It's A Really Bad Look For Doctors To Complain About Student Loan Debt

Please stop, you've actually gotten an amazing deal

This essay is the first of a few opinion pieces on topics in medicine and psychiatry that I’ve been kicking around for a few months now. I’m not sure that anything I say on these subjects will be terribly novel, but as a physician I feel I am obligated to speak on in an attempt to help shape and influence the discourse around them in a broad, societal sense.

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I have always been rather mystified by the constant complaints I’ve heard from medical students and residents about their student loan debt. It’s not just the sort of typical grumbling that you would expect from anyone with 200-400k worth of loans to pay off. There is a genuine sense that we should have some, or all of our loans forgiven. Some of this seems couched in a viewpoint that post-secondary education should be free, full stop. Others seem to not understand that these loans are basically just seed capital in their future career, and that the return on investment is quite good! Another group seems to just think “free money good” and doesn’t think about where that “free money” comes from or what the pros/cons of taxpayers subsidizing their education might be.

I am somewhat sympathetic — though only to the point of generous repayment plans, not to the point of loan forgiveness — to this argument when it comes to college debt. Frankly, I don’t think that most 18 year-olds have the wherewithal to understand the magnitude of the decision they’re making when they choose a college, a major, and decide to take out tens of thousands of dollars in loans. I sure didn’t.

By the time you’re applying to medical school, though, those excuses have run out. The average first year medical student is 24 and their IQ is north of the 85th percentile; the excuse that you couldn’t possibly have understood what you were getting yourself into just doesn’t work at that point. It is not a secret that medical education is expensive. We took out and signed the promissory note for our federal loans. every. single. year. On Match Day, our envelopes did not contain a surprise bill for $250,000 that we looked at in shock and horror while the bursar laughed maniacally and rubbed his hands together like Mr. Burns.

Not only are these loans not even close to a surprise, the federal government offers repayment plans and loan forgiveness programs that private lenders would laugh in your face if you requested.

Take the the Public Service Loan Forgiveness program (PSLF). If you work for a non-profit (read: 65% of hospitals in the US) for 10 years, the remaining balance of your loan is forgiven. 10 years might sound like a long time, but (?almost) all residency programs are part of non-profit hospitals and count towards your 10 years of employment. The average residency is either 4 or 5 years long, so you’re already halfway to the 10 year goal by the time you’re done with your mandatory training.

Ok, but you’ve probably had to pay off a pretty large amount of of that debt over those 4-5 years, right? Nope! Thanks to the various federal repayment plans, your payments are tied to your income; in practical terms this means that your monthly payments aren’t even covering the monthly interest accruing. I’m not even going to go into the various pauses, deferrals, etc. that have been caused by COVID and various lawsuits filed against new repayment plans like SAVE¹.

To put this in more concrete terms, I’ll just use my own loan numbers.

I have $252,551.45 in federal loans at an average interest rate of 5.69% — this is about the average amount of medical school debt. Depending on what repayment plan I chose, my monthly payment with my current household income should be between $300-600. You’ll notice that even the top end of this range is well below even my yearly interest accrual, which works out to ~$1,200/mo. In reality, since I finished medical school in 2021, I’ve paid <$500 due to the various delays, forbearances, and lawsuits that have paused or deferred my payments; most of this time still counts towards my PSLF, by the way, thanks to special rules made by the Department of Education. The few months where my payments weren’t on hold, my monthly payments were a grand total of…

$75.69

And thanks to the SAVE repayment plan, the excess $1,125 in interest did not accrue to my account, but instead was forgiven (read: subsidized) by the federal government.

Wait a second, didn’t I say that my monthly payment should be between $300-600? Well, yes, but because of all of the deferrals, my loan company hasn’t required me to update my income since I entered into repayment after graduating medical school in 2021 and so is calculating my payments based on my 2021 household income of ~$55,000. A couple weeks ago, I was told I don’t have to update my income until at least November of 2025 due to ongoing litigation that has put the SAVE plan on hold.

Ok, that sounds like a sweetheart deal, but maybe you should just be upset with the lucky ones like me complaining about their debt and still feel badly for all of the other doctors with their piles of medical debt? Absolutely not.

Assuming you graduate from a US medical school (96.1% of matriculants do) and match into a residency (93.5% of US MD grads do) you are virtually guaranteed to earn a salary that puts you in the top 10% of earners in the US.

But what does that actually mean for the average physician? Well, let’s put it into some concrete numbers.

There’s a significant range in salary depending on specialty, so let’s try and look at a a few different specialties. I’ll be using Doximity’s 2023 Physician Compensation Report to do so, mostly because it’s free and the numbers look about right.

I’ll use average annual compensation² from three specialties to illustrate the point:

• Pediatric Endocrinology, lowest: $218,000

• Psychiatry, near the national average: $332,000

• Neurosurgery, highest: $788,000

I’m going to use StudentLoanPlanner’s calculator here to model repayment of roughly my loan and interest rate ($250,000 at 6%) with generally unfavorable circumstances: filing as single, not working a job eligible for PSLF. I’ve set the calculator to also assume an inflation rate of 3% and that yearly salary increases by 3%.

The first row shows the range in terms of net present value — the cost of total repayment in 2024 dollars — of the different repayment options the calculator gives me; this includes all of the federal repayment plans, as well as private refinancing.

The second row shows expected net worth 35 years post-residency (roughly around retirement age of 65), assuming you repaid your loan under the SAVE plan (the least favorable option for all 3 specialties), a 15% investment rate, and a 5% yearly return on investment.

The last row shows what that translates to in terms of yearly income, assuming you draw 4% from your retirement accounts.

Those of you capable of reading numbers might notice that all of these specialties are doing more than fine.

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Look, I get it. We worked hard to become doctors. We spent most (if not all) of our 20s in school, and then spent 3-7 years in residency getting underpaid. I understand the feeling that maybe we “deserve” to have our loans forgiven in exchange, especially when those damn kids at NYU aren’t paying anything.

At some point, though, we need to show just a little bit of self-awareness about just how good we have it as physicians. We are very fortunate to be members of a profession whose entire job is in the service of saving and improving the lives of others and actually getting paid well for it. Ask your local firefighter, beat cop, EMT, social worker, or teacher how much they made last year. We are also relatively fortunate that — despite our earnings — physicians are (generally) liked and respected by the public instead of being regarded as preying on the sick and dying in order to make oodles of money.

This piece is my plea to my fellow physicians to not just recognize the reality that we are financially set for life, but to behave in a way that shows that we are grateful and mindful of how fortunate we are relative to the rest of society. Acting as though we deserve loan forgiveness — which comes at the expense of everyone else — is selfish, shameful, and greedy.

Accept the responsibility of the choice you made to take out loans, pay them back under any of the exceptionally generous repayment plans offered to you, and enjoy a life that 90% of Americans will never be able to afford.

1. All of the repayment plans have cute acronyms like SAVE, PAYE, REPAYE and the like

2. rounded to the nearest thousand