Wife wants to go back to Med School...having troubles with the math on this.

[alkemyst]

Well, if you live in a city where a 4000 sq. ft. McMansion costs $500000, it's actually pretty easy to buy one of those after a couple of years of saving if you're a doc making $250000 a year. A 20% downpayment on that is only $100000. There are tons of specialists who make $200000+ as soon as they finish residency, or maybe after residency plus 1 additional year of subspecialty training.

Furthermore, it's not as if they're working for free during their training. After med school, they're making enough money to live off of during residency (say $50000 a year), and more for fellowship training after residency.

The 20% thing is not too common anymore except for those wanting property over $417k.

The first real thing that works against docs is after they take on the $400,000+ debt for medical school they are only making $50-60k on average as a resident so must defer the $3000-4000 repayment per month.

Then the next real thing is malpractice insurance which seems to work directly proportional (at a premium) to salary.

Here in Florida many doctors are not paying for malpractice and having patients sign waivers stating such. Also quite a few are going cash/credit only and not dealing with insurance.

Even general practitioner insurance is $50-60k per year here and surgical ones can be as high as $200k. With $36k-48k of loans + $50-200k of insurance that doesn't leave much of even a $200k salary for the first 15 years of your career (19-23 years if you count the residency).

Even with the $50-200k of malpractice after that time, it's a big hit to your salary.

With a Pharmacist making $80k at the very low end and topping out at $150-175k at the top (unless in Pharmaceutical Sales which I have heard people hitting $500k often)...the pharmacy route is a more attractive to many interested in health careers.

Personally I am going for my CCIE (Cisco Networking). I have a couple CCNAs and a CCNP already and I will have a third CCNA next month. My salary is already nice and although I normally don't get a 9-5 work week (during busy times 60-80 hours can be seen but that is usually a 3 day work week which is really nice or a hard 5 days with the next 9 off)

When I get my CCIE I will pretty much be guaranteed I will always have a very high paying job if I am willing to relocate and always be making $125k+ taking very easy jobs 'doing it' and more like $175k+ if I go the MBA route and enter managing an IT department.

IMHO going deep in the networking field is one of the best bangs for buck right now. 18-24months if you dedicate your life to it like a normal degree and a guaranteed $100k salary at graduation (talking CCIE, not CCNP and CCNA or equivalent) and 0% unemployement.

 

[alkemyst]

Actually working in rural hospitals can pay better than working in a big city. Since no one wants to work there, they usually have to give out additional stipends to attract talent. Its the reason i live in San Jose and work in Gilroy/Hollister.

In your case true....someone deep in Montana may have different luck .

 

[erikistired]

sounds like a situation where either outcome is going to end badly. maybe remind her that there are a lot of people in this country who would jump at the chance to pull down six figures and make the best of what she has instead of bringing stress and turmoil upon her family? good luck either way.

 

[j&j]

Problem isn't the money, why would she not want to be around the family? That would be a huge concern to me. She's choosing herself over the family and it's pretty selfish. Everyone's gotta be happy though I guess.

Long story short, you're fucked.

Also, trading your prime years in your 30's is priceless, so trading those 7 years + all the debt for a "possible" better life at 50, FUCK THAT.


Sounds like at the current rate, you guys will be set fairly well at 50 anyway with no stress at all and be able to have spent a ton more time together.

 

[Eug]

It's certainly not an ideal situation, but if it were my wife at that age, I'd most definitely support her and would encourage her to do it, at least if she were considering it for the right reasons.*

However, if she were 15 years older, then it'd be a different story. Going through med school and residency starting at 31 means she'd be finished by age 40, 25 years before standard retirement age. Going through med school and residency starting at 46 means she'd be finished by age 55, 10 years before standard retirement age.

-

*This is key. If she thinks medicine will be less political with less doofus managers, and she thinks medical school will be a breeze and she's automatically going to get in right away at a school close by, then it would sound like she isn't being realistic about the whole situation.

 

[dagamer34]

The residents in it and the page dedicated to our local program say three.

You're not including a year of internship.

 

[dagamer34]

It's certainly not an ideal situation, but if it were my wife at that age, I'd most definitely support her and would encourage her to do it, at least if she were considering it for the right reasons.*

However, if she were 15 years older, then it'd be a different story. Going through med school and residency starting at 31 means she'd be finished by age 40, 25 years before standard retirement age. Going through med school and residency starting at 46 means she'd be finished by age 55, 10 years before standard retirement age.

-

*This is key. If she thinks medicine will be less political with less doofus managers, and she thinks medical school will be a breeze and she's automatically going to get in right away at a school close by, then it would sound like she isn't being realistic about the whole situation.

Anyone who believes this has never been to medical school. There are always a bunch of idiots who "run" the show and definitely let you know it.

Also, don't be selfish for yourself, be selfish for your kids. This decision will obviously affect them, they will spend many years wondering where their mother is all the time.

 

[schneiderguy]

Sounds like you're going to end up divorced either way :hmm:

Tell her to stay home and take care of the kids already like she's supposed to. Give them illusions of grandeur with "doctor" shit and they'll never learn their place.

I agree with this. Her first responsibility is taking care of her kids, not chasing her dream.

 

[interchange]

I just found this thread and it's already overrun with posts. Some of them are good but many are full of misinformation. I would suggest a dedicated healthcare forum (e.g. studentdoctor.net) if you want accurate advice.

Here's my background. I am 31 years old and married (no kids yet). I just graduated medical school and am about to start my residency. I gave up an $80k/yr job in computer engineering to enter medical school. I feel like, out of everyone here, I should have the most expertise in giving you advice. Yet, I cannot tell you what your wife should do. That's because the only reason your wife should enter medical school is because she's passionate about medicine. If she is, then she will succeed.

Unfortunately, I can also say that going through medical school changes you as a person. It will impact your relationship. I would examine whether or not you can personally handle the strain of taking over a larger burden in maintaining your home and family. And the burden is not really caused by lack of time. Yes there will be weeks where she will not have a moment to spare, but I found myself to have a lot more time than I thought I would. However, it taxes your intellectual and emotional resources to the limit, many times without your own cognizant awareness. You need to be a supportive spouse through all this. Be honest with yourself. Can you do it?

 

[Doppel]

vi edit, any chance you'll just send this thread to your wife, let her read it, and get her thoughts?

 

[Nintendesert]

vi edit, any chance you'll just send this thread to your wife, let her read it, and get her thoughts?

That never ends well. Also, if he can't say all the things he needs to to her from this thread they have bigger issues than her going to Med school.

 

[alkemyst]

Yeah that would back fire ESP where many are probably not even living on there own.

 

[Eug]

vi edit, any chance you'll just send this thread to your wife, let her read it, and get her thoughts?

Bad, bad, BAD idea.

 

[vi edit]

She's read through the entire thing, short a few posts that came in over the weekend. Pretty much every thought/feeling I've had in here has been discussed with her, there's no surprises in my feelings or concerns. We've had a lot of very good discussions on it. Not just about the med school thing, but about her medical profession in general. I honestly believe that some of her burnout is just her field in general and the daily stress of it and not necessarily her particular role in. Sure that plays a part but I'm quite certain that many medical professionals invovled in direct patient care take an emotional and physical beating over the years. There's a certain dulling/numbing of your emotions that you have to do to survive. That's starting to eat away at her. And I don't think switching roles is going to improve that. It might be put on hold for a while when she's in school. But I think it'll come back with the same issues, if not worse as a physician. She's going to set up some appointments with a support team that the hospital staffs to address exactly this burnout/stress issues.

In addition there's some "stuff" that is happening that could make for a very different environment for her in the next 6 weeks or so. I've asked that she put things on hold and wait for that to sort of settle and see what happens.

And as some posters have mentioned here, I have legitimate concerns on the long term pay/job opportunities/roles of physicians in the future. I do feel that MD's are much more at the mercy of government regulations/cost cutting and that can be more easily replaced/reduced with lower cost clinicians making for lower job opportunities. She countered that her field could be replaced with computers. Which I'd agree with in something like a Walgreens, but there's some human component and experience that you can't replace in as complicated environemnt as a hospital ICU.

She's going to try and get some ear time of the head ED director the next time she works there. He's about as brutally blunt as a person can be and I want her to get his opinion of the fields future over the next 10-20 years. He's been in it for over 30 years now and has been heavily invovled in a lot of legistation and trips to the state/national capital for medical related policies. I want him to give her an honest assessment of things.

I've also made her go out and do a lot of the retirement calculators (which I did prior to this thread but needed some validation that I was calculator propery) and really crunch the costs and repayments. I also had her plan things out while in school and see just how to the bone our budget would be without selling our house/waiting for kids out of daycare/ect. While she would be in school, family vacations would amost be a fantasy, reserve funds, Christmases, ect. Just a very limited budget. Our life at this point has been setup on her income, not mine which is half of what hers is right now.

And on top of all that, I've been more than honest that I don't want an empty bed 3 or 4 out of the next 8 years. And I don't want to be a single Dad during that time. I don't want the kids hating me when I get overstressed dealing with everything and get angry with them.

All that is getting digested and what was once a rolling boil has been reduced to a low simmer right now. Flame hasn't been extinguished, but the weight of the sitation is a little more clear.

I've also been very honest and sincere that I don't question her ability to do it. I don't at all. I truely believe that she would be very successful through school and go on to be a very good physician. I really do.

It's really about can we make our existing situation work and is it really the healthiest choice for the long term health (stress, happines, financial, ect) of our family.

And to give a bit of a compromise I also told her that I'd be more open to moving later down the road when the kids were older and both my parents were retired. It's just easier to travel with kids that are older, don't need a sherpa to haul along strollers, carseats, pack and plays, formula, need to take naps ect. And when retired my parents could pack up and stay with us for a couple weeks at a time if they wanted making trips more practical if they want to visit. I'm not opposed to moving to get her a better work environment/position, it just doesn't make sense right now with the housing market, family dynamics, job market, ect.

I think that helped too.

I don't let internet forums help make decisions in my life (ok, maybe on some smaller purchases due to reviews) but threads like these to help allow a person to put their thoughts in writing and really think things out. There's also some outside perspectives that come in that help you point out things you don't consider either out of ignorance or forgetfulness that you need to think about.

This isn't something that is off the table, but it's not a boiling kettle ready to blow either. I've got my weekly games and beer night with a bunch of physicians/husbands of physicians tonight who my wife also works with and has talked about it. So I'm sure there will be a couple hours of conversation about that tonight. They are all mid/late 30's and went through their med school/residency's with a wife & kids so I'll get some good input there too.

 

[blackdogdeek]

thanks for the update, vi.

it sounds like you are both responsible, mature adults. the ability to sit down and rationally discuss situations that have such huge impacts on family life seems all too rare these days.

i've already voiced my opinion on the matter earlier in this thread but i will just say again that i hope it works out for the best for you and your family.

good luck.

 

[Perknose]

She's read through the entire thing, short a few posts that came in over the weekend. Pretty much every thought/feeling I've had in here has been discussed with her, there's no surprises in my feelings or concerns. We've had a lot of very good discussions on it. Not just about the med school thing, but about her medical profession in general.

This right above, the open, honest, in-depth communication that is at the heart of your relationship, is why I believe your family will survive whatever career path your wife chooses.

Best of luck to you! Not that you necessarily need it. Branch Rickey once said that luck is the residue of design. But a little good fortune never hurt anyone. :thumbusp:

 

[vi edit]

And I want to address some comments about "Med School changes you". I don't think Med School changes you. I think medicine/health care general changes you. I alluded to it in my recent post, but wanted to call it out on it's own.

Working in an environment where people in your direct care have a high chance, if not expectation of dying it changes you as a person. You have to develop a numbness and detachment of human life. You walk down a street and diagnose people of their disease states. You see family and friends get admitted and have to ignore that and do your job.

Med school is one thing. You are working with dead bodies, getting some experience in a hospital, having massive amounts of data thrown at you, ect. All new things for a fresh young, intelligent mind to absorb.

It's another thing entirely to actually work in that environment for years, have patients under your care die. See the families greiving. Be at a code when a patient dies. See a family member or friend admitted and die in your facility. Ect. That's a whole different side of things. That's where my wife is at now. She's already had that mind shift happen. That numbness, calousness, ect has taken place. The compassion, desire to help, dedication still exists, but the acceptance of death and coping mechanisms are very different. Ask just about any health care worker what their code instructions are. Almost all of them are DNR for a reason.

 

[rgwalt]

While I'm probably too late to add much to the thread, I wanted to chime in... If I were in your shoes right now, I would use an Excel sheet to get some better ideas of the financial impacts of your wife going back to med school. You can run several "cases". Set up a base case (business as usual with her not going back to school). See how long it will take to pay back her loans, pay off the house, and where your retirement funds will be at ages 55 and 60. Since you can't predict the future in terms of raises, taxes, etc., you need to make some assumptions (take a worst case scenario where you get raises to keep pace with inflation). Know that taxes will get worse with increasing income, and if she did get paid $350K/year once she was done with med school, as a couple you'd probably be up in the lofty zone of the Alternative Minimum Tax, which is pretty brutal. The key is to recognize that you will bump up into higher tax brackets, which reduces the incentive to go after that $350K salary.

If you go into the level of detail of building your own calculator in Excel, you can do sensitivity analysis to see what the effect of altering salaries. For example, consider the case where her raises are double that of inflation for the next 20 years, but instead of making $350K/year as an ED doc, she makes $275K/year. Does that change the answer/incentive?

In the end, this decision is going to be less about the money (though the money is important) and is going to be more about personal job satisfaction and happiness vs what is best for your marriage, relationship, and children.

I think an important question to ask is "Would vi_edit's wife be supportive of him going back to med school at this point?" Are there any double standards?

 

[vi edit]

The "would your wife support you in this decision" is tough to answer. Simply put, I'm not my wife. I'm not as strong of a student, not as dedicated to my career, and just simply a lazier person when it comes to my career at this point. I've even gone so far as to "trade down" in the technical degree of jobs that I've done to better be able to work my schedule around hers. I'm the flex guy of the family. I'm the one that has to adapt my schedule to make hers. And it does certainly affect the aggressivness that I can pursue other opportunities. Upside of that is that I'm not really somebody that *needs* to constantly improve my career situation. I know my role and am comfortable with that.

But to directly answer, after my wife finished her residency I was having a dog of a time finding a job in IT, which is my college educated and post college based work experience. It went so far as to me looking into a career change, applying, and being accepted into Respiratory Therapy school. My wife was the one that actually set me up with the respiratory therapists at her place of residency and I job shadowed and talked to them about the profession.

So yes, she has been, and is supportive of me changing careers. Granted, that is only a 2 year program through the local community college, has no residency match and was practically a slam dunk with job placements due to demand and paid decently.

Turns out I got a job offer a day after I received my acceptance letter to the RT program. I took the job, turned down the program acceptance, and have been at my employer for 6 years now.

I can't fairly answer that question. We are two very different people when it comes to our abilities and career outlooks.

 

[jhu]

Sounds like she already has a good thing going for her. I went through the same thing, and now that I'm done, I'm pretty happy. But, knowing what I know now, if I had a prior career that I was happy with already I definitely wouldn't go the med school route.

 

[erikistired]

i can tell you both this, my wife has to travel about 2 weeks out of the month almost every month for her job and it affects our kids (seven and nine). it's not a "where's mommy" type of thing, but you can tell in their behavior when she is away. they really miss her, especially my youngest who is very attached to her. it's not a solid two weeks, but 2-3 days here and there, and it makes a difference. being gone for the time it sounds like she would have to be, i just have pity on you as the solo parent, because it's not going to be easy.

edit: she has actually turned down better, higher paying jobs (she is the main provider for the family) because the travel was too extensive. we live a comfortable life, and it would be nicer to have more money, but not at the expense of our daughters. and it has nothing to do with me not wanting to shoulder the burden of being a single parent for long stretches, she simply doesn't want to be away from her family.

 

[vi edit]

i can tell you both this, my wife has to travel about 2 weeks out of the month almost every month for her job and it affects our kids (seven and nine). it's not a "where's mommy" type of thing, but you can tell in their behavior when she is away. they really miss her, especially my youngest who is very attached to her. it's not a solid two weeks, but 2-3 days here and there, and it makes a difference. being gone for the time it sounds like she would have to be, i just have pity on you as the solo parent, because it's not going to be easy.

edit: she has actually turned down better, higher paying jobs (she is the main provider for the family) because the travel was too extensive. we live a comfortable life, and it would be nicer to have more money, but not at the expense of our daughters.

I know for a fact that it's going to affect them. My wife already does 2nd shift work sometimes in 3-4 night stints where the kids only see her for an hour or so in the mornings. After the 2nd or 3rd night my daughter starts getting anxious when Mommy isn't around. Oddly enough her behavior is okay when she's alone with me. But once Mommy comes back, if my wife doesn't give her every second of attention then she will act out and make sure you give her attention.

It's gotten better since my Son has been born since there is less attention to 'round naturally. And as she gets older she is more into playing on her.

Trust me, I was very clear that the solo job over the course of things was not something I was feeling good about. And also told her that she is going to be absolutely smothered by her kids (in not always the best ways) the second she walks in the door.

 

[erikistired]

I know for a fact that it's going to affect them. My wife already does 2nd shift work sometimes in 3-4 night stints where the kids only see her for an hour or so in the mornings. After the 2nd or 3rd night my daughter starts getting anxious when Mommy isn't around. Oddly enough her behavior is okay when she's alone with me. But once Mommy comes back, if my wife doesn't give her every second of attention then she will act out and make sure you give her attention.

It's gotten better since my Son has been born since there is less attention to 'round naturally. And as she gets older she is more into playing on her.

Trust me, I was very clear that the solo job over the course of things was not something I was feeling good about. And also told her that she is going to be absolutely smothered by her kids (in not always the best ways) the second she walks in the door.

i feel for you man. either way it's going to be a tough situation. i hope whatever you guys do you everything works out for you.

 

[SP33Demon]

That's a tough decision vi and I don't envy you. I've experienced similar things about the wife being unhappy with her job (and she makes similar to your wife), but it's usually just a phase that lasts for a week. Also, having kids really complicates things. I know that I'd be against her doing the med school thing and tell her to suck it up now that we have kids. You cannot be selfish when you have a family, all of that goes out the window. Luckily we agreed to get all of the academic degrees out of the way before having them, hence we are delaying having them until all of our post grad degrees are finished.

 

[halik]

Quite bluntly, your wife has made her choice when you decide to have kids. Once that cat is out of the bag, your individual desires are secondary to your children and family as whole.

Vast majority of my friends that I would call driven or ambitious don't have kids for the same reason; life is not about you after that point.