#463

The Money Issue

Maybe it's tax time, but there's a whole lot of talk about money among my daily reads. A Practical Wedding had an anthem of sorts about weddings and money which I found applicable to every day life, too. And Young House Love had a very detailed analysis of the ways they cut costs to afford the things they like to do (namely, renovations).

I wish I could go back four years ago and force myself to sock away $40 a month. Granted that's my grocery bill for an entire week these days (including things like toilet paper, conditioner, and those vital G2 gel pens - we all have them on the Wards), so it would have been hard to do. But necessary. I think my resistance stemmed from not knowing where to put the money, as in what's an automatic way to transfer money to a place I can't touch? I guess I shied away from automatic transfers because we get paid twice a year and there are times when the money situation is so precarious that automatic transfer spells recipe for disaster.

Relocating for residency is hard. The government will only fund you for time you're in school. Seeing as classes end April 30th, my last loan disbursement was meant to cover January through April. While my residency activities begin June 9th, my official residency start date is not until June 27th, meaning my first pay check will not be available until at least the second week of July. That leaves two whole months without money, two whole months during which time one must vacate an old apartment and rent a new one. In NYC, the rental game is dicey, with the up-front cost of a new apartment ranging anywhere from first and last month's rent to first, last, security deposit (i.e. a third month's rent), and a broker's fee which can reach as high as 15-20% of a year's rent. Even if I had saved $40 a month and not gotten married, I still wouldn't have been able to save that much money.

So what's a poor medical intern to do? Option 1 is to get a job. But what job would hire you when your commitments include graduation and relocating? And don't we all deserve a break at this point? And what temporary job would actually pay enough to cover the $8,500 you theoretically might have to pony up when you sign your lease? Option 2 is to get a roommate and put everything on credit cards. Well, I'm married now so option 2 is not really an option. Option 3 is to take out a "bridge" loan, the so-called "residency relocation loan" offered by Citibank, Sallie Mae, and Wells Fargo. While the terms are fairly solid on these things (6-11% interest, 0-4% origination fees, and deferment up to 60 months in residency), it seems a shame to borrow more money on top of the already mortgage-level amounts accrued through medical school. Option 4 is to cry to your parents. Not an option for an independent medical intern whose parents were already generous enough to help cover the costs of her amazing wedding. At a certain point, I'd like to be taking care of them already. And then there's option 5, marry a wonderful man like Tom and lean heavily on his financial luck. Tom is nothing short of financially savvy, and while not always willing to cut back on expenses when that's the easy thing to do, he is always able to find the proverbial pot-at-the-end-of-the-rainbow. And yet, as an independent medical inter using your husband's money for your needs leaves a metal taste in your mouth. I suppose that's why marriage is a "partnership" or symbiosis, one in which I bleed the other person dry.

Why write all of this very personal information on the internet? A few reasons. One, maybe my friends who read this blog and have a few years left to their medical school days will find the information about the costs of relocation and the loan availability interesting. To be sure, that last paragraph is the culmination of at least 25 hours of agonizing. Two, I'd like to point out how financially difficult it is to become a doctor. There's an anachronistic assumption that doctors make a lot of money. We do. But we don't come at this thing in the black. Most of us are so far in the red, you'd think we were disciples of Chairman Mao. And every day Congress is working harder and harder to erode the financial incentives in place to become a doctor. I'll spare you the story about how I had to scramble for a new lender in the middle of my surgical rotation because the economy went south and the government did little to help with student lending. Indeed, the time spent looking for a new lender would have been better spent removing colons, or cancer, or gallbladders, or appendices. I am encouraged that there is some lending reform in the pipeline, but man it can't happen soon enough. The day is not far off when the costs of becoming a doctor will exceed your earning potential. And that's a scary thing. Imagine even less diversity in our physician workforce. We're already facing a shortage of health care professionals across all disciplines.

I've thought on occasion that if lawyers and business people had a training experience similar to physicians, our political and economic systems would be a whole lot different. That's hardly fair in that it fails to acknowledge the good among our lawyers and businessmen. Indeed, the Blog Sidekick's husband is one of the most amazing lawyers I know, and deserves to be recognized for who he is. It's just hard not to feel jealous when after three years of schooling a lawyer makes an associate's salary (and that's after completing paid summer internships). I agree that the plight of the business student is precarious at best. And those poor humanity Ph.D.'s. (Although honestly, they did that to themselves.)...And here I am with a mortgage and no house to show for it, contemplating more debt.

I think the answer to my "woe-is-me, I'm-a-poor-medical-student" is to make the obligatory recognition of just how blessed I am to be said medical student. I have a job I love with limitless potential. And furthermore, while the salary and perks may not always be what I wished, I belong to that most amazing category: someone who will always have a job. The second answer is to make sure that our future medical students actually understand their financial landscape from day one. I could have used that AAMC-sponsored lecture on loan repayment in my first year as much as I needed it in my fourth. Being a future "medical educator," it's something I hope to bring to the medical students of my new home institution.

Amen. No go file your taxes!