Medical School FAQ

Paying for Medical School

6.1 How expensive is medical school?

Very. According to the AAMC's Medical School Admissions Requirements, the range of tuition and student fees for 1996-1997 first-year students was:

Keep in mind that these figures represent only tuition and fees. Other expenses include room and board, books, equipment, transportation, insurance, and personal expenses. In all, these additional expenses can easily be up to $15,000 per year.

The first consideration is to reduce your expenses. The less expensive schools tend to be public schools within your state. If you don't have a medical school in your state, you may be eligible to attend other state schools as an in-state resident through an exchange program such as WICHE, the Western Interstate Commission for Higher Education, which allows students from Alaska, Montana, and Wyoming to apply to and attend any western medical school as a state resident (with the exception of the University of Washington). Another major expense that can be reduced, if you qualify, is the cost of application. Be sure to apply for an AMCAS fee waiver (if you qualify), which can save you hundreds of dollars.

Unfortunately, reducing expenses still leaves, in most cases, tens of thousands of dollars to pay. The most common way to pay this is via loans, particularly federal Stafford loans and private alternative loan programs. While some Stafford loans may be subsidized (the government will pay the interest while you are in school), there is a limit to the amount you can borrow. Other loan programs are often offered by the various schools.

Grant aid (aid you don't have to repay) is not common. Most schools offer a minimal amount of merit- and/or need-based grant aid. There are also two programs that will cover the entire cost of school plus give you a stipend. The first, the Medical Scientist Training Program, is a highly competitive government-subsidized program designed to recruit students interested in earning both an M.D. and a Ph.D. The second, the Uniformed Services University of the Health Sciences, is the military's medical school. In return for years of service to the military, your education is paid for in addition to your receiving a commission in the military and the concomitant salary and benefits.

Another possibility for covering your expenses is to obligate yourself to later service. Two examples of this type of program are the Armed Forces HPSP and the Public Health Service program, both of which provide payment for medical school in return for a commitment to serve in either the military or in underserved public health regions, respectively.

Finally, be sure to search the Web and other sources for private scholarship sources. You may be eligible for free money or favorable loans due to your extracurricular activities, ethnicity, religion, heritage, or any number of other factors. Your school's financial aid office will be happy to suggest sources to you as well as discuss means of payment.

The Armed Forces Health Professions Scholarship Program (HPSP) is a scholarship between two to four years in length offered to students in schools of medicine, osteopathic medicine, dentistry, and optometry. HPSP students receive full tuition, school-related expenses, and a stipend as benefits. The stipend is currently (as of 8/98) around $912/month, paid in two parts on the 1st and 15th days on each month by direct deposit. Expenses are reimbursed by the submission on an itemized form with receipts and a signed approval letter from your school stating that the expenses you claim are reasonable ones for your curriculum; typically, most texts and equipment (i.e., stethoscopes, lab coats) are paid without any fuss. Tuition is paid directly to your school.

Basic requirements for the HPSP are that you are a U.S. citizen and meet the qualifications for commissioning as a military officer. There is an application and interview process which takes place at about the same time as med school apps. (Of course, you do have to actually get into med school in order to receive it.) The HPSP is offered through the Navy, Army, and Air Force (the Marine Corps is part of the Department of the Navy and is served by Naval docs, and the Coast Guard is staffed by docs from the Public Health Service).

In return, you owe as many years of service to the military as you received in support. Residency does not count towards this payback time. What you actually wind up doing, of course, varies according to your specialty; there isn't a huge need for pediatric neurosurgery about the average aircraft carrier, for example.

What are the advantages to this little Faustian bargain?

Well, for starters, there are the financial benefits. The more frugal students will emerge from med school debt-free, and those who live a little higher on the hog will owe relatively small student loans. Salary during residency is about $10,000/yr greater in the military (in the neighborhood of $40,000 for interns, $50,000 for more senior residents). Even post-residency, you won't starve; average attending salaries vary by specialty, rank, and years of service, but most wind up in the neighborhood of $100,000/yr as junior attendings (typically O-4 in rank: a lieutenant commander in the Navy, a major in the other two). You are automatically commissioned as an O-1 while a med student (ensign in the Navy, 2nd lieutenant in the other two) and are promoted to O-3 on graduation (lieutenant/captain). There are some pretty entertaining places to work in the military that you might not the chance to work near in the future: Europe, Asia, and so forth. And of course, medicine is medicine: patients can be much the same no matter where you work, and in any case the majority of patients in the military system are not actually active duty troops but retirees and dependents. Benefits can be nice as well: 30 days paid vacation each year, no overhead, and full medical/dental coverage.

Military residencies, by the way, are generally quite good. When considering your training site come application time, you do want to think about issues like patient volume, didactics, and so forth, just as in any residency, but board pass rates for military residency grads have been uniformly excellent, and people have gotten into fine fellowships with minimal difficulty. (Incidentally, if you do a civilian fellowship as an active duty officer, the military will still pay you as an attending. Which is pretty sweet.)

Now for the downside. You are sacrificing a few years of your life, in a sense. Although a flexible mindset and a willingness to compromise will help you get a good posting, not everyone in the Navy gets to go to Italy or San Diego. Internship and residency are relatively separate entities and require separate applications, not only for fields like anesthesia but even for fields with categorical internships like internal medicine or general surgery. Not only that, there is a risk that you will have to spend a couple of years away from training between your R-1 and R-2 years as a general medical officer, or GMO. This risk is greatest in the Navy overall but present in the Army and Air Force; it is also greater if you plan on pursuing a more specialized field like neurosurgery or anesthesia. Medicine, peds, and family med residents are more likely to complete their training uninterrupted. GMO tours vary between one to three years in length.

(A brief proviso on the whole GMO thing. An anesthesiology attending at the National Naval Medical Center in Bethesda spent three years as the medical officer aboard the USS Belknap in the Mediterranean, and he loved it. After finishing his tour, he went on to his residency at Mass General. So it's not the kiss of death. Also, GMOs are a dying breed. The DoD is currently working out a plan to abolish GMOs and staff those positions with residency-trained docs. So stay tuned.)

The military is a startlingly bureaucratic organization which has little ways of reminding you that it is, in fact, a branch of the federal government. For physicians, though, military medicine is actually not really different than working for a good HMO. Research in military medicine is quite impressive, incidentally, although its work is often very practical in orientation. There are good research ties with the NIH and CDC, and most residencies are very supportive of research (and may in fact require it of residents).

There are a certain number of people each year in the HPSP who defer their commitment in order to do civilian residencies. The exact number varies depending on the year, the specialty, and the needs of the service. If you want to defer, it helps to have a good reason (i.e., spouse's job) and to not be rude (e.g., "I want to defer because military residencies are inferior").

If you want to postpone the decision about military service, there is a financial assistance program (FAP) available to residents in most specialties, wherein you get about $30,000/yr on top of your civilian salary to repay loans (or buy a new car, possibly) in exchange for an equivalent number of years of service.

The Public Health Service offers a scholarship (The National Health Service Corps,http://nhsc.hrsa.gov/scholarships/ ) paying full tuition, books, and supplies, and a monthly stipend, with the following requirements:

1. You must enter a primary care-type of residency (medicine, family med, peds) or at least something that's close (OB/GYN, psych), or a residency combining two of the above fields. A main limitation is that the residency not take more than 3 or 4 years. After serving your commitment you can undergo further medical training (i.e., fellowships).

2. You must serve one year in a federally-designated underserved area of your choice for each year the NHSC paid your tuition (minimum two years), be it an inner city (30% of sites) or a rural cow town (70% of sites).

3. As of December 1998, the IRS has deemed ALL parts of the NHSC scholarship as taxable, including tuition. So, if you go to a school that costs $28,000 per year, taxes will leave you with about $350 from your monthly $950 stipend. The NHSC has been trying to get Congress to reverse the IRS's reading of the law, but to no avail as of yet.

There are similar programs available through various state governments and the Indian Health Service, some funded by the NHSC.

Physicians who have completed training in a primary care field are eligible for Public Health Service positions, with opportunities for loan repayment. Some feel that this may be a better choice, as you are not locked into a primary care field without first going through your medical school rotations. See the NHSC web site for more information.

It depends. If you attend a school that participated in the Health Education Assistance Loan Program (HEAL), you may be eligible for higher Unsubsidized Stafford Loan limits. During the 1997-1998 year, students at these schools could borrow up to $30K/yr in unsubsidized loans. Reports indicate that during the 1998-1999 year, students will be able to borrow "up to need," possibly eliminating the need to borrow under Alternative Loan Programs such as bank loans.