From Fourth Year to the Real World, Part 1

By Josh Katzowitz, WCI Content Director

Ariel’s dad is rich. She’s pretty sure that he is, anyway. She stops and thinks a little when asked about his finances. She knows he makes six figures as an engineer—and has for many years. She knows he’s wealthy enough, thanks to his high salary and his commitment to investing, to have put her and her sister through private school and college and to have gifted them both $10,000 in stocks when they graduated.

So yeah, Ariel’s dad is probably wealthy. Well, maybe. But no, when her fiancé, Danny, is asked about it, he’s definitive. Ariel’s dad, he said, is rich.

This creates a fascinating dynamic in their relationship—and in their financial future together. Ariel is going to graduate medical school this spring with zero debt, thanks mostly to her father. Danny is going to be carrying $282,000 worth of student loans when he finishes at the same time. His parents, after all, were anything but rich.

This is the beginning of their journey in medicine and in their lives together. Soon enough, his debt will become her debt, and her rich dad will become his wealthy father-in-law. Both will have to make concessions to each other as they begin to transition from fourth year to the real world.

It might not be easy.

 

 

 

Introducing the Fourth Year Medical Students

Today, we are introducing a new series on The White Coat Investor. I’ve been in contact with a quartet of fourth-year medical students, all with varying degrees of student loan debt who are going into different specialties and who have different wants and needs for their careers and for the money they’re going to make.

So they can be completely transparent with how much they’ll owe, how much they’ll make, and how they plan to live their financial lives, we aren’t using their real names. We’ll check back in with these soon-to-be-doctors a couple of times a year, as they move through residency and into real life. Will they pay off their student loans within the next couple of years? Will they become financially independent a decade or two from now? Will they live like a resident once they become attendings, or will they get flashy homes, cars, and clothes?

Who’s to know? First, though, a quick introduction to these fourth-year students.

• Ariel and Danny met in medical school, and they’ve been together for three years. They’re planning to get married sometime in residency, and right now, they’re in the process of trying to couples match. So, yes, life is stressful.
• Ava is originally from Argentina, and she also won’t have any debt when she graduates from med school. But she’s going into one of the harder specialties in which to match, and, by her own admission, she has a long way to go to reach financial literacy.
• Patrick is married with two children, and he has another baby on the way. Since he’s been traveling for his fourth-year rotations, he hasn’t been home consistently in about five months. He and his wife are swimming in stress—and not only because he’s going to owe about $460,000 once he’s finished with med school.

 

The Partnership of Ariel and Danny

Danny’s parents were blue-collar workers. His dad drove a truck, and at the age of 65, he’s still working full time. His mom was a stay-at-home spouse and then worked as a grocery store cashier. His family wasn’t flush with money, but his parents worked hard and put some away for retirement.

Neither he nor Ariel had much of a financial education growing up, but Danny remembers playing baseball with teammates whose parents had vast sums of money. He’d relax in their massive pools outside their lavish three-story homes that overlooked the river below.

Before high school, he never knew that kind of wealth existed.

Danny didn’t receive any money to go to college. He worked while studying. He went to junior college for a year and lived at home to save money. Then, he went to a local university while still sleeping under his parent’s roof. Even today, his father drives overnight shifts, and though Danny can appreciate that, he also doesn’t want one day to be 65 years old and still working to live.

He’s also not looking for outside help. Soon enough, though, somebody else will have a say in that matter.

Initially, Ariel and Danny didn’t discuss their finances with each other. As their relationship progressed, though, they began discussing their debt obligations: Ariel with $0 and Danny with close to $300,000.

Ariel didn’t flinch when Danny disclosed his number, because she expected that most medical school graduates would have six figures worth of loans to pay. But she's not sure what it’ll mean when they get married. Does his debt turn into her debt? How much does she have to pay toward that mass of loans? How would that affect them buying a house?

Danny, though, has a different take, maybe because of what he learned from his parents’ blue-collar experiences. He has a feeling of ownership over what he owes. His debt, he says, is his debt. It shouldn’t be anybody else’s problem.

“It’s mine,” Danny said. “I was owning it the entire time.”

Yet, Ariel has broached the subject about repaying their debt together. Maybe they should lower the debt as quickly as possible in residency, meaning she’d be paying off a substantial portion of it. Danny immediately said no. But since then, he’s softened on the possibility. He’s put forth a counter-offer. Before they say their vows, he wants to put together a written agreement. It would say that if something were to happen in their marriage and they split during a certain time frame, he would pay her back all the money she contributed to paying off the debt.

“I never want something, like money, to come in the way of wanting or not wanting to be in the relationship,” Danny said. “That’s the motivation. If she wanted to leave or stay, it shouldn’t have anything to do with the money.”

Retorted Ariel with a laugh: “That’s fine with me. I’ll take the money.”

An even thornier issue might arise if Ariel’s dad offers to pay for their wedding or if he wants to give them a down payment on a house.

He can, after all, afford to do so. His journey to financial success is an amazing tale. After the fall of Saigon in 1975, Ariel’s dad, his parents, and his six other siblings escaped from Vietnam when he was in his early teens. He met Ariel’s mother in college, and together, they built a comfortable life for themselves and their two girls. A rich life, even.

At first, Danny was against that idea as well. If it was a difference between a glorious wedding paid for by Ariel’s dad or a backyard wedding with some close friends and family paid for by Danny, he’d choose the latter. He feels the same way about Ariel’s father giving them a potential down payment. It’d feel like he was living in somebody else’s house, and he’s not comfortable with that. But lately, Danny has come around to the idea of Ariel’s father helping with the wedding.

“I’m sure I’m just rationalizing this for myself,” he said, “but he has this money and wants to do things like this with it.”

Ariel’s mother died four years ago, and Ariel still thinks about her sacrifice. It's changed her perception about life.

“I perceive a lot of how we look at medicine and how we look at the world, it’s really an Eastern vs. Western view,” she said. “I’m Asian, and in this culture, family provides all the time. We take care of each other, sometimes with strings attached. But Danny is very independent. He does things for himself.”

Her family genes, though, have experience with stubborn independence as well.

About 10 years after Ariel’s father arrived in the US, her mother, who was making her 10th attempt to flee Vietnam by boat, tried once more. The refugees would leave in the middle of the night, hope to God nobody was patrolling the beach, and set sail into the darkness. You start floating, and you pray that somebody picks you up along the way. Millions of Vietnamese tried to escape this way and thousands died while doing so.

For some, it was the only way to escape from a life they no longer wanted. For some, it was the only way to start over.

 

Ava's Worldly Experiences

Ava can’t imagine what would have happened if she had stayed in that small town in Argentina with the rest of her family—if her life would have stayed stuck in a generational rut with little chance to escape the doldrums of a less prosperous life. These days, she returns to her homeland occasionally, and she and her high-earning brother play down their success from abroad.

For the first time in four years, Ava journeyed back to Argentina for the Christmas and New Year’s holidays. She loved the visit and loves seeing her extended family. But she has to be careful with how she presents herself and what she says.

Like Ariel, Ava won’t have any student loan debt when she graduates from medical school this year. But she doesn’t tell many people about her good fortune (she received a half-scholarship and her parents covered the rest). She knows what it’s like to feel judged.

“It’s not something I talk about much,” Ava said. “I already feel so much more resentment when I go home to Argentina. It’s not a nice feeling. People look at me as if I’m a rich princess. I understand that the opportunities I’ve had were way greater, but you don’t know how hard I’ve worked. It’s not fair. Our realities are different. Our worlds are different.”

Though she was born in Argentina, Ava moved all over the world during her childhood. She lived in Bolivia and Venezuela, where toilet paper and milk were rationed and where the threat of kidnappings constantly hung in the air. And she lived in Oman and Abu Dhabi. Her father was in the oil and gas business (her mom stayed at home), and she moved to Dubai for high school. She attended American private schools while growing up, but the UAE was a different story.

As they started their day, some of the kids in her high school would bid farewell to their pet leopards before driving to school in their Ferraris, their Rolex-covered wrists gripping the steering wheel. How rich were some of her friends? Her prom date offered to buy her a Versace dress, and one of Ava's girlfriends was offered a pair of Louboutins for the big night (both girls ended up declining the gifts).

Before moving to the Middle East, Ava never knew that kind of wealth existed.

Still, the ex-pat life was stable for Ava’s family. Until her father got laid off.

He had been working for 25 years and had no idea that his job was in jeopardy. They were never a big-spending family (Ava always had to take the bus or hitch a ride with her mom for high school), and they had always saved their money. But Ava and her brother were headed to college, and because they lived abroad, they weren’t going to be eligible for in-state tuition in the US. It was scary.

“My dad doesn’t have a job. The industry is terrible. They were really nervous,” Ava said. “That’s when they were hiding things from us. When things weren’t financially stable, they never wanted to tell us how things really were.”

Her parents weren’t even sure Ava should train to be a doctor. Her grandparents had been physicians, but they certainly weren’t wealthy—not with five kids to feed and their propensity for charitable work. Her dad watched his parents give their lives to medicine and yet not make any money. He had branched out and away from Argentina—he had taken his own form of transportation across the ocean for a better life—but he wasn’t sure becoming a doctor would pay off for his daughter.

Ava’s parents eventually found stability, enough to make sure she won’t have to pay student loans. She’s been inspired by them: for their decision to leave Argentina and for their hard work. They didn’t teach Ava much about finances—to this day, she texts her brother basic financial questions about how much she should allocate her future salary to housing and how much she should plan on saving—but her parents’ motivation for a better life has fueled her to work harder.

As a result, Ava is looking to match into one of the hardest physician specialties that exist. Like Ariel, Danny, and Patrick, she’s spent much of the winter interviewing for residencies (Ava has to match for two programs—one for her first year in general medicine and one for the next three years in her desired specialty).

Thanks to the COVID pandemic, all of her residency interviews have been over Zoom, and she estimates she’s saved $10,000 in travel expenses because of it, the same ballpark figure estimate that Ariel, Danny, and Patrick have calculated.

While Ava naturally is nervous about the upcoming Match Day, she’s not scared about the fallout. Even though her specialty might only have a match rate of 50%, she’s going to be OK. Since she won’t have debt, she can always do a research year and wait for the 2023 Match. Some of her classmates who will have hundreds of thousands of dollars of student loans to begin paying off won’t be as fortunate if they can’t find a residency spot for next year. Financially, Ava could take the hit.

“To not have any debt, it makes me incredibly lucky,” she said.

Perhaps even more importantly, it’s allowed her, as she’s set to move into a financial world where she still has so much to learn, to be fearless.

 

Patrick Feeling His Parent’s Worry

Fear constantly pervaded Patrick’s house while growing up in the three-bedroom home that housed his parents and six kids. Because four boys had to share three beds in a teeny, tiny bedroom, Patrick would sometimes take a sleeping bag and a space heater into the shack behind the house and try to get some undisturbed sleep.

That distance from the rest of the house didn’t drown out the sound of his father’s retches. After his father lost his job, Patrick remembers hearing his dad vomiting in the bathroom from panic and fear. Patrick remembers that anxiety filled the air.

The worry about money was a constant in the household—his dad was in the shipping industry and his mother cut hair in their house—and he couldn’t play sports because the family couldn’t spare the cash (Patrick made the junior high basketball team, but because his family couldn’t afford new sneakers, he didn’t get to play).

As Patrick now completes his fourth-year rotations, far from his own growing family, he reflects on his life goal: to be in a position where he doesn’t stress about money.

Unfortunately, he’s probably years away from hitting that objective.

In his most recent calculations, Patrick is going to owe close to $500,000 when he’s finished with medical school. If they were frugal to the max, he figures he and his wife, Brittany, could have possibly chopped off $50,000 of that growing debt. They had to ask themselves, though, if it “was worth it to kill ourselves for four years to save the extra $50K, or should we just maintain our sanity?”

Patrick and Brittany chose the latter. When he first started medical school, Brittany worked long hours as a nurse. She had their first child, cutting into those hours, and then she had another. She once made $50,000 a year, but as their family has expanded (they now have a 5-year-old and a 3-year-old with another child due in March) and she’s had to take fewer shifts, her pay has dropped to about one-fifth of her original salary.

Eventually, Patrick will make plenty of money, but by the time he begins earning an attending salary, he’ll already be in his mid-30s. A later start in medicine combined with $460,000 worth of debt has forced Patrick to change his mindset about his future earnings.

“My goal is not to amass this huge amount of wealth and retire early,” he said. “I’m from a middle-class family. So is my wife. We’re trying to create a nice life for us, but we want to let our kids have all that [wealth]. I feel like I’m starting from behind. I’m going to have to work twice as hard to make up for lost time. I’m going to have to give up some of the luxuries. It’s going to be a little more effort on my part.”

The specialty for which he’s trying to match has become more competitive in recent years, and Patrick is stressed about it. He’s at a DO school that requires at least two audition rotations—which means that his fourth-year rotations, where he’s auditioning for a potential residency spot every time he pulls on his white coat, have been exhausting. He always must be early for his shifts. He constantly must put forth his best effort. He constantly must treat every interaction, with a patient or a colleague, as part of a job interview.

“The stress of not matching along with this debt burden, I had to do everything in my power to match,” Patrick said. “I can’t afford to not match. It would sink me.”

All of his travel, though, means more money gets added on top of his debt. That means double the rent and an increased grocery bill. Patrick feels guilty for buying an $8 sub when his wife and children are eating spaghetti yet again for dinner. He hates the idea of thinking, “Hey, just add it to the pile of debt. Who cares?” But sometimes, that’s where he finds himself.

Even though he terms the student loan obligations as “this big abstract mass that exists somewhere,” Patrick and Brittany already have begun to plan their attack for how to pay down the debt. For the first two years of his residency, they’re planning to save money and learn to be financially literate. By the third of year of residency, he can begin moonlighting. And for the last two years of residency, he’ll list all the debts from smallest to largest and start paying off the smallest. When he finally becomes in attending, they’ll continue to live like residents until they pay down the debt.

Perhaps $460,000 sounds scary, but Patrick tries to think about it from the perspective of this: how do you eat an elephant? One bite at a time.

Besides, he already knows how the retches of fear can infect a household. He thinks about that sometimes when he fills up his car with gasoline. While growing up, Patrick never knew you could just walk into a convenience store and buy something off the shelf. He thought you needed some kind of special permit. If he would have asked his father for a drink or a snack at the gas station, “there was no way in hell that was going to happen.”

Buying a soda and a candy bar at a convenience store? Before becoming an adult, Patrick never knew that kind of wealth existed.

Now, when Patrick goes to a gas station, he feels like he must buy something just to spite his childhood.

Meanwhile, his parents continue to live like they don’t have much money despite the fact their financial situation is now secure. They don’t go on vacations. They haven’t skied in decades because it’s too expensive. It’s almost like his parents are those old-timers who lived through the Great Depression and then never could convince themselves that spending money on non-essentials was OK.

Patrick wants to enjoy his life and spend a little money. He doesn’t want to follow his parents’ ways. He wants to do the exact opposite. He wants to walk into the gas station and buy some snacks.

 

For Ariel and Danny, Ava, and Patrick, the journey in their careers and in their financial lives are just beginning. They’ll have to overcome fear. They’ll have to compromise. They’ll have to eat that elephant slowly and consistently.

They’re not naïve to money. They all know what wealth looks like now. Some will want to retire early, and some will want to let their kids do that instead.

Just like all the white coat investors that came before them, the trek they’re about to take won’t be easy. Life, whether you’re sailing into an unknown future or listening to your dad vomit in the bathroom, never is.

 

Make sure to catch up with the latest on Ariel, Danny, Ava, and Patrick in part 2 and part 3 of our From Fourth Year to the Real World series. 

 

[Editor's Note: Josh Katzowitz is the Content Director for The White Coat Investor, and his work has appeared in the New York Times, Wall Street Journal, Washington Post, Los Angeles Times, and CBSSports.com. A longtime sports writer, he covers boxing for Forbes, and his work has been cited twice in the Best American Sports Writing book series. For comments, complaints, suggestions, or plaudits, email him at [email protected]]