Josiah Warner
This past month, my wife and I sat down to figure out if we could afford ballet lessons for our daughter. It was humbling to realize that despite our years of frugality—both in preparation for and throughout the first three years of medical school— that the $40-per-month lessons were well beyond our means. But, because we have invested time into understanding our financial outlook before even getting into medical school, we have had very few financial surprises through the years. We know that this humbling moment is only temporary.
Josiah Warner
As I navigate through my last year of medical school with a wife, two kids, and a third on the way—and as I juggle both clinical duties and professional duties—my advice to any pre-med student or current medical student is simple but hard to do well: understand the financial aspects of your medical education so you can “afford” the other costs. While programs provide information regarding the basic financial costs—tuition, living expenses, cost of traveling, board exams—few can accurately highlight how much your medical education will cost you in time, energy, and emotional capital beyond a general, “it will be hard.” Because you know there will be “hidden expenses,” do everything in your power to remove the ambiguity and uncertainty around your financial security.
What does that look like? For me, it began while I worked toward my undergraduate degree. I had chosen to study classics before pursuing medical school out of a love of learning (and a nerdy desire to speak Latin); because of that, I knew I would need additional education, which had a cost associated with it. I did everything I could to graduate debt-free, working numerous jobs at times in addition to full-time studies to cover my rent and living expenses. After graduating and marrying the smartest girl in my class, we both chose to stay in our small college town for two years, saving up enough to pay cash for my post-baccalaureate program.
While juggling the intensity of cramming all of the pre-requisite courses into 15 months while volunteering, I researched the finances of medical school. While I commuted, I would stalk through forums discussing repayment options for student loans and research things like the Public Service Loan Forgiveness (PSLF) program and the National Health Service Corps (NHSC) loan repayment program. While I worked out, I would listen to The White Coat Investor podcasts or the Ramsey Show to better understand how to budget and plan ahead. Between finishing the program and starting medical school, we had our first child. At that time, finances trumped experience, and I ended up working as many shifts as possible as a server. Eventually, I was able to cover our expenses and also pay off our only debt (a small $5,000 loan), pay for rent in a new state, and cover our moving expenses from Chicago to rural Oregon.
By the time we reached medical school, we had a good handle on our finances, but, even then, we still had to navigate the realities of living off student loans. We pared down our living even more, and my wife worked part-time until we had our second child. Even then, we still have to work hard to make ends meet. Unexpected things, like waking up at 5am to go to the hospital for your shift only to find your paid-off vehicle stolen, are very challenging.
As a “doctor in training,” it can be tempting to think you should be living a different lifestyle, and social media has not made that any easier. But knowing that you can cover your expenses and have a pathway on how to become financially independent are worth more than a fancy pair of scrubs or a trip to Belize (although the latter does sound pretty nice). Because we have thought about the finances, I have been able this past year to dedicate myself more to learning while on rotations, talking with patients, and volunteering in the community. It has also freed me up to deal with those hidden costs of medical education.
The first day of my clinical rotations, I was on call with my attending surgeon. We were called to evaluate a woman in her late 50s with alcoholic hepatitis, encephalopathy, and a bowel perforation complicated by pneumatosis intestinalis. Over the course of a 12-hour shift, I had transitioned from studying virtually for medical school in my bedroom due to COVID-19 restrictions to being the last person to make eye contact with a woman crushed by life and, without meaning judgment, the weight of poor decisions. Four months ago, I was trying to earn the trust of adolescents admitted to the few inpatient psychiatry beds in Oregon who have some of the worst trauma imaginable. This past week, I have been seeing neurologically devastated children and sitting in on family care conferences to discuss their prognosis. All the while, I still come home to my wife and very energetic kids who need me—my time, my words, my energy, my affection—as much as I need them.
During my first week of medical school, a mentor who saw me sitting in the hallway, holding my white coat and studying anatomy told me: “When you place that white coat on your shoulders, you are putting on the weight of an entire system and the responsibility of caring for people at their lowest.” Life does not stop during medical school, and although finances are a fundamental part of this profession, concern or anxiety about them should not overwhelm you from living or learning how to carry the weight that comes with that enviable white coat.
In order to take care of people—and yourself—work to understand the financial aspects of your medical education. Figure it out now, and make the humbling choices now, so that you can have enough time, energy, and emotional (as well as financial) capital to spend it where it matters. For now, my daughter will have ballet lessons with her father in non-fancy scrubs.