The Cost of Medical School - 20 ways to make it work

         Jason and I both had the privilege of growing up with parents who taught us how to manage money, the importance of a savings account and to fear the big, D word ("debt"). When we met I was living paycheck to paycheck, but I was debt free. Jason was also living small and unbeknownst to me he had an impressive budget spread sheet in Excel. The kind that makes your eyes blurry trying to figure out what to focus on first (is this just my experience with Excel?). So far, we were following our parents wise advice ... and then Jason signed up for medical school! Even though this debt is an investment, I still felt like we threw our parents' advice to the wind. But Lord willing, it's only for the time being. If you are considering marrying a person pursuing any vocation in the medical world I highly recommend having the money talk soon, as in yesterday. Talk about both long term and short term costs. Our first conversation about medical school expenses was during our dating relationship, I remember the conversation well.....

          It was late on a Sunday night when we pulled 
into a friend's driveway and parked off to the side between two other cars. We had arrived late (as usual) and we were wondering why we had decided to come at all because it was around 9:30 PM, the next day was Monday and it wasn't typical bonfire weather (kinda muggy). Looking back I think we went because it gave us another chance to extend the evening together rather then say good bye and head to our separate homes for the night.  Plus, our friends were expecting us, they were already in the back yard around a blazing fire and we could hear them talking and having a good time; probably sweating too. But instead of wrestling the broken door handle to get out, Jason stared ahead and made a comment about how he wasn't at the same place in life as most men his age. Pushing aside the urge to join the laughter that came from the backyard I questioned him to tell me what he meant. He proceeded to talk about how most men his age already had a good job, an established career with regular hours and a good income. Some of his friends were already married, had a family, a house, a white picket fence, etc...  He asked me if I was expecting that of him because as sure as he didn't own a house, he didn't have the finances to consider it. In fact, it was going to be just the opposite since there was going to be medical school loans. 

 

               I sat beside him and contemplated what he said and then I was quick to assure him I wasn't in the least bit concerned that he was only just now pursing what he wanted to do in life.  Afterall, I sure wasn't one to judge! I thought by 30 I would be blissfully married with kids and established in life as a confident adult. In reality, I was approaching 29, dating with no kids, was working at a green house practically on minimum wage, was living next door to my parents and afraid all the time!

              After I felt confident Jason knew I was okay with where he was in life and what it could mean for our future, I hesitated to continue ... dare I ask about the loans?! I knew I had to, it would be foolish of me not to since I was falling in love with this ambitious man beside me. So, I silently gulped and asked him how much he thought it would cost for medical school. 

He answered,

"Oh easily $100,000.00 but probably more depending on where I get accepted." My stomach hit the floorboard! ONE HUNDRED THOUSAND DOLLARS?!?!  I hoped my face didn't show my shock, I think my unintelligent reply was "wow, I guess that's why doctors get paid a lot?". 

 

                The air in the car had long sense turned warm but we continued to talk about the costs and benefits of medical school and how we both felt living off a tight budget was something we were already familiar with as single adults and could benefit life in medical school. This conversation made me respect and trust Jason because he was willing to be honest, not just about the money, but about how he felt. The high dollar cost did scare me but I could trust Jason and I could see that God had already started to provide for us by giving us parents who worked hard to teach us how to be financial savvy.

               This is where my memory of the conversation stops and skips to the way the night ended. By this time I imagined the bonfire was smoldering and dieing because people were emerging from the back yard and getting into their cars to go home. That's when they notice we were there, sitting in the car that by now was steamy with fogged up windows... Yep, there was a lot of pointing, whistling and snarky comments about why we never showed. It was all in good fun and Jason laughed as I sat there blushing!  

          Since that night I was always a bit uncomfortable about our financial future until we talked with some friends who are both doctors. He's a heart surgeon who Jason was shadowing at the time and she an OB/GYN. The overall advice they gave us was, be wise about what you choose to sacrifice for the sake of lowering your debt. The 4 to 6 plus years that it takes to become a doctor is a lot of life and memories and you need to stay healthy both with how you live life and with what you eat ("don't live off of beans and rice"). There are ways to pay back the loans, worry about it just enough to keep you smart but not enough to make you miserable, unhealthy and regret the school years. We also talked with other doctors who mimicked similar advice. One friend in particular who is currently doing a fellowship through Jason's school was extremely helpful. He talked to us about how he went the military route where they paid his school loans so long as he served the same number of years in return, BUT they own you (one helpful blog post here). He also told us about the rural doctors programs where your loans, or a portion of them, will be paid for if you agree to work in a rural clinic for X number of years. Jason signed up to spend 6 weeks in a urban undeserved community over the summer through his school that could potentially help us with loans at the end. The National Health Service Corps also offers a program for serving in rural areas post residency (see here). And there are missionary organizations such as Samaritan's Purse who will try to help you pay back school loans if you serve as a missionary doctor. Lastly, there's the tried and true, the world will never have too many doctors so there will always be a job waiting. Work hard, buy that big house or fancy car later and knockout the school loans! 

          So, what is the financial cost of medical school? It can vary from $11k a year (lowest tuition for a school Jason applied to as an instate resident) through approximately $110k per year (highest tuition plus living expenses for an out of state school Jason considered applying to in Hawaii). Yes, he looked at schools in Hawaii....WHY NOT?... Actually, for us there were 110,000.00 x 4 reasons why not. Plus, compared to a large number of schools, it's a more rigorous and selective process. But even if we wanted to manage the debt, eat sand in our beans and rice and live in a shabby part of town, the beaches, sunsets and food would mostly be enjoyed by me not Jason or us together because he would be studying so much. We decided that's an expensive place for just me to enjoy! But it's on our list of places to visit one day!

          For the last semester and a half we have found ways to get through school affordably. Any good budgeting class or training will be beneficial and a great start to the medical school life. Along with the advice we received from friends and mentors, I truly believe we have gotten through and will continue to do so by, as I already mentioned, our parents' diligence to teach us about money. THANK YOU MOM and DAD! Not just for your words but for living out what you taught and for also teaching us that through subtle and sometimes miraculous ways, God will provide!

          Managing money takes knowledge, effort and diligence. But once in a rhythm (it took us about 6 months to a year to organize a budget) we found that having a tight budget gave us freedom where we least expected it. For example, we put aside a little money each month for clothes so when I come across a good deal I don't have to feel guilty about buying another cute shirt or flannel for Jason (he now has 11). The money is already there! And there's mental freedom to exert energy to other things that deserve more attention like our relationship, napping, meal planning, filing taxes, Jason: sports, me: art and day dreaming! There's more too which you will discover once you get started.  

       For those of you interested, here's how we put this training and advice to use! First, we got set up on a great budgeting program,  Neobudget, and then we made a list:

Things we are NOT willing to do: 
1. Live off Rhoman Noodles or only eat beans and rice.
2. Never go out on dates or out with friends.
3. Skip out on visiting family.
4. Leave our established community to move away for med school when Jason was accepted to a great school only 30 minutes away but cost slightly more.
5. Stop giving to our church.

Things we are willing to do:
1. Replace my car once it died with a sedan we didn't care for, but we payed cash for.
2. Give up living in our own place since we were invited to live with friends.
3. Eat at home and pack lunches rather then eating out. And when we do go out we don't always have to go for dinner. Drinks or dessert are more affordable.
4. Watch movies/TV shows once they post online verses going to movies or buying cable.
5. Skimp on household purchases and buy off brand items like foggy "scotch" tape that isn't pretty but get's the job done. And, I buy makeup/toiletries at BB&B with 20% off coupons.
6. Wait to get any kind of furry friend. (Jason: dog! Me: cat!).
7. Work hard to make money as often as we can (plain and simple).
8. Stick to a rigorous budget (we HIGHLY recommend Neobudget !).
9. Pass up medical schools in Hawaii ($$$!).
10. Email Christmas letters instead of paying postage to mail them. 
11. Look at second hand stores and Craigslist before buying things brand new.
12. Buy things in bulk (I love Costco!). This means I have to be creative with storage but it's worth the extra effort (apartments are the worst!).
13. When I need a random household item, gift wrapping stuff or ingredient for a recipe I take inventory of our belongings to make sure I don't already have that thing needed or I look for a substitute good enough to work. Think outside the box!
14. Grocery shop only after meal planning and plan weekly meals with similar ingredients.
15. Learn how to be crafty. So many DIY projects online are very affordable but require you to be crafty. Don't decide you aren't crafty until you try! It can be a learned skill. 
16. File our own income tax returns. 
17. Go in with family members on a cell phone plan.
18. For Christmas one year I offered to babysit, house clean, do yard work, wash the cars or run errands instead of purchasing presents. I did this for my sister, brother in law and their 3 kids and it turned out to be a gift for all of us because we got some quality time together.
19. Attend/organize clothing exchanges. Some friends and friends of friends get together a few times a year and sort through each others unwanted stuff to get new outfits and accessories. 
20. Learn how to say "no" to things you need to decline without regretting or feeling guilty. This might be the hardest part upfront but it's worth it in the long run!

    
                                                        CONCLUSION:

          You can make medical school work on a small income, single income or with low loan money). Make it a game, challenge yourself to find ways to simplify life and money. We know people who have kids while in their 1st and 2nd years and you wouldn't know they were in medical school unless it came up in conversation. It has been done well and can be done well! To those of you still reading, thanks for sticking with this very long post to the end! This means you hope to find ways to save, you can do it and I'd love it if you would share in the comment section what you already do to save or feel free to ask questions. I'm not an expert but I'd be happy to share our experience if it will help! UPDATE: (March 28, 2015) Here is a helpful web site for managing medical school debt along with much more info. The only disclaimer is that outside of this particular link the rest of the web site is geared towards a specialty in family medicine which is what Jason is currently pursuing. Nonetheless, some of the tips in this particular link are much more broad: AAFP on debt management.

P.S. The reason Neobudget suits Jason and I so well is that Jason can be as detailed as he wants while at the same time it caters to my brain health by using a simple design that can be color coded. It's easy to navigate and some statements can be imported so you don't have to do single transaction entries. It automatically calculates yearly and monthly totals both by digits and by using graphs (another feature that will keep my brain younger longer!). The customer service is exceptional and has even better security. If you like it, there's an App for that! (iPhone & Android friendly)