Here’s one doc’s experience about Med school debt. Below is mine. There are some contrasts. I grew up in Ohio with parents who grew up very poor and as adults moved from lower middle class to solidly middle class while they raised my sister and me. /1 https://twitter.com/jayparkinson/status/1254106212053868544

My parents had lived through tough times and so they had learned to live well below their means. They weren’t cheap; just very practical and were generous with their time and money to help others. My father eventually sold real estate in our little town of Fairborn, OH. /2

So I was familially predisposed against accumulating debt. My parents had saved a little money for my undergrad — enough for the first two years @WSURaiders — nine minutes from my house. I lived at home for a couple of years and worked as a janitor and tutor through undergrad. /3

Between living cheap, going to a good but inexpensive state school, working, my parents help, and honors scholarships, I got through undergrad debt free (and with savings in the bank) with a BA in poly sci in 1987. /4

Keep in mind that tuition was $550 per quarter. I had thought about going to a “fancy” school like Miami, but it just didn’t seem like I’d get enough bang for the buck (and it was a whole lot more buck!), so I stayed local. Didn’t even consider the Ivies. /5

For med school, I tried to get an Air Force scholarship and was medically disqualified after I naively disclosed that I had had bronchitis in college. Even after appealing and passing a pulmonary function test at the base, was denied. /6

Side story: in med school, there were a handful who had military scholarships. One friend told me when he was in Officer’s Training School, over beers one night learned that he and the other med students had all lied about some medical problem on their applications. /7

Had I gotten a full ride scholarship, I probably would have gone for a more recognized med school. Instead I recreived an Ohio Board of Regents scholarship, which covered most of my first two years, and went to @uofcincy an hour from home. /8

I worked summers between the first two years and did clinical jobs 4th year to minimize debt. Lived really cheap. Finished med school with $16k of debt in 1991. I think the average at UC at the time was around $60k. Nationally it was much higher. /9

By then I had learned a little more about how different academic programs were viewed in the marketplace. Cincinnati was a fine school, but had more of a regional than national reputation. I’d also learned by then that I could have gone to a much better school. /10

But I was glad that I didn’t have to worry too much about debt. During residency, I moonlighted to supplement my $30k/y salary. I remember going to my 10y reunion and realizing I was almost 30 and still didn’t have a “real” job while classmates owned houses and had kids. /11

After my second year of OB/GYN residency, I took a year off to try and get my troubled marriage to patch (a story for another time). It didn’t and suddenly I was off the doc factory train and wasn’t sure I wanted to jump back on. I wanted to be a creator and made a plan. /12

I figured I would support my writing habit by going back to school to get an MBA or MHA, become a consultant in healthcare and write my screenplays and musicals on the side. I scored in the 99th %ile on the GMATs and knew I could go pretty much wherever I wanted. /13

I had landed a pretty sweet job as an OB house doc in Northern KY and was working an average of 52h a week in 24h shifts. Had an apartment in the hospital for when I was on call, bought a townhouse in Cincinnati, and was making more than enough to pay cash for grad school. /14

So I did an MHA @XavierU. Got some scholarship money for that. Paid off my undergrad loan, then found myself an MHA residency in SoCal so I could pitch my screenplays and consult. CA was “out of network” for the residencies for Xavier students, so I had to land it on my own. /15

In CA, I got even more interested in electronic health records and medical computing. I had a script optioned, but it never went further. Without an agent, I was able to get pitch meetings with Fox and DreamWorks and made inroads with Imagine (Ron Howard) and others. /16

I was finding modest success in my consulting, but didn’t yet have a brand or reputation to get A-list clients. I thought about going back to finish residency (that’s definitely another story), but then considered getting even more training in informatics. /17

This was the late 90s and EHR adoption was still pretty low. The National Library of Medicine @nlm_news sponsored docs to do Fellowships in Medical Informatics. Seemed like the perfect way to round out my education. /18

I interviewed and was accepted into several programs. One was the joint program between @harvardmed and @MIT. I had the chance to go to two name brand schools and get paid to do it. So I sold my townhouse, sold my car, moved to Boston, and got a roommate. /19

Boston was an amazing experience on a whole lot of levels. Many stories for another day. The point of this thread is about the choices we make about education and deciding how much debt to take on to do it. Clearly I care enough about education to have jumped in repeatedly. /20

And without starting a whole other thread about white male privilege, let’s just say I acknowledge the non-monetary benefits that my unchosen status provides. But I’ve thought a lot about this question of value in education. Here is my general recommendation: /21

Fully count the cost — especially the future opportunity cost — of your education choices and the debt you incur to fund it. Money for education is easy to come by and it is largely a dangerous trap. Do the math of what it will take to get through your path. /22

Going to two Ivy League schools opened doors I never knew existed. But I couldn’t have gone there if I had been saddled in debt. Being debt free early on gave me the flexibility to jump on that opportunity without putting me deeper in the hole. /23

In sum: save your money for the last school you go to and make that one the best one you can afford. But get those early lessons — especially when you don’t know where you want to go with life — as affordably as you can. Not gospel, but food for thought. Good luck! /end