working for a non-profit as an EM doc?

[residentdoc8]

Question for those of you working in the EM field already-- is the standard to be employed by a non-profit private group who is contracted with a hospital? Is it possible for an EM physician to be employed directly with a non-profit hospital or a non-profit entity? I'm worried about my growing 400K in student loans-- how does everyone manage paying back your loans?

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[Birdstrike]

Question for those of you working in the EM field already-- is the standard to be employed by a non-profit private group who is contracted with a hospital? Is it possible for an EM physician to be employed directly with a non-profit hospital or a non-profit entity? I'm worried about my growing 400K in student loans-- how does everyone manage paying back your loans?

Amortize it over the longest time period possible (30 years) to keep the payment as low as possible when you are just starting out. Down the road, when you are able, make extra payments to pay it off early. Take advantage of any refinancing/consolidation program that comes along to get the rate down. Mine were Stafford loans that are around 2-3% interest, now. You bought an education with those loans that will allow you to earn money for 30 years, so if it takes you 30 years to pay it back so be it. If you are doing well enough at some point to pay $400,000 back early, do so to minimize costly interest. If not, don't torture yourself.

For pre-meds: factor tuition costs into your school choice. Barrow and owe as little as possible.

 

[residentdoc8]

You've brought up a really good point that I keep forgetting when I feel suffocated from my student loans-- i've bought myself the ability to always have a job, and most people out there can't say that. I guess I need to get used to the idea of ALWAYS having student loan debt, the trade-off is that I've bought myself the means to live and have a paycheck. I still regret this path with the enormous debt and lost years, but at the same time, maybe the grass is always greener.

 

[dotcb]

Look into public service loan forgiveness:

http://www.studentaid.ed.gov/repay-loans/forgiveness-cancellation/charts/public-service

I work in an academic job, and am in income based repayment. The amount forgiven can be significant. Though I didn't do it, would work best if you did residency in a low cost of living area, lived cheaply, and made payments through residency +/- fellowship. The only reason to pay in residency or enroll early in this program is if, for example, you're sure you wanna do academics. No point suffering as a resident if you take a private job. If you do take a private job, you have to do what feels right for you. Either live like a resident for a few years and pay off ASAP, or settle in for the long haul and pay steadily. Sort of depends on what your interest rates are. 2-3% - no big deal, 6.8% - kill that ASAP.

 

[tkim]

non-profit private group who is contracted with a hospital?

I'm not sure there are contracted private groups that are non-profit. Are there?

 

[Arcan57]

I'm not sure there are contracted private groups that are non-profit. Are there?

That's a somewhat intriguing idea but I don't know of any groups out there. It seems like it would be fairly trivial to make the numbers work out (expenses go to doc salary and "profit" gets rolled back into the group's administrative costs/war chest) but I'm sure there's some angle I'm not seeing.

 

[The White Coat Investor]

I wouldn't be surprised to see more groups become "non-profit" in the future in order to lure in docs with $300-400K in loans and get them some PSLF. At the present time, I don't know of ANY non-profit groups. The only emergency docs I know that are eligible for PSLF work for the military (and thus have little by ways of loans anyway) or the VA. Actually, the ones I know who work at the VA work for a for-profit group that contracts with the VA, so I guess that may not even be an option.

Birdstrike- You may not be aware that med studs can no longer consolidate at lower rates. Consolidation now occurs at an average rate of all the outstanding loans. Subsidized loans are gone too. 6.8% is about as low as you get now days. Obama hates them.

 

[residentdoc8]

YES! Exactly....I don't think ANYONE knows what kind of ridiculously HIGH interest rates there are on an already exorbitant amount of loans JUST FROM MEDICAL SCHOOL these days unless YOU are the ones facing this horrible moutain of loans!!! I feel bad for those who are JUST starting medical school right now, i'm not sure how they are going to repay their loans in another decade. My highest is 8.5%...can you imagine that on a 6-figure loan without any prospects of tacking it down in Residency? That's why i'm trying to figure out what to do-- PSLF would be great, but for EM, not sure if it's possible to be employed at a non-profit group

 

[JacobMcCandles]

YES! Exactly....I don't think ANYONE knows what kind of ridiculously HIGH interest rates there are on an already exorbitant amount of loans JUST FROM MEDICAL SCHOOL these days unless YOU are the ones facing this horrible moutain of loans!!! I feel bad for those who are JUST starting medical school right now, i'm not sure how they are going to repay their loans in another decade. My highest is 8.5%...can you imagine that on a 6-figure loan without any prospects of tacking it down in Residency? That's why i'm trying to figure out what to do-- PSLF would be great, but for EM, not sure if it's possible to be employed at a non-profit group

The best thing to do is to continue to live on a resident's salary the first few years. You could knock out a $200k loan pretty quick. Obviously a $400k loan would take longer.

The best thing to do is not to go to an expensive and/or out of state school but that can't be helped any more for those already in school.

 

[UnderwaterDoc]

The best thing to do is to continue to live on a resident's salary the first few years. You could knock out a $200k loan pretty quick. Obviously a $400k loan would take longer.

The best thing to do is not to go to an expensive and/or out of state school but that can't be helped any more for those already in school.

Bingo, that's what I'm doing.

 

[EctopicFetus]

Yeah the student loan deals now are depressing. While I owe a ton of money none of my loans are over 4.5% and come March 2/3 of my loans (~220k) will be at 1.875%.

I am paying off my loans as slowly as possible. Why rush.. at 8.5% I would be rushing like crazy.

 

[eastcoastEM]

Record low interest rates, yet 6.8% student loan interest. One of these days someone's going to figure out something wacky like get a home/equity loan, pay off med school debt with it, go bankrupt, and start again - to convert the "forever" debt of student loans into something that can be written off in bankruptcy, or just to lower interest rates.

 

[dotcb]

The majority of academic EM departments are not-for-profit. Any program called University of _________ will make you a state employee, and you should qualify for PSLF. Whether you want to do it is another matter, but most academic jobs qualify.

 

[residentdoc8]

Record low interest rates, yet 6.8% student loan interest. One of these days someone's going to figure out something wacky like get a home/equity loan, pay off med school debt with it, go bankrupt, and start again - to convert the "forever" debt of student loans into something that can be written off in bankruptcy, or just to lower interest rates.

Yes, that sounds like a great plan in theory, but home/equity loans do not have the same benefits as federal loans-- such as, the loan will NEVER be discharged at death, so unfortunately, your family would absorb the costs for the rest of their lives should that ever happen. Also, those types of loans aren't forgivable-- they don't care if you make a buck an hour or several bucks an hour, you owe a fixed amount per month....unlike federal IBR programs. Good thought though!

 

[Arcan57]

The majority of academic EM departments are not-for-profit. Any program called University of _________ will make you a state employee, and you should qualify for PSLF. Whether you want to do it is another matter, but most academic jobs qualify.

Depending on the state, the differential between being an academic and a community doc may be small enough to make PSLF worthwhile. In other regions, community makes 75%+ more than academics and you're better off just getting the extra money.

 

[HunterGatherer]

From what I understood a hospital had to be 501c3 to qualify. The affordable care act has new rules to what makes a hospital qualify for 501c3. I had a link which I can't find now. But searching hospitals I figured to not be 501c3 in fact were. I'll. Try to find that link but my laptop from medschool has a dying HD. This is what I have for now:

https://www.fundraise.com/non-profit

.org or .gov website would be ideal. You can also do a search: "<hospital name> 501c3". Personally For the time being I'm not doing this loan program.

 

[WakeTheNation]

Yeah the student loan deals now are depressing. While I owe a ton of money none of my loans are over 4.5% and come March 2/3 of my loans (~220k) will be at 1.875%.

I am paying off my loans as slowly as possible. Why rush.. at 8.5% I would be rushing like crazy.

I'm probably getting ahead of myself but can you consolidate loans or somehow get your interest rate down after graduating? I'm gonna graduate med school with $200,000+ in loans pretty much all at 6.8%. I hear about people getting their rates down to about 2% post graduation and wonder if this will be possible for me or is a thing of the past? Whether or not I can do this will definitely be a factor in how fast I pay them back and how hard I look into loan forgiveness programs.

 

[TooMuchResearch]

I'm probably getting ahead of myself but can you consolidate loans or somehow get your interest rate down after graduating? I'm gonna graduate med school with $200,000+ in loans pretty much all at 6.8%. I hear about people getting their rates down to about 2% post graduation and wonder if this will be possible for me or is a thing of the past? Whether or not I can do this will definitely be a factor in how fast I pay them back and how hard I look into loan forgiveness programs.

Of course you can consolidate at 2%...if you have loans you can lock at a low rate. Sadly, our loans are fixed 6.8%. You might be able to get that down to 6.3% with automatic payments or something like that. But not 2%. Not even 6%. Go to the cheapest school you can...

 

[la gringa]

i probably would have had to totally changed my plans if i had graduated today... no private med school and no applying to 4 year programs. (i applied to 3 and 4 yr, regard only to quality and probable fit. matched at a 4)

the low interest rate made it do-able, plus the fact that it was 2001-2005 tuition. today -- yikes, no way. would have maxed out...

 

[DreamingTheLive]

From what I understood a hospital had to be 501c3 to qualify. The affordable care act has new rules to what makes a hospital qualify for 501c3. I had a link which I can't find now. But searching hospitals I figured to not be 501c3 in fact were. I'll. Try to find that link but my laptop from medschool has a dying HD. This is what I have for now:

https://www.fundraise.com/non-profit

.org or .gov website would be ideal. You can also do a search: "<hospital name> 501c3". Personally For the time being I'm not doing this loan program.

Even if the majority of Hospitals are 501c3, wouldn't the fact that most effectively contract out to some form of private EM group effectively nullify any chance at PSLF. I.e., you work AT the hospital, but you work FOR a private, non-501c3 group. Wrong?

 

[residentdoc8]

Even if the majority of Hospitals are 501c3, wouldn't the fact that most effectively contract out to some form of private EM group effectively nullify any chance at PSLF. I.e., you work AT the hospital, but you work FOR a private, non-501c3 group. Wrong?

That's the whole point of my post- it seems as though the majority of work that EM Physicians will be doing is with a private group that contracts with a non-profit hospital....so essentially, the EM track won't lend itself to PSLF. So a Plan B needs to be set in place to tackle these loans-- I was trying to reach out on this forum but it doesn't seem as though there are really any solutions to huge mountain of loans I have (and most med students have these days).

 

[dotcb]

Work hard, save money, live cheap. There's no easy way around it.

But you've gotta do what you love. You can't spend 7+ years training and not be happy. EM pays in the middle range of medical specialties. More than primary care, on par with several of the IM and peds subspecialties, but nowhere near some of the surgical subspecialties. But for 3-4 years of training, it's quite good. But the key is - you've gotta do what you love. It's a lot easier to work hard doing something you enjoy, than grind it out day after day doing something you're not really into.

I'm in PSLF, but it works for me because I wanted to do academics anyway.

I don't think it's worth doing academics just for PSLF in EM. I could get rid of my loans much faster if I just worked a private job. Private jobs pay 30-40% more, on average. It's just that I, personally, wouldn't enjoy it as much and so for me it is worth it. . But there's more to life than $, and what you do should not be purely a financial decision.