The Plight Of The Late-Bloomer Physician


                                                            By Stanley Sack, MD

I'm wondering if there are any docs out there -- past, present and future -- who feel they've been born at the wrong time. I certainly do.

I was a child of the 1950s, a time the likes of which I don't think we'll see for a while, if ever. My parents grew up in the Depression: One lived in poverty, yet through various channels managed to make his way into college and, eventually, into a reasonably comfortable life. The other had challenges growing up as well, though not at an economic level quite that low.

In other words, my parents, and (subsequently) I, were able to reap the benefits of the American Dream: the single-family house, two cars, eating more or less whatever we wanted, whenever we wanted it.

Part of that American Dream, it seemed, was that everyone -- at least everyone with decent grades -- was going to have the chance to go to college. I recall many of the TV commercials from the 1960s. One prominent one proclaimed: "Stay in school -- you will get a better job." Although that was probably aimed more toward potential high school dropouts, I remember others that ordered people to "give to the college of your choice." The implication was that everyone was going to go.

Fast forward a couple of decades. I finish college and ultimately get into medical school. I'm overjoyed, largely for the right reasons. I'll be doing work I want to be doing, and it's something I can and will be good at. And in the back of my mind lurks another happy thought: I should be set, economically speaking.

However, over the weeks, months, and years to follow, lots of things happen that will temper my enthusiasm regarding the economic part.

The first issue: Medical school tuition begins to skyrocket. I'm at a private medical school, which turns out to be the 11th most expensive in the U.S. My parents generously paid for my undergraduate college. However, they were older -- one would turn 65 while I was in medical school, the other during my internship year -- and would not be able to cover that cost.

"No problem," I thought, "I'll just take out loans." Whoops! Health Education Assistance Loan (HEAL) interest is well into the double digits -- I believe it once hit 18%. The Guaranteed Student Loan was lower and helped, but I would definitely need more than the $5,000 per year maximum it provided to make it.

"No problem," I thought, "I'll practice in a physician shortage area for a while." Whoops! The National Health Service Corps is no longer an option. (It was dramatically curtailed but would be reinstated a few years later, after I was no longer eligible.)

Well, I guess I'll pay them off, but it shouldn't be too bad with the interest being tax deductible and all. Whoops! Tax deductibility was not an option at that time.

Meanwhile, the generation before me, although they went through hardships growing up, was enjoying some pretty good perks. Pensions. Safe CDs with double-digit returns. Houses bought when relatively affordable, now paid off. And little talk of Social Security going away.

Despite all that -- and despite my loan ballooning from $60,000 to $80,000 by the time I could pay it off -- I did it in 5 years. It was a lesson in frugality. At one point in medical school I was, technically, homeless. Since I was being farmed out for some consecutive rotations, I sublet my apartment and lived in student/resident call-room housing for a few months.

Of course, this economic situation meant that I couldn't really start saving until well into my 30s, although I was able to buy a house. I also had a couple of big fears: that I would be laid off (a thing in the 90s for physicians), and that I would be sued (always a thing). None of those things happened. But what it meant is that I kept my investments conservative in case I needed the money to live on.

Some of you may be wondering, what about the medical students of today? Aren't they in a terrible financial situation too?

Let's fast-forward again, a few decades. It seems that nowadays, higher education loans for some students are being forgiven altogether. As to how much of this debt forgiveness has carried over to medical students, I can't say at this point.

While it's well known that medical school tuition has again skyrocketed (the average debt for a graduate from a private medical school is now in the $200,000s -- one source has it at $218,746; adjusted for inflation, that's pretty close to my debt of $80,000), a few factors may make it more manageable. Presumably, that debt is without the double-digit interest rate. Also, it's tax-deductible, and working in a physician shortage area for student loan forgiveness has again been present as an option for a while.

Every generation of physicians is likely to have economic challenges (decreased earnings come to mind for the current generation, for example). But those challenges, whether better or worse, will probably not be the "perfect storm" of the ones I had.

Our newer doctors, of course, haven't come close to completing their careers, so we don't know what their average financial situation will look like. Right now, however, there's a palpable unease among many of us older folks regarding a safety net we didn't expect to need as physicians, but just might. There's suddenly a lot of talk about reforming "entitlement" programs for seniors -- Social Security and, perhaps more concerning, Medicare -- and many of us see the writing on the wall regarding availability.

Does anyone else besides me feel like late boomers, especially those who went on to professional schools, got the short end of the stick? And why? Were we too rebellious in the 60s? Or is this revenge for bringing everyone the disco era? Whatever the cause, physicians like me in the lower-paying specialties are a little concerned.

Of course, it's by no means all on the government. I could have bitten the bullet and invested more aggressively, but I did my best to spend wisely. Plus, I've learned lessons in resilience, self-reliance, and simply how to calm down. All that said, it would be nice if -- just once -- the legislative tea leaves would read in my favor.

Stanley Sack, MD, is a retired pediatrician.


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    • Editor-in Chief:
    • Theodore Massey
    • Editor:
    • Robert Sokonow
    • Editorial Staff:
    • Musaba Dekau
      Lin Takahashi
      Thomas Levine
      Cynthia Casteneda Avina
      Ronald Harvinger
      Lisa Andonis

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