[Puffer Fish]

Man tried to be a doctor, now in $430,000 of debt with nothing to show for it

There is all sorts of "talk" about society needing a workforce which is more educated, with "skills". In my personal opinion, a lot of that is very debatable and questionable. But there is one occupation that society definitely needs more of, a category of skills that is indisputably beneficial to the society and the economy: physicians.
But before we advocate that we should start sending lots more people on the education path to becoming doctors, there are some things that need to be considered.
Being a physician is not a job that is for every person. Or even most persons. A lot of ordinary people are simply not cut out for the job. And it requires a major amount of investment, personal sacrifice, and risk.

Many people don't realize how much sacrifice doctors have to make to be able to become a doctor. Not only just sacrifice, but there is also a degree of risk. They can get into all that debt, spend all those years in school and training, and the intense amount of work and effort it takes to get through it, and there are still no guarantees that they will ever make it through and start earning a big income.
If a person graduates from high school at the age of 18, they will likely be 30 years old by the time they can begin to practice medicine. That is assuming they continue in school and training full time and do not take any breaks. That of course does not leave them time to work and earn any real money, during that long period. It's a major sacrifice of the best part of their lives.
The below story illustrates what can happen when that investment and those hopes do not end up paying off. Stories like this are less common, but they sometimes can happen.

I Owe $430,000 of Student Loans! , The Ramsey Show Highlights, Nov 3, 2018

Ramsey: James is in Lexington, Kentucky. Hi James. How are you?

I'm pretty good today Dave... [sounding a little hesitant] How about yourself?

Better than I deserve. How can I help?

Well, I'm in something quite of a mess right now, and I'm not really sure where to start to get out. To start with I have currently about four hundred and thirty thousand dollars ($430,000) in student loans

Good lord...

Ah... Yes... I was in medical school... I had failed two sets of boards after three years, and then was recently dismissed and so about 80 of that eighty thousand is from undergrad and then other courses later on to take to get into medical school, and the remainder is from medical school.
Right now I have a debt but no degree though. You know, that I was planning to use actually be able to pay that back.
At this point I don't really know what my options are... [sounds very downcast, immobilized and depressed] How to dig out of this...

You're right, that's a mess. I'm so sorry that's scary.

It is. [starting to sound like he might have a breakdown]

How did you get that far into it and then not be able to pass the boards?

I did fairly well the first two years, but... it was just I think being able to... I guess it was one thing to take the exam every few weeks or every month, but being able to retain that, and then the recall it to the level of detail that I needed for the exams... I just couldn't put it all together at the end. [sounding very emotionally devastated and falling apart]

Is there any way you can re-engage and still have a shot at finishing?

Not without having to reapply, and then go through the process all those... [over] again.
Then have to also take out more loans.

So what are your... When did when did you, um... flunk the last one?

That was this past spring, and so then let go this summer...

Since then, what has been your plan?

Well basically I've just been getting by... I was able to find a job first of all as a substitute teacher. And then I was hired as a high school biology teacher.But, uh, my loans are on deferments right now, and I have some forbearance to go.
But at this point I'm not sure any of the other career options. I thought about, you know, physician assistant, other programs like that... But it requires going into more debt...
Because I'm not in a position where I could work and then pay as I go... Plus pay off the current loans I've got now, too.

Ramsey: Yeah... So what would it take to be a PA (physicians assistant) from where you are?

I would have to take up another year of classes. I would have to take some other entrance classes and then two and half years for the program itself.
Ramsey: Wow...

Then it would be, that's probably at least another 70... 60 to 70 thousand dollars in tuition and living expenses.

Ramsey: What about nursing?

My undergraduate degree was in biology, and then ended pre-med...

And so none of the med school work you've done applies to anything else?

No, none of it... it's... I have the debt but none of the courses, none of it actually I can transfer to anything.

[moment of silence]
Wow
...
Right now I'm 34 years old, and so I have all this debt, but no savings, nothing at all.
...
Ramsey: I'm sorry you're facing this.
[Ramsey has a sad frown, and doesn't really know what the exact solution is to get the man out of this]


To give some idea of how much $430,000 is, the median income for someone with a 4-year college degree in the U.S. was $54,700 in 2018. (That is before taxes)

In the U.S., student loans usually cannot be discharged through bankruptcy.

And maybe you'll also get some idea of why the UK and France have to bring in so many immigrant doctors from other countries, why huge numbers of British and French people are not rushing into this profession, despite the seemingly high salaries. Because even a salary of 110,000 Euros is not really high enough to compensate for all the personal sacrifice and risk.

[Truth To Power]

Man tried to be a doctor, now in $430,000 of debt with nothing to show for it

Do you actually have a problem with this? After all, if we didn't force working people into decades of debt slavery in order to have a productive career or own a home, how would banksters be able to afford their mansions, private jets and yachts without having to make any commensurate contribution to the community? Get your priorities straight.

[Godstud]

@Puffer Fish The average physician income was $352,000 USD vs. $339,000 in 2022.. Paying off student loans is not normally a problem because of these wages, and this is ONLY an average. Some make significantly more.

Your doctor would be out of debt easily after 3 years of leaving school and finishing residency. He could do it in 2 years if he felt like it.

[MistyTiger]

Medical school is not for everyone.

In some countries, they have qualification exams that determine if a student is suited for medical school to be a doctor or if they're better suited to be a teacher or working in another profession.

It's clear that this man is not suited for the doctoral profession. He did not have to keep pushing himself to study and take all the exams if he kept failing. The universe was trying to tell him that he is not cut out to be a doctor. Medical school is not supposed to be easy. It takes years of intense study, interning, attending classes and lab sessions, late nights and lots of study sessions. I know someone who didn't score high enough on the qualification exam so she went into nursing instead, but she did want to be a doctor. I don't think she was suited to be a doctor. Not everyone can tolerate the life of a doctor. It's not just about the pay, it's about lifestyle. Depending on what type of doctor you are, you might be working late shifts all the time and missing out on a regular family life. Not all doctors have happy marriages or even have a spouse and kids.

[Rancid]

I'm guessing this guy sucks and I wouldn't want him to be a doctor anyway.

He can fuck off.

[Potemkin]

I'm guessing this guy sucks and I wouldn't want him to be a doctor anyway.

He can fuck off.

The quacks need to be filtered out. A medical degree means something precisely because it is possible to fail it. This protects the public.

[Puffer Fish]

The average physician income was $352,000 USD vs. $339,000 in 2022.. Paying off student loans is not normally a problem because of these wages, and this is ONLY an average. Some make significantly more.

It's not quite as good as it might seem. That often does not include the cost of liability insurance (necessary in this profession) which costs $60,000 to $120,000 a year (depending on specialty). Then because your annual income is so high, your tax rate will be higher too. Perhaps you will end up paying a little over 35% of that income in taxes. A higher percentage of your income will be taxed because so much of your total income in your early years was pushed into a narrower time bracket.

According to certain estimates, following the normal career path, going the route of a doctor will not even begin to reach the financial break-even point until about the age of 37. That is, if you were just doing it entirely just for the financial benefit, it would probably have ended up a waste of your time if you died before around the age of 44.

[Puffer Fish]

The quacks need to be filtered out. A medical degree means something precisely because it is possible to fail it. This protects the public.

True, but I think there is some trade-off. The U.S. needs more physicians, and needs more high paying jobs.

I've got to think there must be some medical specialty for a doctor where incompetence is unlikely to harm patients.

I have heard that a lot of doctors who can't cut it in other specialties end up becoming abortion doctors (kind of a field no doctor ever desired or planned to get into but found themselves shoe-horned into it).
Then there's also gerontology (specializing in care for the old). Dermatology also doesn't require too much intellectual prowess or stress. Urology is pretty straightforward as well, not too many different types of things that can go wrong there. Pain doctors pretty much mostly just prescribe pain pills, not too difficult.

[Potemkin]

True, but I think there is some trade-off. The U.S. needs more physicians, and needs more high paying jobs.

The U.S. needs more properly qualified physicians, and other high-paying jobs usually also require the appropriate professional qualifications. Even as it is, there are too many duff lawyers and quack doctors.

[Puffer Fish]

It does raise the question of whether these individuals should even aspire to wanting to become a doctor if there's a risk it could end up being a gigantic waste when they find out they're not cut out for it.
It can be difficult to know when to keep being persistent and when to give up early so you don't get deeper into the hole.

[Potemkin]

It does raise the question of whether these individuals should even aspire to wanting to become a doctor if there's a risk it could end up being a gigantic waste when they find out they're not cut out for it.
It can be difficult to know when to keep being persistent and when to give up early so you don't get deeper into the hole.

Everyone wants to be a doctor and no-one wants to be the guy who takes away people’s garbage. But society needs both kinds of workers. A society full of doctors but with no garbage removal would not be a healthy society.

[Fasces]

It's unfortunate that your solution to this problem isn't waiving tuition or otherwise having the state minimizing the costs, but letting anyone off the street start fooling around with the organs of others.

[Puffer Fish]

It's unfortunate that your solution to this problem isn't waiving tuition or otherwise having the state minimizing the costs, but letting anyone off the street start fooling around with the organs of others.

This is a fair point.

It's easy to feel very sorry for this man.

I think the point I was trying to make was that things that result in lots of money had big risks that came along with it. The reason people take those big risks is the potential high returns at the end of the tunnel.
That's sort of basic economics, which those on the economic Left should take some trouble to understand.

I think part of the problem is that medical education in the U.S. (and other countries, but especially the U.S.) is so expensive. I am not sure the precise solution to that.

I suspect this man may be dealing with emotional issues, depression and lack of motivation. Those are not always easy to overcome. And for some people, they can be debilitating in life.
Trying to pursue this goal requires a huge investment of time and energy and pretty much puts the rest of these people's life on hold. They do not have time for other activities or fun or relaxation.

If we consider a system like the NHS in the UK, would the system in the UK be able to get away with paying doctors salaries that are so much lower, if immigrant doctors were completely cut off to them? I mean if the UK had to only look to within the ranks of its own population to find doctors. Let's say the borders were completely closed, all the immigrants just sent back.

Economics tell us that when there is a shortage of something, prices tend to rise until that shortage starts being filled. (Well, certainly prices would rise, helping to incentivise some significant level of increase in supply, at least)

[Puffer Fish]

It's unfortunate that your solution to this problem isn't waiving tuition or otherwise having the state minimizing the costs,

Medical school is not free. Someone pays for it.

Making medical schools "free" would not end up being fair. Because any time government makes something "free", they end up rationing it and only a limited number of people get it. That would end up meaning that some people who go to medical school would end up having to take on huge amounts of debt, while other wouldn't. Indeed, the ones who did have to get into debt would even end up paying taxes to pay off the debt of the other students.

The government cannot provide free medical education for everyone who wants it. That would not be a wise use of resources. The government could not even afford to do that.

Rather than using limited available funding to send a small select group of people to medical school for free, it might be a better idea to use any increase in funding to increase the number of positions in medical schools, so a larger number of applicants can get in.

Taxpayers sort of already subsidize part of the cost of medical school, and the tuition for public medical schools, while it may be expensive, still does not cover all of the cost.

I do think however there should be some sort of forgiveness program in place so that those who do not end up finishing the program and qualify for practicing as a doctor do not have to pay back the full amount of money they borrowed, and in addition have an income-based repayment plan. Otherwise the small percentage of people who never finish the program will be burdened with a gigantic crushing debt that is too difficult to pay back with their small incomes. Virtually no one who goes through medical school and then halfway through a residency training program just decides they do not want to be a doctor. If they drop out, it's not an intentional decision, either that or it is because of an extreme mental breakdown, which is still not really like it was their choice.

[Fasces]

Because any time government makes something "free", they end up rationing it and only a limited number of people get it.

A market system is also, quite literally, the rationing of a scarce resource.

You're just choosing to ration the limited medical seats by how much money someone is willing to pay for it, rather than their innate ability or merit.

Seems like a step backward, for me. What does 'willing to spend money' have to do with being a doctor?

[Rancid]

True, but I think there is some trade-off. The U.S. needs more physicians, and needs more high paying jobs.

Are you proposing lowering the standards? Very uncharacteristic of you....

[Puffer Fish]

You're just choosing to ration the limited medical seats by how much money someone is willing to pay for it, rather than their innate ability or merit.

Rationing by innate ability or merit is not necessarily as fair as it sounds.

Many people could become a doctor, who are not at the top of the testing scores. Not having (or showing promise of) more "innate ability" than others does not mean they do not have the adequate innate ability to do it.

[Fasces]

You have one job to fill, and you have 2 options.

Option A: Is poor, and brilliant. Will perform at incredibly high levels, innovate, and be a key team member for decades.

Option B: Is rich, but adequate. Will meet minimum standards, and hit benchmarks, but won't set the world alight.

You're going to sit here and with a straight face tell me that you would hire Option B?

[Potemkin]

You have one job to fill, and you have 2 options.

Option A: Is poor, and brilliant. Will perform at incredibly high levels, innovate, and be a key team member for decades.

Option B: Is rich, but adequate. Will meet minimum standards, and hit benchmarks, but won't set the world alight.

You're going to sit here and with a straight face tell me that you would hire Option B?

By definition, having a ‘free market’ in education means choosing Option B every time.

[Fasces]

And as we can see around us, its working great.