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!