She's going to trade an intense job for intense schooling. The only difference is the payday - and with the schooling, that's pretty far off.
One big concern is her overall satisfaction and happiness. Which I can honestly are not that great right now. Would going back to school fix it? Don't know. Maybe the break from an intense job is what she needs for a few years. I don't really know.
Oh, and Emergency Medicine is 4 years, not 3. That makes a total of 8 years
If she is interested in doing emergency medicine I would look at becoming a paramedic first as that would give her a lot of experience that she could use once she becomes an MD, she would know how things work out in the field as well as within a hospital.
Money certainly isn't the deciding factor on it, but it's something that you can at least put a tangible/objective value on in helping base a decision. It's hard to put a "value" on the amount of time a child spends with their parents. That's what is hard about it. One year would almost a total loss. The next several would almost be an improvement to be honest. And then it would dive again as residency wrapped up.
There's a few years that would be hell on our family. And a few that would actually be an improvement.
One big concern is her overall satisfaction and happiness. Which I can honestly are not that great right now. Would going back to school fix it? Don't know. Maybe the break from an intense job is what she needs for a few years. I don't really know.
The other elephant in the room is the outlook 20-25 years down the road that I have to admit does look pretty good. How many couples at 50-55 years old can say they have a house paid off, a million or more in the bank, one spouse retired, and the other working part time and still making $150,000+? At that point an extra shift a week every now and then covers any vacation we'd want or college expenses for the kids.
It's that 10 year stretch setting it up that I really just don't know how to digest and say "yeah, lets do this".
That's where some of my selfishness is being teased.
So the factor that really matters is her availability to her children. Being a doctor at a teaching hospital (private practice is different) is not a normal job. It's much more like being a professor or a CEO. My mother has worked 60-70 hour weeks for the past 30 years. She loves the intensity and the stress, and has no real interest in hobbies outside of her work. I could never live like that, but it's her dream job. The result was that my father did most of the work managing the house, picking up the kids, etc. since he had a more normal 9-5 job.
Chances are, your wife is like my mother, and she needs that kind of intensity to be happy. You are thus faced with two alternatives: either force her to feel unfulfilled in her career, or be willing to pick up a lot of the slack in the child rearing (or hire someone, as you'll have the money for it). My recommendation is the second option, since you'll likely not convince her to be happy where she is.
She staffs the ED at a level one trauma center has coffee in the physician pods with the ED attendings and residents quite frequently. She's pretty comfortable with what happens there.
One person in the hospital switching their title from "PharmD" to "MD" isn't going to change any of that.It's a little different in healthcare. Management decisions and being spineless to shitty practice actually have an impact on the health and well being of people you are actually taking care of. Not to mention the bully practice of having to deal with power tripping surgeons on a daily basis that administration allows to run wild.
To be honest, I'd say studying to become a paramedic in this context would be a waste of timeShe is getting experience in the hospital but not out in the field. There is a lot of difference between someone bought in the door of the hospital and having to help someone in a car accident and you are the first person there.
The reason I bring this up is I have a good friend that went a very similar route, he was a pharmacist, then a paramedic, then a PA, and now a surgeon. It took a lot of years and certainly longer than going straight to school for MD but if you ask him where he learned the most it was being a paramedic. He told me there are paramedics he would rather try to save his life than some of the MD he knows.
Not saying paramedic is the only option , but consider other areas that lead to the same path.
Also, what guarantee does she have that she can get a position in the hospital in town in 7 years? What happens if she can't get a job at that point in town with her new even more expensive degree?
I know that no one really wants to think about it, but make sure you plan for a potential disaster scenario. The death of you or your spouse after racking up $500k in debt could be insurmountable. Up the life insurance.
She's a sharp cookie. 34 on her ACT (we don't do SAT).
Well there's always towns out in the sticks who will let her work and payoff a chunk of her loans. But then the whole family has to serve a term in Siberia along with her.
That's my point. IIRC, they just built a home. So they aren't going to want to move from it in 7 years for the job I'm guessing.
She's a sharp cookie. 34 on her ACT (we don't do SAT). 36 is highest. She was 99th percentile on her PCAT (Pharmacy admittance) and did a 3.7 in Pharmacy school working almost full time.