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Attending Anesthesiologist Returns to Training with Huge Debt

Home Personal Finance and Budgeting Attending Anesthesiologist Returns to Training with Huge Debt

  • Lordosis Lordosis 
    Status: Physician
    Posts: 2222
    Joined: 02/11/2019

    I think we might have scared the OP away.

    I do not think anyone is trying to be belittling or mean. It is just such a hole you are in and you just traded your shovel for a spoon. It is frustrating to hear these kinds of things because we have first or at least second hand experience.

    Good luck and I hope you listen to the general message given to you today.

    “Never let your sense of morals prevent you from doing what is right.”

    #227842 Reply
    Avatar MaxPower 
    Status: Physician
    Posts: 374
    Joined: 02/22/2016

    I’m going to try and not be mean here and also not repeat everything that has already been said by nearly everyone else.

    First off, the good. You’re still young and have lots of time to turn this around. Having said that, in order for this to work you’ve got to make some serious changes.

    About your wife not working, I understand her not wanting to go back right away if you have a newborn, but the fact is that with your current debt level you can’t afford for her to NOT go back to work in some capacity. If her interest rate is anywhere close to yours (4.9%), then the interest alone on her student loans is accumulating at the rate of about $33.50 per day. So even if you paid $1000/month toward that loan that would just be covering the interest without making a dent in the principal owed. My sister-in-law has an architecture degree and does some work at home, many states away, for her previous architecture firm. She can set her own hours (mostly) and she gets a paycheck, plus she keeps her skills up. If your wife doesn’t work for 2 years she may be incapable of getting and doing a job.

    In regards to the home you owe money on, how much is it worth? Will it be cash flow positive if you rent it out? If you have equity in the house and it won’t be cash flow positive, then I would sell it. If it will be cash flow positive it may not be the worst thing to keep it.

    In regards to the fellowship, I would think king and hard about the “peripheral” reasons you don’t like anesthesia and make darn sure that they aren’t things that are going to follow you anywhere you go in medicine. Lots of issues with medicine are endemic to medicine and are not specialty dependent. If it truly is an anesthesia only issue and you couldn’t see yourself continuing medicine without doing this fellowship, then it may be worthwhile to suck it up and do it, since I doubt you’ll find a job that pays as well with no additional training (or only 2 years of school/training).

    The biggest takeaway from all of this is your comfort level with debt. Some people are very comfortable with enormous amounts of debt. I am not one of those people but you seem to be. I am probably unhealthy on the other side of the spectrum, and would be laying awake at night worrying about debt level like you have. As an example of this, you went out and bought a $60k RV without doing any type of reasonable due diligence that it would work out as you had hoped. That is a huge (yuge) red flag. Enormous.

    To piggyback on that, you’ve worked as an anesthesiologist, and I assume your wife has worked as an engineer/architect in a LCOL area and all you have to show for it after 2 years is +$245k on the balance sheet. Between your minimal loan payoff ($36k to your 4.9% loans in 2 years?), your 401k balance, your backdoor Roth, and $80k saved for fellowship expenses (kudos for that by the way). But where has all of the other money gone? You have a mortgage, have car loans, and an RV loan do you obviously aren’t paying for things with cash. So where is all of the money going?

    I just think you seriously need to recalibrate your lifestyle to your earning power and most importantly your debt level. You’re poorer than a goat herder’s son, but you’re living like royalty. You can’t afford that. Yet. You need a plan to get out of this mess. It won’t be easy. Even just servicing the interest on your loans, without even touching the principal (assuming an aggregate 3.5% interest rate) costs you $100 PER DAY! You’re paying $36,000 a year (at least) just for the privilege of owing someone else money. That is astounding.

    Like I said, you can do it but it’s going to take some work. Good luck and keep us posted on your progress.

    #227882 Reply
    Avatar Peds 
    Status: Physician
    Posts: 4715
    Joined: 01/08/2016

    Can we close this until the op responds?

    #227891 Reply
    Liked by Zaphod
    Avatar CharleyAnnMan 
    Status: Physician
    Posts: 12
    Joined: 09/28/2018


    I truly appreciate the input. I read the WCI as a PGY4 and started regularly receiving emails and checking the site about 6 months into practice. I most certainly still consider myself a novice (as you can see) but I am happy with what I’m learning and am continuing to learn. As a noob here I have had to learn all the abbreviations and short hand used (heck it wasn’t until this thread that I learned what OP was!) (threw that in for some laughter for you serious folks out there). My initial post yesterday morning was short and vague purposefully as sometimes reading very detailed posts on here turns me off to the thread. I must say, though I am astonished with the volume of responses. Thanks! As a physician and especially as an anesthesiologist I’ve developed some tough skin dealing with arrogant surgeons, and good thing I did after reading some of these. But, that’s what I expected. I came here to get financial advice and many have asked other more personal questions. Initially I was a little annoyed by the irrelevance of these, but I suppose when you get down to it finances, emotions, career passion are all very much intertwined. As the posts continued to pour in yesterday, on a holiday no less, each one made my stomach turn a little more as well as my wife’s. Thank you, it was needed. With this being said, I am definitely not happy with our level of debt but I don’t think it is as unusual or terrible as others may believe. No I am not ‘debt tolerant’ although I also don’t believe in the ‘make yourself suffer for 5 years’ mantra that many here ascribe to. Personally, many of you obviously disagree, I think a happy medium is best where I can enjoy some of life’s fruits while paying down the debt, investing for retirement, and living a happy life with family time. It really is the dream that all are chasing out side of “high-income earners”. It’s quite clear we have made a couple mistakes, the largest being the RV purchase. I will attempt to address each aspect more thoroughly below and better detail some of our choices good and bad. Thanks again if you are still reading.

    1. Fellowship: I had matched to CCM in residency and actually withdrew for a multitude of reasons, a big one being financially. Another reason was moving to a small town (hometown) was the ultimate goal and a fellowship seemed like overkill. Obviously I very much enjoy both anesthesia and critical care, but after two years I regret not doing the fellowship and am unable to staff an ICU without it in this area. If I was actually in the OR doing anesthesia that would be great. However as healthcare has evolved and the need for mid-levels has risen that pushes physicians, specifically anesthesiologists into other roles. I do not enjoy supervising and there are very few physician only groups left in the country from what I can tell (definitely not in my desired geographic location). Another realistic draw to CCM (beyond the nature of the patients, more diverse interactions with staff and families, more procedures, etc.) is the ability to plan my life around work. I’ve seen far too many older physicians with failed marriages and poor relationships with children to say that taking call every 3rd night and having unpredictable work schedules is worth it. With CCM it’s shift work and I know and my wife knows when I’ll be home.

    2. Wife’s job: She is a certified P.E. She had an excellent job in the big city that I trained in, on track to make six figures yes like many have alluded to here. Moving to a smaller town, though, has limited her options tremendously, especially regarding pay. Her job that she had prior to the baby was less than 50K salary with average to less than average benefits. Of course it doesn’t make financial sense to have her stay home long term, nor does she desire to do so. BUT our baby is not even 6 weeks old and we are moving to another city for ONE year. She will return to work in some capacity when the fellowship is over. The expenses of child care make it so that is simply does not make sense for her to find a job during that year. When we return to our home there is family to help as well. She is trying and has tried to find a reduced work schedule that she can do from home during this year.

    3. My job when I’m finished: I’m keeping my options open. I may return to the same hospital to work CCM 10 days/month and fill in my other time prn with anesthesia. I’m in discussions with my hospital and the group about this now. There are other opportunities that I’m pursuing as well with in a 2 hour radius of our home, though I hope not to go that far.

    4. My current vs. future job: You would think that a small PP group would pay excellent, but it’s much close to average. My base salary is 288K, plus 55K in 401K and profit sharing, and 20K for CME, with a lousy health insurance plan that costs our family of three 20K per year. Last year I was able to pick up an extra 80K picking up extra shifts (so for you older generations, yes we ‘millennials’ are able to work hard and we hate that term btw). The way my calculations add up making just under 400K annually as an anesthesiologist who is more of a pre-op jockey with unpredictable hours loses to an intensivist who could be 7on/7off making 400K annually with the possibility to pick up anesthesia calls as needed/wanted.

    5. Management of current debt: CLEARLY the RV was the dumbest thing we have done. But I would be remised to say that we did not research this option thoroughly. Looking at the cost of a 1BR apt in an expensive city for fellowship it was going to be about 2,000 per month = 24K over a year. We took out a loan on the RV because we saw the cost of a 500/month plus utilities to be far less than the apartment. We were also told by many in the RV community that purchasing the RV in the winter and selling at the end of fellowship in the summer would yield us better returns as these RVs are in higher demand in the summer. We called 5-6 campgrounds within 30 minutes of the hospital prior to purchase who said it would be no problem, but they would not take reservations more than 6 weeks in advance. Fast forward to last month when every campground when back on their word and the closest was an hour commute. Now, I’m not saying we made a good decision here by any means, but our financial hearts were in the right place. We should not have purchased without having a written agreement about where we could park it for the year. NEXT, while it seems that over 2 years we’ve only paid down 35K on the student loan debt ya’ll seem to be forgetting how amortization works (I know I’m no expert). The monthly payment on my student debt is 3,500, so over two years that is 84,000 paid into debt. Still not great I know, But we aren’t pooping on gold toilets and driving Rolls over here. My wife’s debt scenario is a whole other topic and until out of bankruptcy the legal advice we have been given is to pay the trustee payments as dictated by the courts and then refinance after bankruptcy. So over two years this is probably 25K paid into it. Buying a home is hotly debated on this site as a new attending. Since we planned to stay close to family we felt it was a wise decision, and I mostly still do because this isn’t a ‘doctor home’. It’s barely 200K, roughly less than half of gross income. The renter is not going to make the cash flow positive, which is clearly a big problem. For all of you asking where the money is going: 24K gross per month nets after taxes about 15K take home. Subtract 4,500 for both of our student loans, minus 1300 mortgage, minus 1000 car payments, minus 500 utilities, minus 400 fuel, minus 6-800 on food. This leaves about 6,000 per month which we have been saving for fellowship, doing the math this took about 13 months. Take away the cost for the wedding and other incidentals (insurance, house maintenance when things break, etc. ) the other 66,000 has gone this route. Now, we don’t plan on taking any big trips, getting married again, or any other silly large payments. So, I’d say we are close to what others start out at when finishing training. OF COURSE I wish we were paying off all this debt in less than 5 years, and before deciding on the fellowship we were on track to have all student debt gone in less than 7 years post training including her debt, while still maximizing tax deferred savings.

    6. Plan going forward: This is dynamic. We are discussing canceling the renter, who is my cousin and nothing has been signed, and he still has a place to live. Considering selling the house. Considering a property manager consultation to see if they could make the cash flow positive and then living in a rented townhome post fellowship. The RV, we are trying to cut our losses and rid ourselves of this headache asap. Dealership buy back is a huge loss, so we plan to attempt to sell on our own for 2 months and if unsuccessful then sell back to dealer. Renting the RV was considered, but it doesn’t seem wise after the research. We are discussing reducing to one vehicle at least for fellowship. My wife is brainstorming income ideas that allow her to stay at home FOR NOW.


    Now I’m not trying to make excuses here, rather provide a more complete picture of the scenario for all those who were so kind to offer advise and honest enough to call us on our mistakes. Yes, I’m concerned about the debt and for a time thought we had a good plan. When it became apparent that we didn’t recently and I felt like vomiting constantly I reached out for help here. So thank you again for your constructive criticism. I’ll continue to read comments as they come in and will reply when able.


    the OP (far from the OG)


    Avatar CharleyAnnMan 
    Status: Physician
    Posts: 12
    Joined: 09/28/2018

    I forgot to mention I’m also exploring moonlighting possibilities at my fellowship site as well as my current job during vacation time.

    #227939 Reply
    fatlittlepig fatlittlepig 
    Status: Physician
    Posts: 1313
    Joined: 01/26/2017

    sorry dude, leaving that job, with that salary, for fellowship with your debt burden is absolutely stupid. keep the job, work extra, and cut spending. you could loosen up a little bit when debt is <100-150K, until then it’s all hands on deck.

    #227940 Reply
    Liked by Tangler, MPMD
    Avatar Panscan 
    Status: Resident
    Posts: 1152
    Joined: 03/18/2017

    I guess I still don’t understand buying an rv to live 30 min away, and pay the camp ground or whatever instead of just paying 2k/mo for 12 mo. You’re going to lose 20k on the rv probably and youre going to be living in an rv for a year. boggles my mind

    I would do the dealership buy back and just be done with the hassle unless they’re offering you like 50% of its value.

    #227948 Reply
    Lithium Lithium 
    Status: Physician
    Posts: 1237
    Joined: 02/15/2016

    The smartest thing you’re doing right now is considering your wife’s goals and happiness in your career decisions.  Working extra shifts is not worth increasing your risk of divorce.

    Your burden is not insurmountable, but I get exhausted just reading about it.  I still think you are overly sanguine and should shift your mindset about your debt from an inconvenience to a real emergency.  If most things go right, you will probably do okay.  But a lot of things aren’t totally within your control.  If your wife files for divorce?  If you get disabled (I really hope you are adequately insured)?  If you get severely burned out?  What sounds like a great plan now is really hard to put into action for decades.  You’re giving yourself zero breathing room.

    Thanks for the update.  I’m glad you’re still reading and listening.  Hopefully you can ignore some of the caustic responses that offer nothing useful or actionable and stick around.

    Avatar G 
    Status: Physician, Small Business Owner
    Posts: 1905
    Joined: 01/08/2016

    Good to hear the details, glad you have a thick skin.

    If the fellowship lets you be where you want to be and increases the likelihood that you work longer/happier, it will be a good investment.

    Most here understand how servicing debt works, no need to point out how that works.  For you guys to rack up that kind of debt with your stated income suggests that you and your wife are the ones who don’t understand how servicing debt works.  <tone is sincere, not snarky>

    I don’t care if you choose not to “suffer”, but don’t delude yourself with fuzzy math.  66k on incidentals, 1k/mo on cars, 6-800/mo on food?  The biggest thing I disagree with is your wife not working; you guys need to figure out some kind of way for her to make a paycheck commensurate with her debt burden.  And I call complete BS on the following:

    The expenses of child care make it so that is simply does not make sense for her to find a job during that year.

    Click to expand…

    Your plan wouldn’t work for me, but I’m not you.  I’m FI at 45 and living well; some back of the envelope math puts you at a net worth of “broke” in 20ish years if you change nothing.


    #227951 Reply
    Liked by Kamban, octopus85
    Avatar ZZZ 
    Status: Spouse
    Posts: 730
    Joined: 06/18/2018
    Earnest refinancing bonus

    “while it seems that over 2 years we’ve only paid down 35K on the student loan debt ya’ll seem to be forgetting how amortization works (I know I’m no expert). The monthly payment on my student debt is 3,500, so over two years that is 84,000 paid into debt”

    No. You only paid down 35k on the loan debt. The rest was interest payments, which did nothing to reduce said debt.

    It’s amazing to me that some lender gave you a loan for an RV while your wife is in bankruptcy.

    ” I am definitely not happy with our level of debt but I don’t think it is as unusual or terrible as others may believe. No I am not ‘debt tolerant’”
    – Read that back to yourself. Do you know many people with $950k in debts with minimal assets?

    A sit down with someone patient and knowledgable to discuss personal finance, debt, how interest works, and laying out a plan may be of great value for you and could change your life for the better.

    #227959 Reply
    Avatar pierre 
    Status: Resident
    Posts: 211
    Joined: 02/01/2016

    Management of current debt: CLEARLY the RV was the dumbest thing we have done.

    Click to expand…

    From a strictly financial perspective, I don’t think this is true. The fellowship will likely cost you a lot more than the sunk cost of the RV. However, I understand the decision to go back to fellowship is not purely financial.

    Frugality does not equal suffering.

    Best of luck to you going forward.

    #227963 Reply
    CordMcNally CordMcNally 
    Status: Physician
    Posts: 3073
    Joined: 01/03/2017

    I disagree about the debt not being terrible. It is unusual in the amount AND the type of debt.


    I’ll also speak to the shiftwork a little. While the shiftwork may seem nice on the outside, it certainly has its downsides. I’m just afraid many of the things you don’t like about your current situation will be replaced by other things in a new situation. It would have been ideal to put your head down for a few years to get out yourself above water and then reconsider fellowship opportunities. Either way, thanks for the detailed response and I wish you the best of luck.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #227965 Reply
    q-school q-school 
    Status: Physician
    Posts: 2640
    Joined: 05/07/2017

    it’s interesting as an outsider because most surveys have critical care medicine higher on the list of burnout than anesthesia.  sounds like you really want to do critical care medicine though, which to me is way more important in predicting burnout than schedule.  however, some of your millenial comments make me laugh.  if you have a base salary of 288 in LCOL area, it doesn’t read to me that the ‘extra’ shifts you are taking are necessarily any more than full time people are working, just that you have flexibility-which it kind of sounds like you want–the ability to plan work around your life.  i will grant that shift work may provide that better than traditional anesthesia schedules, but it depends on which shifts you get.  switching shifts is no joke.

    i’m always interested in a smart person with the unexpected take.  thanks for sharing.

    good luck to you!


    #227980 Reply
    Avatar mjohnson 
    Status: Physician
    Posts: 64
    Joined: 05/05/2019

    It sounds like the decision to do the fellowship is set in stone, whether everyone agrees or not if that is the most financially responsible plan.  Has it already started July 1st or is for the next cycle, July 2020?


    Anesthesia in my neck of woods has a sweet gig, tons of vacation, typically goes home early afternoon (although starts early).  You both will have to sacrifice which can lead to resentment on both sides.  You both will be working very long, hard hours, you in the hospital and her at home with the baby.  Taking care of a baby is not easy.  It is also very hard to go from a good salary down to a much lower salary.  That happened to me for a year and believe me, it wasn’t fun.

    #227983 Reply
    Avatar MaxPower 
    Status: Physician
    Posts: 374
    Joined: 02/22/2016

    You don’t get credit for interest paid towards your loans. With that, all you’ve done as a drowning person is tread water. You’re still no closer to the edge of the pool, my man.

    #227984 Reply

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