The burden of medical school costs is undeniably stressful. For those not fortunate enough to have these costs offset by private funds, the only option available to future doctors is debt. And a lot of it. According to the American Medical Association, the average student-doctor debt load for 2011 was $161,290, with more than half of 2011 graduates carrying a debt load over $150,000. While rising school costs play a major part in deepening the debt-hole, the fact remains that we live in a progressive society—one in which underprivileged students have plenty of financial resources available to make dreams come true, and one in which having a child (or children) doesn’t prohibit one from pursuing a medical career. As a result, large amounts of undergraduate debt rollover into a medical student’s debt-folio. Additionally, with larger debt-loads, longer debt-payoff schedules, and higher interest rates, medical school debt continues to rise after the borrower has begun practicing medicine.
So, those are your options: have someone bankroll your medical school education, or go into deep, deep debt. Those are your options unless your name is George Obeng, or you are kindred in spirit to Obeng. Obeng, 29, is from Ghana, and grew up relatively poor. I say relatively because he learned to count by drawing numbers in the dirt outside of his school. Still, the fact that he was able to attend school instead of having to find work put him at an advantage. An industrious kid, Obeng hauled a large jug of kerosene to school, which he kept under his desk, to sell in the village after school. As an adolescent, Obeng found a mentor of sorts, a man who fixed computers, and Obeng learned to install anti-virus software on computer systems. It’s something that he’s not proud of today, because he literally had to hack into lines of code in the software to be able to distribute it amongst multiple computers. This is the sort of mentor he found in Ghana. “When I come to America, I say that’s it, no more. Because it’s like stealing, you know? And I say, why steal when I have these opportunities?” This is an important theme for Obeng: making use of any and all opportunities. When he realized he had a knack for mathematics (coding, in Obeng’s mind, is nothing more than advanced math), he competed for (and won) a scholarship to his local university in Ghana. Upon completion, he then competed for (and won) a scholarship for his Master’s degree in mathematics in the States.
He chose to major in mathematics because he couldn’t get into the two medical schools in Ghana. So, out of disappointment, he chose math, reasoning that all things stem from math, and that it would provide him the most opportunities. Indeed, Obeng’s history with computers relied heavily on his math skills, and his entrepreneurial spirit had him at one point looking into geology, as oil was discovered near his home. While Obeng has an aptitude for most anything he studies, medicine has been calling him for as long as he can remember. “The one thing I dream of doing is medicine,” he says over and over. And this is where taking advantage of opportunities comes into play. Obeng’s uncle is a physician in the States and when Obeng received the scholarship to study stateside, his uncle put up cash for his plane ticket.
However, Obeng’s financial story does not take the route of a bankrolled beneficiary. Rather, Obeng has since paid off the debt to his uncle and has been working full-time since arriving in the States. Since his Master’s degree is in mathematics, he’s missing some basic medical school requirements, so he teaches undergraduate courses in exchange for tuition. However, the impressive part of Obeng’s story—other than getting married, having a daughter, and keeping his head afloat despite almost 16-hour work-school days—is the amount of debt he has accumulated: $0.
His plan for medical school is equal parts ambition, determination, and insanity. Obeng plans to continue through medical school with no debt load, either exchanging teaching hours for tuition hours, or working off-campus in some capacity. Whether he has to mop a kitchen or tutor undergrads in calculus, Obeng is willing to do what it takes to avoid going into debt. Put simply, owing money to a school or government is not an opportunity he wants to pursue if he can help it. Now, don’t discount Obeng’s thinking. A crucial part of his plan also involves scholarships and grants. These are the opportunities George Obeng believes are most beneficial. Obeng has compiled a list of medical schools that offer the highest scholarships to qualifying students. He has a second list of state medical schools with the lowest tuition rates. Obeng also has a military backup plan in case he can’t find the scholarship he’s looking for. As a nationalized citizen, Obeng just has to gain acceptance to any medical school and the military will pay the cost of attendance. Lastly, Obeng does account for some debt. He is fully aware of how his plan sounds, and he concedes that a $20-30,000 debt load wouldn’t be too bad to manage if he has no other choice.
Of course, Obeng’s plan doesn’t come without criticism. Bryan Goodman, a Duke University graduate and Obeng’s classmate, sounded skeptical when told that Obeng was determined to avoid debt. “Even with the best scholarships, you still have to live. I don’t know what George’s plan is. I don’t even know how that would work.” Indeed, Goodman’s perspective is shared with nearly every medical student. The idea is that debt is inevitable, end of story. Goodman shared this story about a recent conversation with an admissions counselor: “He didn’t mention any sort of punishment for [working], but he kind of just said that it was…known that that wasn’t happening…I feel like a lot of people, they already account for not working, and that comes with their loans and stuff. So, it’s kind of like when they come into that they know that for four years [they] are not going to be working…It is not a normal thing to hear. People working while in med school.”
One spot given to one candidate is no longer available to others. Maybe the decision to choose one student over another was a toss-up, and dedication could be that deciding factor. Delivering on that investment looks like handling another kind of debt: gratitude for being able to study medicine anywhere. Saint Louis University (ranked 79th in Primary Care schools) receives over 5,000 applications for just 175 seats every year. With just over 200 medical schools in the United States (allopathic and osteopathic), these odds make any spot, in any program, a coveted one, and this helps cement the notion that one has to be devoted on an epic scale to school work. Anything less than this devotion looks like slacking, even if it occurs through a work-study program. “I don’t know that [a school] is more willing to advise [work-study] programs, but I feel like they know that there are different financial circumstances, so if you do qualify for work study they have to provide it. But that’s definitely not the norm, either,” Goodman says.
It may seem strange to the prospective medical student that most medical programs require specific physician shadowing or community service hours in order to be considered for acceptance, but frown upon having an actual job once accepted. Keep in mind that shadowing is a way for students to see firsthand what the daily duties of a doctor are like. It helps ensure that students understand the lifelong commitment they’ll face as doctors. Likewise, volunteering shows that applicants can use the skills they already have to perform tasks for others—it’s a practical application of knowledge and ability. Together, they give the school a set of references about an individual’s character, which give a much clearer picture of how students work with others and their demeanor with patients—something not necessarily gleaned from having a part-time job. Once a student is admitted, she or he is expected to prioritize schoolwork, whereas one’s priorities once centered around getting into medical school.
Managing a work schedule around medical school—or even pre-med classes as Goodman is doing—seems impossible in the first place. After eight hours on campus, Goodman spends another 5-6 hours studying. His weekends don’t offer much freedom, either, with an estimated fifteen hours of study split between Saturday and Sunday. Often, Goodman doesn’t go to sleep until two or three in the morning. And keep in mind, this is just to add undergraduate hours to his transcript. He’s not working on a degree and he hasn’t been accepted to a dental school yet. He’s just trying to set himself up for success, and he’s using a strategy that he’ll have to keep up once accepted.
Of course, this is the kind of student medical schools want. That’s not to say that Obeng is the kind of student schools don’t want, but it does make him something of a wild card. On paper, Goodman and Obeng are quite competitive—they both have impressive educational backgrounds and are very driven. In the eyes of an admissions board, Goodman may be the better candidate because he appears to have already adapted to the sort of demanding schedule required by medical schools. If the stigma of an overloaded plate, so to say, is the deciding factor between two candidates, who’s to say that balancing a job on top of everything else doesn’t make a candidate stronger or more impressive? However, it could also be said that if a first- or second-year medical school student has a part-time job, then she or he must also be only a part-time student—perhaps they’re just not able to focus 100% on their course load. Obviously, not every student can handle such strenuous workloads the way George Obeng does. That may be why it’s so important for medical schools to recruit students with similar mentalities toward time and study habits. They want a level playing field, and for all students to share a common burden so there isn’t any room for stigmatizing. Even if that burden is huge debt.
American Medical Association. “Medical Student Debt.” Retrieved June 12, 2013 from:
U.S. News. “Top Medical Schools” Rankings and reviews. Retrieved June 18, 2013 from: http://grad-schools.usnews.rankingsa…t=grad%3Aarrow
Interview with George Obeng. June 7, 2013. 9:55am. 00:30:04.
Interview with Bryan Goodman. June 6, 2013. 2:38pm. 00:33:57.