By AA, a BU BA/MD program graduate
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The High Cost of Medical School
When I started the BS/MD application process (now nearly 14 years ago), the cost of 3-4 years of college and 4 years of medical school seemed impossibly high! The estimated cost to attend (including tuition, housing, etc) ranged from $400,000 – $600,000. It was an astronomical amount. When I was finally admitted to my dream BS/MD schools, University of Southern California (which no longer has a BS/MD program) and Boston University, one of the factors that did play into my decision was financial aid. I was fortunate to receive sizable merit scholarships to both schools; however, an additional year of college + deferring a year of earnings made the decision to go to Boston University literally hundreds of thousands of dollars more affordable in the long run.
Undergraduate Costs
I always encourage students to apply widely. Many of the students I have worked with have been fortunate to get scholarship money. Others rely on their parents to pay and choose their #1 dream school regardless of cost. Whichever path you choose – its never bad to apply more widely and have more options! I was fortunate to receive a full ride Trustee Scholarship at Boston University to help defray most of my costs during the undergraduate portion of my education.
Most of the top schools do provide need-based aid as well, although how much the aid those schools offer in the form of work-study programs or loans vs. outright scholarships can vary widely.
Medical School
According to Boston University School of Medicine’s website, the current 4-year cost of attendance for medical school is $385,90 (in 2021). Yikes! While some parents do pay for the entire cost of medical school, rest assured that most parents do not pay for medical school. At BUSM, for example, 68% of students graduate with debt and the average debt is over $220,000. Many students take out loans for the entire cost of attendance.
One of the disadvantages of BS/MD programs is that students cannot apply to multiple medical schools and “shop around” for the best deal. Public institutions tend to be much more affordable than private universities and some schools do offer scholarship money during medical school. However, I believe that the time saved from attending a BS/MD program (+ extra years of earning) typically offsets the potential higher cost of medical school from a purely financial perspective.
Full Scholarship to Medical School
There are three programs widely available to fully pay for the cost of medical school: PhD programs, military programs, and the National Health Service Corps (NHSC) Scholarship Program.
PhD programs are geared towards students who want to build a primarily research based academic career. Most students take 3-5 years in between their second and third years of medical school to pursue the PhD. In return, most medical schools provide a full tuition scholarship during both the medical school and graduate school years in addition to a small stipend to offset other costs (housing, food, transportation, etc). While the programs are competitive to get into, BS/MD students do pursue these programs each year. However, I would advise students to apply to these programs only If they are truly interested in the PhD pathway. The 3-5 years of additional school in terms of opportunity cost/delayed earnings is not typically worth it in financial terms.
The second option is the military option. Students with an interest in serving the nation via military service have several options (Army, Navy, Air Force, etc). The military will then pay for students’ medical school costs. In return, students must serve in the military upon completion of training. This is a highly rewarding pathway interested students; however, again, I would only recommend this to students truly interested in serving.
The last major option is the highly coveted NHSC Scholarship program. The NHSC program can support students for 1-4 years in medical school for students interested in pursuing careers in primary care. In return, students must serve as a primary care physician in a Health Professional Shortage Area (HPSA), as defined by the government.
While all these programs are excellent programs for the right student, I do not believe any student should pursue these for financial reasons alone as the ultimate financial cost of these programs (in deferred or reduced full-time physician salary) is higher than the savings from going to medical school for free.
Types of Loans
There are three types of loans generally: government loans, private loans (e.g. from a bank), and institution backed loans (loans from Boston University or other institutionally-supported loans).
Federal loans are the most popular and what I would recommend for most students (however, talk to your own institutional financial aid officer for more detailed advice on your specific situation). The two types of federal loans that most students receive are Direct Unsubsidized Loans (also called Stafford Loans) and Direct Plus Loans. Typically, students first borrow with direct unsubsidized loans, which have a lower interest rate (~5%) and then borrow the remaining with direct PLUS loans (~6%). Ultimately, most students will consolidate these loans into a single consolidated loan upon graduation. While these loan amounts seem gigantic (hint: they are), flexible repayment options make them manageable long term!
Repayment Options on Federal Loans
Repayment options will likely change due to legislation between when you read this and when you finish medical school. However, the general theme of income-based repayment will likely remain the same. Under income-based repayment plans, graduates can elect to pay a maximum of 10% of their discretionary income per year on loans. For example, a first year physician-resident who had $0 income in their previous year (during their last year of medical school), would owe $0 in monthly payments. In addition, with programs such as REPAYE (a form of income-based repayment), 50% of the accrued interest will be covered by the government (making the effective interest rate HALF of the 5-7%). In their second year of residency, residents may have to pay $300-$500 per month in loan repayment. This will gradually increase as residents become attendings and make more money.
While this is the most popular strategy, some residents also defer their loans. Other residents choose to more aggressively pay down their loans and pay higher than the 10% required income-based rate.
Loan Forgiveness
There are several options for loan forgiveness available, including Public Service Loan Forgiveness (PSLF). This option forgives the loans of graduates after 10 years of on-time payments as long as they are employed by a public institution. For most graduates, time spent in residency and/or fellowship count towards these 10 years. While this option is available today, it is likely that this option may face legislative reform before you start medical school if you are currently reading this as a high schooler/parent of a high schooler.
Other options for loan forgiveness include automatic loan forgiveness at 20 or 25 years depending on the repayment option chosen. However, most physicians will make enough income to completely repay their loans before the 20 or 25 year mark even if they have in excess of $500,000 loans and choose to pay with the 10% income-based repayment plan.
Conclusion
Medical education is very expensive! But there are lots of options available for students in order to approach these costs with a plan. I recommend that all students look at their college and medical school choices with costs in mind and meet early with their financial aid counsellor in medical school to make a personalized plan for you.
If you are a high school student interested in applying to BS/MD programs, The Perfect Med team is here to help. Please reach out to learn more about our services or any other questions you may have!