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Upcoming Med Student with three kids a wife and lots of current debt

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  • Drop it into MD Drop it into MD 
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    Joined: 09/20/2018

    ‘Medical school is pretty crammed full of information as it is’…really? Did you really learn anything that you otherwise wouldn’t have your 4th year that has impacted your career?

    As per an earlier thread, midlevels are practicing independently in many locales with far less training. A future FP would benefit more from saving 50k on a year of tuition, the opportunity cost of a year of their life, and less time for interest to accumulate then they’ll get out of doing some electives and hitting the interview trail their 4th year. The more options, the better. It’s not for everybody (I’d never do that), but it undoubtedly makes sense for some.

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    I am an FP.  I chose to be an FP early into med school.  I chose it despite being able to choose more lucrative specialties.  I found value in my 4th year.  True I did take some time to interview which could be avoided if you already have a residency spot saved for you but those were a few random days over several months.  I agree with FLP that there is a lot of useless crap in medical school.  However if you leave it up to the school to shave a year off I bet the crap is still there and you will lose out on some good learning.  I spent my 4th year doing electives in specialties that interest me that will translate to primary care.

    I would worry that shortening the education requirements for primary care will bring truth to the claim that we are weakest of the graduates.  I do not believe that.  I know several of us who chose primary care.  I also know several who chose it after just squeaking by the usmle.  We all cannot be lumped together.    We have concerns that NPs and PAs are going to practice independently with less education the an MD.  Why would we voluntarily do that to our selves.

    #161901 Reply
    Avatar Panscan 
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    There are quite a few 3 year schools now and not just for primary care. Plus there’s some places of 3 yr med school and 1 yr research

    #161902 Reply
    Avatar Saucy7 
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    Status: Student
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    Joined: 11/02/2018

    We’re still working through the childcare. They’re all in daycare currently and the bill is more than my mortgage per month. However, we live in Georgia and the state has a freee pre K program that our oldest will be in next year so it will be 2 in daycare which translates to roughly $12k a year. During 2nd year of school my middle one will go to free pre K and so on so it’ll drop off as time goes on per year. My wife is currently working on her masters which will lead to a pay increase into the $50k range plus the insurance etc. she would absolutely be willing to stay home I’m just not sure how I could make it work as the school only allows for increases of cost of living for childcare not for spouse etc. I guess a private loan? This is where I’m in uncharted Waters with how to finance my education regardless of doing the accelerated program or not.

    #161907 Reply
    Avatar Tim 
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    There are quite a few 3 year schools now and not just for primary care. Plus there’s some places of 3 yr med school and 1 yr research

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    “A medical school develops and publishes technical standards for the admission, retention, and graduation of applicants or medical students in accordance with legal requirements.”

    LCME is the accrediting body.  Medical school trains for MD, not a specific specialty. The typical calendar is August through May. I would venture a guess that “Acceleration” involves a series of Summer sessions in addition to the Fall and Spring semesters. Summer break becomes measured in weeks instead of months. Using June and July for three years provide the window for classroom and clinical experience. They may have state funding to take care of the tuition and fund the residencies in there states. As everyone “speculates”, some residencies are more of a “blue collar nature” and used to provide “manpower” in a lot of way. The stated and medical school are simply providing a “guaranteed residency” to fill a need for primary care. Add on the requirement for 3 years practice in state that will lead to a supply of physicians (potentially pressures on compensation) in primary care in the state. The real measure of needs to be weeks, rather than years. Typically, in a four year medical school program, summers are research and fall and spring are training. Same number of weeks, just different labels.

    The real disadvantage may lie in the fellowship after 3 yrs of practice. It might be difficult to compete and I am sure the downward income will discourage some physicians that wanted and could have really used the fellowship training.

    It’s a great program that could actually provide the same weeks of training and financial incentives for primary care in the state at a lower cost to the students. It reminds me of the saying , “What do they call the lowest ranking medical school graduate? Doctor!”  I think some folks prematurely jumped on the band wagon regarding “dumbing down the training”. The weeks of training would be much better measure. One key point would be the ability to “match” with other residency opportunities either by timing or structure.

    #161910 Reply
    Avatar Panscan 
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    Not sure what copy and pasting a portion of article adds to discussion but OK

    Things like biochem are pretty unnecessary and could be cut out with little consequence IMO

    #161916 Reply
    Avatar Tim 
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    Some schools have been doing this for at least a decade.

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    So does Dr* mean kind of a medical school graduate? Everyone that graduates from med school is called Doctor.

    I sure hope this doesn’t mean they are wrong 25% more of the time.

    #161921 Reply
    Avatar Dusn 
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    Status: Physician
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    I would only do primary care if you love it and hate everything else.   EM and anesthesia have similar board scores as Internal Medicine and yet have substantially higher average incomes, far less after-hours work, and far more job flexibility.  EM has the same length, 3 year residency and yet will literally start out making double what primary care does.  If you’re interested in EM then I think the decision between that and primary care is simple.

    #161952 Reply
    Avatar fasteddie911 
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    That deal sounds attractive. Having 250k less debt and at least year headstart on attending salary isn’t insignificant.  I’d spend the next 1.5 yrs (including the 1st year of school), shadowing and talking with as many specialties you can to help you decide what you want to do, thinking about all aspects of the specialty (inpatient/outpatient, procedural, patient population, call, etc.).  Not only should you think about your specialty, but you can use this time to think about your place in medicine (ex. is it your passion or just a job), where you think you want to settle (if you want to live in small town, being super-specialized may not be a good idea), what you see as your work-life balance in the future, etc.  I know some IM/FM trained docs doing EM work in smaller hospitals, moonlighting, etc.  Fellowships, even after 3yrs of being PCP, aren’t closed off.  Maybe something like GI/cards would be tough, but it depends on your board scores, residency program rep and what you do as a pcp (i.e. research).  IMO, pcp’s are in demand and jobs are everywhere.  I know some pcp’s (particularly in PP) are challenged, but I have a friend doing PCP at Kaiser and it sounds like a nice gig, basically 9-5 type job with occasional weekend coverage.  Also colleague did IM (at big name program though), then hospitalist/EM work for a few years while also staying up on research activities, then matched in cardiology.

    As for the 3yr vs 4yr discussion, I don’t see any issue with it. I too think there’s inefficiency in med school education and I could see how 3yrs could be efficiently used for a dedicated primary care track, cutting back on some rotations and squeezing in others.

    #162042 Reply
    Avatar Monesthesiologist 
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    The programs that I know of that can do Med school in 3 and shunt you towards primary care advertise med school in three then residency early but it’s not the whole story. There’s a wave in academic medicine of “competency-based” training where you advance to the next “level” in residency based on your skill, not based on time in training. So 3 years primary care residency is the fast version but it could take 4 (thereby negating the advantage of 3 yr med school) or even longer if you’re incompetent.
    I’m not sure if this is the type of program OP is talking about but it’s getting pretty common. Something to keep in mind is new programs often have a lot of kinks to work out, so if the program is new to your institution, ask the people ahead of you lots and lots of questions about their experience.
    Congratulations on working your tail off while having a family to get this far. I think you’ll do great.

    #162119 Reply
    Avatar snowcanyon 
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    Have you started yet? Why medical school? Why not PA or NP school?

    I truly hope this works out for you, mainly for the sake of your kids, but it seems like the kinder thing to do for them would be NP or PA school. The future of medicine is anything but clear- it seems as though it will be less and less remunerative and more and more stressful. You will either end up with a long residency and years of debt and stress for your kids, or a short residency and a lower salary, making loan repayment harder. You are already behind- it’s great you own your house, but what about retirement, 401ks, and 529s? If you are considering this “accelerated” track, why not just attend PA school?

    Please, I beg you to reconsider. Think of your kids.

    #162121 Reply
    Liked by MPMD
    Avatar Saucy7 
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    Thanks for the response. I have not started yet I will begin next August 2019. I currently work as a Pathology Assistant in a role very similar to those that physician assistants take on daily. My job is great with decent compensation and benefits but is not satisfying intellectually or emotionally because I cannot utilize my knowledge base to help people directly or in ways more detailed which medicine provides opportunities for. Also I’ve heavily considered going to PA school which was actually my path before I worked my tail off for 2 years taking night classes and working full time supporting my family to gain acceptance to an MD program. I know that if I feel unsatisfied in my current position being a PA would only do the same thing once a ceiling of knowledge had been reached plus compensation is not in the vicinity of Physicians even with all of the changes to healthcare. Yes I’m aware it will be difficult, yes I know nothing is guaranteed and yes I know that there are huge risks involved from financial and relational strains but I’ve spent enough time introspectively and prayerfully making this decision to become a physician and now I want to ensure I continue to make the most informed choices regarding what area in medicine I ultimately choose. I am not going in for money or else I would’ve chosen something in business to begin with but money still is an important consideration of this journey. The only reason I even mention interest in the accelerated program is that I don’t know what field I want to enter so If I ultimately decided family medicine or general internal Med was best for me wouldn’t it be prudent to figure out ways to offset costs efficiently and effectively? I’ve ran into more people than I can count telling me not to go into medicine from physicians to other healthcare professionals to even family members but I’ve also had enough experiences with physicians that still love this profession and see the need for more doctors who have encouraged me to continue. I’ve answered the question for myself and have the full support of my wife (who encouraged me from the start or I wouldn’t be here today). Yes it will be long and yes it will be difficult but that doesn’t mean that I will be an absent or horrible father for my children. Life comes with choices and I’ve chosen this path. Thanks for the reply

    #162139 Reply
    Avatar snowcanyon 
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    Status: Physician
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    I think you have an unrealistic fantasy of what being a physician is- obviously you will do what you will do, and it’s not an awful field. BUT I do caution you if you are looking for intellectual stimulation.  It’s not very intellectual. It is not quantum computing or theoretical physics or philosophy. It’s not terribly academically challenging. It’s not that stimulating. It’s not that different from what NPs and PAs do except that there’s more responsibility and stress. There isn’t much more intellectual challenge unless you do MD/PhD (which I would consider in your shoes as it’s free and it’s academically challenging).

    Medicine may or may not be the right field for you- as you note, only you can decide. But it’s not a field for academic superstars- that’s research. If you really want intellectual challenge, you will need to look elsewhere or get a second degree.

    Best of luck.

    #162147 Reply
    Avatar PhotonsRGR8 
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    Status: Physician
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    Congratulations are in order! You absolutely made the right decision. If you got accepted at 28, it means you’ve got very competitive stats. Any profession can remain intellectually stimulating through a career as long as you’ve got the intellect to stimulate. Accruing 300K in debt looks just as daunting as 100K in 1989.(Our debt @graduation) Nevertheless, if you live like starving residents in debt and fall in love with a specialty that compensates well, the numbers will take care of themselves as long as wife is OK with mentally going with the plan for a decade and convincing the kids that teacher lifestyle is perfectly acceptable. I was 5 when my Dad graduated med school and I didn’t notice we were dirt poor. He was 34. You’ve got a head start.

    #162153 Reply
    abds abds 
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    I think you have an unrealistic fantasy of what being a physician is- obviously you will do what you will do, and it’s not an awful field. BUT I do caution you if you are looking for intellectual stimulation.  It’s not very intellectual. It is not quantum computing or theoretical physics or philosophy. It’s not terribly academically challenging. It’s not that stimulating. It’s not that different from what NPs and PAs do except that there’s more responsibility and stress. There isn’t much more intellectual challenge unless you do MD/PhD (which I would consider in your shoes as it’s free and it’s academically challenging).

    Medicine may or may not be the right field for you- as you note, only you can decide. But it’s not a field for academic superstars- that’s research. If you really want intellectual challenge, you will need to look elsewhere or get a second degree.

    Best of luck.

    Click to expand…

    This is bad advice. You can absolutely make medicine intellectually challenging as a physician, and I would bet much more easily than you can as a PA. I’m a surgeon and 90 % of what I do is fairly routine, but coming up with complex treatment plans for complicated patients every week or two is certainly intellectually challenging enough for me. Even the routine stuff requires the utmost attention and skill, which is enough to keep me mentally checked-in.

    If you you have the same level of intellectual stimulation as your mid-levels, it’s because you chose to have it that way (for good or for bad, depends on what you want).

    #162173 Reply
    Avatar WuzUpDoc 
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    I’m really surprised no one else has mentioned this…Unless you have a high earning spouse or family helping you out financially, the reality for a lot of families in med school is low-income housing and government aid. We also had 3 kids going into med school. We lived in low-income housing in a suburb about 30 min from the school. It put us in one of the best school districts in the area and the housing was nice, near a park, library, had a gym and a pool. We also had medicaid and food stamps to make ends meet. You can also look into daycare assistance, WIC, or utility subsidies. You have to weigh what your wife would make while paying childcare vs her staying home and using some of these government programs. It’s there to help you out for the short term and you will more than pay the government back once you are an attending.

    #162214 Reply

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