Advice wanted for future female EM physician!

[sbridge514]

I am a fourth year medical student and recently read The White Coat Investor. I found the book very informative but also very troubling to me — I already have done so many things “wrong”: I was a non-traditional student and had to take four years off between undergrad and medical school (one year because I didn’t get into med school the first time I applied), I have debt from undergrad, have zero savings and no family contribution to my medical education, so I am going to be graduating with >$250,000 of student debt. Furthermore, I received a prestigious research fellowship between third and fourth year of medical school, so I am taking another year out of medical school to conduct research. While this was a great opportunity and one that I could not turn down, I am concerned again that I am missing out on one year of lost income as a practicing physician, on top of the four I already took between undergrad and med school.

As it stands, I will not be done with my training until I am 35 years old. I also am single and don’t have any other household income. I am a woman and am unsure about if I want a family or not, but I have to think about things that I might want in the future: kids and the very likely possibility that I may need to freeze my eggs, pay for adoption fees and or pay for fertility treatments and IVF, because at age 29 with no potential husband in sight yet I realize it is very likely that I will either be having children at an "advanced maternal age" or will be adopting. These things are expensive. I do have a few things going for me: I have no dependents and do not own a house and am paying in-state tuition, but beyond that I don’t feel like I am in a very good place financially and am concerned about the future.
I am proud of myself in that I have followed my dreams to go to medical school (including taking this prestigious fellowship), but all my dreams won’t matter in the long run if I’m in financial ruin. I return for my final year of medical school in June of 2017, and will be starting residency in July of 2018 (most likely emergency medicine). Moving forward, I want to set myself up for the best future financially that I can. Do you have any advice for me, or is there a place on this website (blog entry or the like) where I can find advice for someone in a situation like mine? Let me know

[lernd]

I am not a woman and finished EM residency when I was 30 so take this with a grain of salt.  I did graduate from medical school with loans equivalent to yours and that was a decade ago...

First, I would congratulate you on being conscious and aware of long term planning and future.  That will definitely serve you well as you shouldn't have any "surprises"

Second, I would also encourage you not to worry so much (a natural product of long term planning - once you are looking down the road, you see uncertainty and naturally worry).  Career-wise, finishing residency at 35 still gives you potentially 30+ years at the attending level.  Emergency Medicine is a fairly well compensated field, particularly relative to the length of training, and if you are fairly flexible about what part of the country you work in, you will find very high paying jobs right out of residency.  WCI has numerous articles about "living like a resident" your first few years out of residency and handling student debt so this site will be a big help.  EM is a flexible, portable field of medicine that should help you in your personal life as well.

Save early and save often.

Best of luck, and congrats on the research fellowship!

[MrsIMDoc]

You are actually in a pretty common scenario.  I also finished medical school with similar debt and did the extra year of research to boost my residency application not thinking about the lost income.  The extra year did however help my residency application.  I would recommend trying not to worry about the things you cannot change.

Unlike me you have been "WCI enlightened" as a medical student so you can use the information you learned to make better decisions going forward.  I chose a high cost of living (HCOL)area for residency and went into forbearance for my first three years of residency until I found WCI and understood how loan interest works. I had to have a complete financial makeover and it was painful for me to realize how much money I had wasted by poor choices in medical school and residency.

As far as the personal life component, are you feeling like you are the only single medical student? In my medical school in the conservative suburban south I was one of the few in my graduating class that did not have a serious significant other and I was convinced that I would never find anyone.  You still have a whole year and a half to date, and a lot can happen in a year. Despite my medical school experience, I found during residency that many residents enter residency single and end up meeting their spouse during their time in residency. One consideration that goes against the WCI advice is to consider residencies that have a reasonable number of single residents, however these tend to be in cities with HCOL.  When I moved to a large city for residency there were many other single people like me in my residency class and that helped with making friends that were in a similar place in life.  Again, this is not the best financial advice because cities tend to be HCOL so take that bit with a grain of salt.  Ultimately I met my husband during my residency and two and half years later we are married and pregnant.

I think you have a lot of things going for you so enjoy this research time and use it to make as many positive financial considerations you can before residency starts and you have many more things on your plate. Best of luck to you!

[The White Coat Investor]

I don't know why people who are "barely non-traditional" worry so much about a few years of a late start. Yes, you lose a few years of physician level earnings, but you have a whole career ahead of you.

I think keeping your loans down close to $250K (you don't say exactly what it is, but even if it is $350K after residency) is very doable as an emergency doc or any other moderately well paid specialty. So I wouldn't let that trouble you. The key is the first 2-5 years after residency. That's where you fix all the little financial mistakes you've made.

I'll leave the advice about children to others but if I'm doing the math right, you're only about 30 now. Lots of professional people get married and start having kids in their early 30s. There's no rule that says you can't have kids in residency either, even as a female physician. What you won't be able to do is be a stay at home mother, at least before 40, but you kind of made that decision when you chose to go to medical school. But I don't think I'd start freezing eggs and such unless you hit 35 and still see no possibilities at that point. Certainly I wouldn't worry about that expense. As an attending emergency physician, you will certainly be able to afford adoption/IVF/egg-freezing etc.

As far as where you're at financially compared to your peers, you're slightly below average, but nowhere near the place where I really worry about people (bottom 10-20%). You could have twice the debt, 6 kids, and a burning interest in practicing pediatrics in San Francisco.

[jfoxcpacfp]

Let's look at the bright side:

• You are graduating with an average amount of debt. $250k is not as worrisome as $400k or $500k - which you might be saddled with as a dual doctor couple.


• 35? Not so bad - I recently spoke with a doctor who will finish training at 59,


• You found WCI before buying a house, having children before you can afford them, buying a ton of whole life insurance, and you are not sticking your head in the sand. Pat yourself on the back!

You are worried because you "don’t feel like I am in a very good place financially". Med school and residency is not the path for those who want to graduate in a very good place financially. You will graduate with negative net worth and an abundance of opportunity. There is really nothing unusual about your situation. Quit beating up on yourself and enjoy your youth, health, and the prospects that your brains and grit are affording you. Sufficient unto the day is the evil thereof. Once you are out, some of the things you are worrying about today will be immaterial and you will find plenty of other things to worry about - that's just life. Don't let worry paralyze you. Be concerned, take appropriate action, and focus outward, not inward.

[pulmdoc]

I agree with the other commenters that there is absolutely no reason to panic about your situation.

1) You woke up to the realization that you need to care about your financial situation and found WCI while you are still in med school. Many docs dont do this until mid-career, if ever. I very highly recommend WCI's book if you don't know where to start on your "continuing financial education." It's well-written, concise, and organized so that it's easy to use to answer the question "what should I be worried about at this point in my career?" I bought the book even after reading the blog regularly for a couple of years and still found it helpful.

2) Being a new attending at 35 isn't unusual at all. Many surgical specialties are fortunate to start their career at 35, even if they went the traditional route straight from college to med school. You'll have plenty of time for a long career.

[VagabondMD]

I took off two years between my third and fourth years of medical school for a similar "prestigious" research fellowship, and these were two of the best years of my life! I remember a physician family friend, pulling me aside, and giving me the business about wasting extra time in med school that will in turn translate into two years of lost wages at a much higher level down the road. What a crock!

 

[conniebird]

You're doing great. I am female and finished residency at age 38 - so you'll be ahead of me, and I can confidently say I will be OK $$ wise. Similar boat - had 200K of debt and NO savings at 38 (well $1K in a roth IRA). I also did a research year between 3rd and 4th year.

I didn't meet my partner until this year and we are trying now for a kid. I do think you should get your eggs frozen now though since you're thinking about it - the earlier the better egg quality. Not cheap though but worth the investment if you def want kids in the future. I guess you could wait a little longer though, but wouldn't wait past 34-35 to freeze.

You are off to a much better start than me by reading this book as a student! Feel free to PM me anytime.

Also join the facebook group for female MDs & finance. You need to be friends with someone in the group to be added as it is a secret group.

[Hatton]

I am a female ob/gyn. I think you are way ahead actually because you are thinking about these issues now.  I felt like I was flying without a net for years as a single female student/ resident/ attending.  there is time for the right person to appear.  Your biological clock has many years left on it.

[drcolleen]

The mere fact that you are thinking about your financial future says a lot, you'll be fine.  Enjoy life but don't spend more money unless it increases your happiness.  I was a bit younger but didn't meet my husband until 3rd yr of med school by chance -- he's not medical and wasn't a student -- so if you want a family you can't time these things, but you have plenty of time.  Don't get so worried about the future that you don't enjoy the present!

[Sneezy]

I can't help with fertility issues, but have a similar story in some ways.  I took 3 years off before medical school and then spent 4 years getting a Ph.D so didn't finish training until age 38, although I didn't have any debt.  I don't really use my Ph.D. but am still glad I did it.  I am in a pediatric subspecialty that pays okay but not great.  I did residency and fellowship in a HCOL area and had my kids in 4th year medical school and 3rd year of residency.  My spouse has stayed-at-home throughout.  I am 51 and approaching financial independence

1.  99% of people in the US would love to be in your situation financially.  Sure you have some debts, but you'll earn okay during residency and very highly after

2. Get out there and meet potential spouses.  No one sits around and hopes they'll get into medical school, so don't sit around hoping you'll meet the right person.  The more people you meet the more potential spouses

3. You need to be more aware than some about finances, loan forgiveness, etc.  I move to a very LCOL (but academic) job after fellowship because I couldn't afford to stay where I was.  I worked hard, did some research and was able to move back after 7 years at a pay level much higher than typical for my specialty (but less than I could make in some private practices, life is about trade offs)

4. Look for opportunities to increase income in residency and fellowship.  I moonlit so much in our pediatric ED as a fellow that the attendings joked I should do a combined fellowship.  I also worked covering a primary care office and the extra money I made many years (30k now almost 20 years ago) allowed my spouse to stay home, which was the best choice for our family

 

[PhysicianOnFIRE]

You can relax. You're not in a bad spot at all. If you're willing to work and live like a resident, you could be making between $300,000 and $400,000 a year based on current pay rates.

Your loans could be paid off in 2 years. You'll be 37. With an $80,000 a year spending budget, you could be financially independent in ten years or less. Or live on half your pay and you're there with a higher budget allowance in about fifteen.

Family, marriage, etc... could alter the equation for better or worse, but I imagine you'll do well in any situation. The fact that you're concerned are brave enough to share your concerns with us says a lot about your character.

Best,

-PoF

 

[conniebird]

Agree with Sneezy - if meeting someone to marry and have a family is important to you - def make it a priority and get out there! When I moved back after residency I literally joined multiple dating apps and started dating immediately. Met fiancé on a dating app.

[G]

Add me to the others who say not to panic, you're doing great!

[RocDoc]

Agree with all the others above. You're doing great and are far ahead just to be thinking about all these things. Get financially educated by reading the books WCI recommends and reading the blog and forum. You'll be fine!