Yale v. UCSD

[thrwaway2017]

UPDATE: I've decided on Yale. Thank you all so much for your sage advice!

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[Ebayit]

Hey friend,

Just curious, what are your career goals/interests? I feel like that would also be helpful in the community giving advice

 

[thrwaway2017]

Hey friend,

Just curious, what are your career goals/interests? I feel like that would also be helpful in the community giving advice

Hey there! Thanks so much for responding.

Specialty-wise, I think I'd like to specialize. While I think a career in academic medicine sounds interesting, I think I'd probably prefer a role as a clinician-educator (mainly in clinic w/some clinical research and teaching duties, no basic science research) as opposed to the traditional "academic physician", bc I enjoy the clinical component of medicine (and I really like working as a teacher/educator/mentor as well).

EDIT: Also paging @Willy38 for advice haha

 

[coffeeandcodeine]

This is pretty tough, because Yale will give you superior opportunities in academic medicine (not just basic science research, but teaching and clinical research). However, 340k is a pretty steep figure, especially when you add interest. 230k is not great either, though. You have to consider how much debt you're comfortable with, and whether you're willing to sacrifice some financial freedom for the possibility of better teaching opportunities down the line.

 

[Ebayit]

This is pretty tough, because Yale will give you superior opportunities in academic medicine (not just basic science research, but teaching and clinical research). However, 340k is a pretty steep figure, especially when you add interest. 230k is not great either, though. You have to consider how much debt you're comfortable with, and whether you're willing to sacrifice some financial freedom for the possibility of better teaching opportunities down the line.

hmm yeah I agree. It is good though that the 110k difference will seem a bit smaller if you do indeed specializing, I'm going to defer to more experienced members in the community on this one, it's a tough situation (but congrats!! this is a good tough situation)

 

[deev04]

Congrats on another incredible option and for (at least) ruling out one school! This is probably one of those decisions (as I'm sure you know) where anonymous internet people can only be so helpful, since it ultimately comes down to how much you value the advantages of yale and whether those advantages are worth the financial cost. Even if Yale/UCSD is the hands down winner for 100 people, when you're talking about schools as incredible as these, the relative advantages of them are very personal. Financial thresholds are also individual since we take into account non-monetary sacrifices/benefits. Your $x for when the benefits of yale no longer seem worth the cost will be different from mine.

But, those are some scary looking debt burdens. No matter the "worth" of choosing Yale, it's probably worth considering what carrying a $340k+interest debt load really looks like. Mid 300s is getting into the range where your debt starts to weigh significantly on decisions regarding specialty, lifestyle, COL, residency/job location, etc. You mentioned wanting a career in academics as a clinician educator. This can be done in high-paying fields, but academics is going to mean substantial pay-cuts and even more so if you want to live in a desirable coastal city. If you're thinking (or later fall in love with) academic general internal medicine, primary care, ID, rheum, neuro, FM, anything pediatrics (besides maybe cards or nenoatal) etc., you're looking at starting salaries below 200k with minimal growth.

--
I've personally wondered about various debt burden/loan payment scenarios, so I spent a little time playing around with the AAMC's Loan Calculator to see what repayment might look like. I chose the hypothetical scenario of 6 years of residency since this might be IM+chief year+GIM fellowship or IM+fellowship. Adding on a 7th year of fellowship only changed monthly payment by ~$100, so this should be a good ballpark for a range of specialties. I also assumed you used REPAYE during residency/fellowship, the maximum Stafford Loan Amount (5.31% interest), and GradPlus (6.31%) for the rest. Most of the values are rounded.

Scenario A: UCSD, $230k

• REPAYE Payments During residency/fellowship:$308-436
• In order to pay off debt within 5 years post-residency/fellowship: $5800/month, Total Paid w/Interest = $346,600
• In order to pay off debt within 10 years post-residency/fellowship: $3100/month, Total Paid = $371,500

Scenario B: Yale, $340k

• REPAYE Payments During residency/fellowship:$308-436
• 5 Year Repayment: $8340/month, Total Paid = $498,560
• 10 Year Repayment: $4750/month, Total Paid = $568,800

So there's obviously a difference in monthly payments. Whether or not that difference significantly affects your quality of life probably depends on how much you're making. If you're working in academic medicine as a PCP or in General IM, general neuro, most of the IM subspecialties that aren't cards/gas/onc, FM or peds, $200k is a good guess. 200k is ~133k post-tax, which is 11,100/month. That would make the 5 year monthly payments if you went to Yale really difficult (almost impossible if you wanted a house, to travel or had kids). Of course, paying 10 years post residency isn't horrible, but that's 16 years post-med school and a whole lot of interest.

 

[Thenewguy02]

Hey there! Thanks so much for responding.

Specialty-wise, I think I'd like to specialize. While I think a career in academic medicine sounds interesting, I think I'd probably prefer a role as a clinician-educator (mainly in clinic w/some clinical research and teaching duties, no basic science research) as opposed to the traditional "academic physician", bc I enjoy the clinical component of medicine (and I really like working as a teacher/educator/mentor as well).

EDIT: Also paging @Willy38 for advice haha

A few considerations (All my opinion):

1: Specialty is irrelevant for these schools. They are both great schools that can match you into any specialty. That being said, if you want a neurosurgery residency at Columbia, Yale's name could give you that edge.

2: Both schools will provide ample opportunity to become a clinician educator as well. I think the key question is the location. You are likely to practice where you do residency, to some extent. If California is your dream, UCSD has a largely regional match list (but good) and will be very well suited for this.

3: Your car should be a non-issue. I interviewed at Yale a week after a snowstorm and all the roads were cleared. Worst case you take public transit. New Haven is also practically two cities. Yale and New Haven. If you are snowed in, everything you need should be within walking distance.

4: Your classmates. When I interviewed at UCSD I was one of three from thirty that was OOS. The second biggest factor (the biggest being that I was rejected - I thought it was my best safety, but it turned into my only post II rejection) for me not choosing my state school (OHSU) was the fact that almost everyone was from in state. I wanted a new experience, to meet new people from new backgrounds. If you like Californian's this is a bonus! Cali also has more major cities, so people will be from further away.

5: Loan type: I don't know much about non-need based loans, but here is a few things I would consider. Federal loans at 7.5% cap at 200k. Additional loans may have a higher interest rate, thus widening that 110k gap. On the flip side take a look at your Yale loans. "Yale Alumni Loan", for example, has no interest for medical school plus the first two years of residency. 100k at 6 years of 7.5% is over 30k. It could make that gap much smaller.

6: Population: Again a regional thing. If you want to practice in Cali, a large Latino population will be an asset. New Haven has diverse population as well, but not necessarily Latino - I was told that it has been a city for refugees.

All that said, if I were in your shoes I would flip a coin. I don't think you can make a bad decision, but flipping a coin would give you an icebreaker for orientation week. Feel free to ask me anything about these schools - although I only spent a day at each so my opinion will be biased and limited.

 

[Willy38]

It depends on what you are interested in. If you know you want to enter a high paying surgical subspecialty then go for Yale (pretty much guaranteed to match into whatever specialty you want, if not your top choice of program in that specialty). If you are unsure then maybe opt for cheaper option at UCSD. Going into FM or IM with 340k in debt is a lot and I would avoid that if you can. If you are going to be a spine surgeon, then I would say its absolutely worth the extra money for the competitive advantage gained from attending Yale.

Also, surprised you aren't receiving any aid? Yale normally has pretty generous need-based aid.

 

[thrwaway2017]

Congrats on another incredible option and for (at least) ruling out one school! This is probably one of those decisions (as I'm sure you know) where anonymous internet people can only be so helpful, since it ultimately comes down to how much you value the advantages of yale and whether those advantages are worth the financial cost. Even if Yale/UCSD is the hands down winner for 100 people, when you're talking about schools as incredible as these, the relative advantages of them are very personal. Financial thresholds are also individual since we take into account non-monetary sacrifices/benefits. Your $x for when the benefits of yale no longer seem worth the cost will be different from mine.

But, those are some scary looking debt burdens. No matter the "worth" of choosing Yale, it's probably worth considering what carrying a $340k+interest debt load really looks like. Mid 300s is getting into the range where your debt starts to weigh significantly on decisions regarding specialty, lifestyle, COL, residency/job location, etc. You mentioned wanting a career in academics as a clinician educator. This can be done in high-paying fields, but academics is going to mean substantial pay-cuts and even more so if you want to live in a desirable coastal city. If you're thinking (or later fall in love with) academic general internal medicine, primary care, ID, rheum, neuro, FM, anything pediatrics (besides maybe cards or nenoatal) etc., you're looking at starting salaries below 200k with minimal growth.

--
I've personally wondered about various debt burden/loan payment scenarios, so I spent a little time playing around with the AAMC's Loan Calculator to see what repayment might look like. I chose the hypothetical scenario of 6 years of residency since this might be IM+chief year+GIM fellowship or IM+fellowship. Adding on a 7th year of fellowship only changed monthly payment by ~$100, so this should be a good ballpark for a range of specialties. I also assumed you used REPAYE during residency/fellowship, the maximum Stafford Loan Amount (5.31% interest), and GradPlus (6.31%) for the rest. Most of the values are rounded.

Scenario A: UCSD, $230k

• REPAYE Payments During residency/fellowship:$308-436
• In order to pay off debt within 5 years post-residency/fellowship: $5800/month, Total Paid w/Interest = $346,600
• In order to pay off debt within 10 years post-residency/fellowship: $3100/month, Total Paid = $371,500

Scenario B: Yale, $340k

• REPAYE Payments During residency/fellowship:$308-436
• 5 Year Repayment: $8340/month, Total Paid = $498,560
• 10 Year Repayment: $4750/month, Total Paid = $568,800

So there's obviously a difference in monthly payments. Whether or not that difference significantly affects your quality of life probably depends on how much you're making. If you're working in academic medicine as a PCP or in General IM, general neuro, most of the IM subspecialties that aren't cards/gas/onc, FM or peds, $200k is a good guess. 200k is ~133k post-tax, which is 11,100/month. That would make the 5 year monthly payments if you went to Yale really difficult (almost impossible if you wanted a house, to travel or had kids). Of course, paying 10 years post residency isn't horrible, but that's 16 years post-med school and a whole lot of interest.

Thank you so much for going through these scenarios! They've definitely helped me put the money into more concrete considerations (an extra 2.5K/month for 5 years would be kind of sick haha BUT I agree if I end up specializing it may not be as huge of a deal).

This will definitely play into what I end up deciding

 

[thrwaway2017]

A few considerations (All my opinion):

1: Specialty is irrelevant for these schools. They are both great schools that can match you into any specialty. That being said, if you want a neurosurgery residency at Columbia, Yale's name could give you that edge.

2: Both schools will provide ample opportunity to become a clinician educator as well. I think the key question is the location. You are likely to practice where you do residency, to some extent. If California is your dream, UCSD has a largely regional match list (but good) and will be very well suited for this.

3: Your car should be a non-issue. I interviewed at Yale a week after a snowstorm and all the roads were cleared. Worst case you take public transit. New Haven is also practically two cities. Yale and New Haven. If you are snowed in, everything you need should be within walking distance.

4: Your classmates. When I interviewed at UCSD I was one of three from thirty that was OOS. The second biggest factor (the biggest being that I was rejected - I thought it was my best safety, but it turned into my only post II rejection) for me not choosing my state school (OHSU) was the fact that almost everyone was from in state. I wanted a new experience, to meet new people from new backgrounds. If you like Californian's this is a bonus! Cali also has more major cities, so people will be from further away.

5: Loan type: I don't know much about non-need based loans, but here is a few things I would consider. Federal loans at 7.5% cap at 200k. Additional loans may have a higher interest rate, thus widening that 110k gap. On the flip side take a look at your Yale loans. "Yale Alumni Loan", for example, has no interest for medical school plus the first two years of residency. 100k at 6 years of 7.5% is over 30k. It could make that gap much smaller.

6: Population: Again a regional thing. If you want to practice in Cali, a large Latino population will be an asset. New Haven has diverse population as well, but not necessarily Latino - I was told that it has been a city for refugees.

All that said, if I were in your shoes I would flip a coin. I don't think you can make a bad decision, but flipping a coin would give you an icebreaker for orientation week. Feel free to ask me anything about these schools - although I only spent a day at each so my opinion will be biased and limited.

Very very good points. I will say that I agree w/almost everything you said. I did the "flip a coin and you'll know what you want once it's in the air" thing and I wanted both really so that was unhelpful aha BUT you make salient points I'll 100% keep in consideration. Are you going to be attending Yale?

 

[thrwaway2017]

It depends on what you are interested in. If you know you want to enter a high paying surgical subspecialty then go for Yale (pretty much guaranteed to match into whatever specialty you want, if not your top choice of program in that specialty). If you are unsure then maybe opt for cheaper option at UCSD. Going into FM or IM with 340k in debt is a lot and I would avoid that if you can. If you are going to be a spine surgeon, then I would say its absolutely worth the extra money for the competitive advantage gained from attending Yale.

Also, surprised you aren't receiving any aid? Yale normally has pretty generous need-based aid.

I'm pretty sure I want to go into a procedure-based or subspecialty-type career. With that said, you think Yale would very likely be a better choice then?

 

[Thenewguy02]

Very very good points. I will say that I agree w/almost everything you said. I did the "flip a coin and you'll know what you want once it's in the air" thing and I wanted both really so that was unhelpful aha BUT you make salient points I'll 100% keep in consideration. Are you going to be attending Yale?

That's the plan. I've withdrawn from everywhere else, so if I don't I'll have to reapply.


It's four years of my life. I want a school that offers great opportunities, but also in an environment that I'll enjoy. For me Yale was the school that offered both. I loved their system and location.

To me it sounds like both schools offer this to you, albeit in a different manner.

 

[deev04]

I'm pretty sure I want to go into a procedure-based or subspecialty-type career. With that said, you think Yale would very likely be a better choice then?

I think he meant that 340k of debt is well into the range that would make choosing IM/FM/peds not financially comfortable. Given that you have another incredible option (UCSD), if you were pretty sure you wanted to go into a lower paying specialty (like IM/FM/peds/neuro), UCSD would be the way to go.

With procedural and surgical specialties, which are higher paying, 340k is a bit more manageable.

If you look at the repayment scenarios above, the most important factor in determining whether those debt payments are manageable is your monthly income. For most of the lower paying academic specialties (IM, FM, Peds, general Neuro), 200k is really the top end of what you could expect to make in a major market. That's ~11k/month. If you went into a higher paying procedural specialty (interventional cards, gas, onc, IR, surgery) 300k in a major market is very doable. That's ~16k/month (post-taxes), which is a pretty substantial difference.

But, interests do change and you might fall in love with IM/peds/FM. UCSD is a great school and you will be able to match into any specialty at great academic programs coming from either school.

 

[thrwaway2017]

UPDATE: @deev04 @Thenewguy02 @coffeeandcodeine @Ebayit

There's a reasonable chance I'll be able to make up the difference to bring Yale's cost roughly on par with UCSD's (~240K). Assuming this plays out, how would y'all advise?

 

[deev04]

There's a reasonable chance I'll be able to equalize the cost of Yale down to roughly UCSD's (~240K). Assuming this plays out, how would y'all advise?

Yale. You want to go into academic medicine, you love the Yale system, you're from the east coast with family/SO nearby. Yale gives you the prestige and everything else. New Haven might be a downside, but you can always spend your breaks doing research in some cool location on Yale's dime, or just chilling on a beach in Fiji.

Congrats on a sweet set up!

 

[coffeeandcodeine]

UPDATE: @deev04 @Thenewguy02 @coffeeandcodeine @Ebayit

There's a reasonable chance I'll be able to make up the difference to bring Yale's cost roughly on par with UCSD's (~240K). Assuming this plays out, how would y'all advise?

That's awesome! I agree with @deev04, Yale seems like your best option in this case -- it's a wonderful place to be, with infinite opportunities and a super laid-back curriculum. Congrats!

 

[Ebayit]

UPDATE: @deev04 @Thenewguy02 @coffeeandcodeine @Ebayit

There's a reasonable chance I'll be able to make up the difference to bring Yale's cost roughly on par with UCSD's (~240K). Assuming this plays out, how would y'all advise?

Wow congrats once again! Hopefully it pans out, because attending Yale would be a great opportunity. Although it seems like you have interest in moving to California (which I don't blame you for because it's great over here), Yale would certainly put you in a solid position to moving out here after school or even some of the top programs in the NE. I feel like your natural inclination to their curriculum style, the prestige, and the proximity to family/SO heavily swings this decision to Yale's favor. The really only advantage I see now is the weather which is amazing compared to New Haven, so I wouldn't necessarily fault you for wanting to leave the winters behind you as well, since by no means would you be shutting yourself from great opportunities at UCSD as well

 

[Thenewguy02]

I agree. Your original dilemma was if Yale was worth the 110k. If that is removed the only thing holding you back is the weather!

 

[mariagefreres]

yale definitely...

 

[thrwaway2017]

After a lot of thinking and soul-searching, I've decided to attend Yale! I thank you all for your tremendous help and I'm excited to take the next step forward