The Big Question And Immigrant Pressure

SPEAKER_00 0:00

Welcome to Pizza Punch Lines, everybody. Okay, guys. Today on this episode, we're going to talk about whether it makes sense for the poor to go to medical school. Because I don't know, guys, in this economy, things are looking pretty tough. So, all right. Regardless of how you feel about this point, honestly, if you are an immigrant or a child of an immigrant, it's not going to matter because your parents will still want you to become a doctor. However, ultimately it is still your decision to make. And as I think about this particular topic, I think it's important to think about finances in many different ways. But ultimately, it doesn't really matter because if you're an immigrant kid, your parents are going to be like, this is the best. All right. How did I get into this topic?

A Patient Asks About Money

SPEAKER_00 0:47

I actually thought about this more recently when I had a patient in the emergency department more recently. And this patient, I'll be honest, gave me kind of weird vibes. And I remember because he looked at me, he was just like at the beginning of the conversation about why he was there, he was just like, hmm. Are you in this field because you like it or because of money? And I'm like, how is this relevant to anything that we are here for? I'm here to take care of you. Uh but as I think about it though, especially when I think about it in the context of being a doctor in the US, it's always a question that I'm sure people who aren't in medicine think about are these doctors just here for the money? And I have another reason why I thought about it because a friend of mine who is a professor at a medical school, uh, she was talking about recently how the loans that her students are taking out are outrageous. So I don't know. Both of these things had me thinking about okay, is it really such a lucrative career to go into medicine nowadays? Um the answer may be interesting for you.

Are Doctors Still Respected?

SPEAKER_00 1:52

All right. First thing I'm thinking about when I talk about this topic is are doctors balling out like they used to, right? In the past, people thinking about, you know, these doctors just like balling out with money, money, money. Uh, but I actually am now thinking about is medicine the same thing it used to be, where it's a it's a field where you have such great, not just financial stability, but financial potential. But also, is it a field where you still have the same respect as you used to, which is one of the reasons why a lot of people went into medicine in the past? Not as I'll be honest, I don't really think the respect people have for doctors is the same as it was in the past because people will come to the emergency department and be like, hey, I was looking at Chat GPT and it says I has maybe this, this, or this. Test me for this, this, or this. And obviously, ChatGPT cannot replace doctors. They cannot put IVs in here, they cannot put all these different things. And a lot of medicine depends on the context and how things present. But I also think that these tools that we have now are probably reducing the respect people have for doctors. And I will also probably say that maybe the way medicine is nowadays already and the culture already reduces the respect people have for doctors. But that is part of one of the things I'm thinking of. But

How Long Until Doctor Pay?

SPEAKER_00 3:09

before we even go down this more philosophical discussion, I want people who are thinking about going into medicine right now, specifically becoming a doctor, to think about how long it actually takes to make what we call quote unquote doctor money, right? So you start off going through undergrad, where most people are making not any or negative money, because a lot of people take out loans. Then you go to med school where you're definitely making negative money because most people take out loans that don't have time to work. Then you have residency where you make just enough money to get by. And if you decide to specialize even more, you go through fellowship where you make a little bit more money than you did in residency. Sorry, yep, a little bit more than we did in residency. And then after that, you finally make doctor money, right? So if you think about it, in the best case scenario, let's say you take the shortest path to everything, right? Four years of undergrad, four years of medical school, three years of a residency, that's 11 years before you're making this quote unquote doctor money. 11 years of, let's say, delayed gratification. In the worst case scenario, let's go you go into a neurosurgical specialty and also do a fellowship. So that's four years plus four years plus seven years of residency, and then two years of fellowship. That's 17 years. Now, if you think about it too, there's some people who start in one residency and then switch to a completely different residency. And you must be these people who are crazy, but this is actually something that happens pretty often. So that's even more years you take away from making money. And you could argue if you just go into a job that pays you decently, you work a lot right after you get out of college, you'll probably be better off in some ways than a doctor. So it depends on what you're looking at and what you're looking for. But I just don't want to talk about the numbers of how long it takes to get to the point where you are in terms of education. I actually want to talk about numbers in terms of money. Because for a lot of people, it matters because not everyone has the flexibility of having delayed gratification, essentially, where you can't just not make any money for a long period of time. You have family to take care of family to take care of, kids to take care of. You don't necessarily know, things happen. So let's talk about college to start off with, right?

College And Med School Price Tags

SPEAKER_00 5:23

Because that's a precursor to medical school. So some of these numbers I should let you know I got from College Board, and some of them I did get from ChatGPT, but I also looked up the sources. So for a public in-state university, the average cost nowadays is $12,000 per year, assuming you don't get any financial aid at all. You have to pay it all out. Uh or you get loans. So $12,000 for one year for in-state tuition. If you do out of state, it's $31,000. $3,11,000. Private, you're looking at on average $43,000 per year. And these numbers, I should mention, don't include room and board, right? This is just the numbers for tuition. Now let's switch over to medical school, which is kind of the main topic while we're here and how much it costs to go to medical school in this country here. And on average, for a public medical school, tuition for an in-state resident is $42,000. And an out-of-state resident is $66,000. And for a private school for tuition per year, on average, it's $68,000. And if you look at all of this together, on average, you're looking at people spending $235,000 to go to medical school. In my own experience, because I think I like talking and giving people examples of what I've gone through, I uh went to a private medical school in Chicago. I had an 80% tuition scholarship, which paid for most of my tuition. So most of the loans I took out was for living expenses and also for the other 20% I couldn't pay for. I ended up uh after graduating in debt and I had to pay about $160,000 back, right? And that's the thing. If you just took out that amount and just like stayed there, that is one thing. But this game of taking out loans means you also have interest, which means the money that you took out continues to essentially you have to owe more the more time you take to take it, the more time you take to pay it back.

Interest Rates And New Loan Limits

SPEAKER_00 7:20

Just while talking about pure numbers really, really quickly, uh, I'm gonna talk about something that's probably gonna bore the hell out of most of you guys, which is interest rates. But I think it's important to talk about. When I was going to medical school, uh it was about uh the Stafford unsubsidized loans, which is the government loan that most people take, it was about 6.8 uh percent that you uh that was the interest rate at that time. Um at that time, the max you could take out is $224,000. And the difference um between uh uh then is that you also had the option to take out more loans if you needed more, because a lot of people had to pay for living expenses and other things. You had something called the direct graduate loan plus, which the interest rate was higher, about 7.9%, but you can take out as much as you would like. Now things are different. Uh under the new administration, uh, starting in July of this year, 2026, essentially you have less federal loans you can take out overall, and the interest rate is higher. So essentially, you can only take out up to $200,000 if your loan qualifies as one of the uh essentially professional careers. And the interest rate is 7.94%, not 6.8, 7.94. And once again, like I mentioned, the max you can take out from the government regardless is $200,000. When back when I went to medical school, uh, the average for people in general to take out was $235,000. But now the average you can take out from the government, or rather, the most you can take out from the government is under $200,000, which means the rest of this money you have to take from private loans. And private loans are not great. They are not great. Uh, they will come after you with the federal loan. There are some protections. If you die, poof, it disappears because you know it is what it is. Um, it's the federal government, but private loans, they will come after you and come after other things. Uh man. I mean, don't get me wrong. Loans are loans and the reality of what we have to do in this country. But if we think about it to a certain extent, this is a lot of money, assuming that you go into a well-paying career in medicine can pay it all off. Uh, or you are fortunate enough to qualify for loan forgiveness, which may be a topic of another conversation, but that might be going away as well. But

How Other Countries Fund Training

SPEAKER_00 9:39

what I love talking about when I talk about this topic is because we don't live in isolation. There are other countries which are close by, similar countries that don't do things in the same way. Uh, I want to talk about a couple of different examples of quote-unquote developed countries and how they do this. So we're gonna talk about three countries: France, Canada, and England. In France, you don't actually have to pay anything for medical school tuition. You essentially just pay for registration and other things and living expenses. So people essentially pay about $170,000 to $450 per year for tuition for medical school. And that's just a registration. In Canada, quite a bit more. It's about maybe close to $17,000 per year. And in England, it's about maybe close to $10,000 per year. But take those numbers compared to our numbers, and you're like, sheesh, it's quite a bit, right? And you know, people will often make the argument, but bro, bro, we make so much more money than they do, right? And yeah, if we want to look at it, American doctors do make more than doctors in other countries. But that being said, that those other countries pay a lot less in terms of how much they pay to go to school, right? So if we want to make comparison, right? Let's take an anesthesiologist, a very good paying job in the US, um, if you finish everything, right? Uh and I will say that, you know, for an anesthesiologist in this country, um, on average they make about $440,000 a year. Uh, in Canada, friendly labor, they make about $200,000 a year. In France, $165,000. And in uh England, about maybe $160,000. The thing is that all those other countries you pay a lot, lot less in loans. So they don't have to actually worry about paying those things back. So if you actually look about how much, if you actually look at how much people are making and how much they have to pay for these crazy loans that have really high interest rates, you have to ask yourself, does it all equal out? I don't really know. It depends on your quality of life. And also in a lot of those other countries that have universal health care where they don't have to actually pay any money to pay for their health care, which is one of the highest expenses that we have in this country. So it's things to think about. It's things to think about. I'm not saying you should make the same decision that I made or other people make. I think it's important for you to decide ultimately based on all these factors, because how much you make, but also how much you're paying back is important. And the truth is that not everyone who starts medical school finishes. So it's like a pretty, you could say high risk, high reward type situation, but I don't know, just something to think about.

TV Doctor Fantasy Versus Real Needs

SPEAKER_00 12:33

But I think there are some final points I do want to make about this phenomenon. And essentially, when I think about the way the media is nowadays, there are a lot of TV shows that are coming out or that actually have been out for a while, from Grey's Anatomy to the Pit, where they're showing these hot, sexy surgeons or these smoldering ER docs who are just like putting out buyers left and right. And a lot of these shows will focus on perhaps the most intense or quote unquote sexy careers in medicine. And I really haven't even really seen a show about perhaps just a primary care doc. And when we think about a society and a very healthy society and what goes into making a healthy society, the truth is that it's the pediatricians and the primary care doctors who actually help make a society healthy. But no one's trying to make a show about, ooh, I just prescribed you some life-saving blood pressure medications, or, ooh, I just gave your kid a vaccine. Like that's not sexy. People are like, ooh, that's like a boring thing. But when we think about it, in our society, specifically in the US, primary care doctors are disappearing. And why is that? For the most part, everyone who goes to medical school pays the same loans, right? They are essentially paying the same amount for tuition. But when they come out of it, there's a significant discrepancy between primary care and the subspecialties. So no one really wants to go into primary care because essentially they have these crazy loans that they have to pay back. And if you're not making as much, yet you've been in school for a while and your loans have been acquiring interest, why would you want to go into primary care? And with the current administration trying to potentially even end public service loan forgiveness, which is a program where if you work in a public hospital or certain hospitals in lower income or maybe less resource settings, you can your loans can be forgiven after you work for a certain period of time. That's also going on. So there's not really much of an incentive as much to go into primary care, but that is the foundation of a healthy society. However, who's going to want to go into that if they have crippling loans as they come out?

Why Primary Care Keeps Disappearing

SPEAKER_00 14:57

And the truth is that for me, as an ER doc, when I go into a patient room, I really only have maybe 2.156 seconds when I can actually listen to a patient before I have to talk to them, before I run to another room and see another patient, right? It's just like it's a different setting whereas a primary care doctor, they establish more relationships with their patients. They establish great rapport, they get them to be healthier and do things and talk about how to improve their health overall. And they are literally the backbone of a good, healthy society. But ultimately, that is not where medicine is going in this country. And the way we are going in terms of the loads and how pricey it is to go to medical school or even undergraduate college degree is becoming absolutely ridiculous.

Risk Reward And A Blunt Closing

SPEAKER_00 15:49

So if you learn anything from this particular episode, I think the main thing I want to end with is that if you have the opportunity, you should marry rich, just find a sugar daddy or a sugar mama and marry rich, because you know, hey, you can do whatever you want. It is what it is.