what would you do? try to go to med school?

[ertyu]

I'm sure figuring out how to make it transfer would be cheaper than doing it in the states. plus it would broaden your horizons to live abroad.

[zarathustra]

Yeah @Ego @ertyu this is definitely a far cheaper option, but returning to the states for residency is much much harder. It's not impossible, but the barriers are high. Also, I am not interested in living out of the states or even traveling again any time soon. Living outside the states for 1.5 years was enough for me for a long time.

There are also commitments I could make to government organizations like:

(1) the military
(2) national health service corp
(3) the VA
(4) indian health services, etc

to pay for my tuition and books, and give me a monthly stipend, for a commitment for 4-6 years to work for their facilities. This is what I've been investigating the most, but it would limit my freedom of where I live and work, as well as limit my potential specialties for those 4-6 years; some more than others.

There is also the idea of going into debt using government subsidized programs, as was mentioned. They effectively cut the interest in half at the end of your residency, so it's like borrowing at 3% instead of 6%. My investments certainly have made far more than that over the years, but that cannot be guaranteed to continue.

[Qazwer]

The cost of medical school is only really high if you need to spend a large salary when you are done. Yes, you might be in debt for hundreds of thousands of dollars. But after residency training, you will be making a significant income. If you live ERE style for 5 years after training, the debt will be more than payed off. Prior to medical school it is hard to predict what field of medicine you might enjoy the most. Medical school in the US will give you exposure to more fields. Borrowing money is a reasonable financial decision. Limiting your possibilities by signing up for military or such only makes sense if you want to serve. Check out Student Doctor Network website for advice.
Good luck on the application

[Alphaville]

i don’t know what kind of doctor you plan to be but the best doctor i’ve ever found is a harvard graduate. so now i look for harvard graduates.

otoh your residency would be decided for you by computer match for which you’ll have no control. and as a resident you’ll start to get paid already, yes? not a ton, but some.

so why don’t you just go for the best education they let you have, and go from there?

really trying to cheapen out on this path is silly. you want to increase your exposure to serendipity not limit it.

medicine is a vocation not a job or a house you flip.

just try to be the best you can at it. everyone needs the best possible doctors.

is there someone you want to learn from? is there someone doing research you like? is any school famous for something that interests you?

[zarathustra]

@alphaville et al, really good points and questions that are quite relevant in this decision.

The military would be too much commitment in the sense that I would lose all choice about where in the world I would live for residency and then four years afterwards, but I would have more ability to choose specialty.

VA is pretty much open 100% specialty-wise, but you pay back 1.5 years for every year of support but you can work at any VA with an open slot you want, so more flexibility on location. This is the first year they have had this scholarship for medical school, so few people know about it. I am hoping that stays the case this cycle too.

NHSC must be primary care specialty (family med, internal med, pediatrics, OBGYN, & psychiatry). I have underlined and bolded the specialties I am very keen on. Primary care is very much my interest. Locations are just nonprofits rated a certain score and serve underserved communities so it can be rural or urban. But this scholarship is very very competitive and not something I could bank on. I am likely going to apply for it.

as a resident you’ll start to get paid already, yes? not a ton, but some.

Yes, over 50k/year during residency (3-4 years for me), which is ridiculously more than enough.

so why don’t you just go for the best education they let you have, and go from there?

I will go where I get in. If I have a choice between two or more schools that will be miraculous. I think the stats are that 40% of applicants get accepted and most of those people only get one acceptance. Very few people get more than one acceptance.

really trying to cheapen out on this path is silly. you want to increase your exposure to serendipity not limit it.

medicine is a vocation not a job or a house you flip.

just try to be the best you can at it. everyone needs the best possible doctors.

is there someone you want to learn from? is there someone doing research you like? is any school famous for something that interests you?

I am not an applicant that could get into Harvard or any of the fancy medical schools, but in reality, unless you are trying to do a very competitive specialty like Dermatology or Neurosurgery or Orthopedic Surgery, basically all medical schools teach the same things and it's all what you get out of it yourself. I am not interested in those specialties at all.

As far as my interests, I am very passionate about preventative and lifestyle medicine. I am big on the continuity of care and forming very deep, meaningful relationships with people. I am definitely a person that would not enjoy specialization except to specialize in being good at understanding how everything works together and being great at problem solving, hence why internal medicine would probably be a good fit.

I will probably need to be a part-time primary care-type doctor for ~4-5 years (maybe to pay off loans and/or the scholarship?) and start building my own practice doing medicine my way part-time that is more preventative medicine focused, no-insurance-taken, barter-based, sliding-scale, likely for a smaller community. After I built up my savings again after a few years, I'd just do my barter-practice and garden, etc. Yields and flows . . . Wheaton 6 & 7, ya know?

I already know I don't need much when it comes to savings/investments and I guess everyone is right that with a doctor salary I can get back to my current savings level quickly. I just really hate that feeling of HAVING to work. I love choosing to work. It is such a wonderful feeling and I am so used to it now. Not having debt and having enough savings lets me do that. But if I took a deal to have that shit covered by someone else, I am then going to "owe" in another way.

Interesting. This is making me realize that owing time to an organization is more palatable to me than owing money and/or not having the savings I have. Maybe. I will have to think about this further. Maybe because it feels less risky?

I would still have the safety-net of investments that hopefully are growing. I wouldn't owe money. I would just promise to work (and be paid full salary) at specific types of places, which serve populations I would love to serve. Hmmm.

[Alphaville]

yeah, i get that harvard is far and away, for everyone really not just you. it’s a long shot for everyone.

i’m just saying, in matters like these, simply do your best, whatever that may be. i meant that as a refutation of other advice, not of your own plans—go to the best school you can. if it’s one, then it’s that one. don’t go for “the cheapest” (but you already knew that).

also i think that doing some service would be homeotelic with your goals no? besides lowering costs, it would deepen your practice a d sense of mission. nobody goes to the ihs for the deluxe acommodations (but i once had a chat with an ihs pharmacists who likes to take scuba diving vacations around the world lol).

im familiar with the national naval medical center (great location), i’ve caught a glimpse of walter reed (same), i’m vaguely familiar with the va, and i’ve seen a lot of the ihs due to their strong presence in my state + people i know + business.

there is a lot of need at the ihs in my region (sw usa) which has been felt during this pandemic. ideal space for family medicine etc. lots of work to do. lots of primary care, lots of diabetes, lots of prevention needed. currently, furious covid.

as for psychiatry, without sounding flippant, the va seems to be ripe for it. i had a therapist who worked with a lot of veterans (was a veteran himself) and there’s a massive need for mental health services in that population. same i think for ihs where there is a lot of trauma, addiction, and not enough personnel.

but you won’t know exactly what you want till you’re done with your rotations, right?

anyway sounds like you’re on a good path and have the right motivations. all the best to you!

ps in my experience internists make the best pcps... no offense to other specializations—just my luck with them has been excellent.