health of a patient, and makes decisions that could ultimately place lives in jeopardy. A doctor is in charge of routinely making life-saving diagnoses, and depending on his or her specialty, may perform complicated procedures on a regular basis. Physicians must be capable to handle the pressure and stress that comes with assuming such a substantial position, as well as be able to accept the liability and consequences when outcomes do not turn out as expected.
High Levels of Stress: The long hours and challenging situations associated with entering such an influential and significant profession contributes to a high incidence of stress amongst both students and physicians.
“I don’t think people really understand the stress that medical students undergo,” says Dr. Swenson. “You’re dealing with a group of people that are competing and fighting every day to be the best.”
Burnout Rates: Increased stress levels also lead to high rates of burnout for medical school graduates. According to Medscape’s 2015 Family Physician Lifestyle report, nearly 50 percent of family physicians younger than 35 years feel burned out. Citing loss of enthusiasm for work, feelings of disparagement and a low sense of personal accomplishment, these statistics show a significant increase over the rates from the 2013 report, in which less than 10 percent of young physicians expressed feelings of burnout.
High Incidence of Professional Conflicts: As with many places of employment, hierarchies and fierce competition exists within healthcare work environments, as demonstrated in the conflict that may occur between seasoned physicians and junior doctors.
“…the healthcare industry is an extremely malignant environment,” says Dr. Alashari. “In fact, according to the Workplace Bullying Institute, the healthcare industry has a higher prevalence of workplace bullying than all other industries, including service, manufacturing, I.T., and education.”
Government Regulation of Healthcare: A Cornell Chronicle piece titled Study: Medical education is still worth the cost, took into consideration the effect that government regulation has on the future of healthcare (and how medical professionals are paid). In response to an increasing demand to cut health care costs in the United States, changes in government policy, such as the Affordable Care Act, concentrate on funding such programs through actions that include a reduction of Medicare payments to hospitals. To date, the salaries of most medical doctors remain high enough to offset debt accumulated while in training. However, as more cuts are foreseen, a doctors’ income might be the next target.
Additionally, those with entrepreneurial dreams of enjoying flexibility and autonomy by establishing their own private practice may face a rude awakening in the future. “Private practice” might not even exist by 2020,” notes a surgeon identified by the pen name ‘Skeptical Scalpel,’ who wrote a guest blog post for KevinMD.com. “Every doctor may be salaried as regulated by the government.”
The specific benefits associated with becoming a doctor will differ for all medical school graduates, yet the following rewards represent some of the primary reasons that set this profession apart from others:
Being Able to Help Others and Save Lives: The ability to cure the sick and provide care to those in need is an undeniably gratifying aspect of becoming a doctor.
“Relieving suffering and treating disease brings a great deal of happiness not just to the patients, but to the one rendering the service,” says Dr. Alashari.
“For me personally, the biggest reward with being a doctor is the personal relationships I have developed with my patients over the years,” says Dr. Swenson.
“As a family practitioner, I take care of pregnant women, their children, their husbands, and the grandparents,” says Dr. Swenson. “It’s a fabulous feeling being part of and trusted with entire families.”
A Respected Career: When compared to any other type of work, medical doctors typically receive a higher level of respect and trust than professionals in other occupations. People automatically recognize the years of education it took to earn a medical degree. Physicians are viewed as being highly knowledgeable and revered for possessing the ability to save lives.
Challenging and Intriguing: Medical doctors continue to learn and grow throughout their career, as the intricacies associated with the human body are unending. The ever-evolving field of medicine connects physicians to advanced technology, cutting-edge treatments, new research, mysterious symptoms, and difficult-to-treat conditions that challenge the mind.
A Versatile Career Choice: Dr. Alashari says the degree of opportunity available to those who complete a medical education is “tremendous.” With a captivating range of medical fields to study that offer employment in numerous diverse health care settings (both nationally and globally), medical school graduates may choose to work at a hospital, become a consultant, conduct research, and/or teach the next generation of medical doctors.
“A medical doctor can branch out into any field of medicine, ranging from a private practice office, an Intensive Care Unit, Emergency Department, Operating Room, or a Laboratory, to the nonclinical world of hospital administration,” says Dr. Alashari. “The lifestyle can be designed to fit the working role and vice versa.”
Financial Stability: After conquering medical school debt, doctors earn a median salary between $174,000 and $413,000 that potentially makes it possible to achieve many personal goals, such as become a homeowner, start and provide for a family, invest in a business, and lead an overall financially stable lifestyle.
Motivating U.S. News & World Report Rankings: The U.S. News & World Report ranks physicians as one of the leading career choices in the United States. Noting its promising job growth and high salaries, the medical doctor occupation earned the following accolades for 2015:
Relocation and Travel Opportunities: “There will always be a need for physicians, so finding a job is relatively easy,” says Dr. Alashari. “Also, the opportunities are abundant and relocation is also easy.
The demand for doctors to provide relief in areas across the nation also creates opportunities to travel, as seen in the critical primary care shortage observed in some parts of California a few years ago. The medical field also provides an opportunity for professionals to explore working in different areas around the world, especially in largely underserved communities, or locations in dire need of medical doctors to address an epidemic or natural disaster.
In addition to securing financial aid for medical school, being awarded a scholarship and acquiring grants, students have an array of available options for minimizing education debt before, during and after they’ve received their medical credentials by doing the following:
Analyzing Potential Expenses: Before deciding to apply to medical school, it is important to acknowledge and assess how much it will cost to attend – including all applicable fees and associated expenses – such as MCAT testing, residency application fees, and the cost of living (including rent, utilities and possibly the cost to relocate).
Assess Both Your Definite and Potential Resources: After determining a ballpark figure of how much medical school might cost, it is recommended to calculate the financial contribution possible by you and your family, if they are able. Students who research and apply early for loans, grants, and/or scholarships have a better chance of lowering their overall cost of a medical school education.
Do Your Homework: In addition to acquiring financial assistance to help pay for medical school, there are also emerging trends that help aspiring doctors obtain an education, such as individual colleges and universities that have created programs which increase the affordability of and accessibility to a medical school education.
For example, the University of Kentucky’s College of Medicine launched a tuition guarantee pilot program in 2007, and became one of few institutions to secure each entering class a set tuition rate that remains constant for the four years they attend medical school.
Promising trends related to specific areas of medicine are also in place, as demonstrated in nearly three-fourths of medical schools now having initiatives meant to encourage careers in primary care; and leaders in family medicine residency training pushing Congress for change by recommending incentives for potential enrollees [1].
Consider Newer Schools and Programs: In an effort to increase the number of primary care physicians, new schools have been established, such as Quinnipiac University’s Frank H. Netter MD School of Medicine, which recently created a Primary Care Fellowship to attract new students with the promise of a fellowship that includes full tuition and fee waiver for four years. Graduates who practice primary care for four years keep the money, while those who do not, must repay the funds as a loan.
Explore All Repayment Options: Forty percent of medical school graduates who completed the 2014 Medical School Graduation Questionnaire planned on entering a loan forgiveness/repayment program. Available opportunities include:
Dr. Swenson says defining the overall worth of a medical degree education is a “tough question” to answer. “A lot of us leave medical school residency with a $250,000 debt,” he says. “I equate this to buying a house before you made a dollar.”
“Now after all of your hard work, you really want to buy a house, a car that doesn’t blow smoke, and take a real vacation,” says Dr. Swenson. “The next thing you know you are in debt 500+ thousand dollars or a lot more depending on where you live.”
Alashari says that the “degree of debt is so extensive” that it continues to be “a cause of lingering stress and reduced income” that further compounds the issue.
“With the changes in medicine that are happening and decrease in reimbursement, doctors will be making less and less,” adds Dr. Swenson. “Granted, we will still make a lot of money compared to the average salary of most Americans but the time, stress (making decisions on people’s lives daily), and cost of the education makes it really difficult to say it is ultimately worth the cost.”
When asked if he would choose a career in medicine again, Dr. Swenson answered, “99% of the time I would answer this question with a definite yes; the 1% of the time I do not like being a physician almost makes a 99% of the time I do like it, not worth it.”
Dr. Swenson adds that the relationships built throughout the years and “the satisfaction I have at the end of the day makes it all worth it.”
When Medscape surveyed physicians for their 2014 Physician Compensation Report on whether they’d select a career in medicine if given the chance to do it all over again, 58 percent of respondents answered ‘yes’ with 47 percent stating they’d pursue the same specialty again. These particular figures show a slight improvement in physician career satisfaction; the same survey taken in 2011 produced figures of 54% and 41%, respectively.
In conclusion, despite the lengthy time commitment and oftentimes exorbitant cost and debt potential related to obtaining a medical school education, becoming a doctor offers many attractive rewards and benefits that vary for those with an interest to enter the health care field.
While many medical school students accumulate mountains of debt during their training, there are plenty of options to enhance affordability by reducing overall tuition costs through financial aid, scholarships and entering select programs. A range of repayment opportunities also lessens the burden of debt for new graduates.
With great responsibility and the ability to make an impact in the lives of many, the wide-ranging opportunities and growth potential related to a career in medicine is still a lucrative and personally satisfying option that will differ for every student involved.
Those who receive financial assistance and graduate with a lower amount of debt typically reap the profits and additional benefits that come from the higher-paying salaries of doctors faster than those with greater debt.
Aspiring medical doctors must decide whether they are ready and willing to commit themselves to an average of 13 years of training and education along with debt that generally reaches substantial levels. While each student initially goes into medicine to reap his or her own personal benefits, it’s a field that (no matter what the reason behind the decision) involves a great deal of hard work and responsibility before and after the title of ‘Dr.’ is earned.
[1] Residents: Will They Ever Pay Off Medical School Debt? Medscape. Aug 05, 2014.
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