By Dr. James M. Dahle, WCI Founder
Medical school is still a good investment of both time and money, as long as practicing medicine is what you want to do with your life. Those who hear naysayers about the field need to be aware that those naysayers have been around at least since I was a pre-med—and I suspect for thousands of years before that. The “Golden Age of Medicine” always seems to have ended about five years before the person talking about it entered medical school. I imagine a conversation among ancient Greek physicians:
“Student (to Hippocrates): Other than having to taste piss in order to check for diabetes, is medicine still worthwhile?
Hippocrates (speaking to his student): Don't go into medicine. It sucks now. The patients aren't grateful, and senators are always trying to tell us what we can do and not do. Every time I cut on someone with a stone, they die, and the new EMR keeps burning down. It was all a lot better in my father's day. I'm just trying to hit FIRE ASAP so I can go be a hedge fund manager and trade wine and cheese with the Egyptians.”
Students continue to ask this question all the time. This one from a pre-med recently hit my email inbox:
“Big fan of your YouTube channel. I’m a recent college graduate and am debating whether to pursue medicine or dentistry. I’ve been taking everything into consideration, such as passion, work-life balance, opportunity cost, debt, and income potential. I was wondering if you’d say medical school is worth it financially. Let’s say I have $350,000-$400,000 debt and end up with a salary of perhaps $300,000. Also, I was wondering what your opinion is of dentistry from a financial perspective. Much higher debt than medical school but no residency and I believe it is easier to own a private practice? What is the cap or at least a realistic salary for a dentist?”
Does Going to Medical School Make Financial Sense?
Short answer: Yes. The average American household in this country makes $60,000. The average physician earns $275,000 without any input from a working spouse. Earning 4-5 times the average is a great income. You can have a wonderful financial life on an income of $275,000. You can pay off your debts, live comfortably, never worry about money, become financially independent by mid-career, help others, and even buy a few luxuries along the way. It does require that you use that income wisely, and you'll probably never be able to afford bottle service five nights a week or get a NetJets subscription. But it's certainly “worth it” financially.
The debt worries a lot of people, but unlike some high-income professions, medicine is still a “good bet.” As long as you match and don't have a higher-than-average loan burden and a lower-than-average income, you're not going to have trouble paying off those student loans. The averages right now are just fine. The average MD graduates with $205,000 in debt, and the average DO graduates with $240,000. Yes, that debt grows in residency, but so does the average income for physicians over the years.
Just as an exercise, let's see how this works after residency. Let's say you are making $300,000 and have $300,000 in debt. Here's a reasonable budget for the first two years out of training:
- $75,000 living expenses
- $75,000 taxes
- $150,000 toward your student loans
- $300,000 total
How long until the student loans are paid off? Just over two years due to the small amount of interest they accumulate. Then you have an income of $300,000 for the rest of your career. I don't know how anyone can argue that it's a bad deal from a financial perspective.
More information here:
Cheapest Medical Schools in the US
Is Dental School Worth It?
On the dental side, the numbers don't look quite as good. The debt is higher, and the average income is lower. But you do have the advantage of a shorter course of post-graduate training. Many dentists do none at all, and only the specialists do more than one year. Even an orthodontics residency is only 2-3 years (although you are usually paying for that rather than being paid). What's my honest opinion on whether dentistry is worth it? I would say it isn't the no-brainer that medical school is, but it can still work out very well. Someone who has paid all of the costs of dental school with borrowed money and then takes an average associate job long-term afterward is facing a much worse debt-to-income ratio than the average medical school graduate.
The most recent ADA salary survey data is from 2020 and shows that the median employee dentist made $120,000. Meanwhile, recent surveys of dental graduates indicate that the average graduate owes nearly $300,000 in student loans.
Do I think it is worth borrowing $300,000 (much less the $400,000 many graduates have) to get a job that pays $120,000? Nope. Not even close. However, there are other options. The median practice owner makes $150,000, and the median specialist makes $250,000. And obviously, half of dentists are making more than that. Some even have seven-figure incomes. Going to dental school can still make sense, as long as you don't borrow the whole cost and/or don't end up with an income among the bottom half of dentists. Personally, I wouldn't go to dental school if I wasn't willing/interested in being a practice owner (with all the additional work and risk that goes along with that) down the road and my only method of paying for it was with student loans.
More information here:
A Dental Career Reimagined — I Thought I’d Be Rich But I Found Wealth in Another Way
If You Can Be Talked Out of It, You Should Be
The truth, however, is that attending medical or dental school should not primarily be a financial decision. While medicine and dentistry provide a fairly reliable pathway to a top 1%-5% income, it's actually a fairly rare doctor that makes more than $500,000, much less $1 million. It is not a pathway to uber riches.
However, it is a great profession and career. It is an honor and a privilege to practice it. But it isn't easy. It has never been easy. It will never be easy. You're going to earn your income. And you're only going to get paid while you're working. You're not going to make money while you sleep and, at least until you have a large nest egg, you won't be returning richer from a vacation than you were when you left.
There are numerous pathways to making just as much money as doctors make. Many of them do not require nearly as much hard work, indebtedness, and liability. For instance, HVAC techs in my area are starting at $100,000. No college. No dental school. And an income similar to that of an associate dentist.
There are a few pathways to earning more than doctors make. None are anywhere near as guaranteed as a physician's income, but they are possible. Entrepreneurship can be a high-risk, high-reward activity, but some pathways have lower risks than others. For example, imagine you put in just as much time, effort, capital, and intelligence into real estate investing starting at age 18 as you put into medicine. What would your income and wealth be at age 35? More or less than you have now? See my point?
Thus, my advice to pre-meds:
“If you can see yourself doing something else and being happy, go do that. If not, welcome to the club!”
Most of us couldn't have been talked out of medicine by anyone. That's the kind of commitment that is needed to get through your intern year. When you're staring at that trauma patient with two chest tubes, three limbs splinted, and a liver laceration and thinking that you need that bed more than he does, it takes an awful lot of motivation to continue rounding on the rest of your 20-patient service. I don't think you can get that kind of motivation if you have this nagging idea in the back of your mind that you should have gone into law, tech, finance, or real estate instead.
My eldest recently started college. She has met a lot of doctors, we have spent hours talking about medicine as a career, and she has been on two international medical mission trips (one with me and one without). I wasn't surprised to see her start her college career as a pre-med. But I also wasn't surprised to see her switch to a business major with a focus on entrepreneurship a month later. Comments included:
“I'm really not liking Chemistry, and I have two more years of it.
None of my friends or roommates are working as hard as I am.”
I get it. She's right, of course.
More information here:
From Fourth Year to the Real World
It's Still Work
I often survey groups of doctors, both anonymously and at live events. I ask them how their work life would change if I wrote them a check for $10 million. When they have the opportunity to answer anonymously (instead of in front of their peers), the answers look like this:
- 35% would not show up to work tomorrow
- 55% would cut back on work
- 10% would continue to practice as they currently are (I suspect a significant chunk of these are already working part-time)
What do those results tell you? They tell me that medicine is still work, no matter how much of an honor or privilege it might be to practice it. It also tells me that its practitioners are human. I'm still practicing even though I don't need the money, but I'm clearly not in that top 10%. I'm in the 55% because if you ask me to take 0.4 FTEs without any night shifts, yeah, I'll do that. Full-time doing my share of the nights? No way. In fact, if my current work situation imploded, there is a very good chance I would not go out and seek new physician work. Just re-credentialing with the hospital or re-certifying with my specialty board nearly talks me into quitting. Like The Physician on FIRE, I enjoy my work, but I do like my Saturdays more. I know that work is still an important part of my life, even if I don't need the money. But I don't necessarily need that work to be practicing medicine. And I'm still cashing that monthly check for doing it.
So, if you still have a need to work, there are far worse things to do than practice medicine or dentistry. If you have to work, you might as well be doing something you love at least part of the time. Do what you can to make improvements to your situation as you move through your career. And don't feel guilty when it comes time to pull the plug, whenever that time might be for you.
Don't forget that all jobs suck. No matter what you do, there will be something that annoys you. Doctors aren't the only ones with bosses who don't understand what they're doing or co-workers they don't like. They're not the only ones fighting poorly designed software. They are not the only workers who feel under-appreciated by their clients. They are not the only ones with liability concerns. They are not the only ones fighting government regulations and red tape. They're not the only ones facing potential future decreases in compensation. They're certainly not the only ones who had to borrow money to get that job.
I suspect that non-traditional students with a prior career make some of the most satisfied docs, because I think they're more aware that all jobs, even those that save lives, have their downsides.
What do you think? Is medical or dental school worth it? Why or why not? Is there a debt-to-income ratio at which your answer would change? Comment below!
What job have the same liabilities like doctors/dentists have to face every day all day ? I honestly can’t think of any. In my opinion Liabilities is the major reason it is increasingly becoming not desirable career paths. The honor and privilege to practice in our society, which was the driving force for many to become doctors and to help people, is almost gone.
We all face liabilities all the time. Businesses face liabilities. Now I don’t know of a “rank list” of liability prone professions, but I suspect if one existed medicine would be very near the top if not at it. But the likelihood of a doctor actually losing personal assets to a malpractice suit is still extremely low.
It also depends on the type of doctor. Big difference between an OB and a dermatologist.
I’m not a doctor, but as one of the more successful engineers turned executive I made similar wages without the extra four years of school and extra four years of slave labor residency. My son is also a chemical engineer who went to med school after seven years of working as an engineer and eight years later exits residency in June of 2023 as a radiation oncologist. Median wages are about $430K for that specialty. I think he’ll out pace his debt very quickly since he’s smart enough to be driving a 2004 Toyota. Couldn’t agree more that medicine is still a good financial decision, but I was no way tough enough to defer making real money for eight years, or dedicated enough to study hard enough to get into med school when I could coast through chemical engineering with virtually zero effort. I highly admire those of you who have that kind of discipline and thank you for what you do serving others.
Medicine is still a good deal for a virtually guaranteed good income (assuming you can pass the training) but isn’t easy. You can see how the average doctor in their mid 40s who doesn’t have a successful side business like you, hasn’t been financial savvy, and is looking at another 10-20 years of difficult full time work isn’t super enthusiastic about the field.
Via email:
I just wanted to say, “Thank you” for this very candid, humorous, and true post today. It is good to read (especially as a 38 year-old preparing for another board exam).
Tough question and very subjective. Yes, medicine is a gateway to a good upper middle class income and it challenges bright minds. Knowing what I know now I wouldn’t do it again, even though my income is on the higher side for doctors. Between the high liability, bad work hours, years of studying, mediocre administrators, ever decreasing reimbursements and ever increasing demands, and insurance companies/various government entities, the job is not a good one. Most people who make it through all the training are smart enough to do well in the business world and can make more with very little liability, more independence, and better work hours.
Fyi, the CAPTCHA setup you have now where new images keep coming up is extremely annoying and it constantly times out while you are writing the post
Thanks for the feedback for the CAPTCHA. I’ll have James look into it. We’ve had to change from time to time over the years to stay ahead of the spammers.
From James: if you fill out the captcha and then spend 5 minutes writing a reply, the captcha will time out. that’s true on any website. You should always fill out the captcha last. Unfortunately, our captcha shows up above the place where you write your reply and that tricks some people into doing the captcha before they start their reply. We haven’t found a great way to fix it, but we can look further into it.
Can you post something in the prompt ? “Fill out Captain Last”
Probably discourages new users.
I started out as an unenthusiastic H.S. student with a 2.26 GPA and had to go to a “junior college” to jump start my academics. I was simply not a serious student during H.S.
After dreaming of becoming a doctor and getting half A’s and half B’s at the Junior College, the Selby Foundation gave me a scholarship to the “real university”.
I got mostly A’s on their dime in the tough courses, applied to ten schools and was accepted by three. I picked the cheapest. Fast forward…Med school and residency (eight years) and my dreams came true.
A medical career was the right answer for me and I’m glad to have been given the Pell grants and Selby foundation award that made it possible. Both were based on financial need, although the Selby Foundation also looked at my grades. It was a scholarship for “promising students with financial challenges.” I’ve since written to them, thanking them again.
The government then lent me the money to be a doctor and I’ve been grateful since…paid back the loans with interest and then…a lot of taxes. I borrowed $67,000, and with interest, it blossomed to $83,000 by the end of residency in 1994.
I think it’s individual, but for me it was worth it, even though I got tired of some of the negatives after twenty-five years in the chair.
It had meaning. I saved lives. I reduced suffering. I’d do it again…maybe even Psychiatry again. I wasn’t any good at surgery.
I’d say it’s definitely “worth it”, but I’ve always been in the group that would answer, “I’d quit tomorrow”, if several million dropped in my lap.
I have encouraged my children to look into the many health sciences and 2/4 have so far.
Another guy born at the right time – but I ain’t mad at ya, haha. By the way, I’m grateful for what I’ve been able to accomplish, and happy I got in (fortunate/lucky?) to a specialty that was one of the few that fit me, if not the only one. There only reason why I might not tell others to go into medicine (I wouldn’t) would be because you have no idea how much you’ll hate most of the specialties in it. That’s why I wouldn’t, but that is hard to apply to others. I don’t see the medical system lasting either, as all entitlements are going to be even worse and sooner than later, though no one believes it. What is your alternative is always the question though, in big gov/corp fascist America of the 21st century.
Forum conversation about whether you’d encourage your kids to go into medicine here: https://forum.whitecoatinvestor.com/general-welcome/385125-discuss-latest-wci-blog-post-is-medical-school-worth-it
Thank you for a great post that highlights how financially good medicine really is. I’m in my 14th year in EM, and would choose medicine 100x over.
I find that our fellow physicians often fail to recognize a few things that you touch upon and miss how extremely lucky we are to be doing such a great job every day.
1) “Job/reimbursement changes”. All jobs change. Someone in IT has a completely different job now than 15 years ago.
Medicine is no exception. It’s important for us as physicians to be ready to adapt and be somewhat financially nimble.
2) “Residency is hard”. There are very few people in the world that make 300k+ that didnt work very hard in their 20’s. My cousin is in private equity and literally gets spit on to “put in the time”. At least as a resident you are learning something really fulfilling that your entire career will depend upon.
3) “I could have been rich in anything”. Not true. Because you’re smart enough to take tests well and become a doctor does not imply that you have the skill set to be successful in any other profession.
4) “I work really hard”. Lots of people work much harder. Go to any fast food restaurant, construction company, or startup, and see people working 80-100 hour weeks to make 80k. My brother in law is on the SWAT team in chicago working 80 hour weeks, feeding a family of 4, making 100k/year.
Thanks for everything you do Jim!
I once commented on a joke coming around:
The HVAC goes to doctor’s home , fixes something for half an hours and asks 500 $.
The doctor coming back from a long tough day as he pays him, tells the HVAC guy, How is it possible , I am a doctor and can not make that much money per half an hour.
The HVAC guy replies: “That is more than true, I could not make that much when I was a doctor”
By the way that HVAC guy if dedicated and working for himself makes over 250,000 per year.
I doubt he has same responsibility as the Dr OR Dentist.
Going retrospectively to some of my interesting patients, I once met a foreign trained Psychiatry doctor. I asked him what do you practice now? He answered I have become a builder. I am a general contractor building Custom Build Homes.
Good article. I agree for the most part. While other fields make more there’s definitely more of a guarantee with medicine.
There are a few points that I would make:
Definitely at the extremes of debt and income the finances aren’t so glamourous. I’m a peds intensivist in a program that takes a lot of IMGs, DOs and Caribbean grads. For the DO’s and Carribean folks who want to do gen peds in the NYC area OR pursue most of the fellowships, they’re looking at an effective income that’s very “undoctor-like” not starving but not as money much as our adult counter parents.
I don’t think comparing physicians to the 60k average is a fair comparison. Anyone who is successful enough in college to go to med school is probably going to make more than the average salary in their chosen field.
Also, it’s easy to get green with envy over skilled tradesmen who make doctor money. We recently redid our backyard. When I went to pay for our work my mason had a heated garage with a ferrari Testarossa. While it’s easy to get envious. The last thing I’d want is to be out in the hot son laying brick.
I am a working Cardiologist in a 8 member group. None of my colleagues who are in their 40’s would advice their children to go into medicine. With more employed doctors and complaining the joy of medicine is lost. These days if you are smart and have an idea you can make more money than a doctor. And the working hours are horrendous. You will be 60 even before you realize it.
I am 50+ years old, and not involved in medicine (other than as an occasional patient). I found this article after reading about student loan debt and the recent debt ceiling negotiations.
The reason for this message is that the premise of the break even on medical school loan debt is based on a $300k salary. Yet when I look up (via an admittedly simple Google query) the average salary of post grad med students, the 75 percentile is 161k (the 25th is merely $38k) would mean that 75+% of post graduate doctors only have a fraction of the extra income assumed available to pay down loan debt as described in this article. Paying down a $200-250k loan debt at those salary levels is NOT a 2 year prospect.
I will acknowledge that my one simple query is not an exhaustive analysis, but I would maintain that this article is based on popular assumption on doctoral income with even less critical analysis than my single web search.
The average physician makes $275K. Borrowing $200K (the average) for a $275K salary makes sense still IMHO. But $400K for a $175K income? Nope. Bad idea.
Not sure where you got your data from, but it’s not accurate.
The investment is still viable, but I fear we have already lost by framing the discussion this way. We need more doctors. I think that’s easy to prove. Why do we, as a society, allow institutions to de-incentivize our best and brightest from serving in the most important roles of our society? If and when I become sick, I want the best and brightest taking care of me. Taking on 300k+ in debt to go to medical school, when you can make more money being an online influencer, makes no sense to most young people. It’s devolved to “medicine should be your calling” before it makes sense. That’s not going to ensure our best are applying. As a society, we used to invest in medical education. It wasn’t until the late 80’s when increasing student loan debt took off. Government actions directly to blame. It’s a shame!