Loan Repayment During Residency

A long time ago I tried to write about residency repayment. Well since then I have learned a lot.

Here are two excellent posts about repayment in residency:

Financial Aid - Part I

Financial Aid - Part II

Now that we are actually in repayment, I can also help explain or answer any questions you may have, but I figured I would just link to the post because it explains everything pretty well.

Also if you haven't made it over to my new blog, please check it out at:

champagneandbonbons.blogspot.com and you can still email me at: marriedtoamedicalstudent@gmail.com or now at champagneandbonbons@gmail.com regarding any questions on loan repayment, applying to residency or any other questions you may have!

Residency Match

So my main experience with being married to a medical spouse is that for the most part, I had no idea what I was in for. Year by year it seems like I don't know whats going on until we get there. And as a planner, I hate not knowing what is going on. I spend much of my time trying to find out what happens next. For that reason I want to explain the whole "Match Process" for any of you MS1 or MS2 spouses out there who are curious as to how it works. I know I was always curious as to the process and my husbands answer was always, "just wait" or "we'll know when we have to do anything." I have also found that most people (who aren't married or related to a medical student) have no idea about the whole process that is involved in "matching" to your residency program. Therefore I am going to take this opportunity to describe the process (based on my understanding).*
The match process begins in July of a medical student's fourth and final year of school. This is when a fourth year gets a password to log-in to the match website. At this time medical students can start entering information into their application. Then in August (the 15th) a students applications can officially be sent to schools. The match website (www.NRMP.org is the main site but some programs use www.sfmatch.org, or www.auanet.org) sends or submits the applications out to the different programs (selected by the applicant). Then usually in October and November the programs send out invitations for interviews. Programs are selective in granting interviews and therefore if an applicant doesn't get an interview they are out of the running for a spot. Medical students can choose to accept or deny these interviews but if they deny an interview, it takes them out of the running. Interviews usually take place in November, December and early January. Interviews usually last at least one day. Often times they are two days; the first evening is a reception and the second day will include a tour and the actual interview. (Some programs invite spouses to the reception - which is a nice opportunity for them to visit the city and learn more about the program). The next step in the process is the rank list.
Starting in January every student will rank the programs they interviewed with. This is another step where an applicant can eliminate a program by not ranking them. At the end of February (the 24th at midnight next year) the rank lists are officially due and must be submitted. All programs will also submit a list ranking their candidates by order of preference. The match process is weighed in favor of the applicants in the sense that the match system will look at a student's list and look to their first pick, if their first pick has them ranked number one they match (or if their program takes six and they are ranked in the top six then they will match there). If a program has a student ranked number one but that student has them ranked five, the match process will first see if that student matches with their top four. This is why it is necessary for all applicants to make sure they rank their programs in order of their preference. All of the matching is done electronically or by computer and it tries to match students to their highest (or lowest if you are referring to numbers) ranked program. Hypothetically the more places a student ranks should increase their chances of matching. Many students will apply to programs across the country. Between the cost of applications, travel and hotels, many students will spend several thousands of dollars on this process. Usually your financial aid office can help you take out special loans to cover the additional expenses.
Then the third Monday in March (the 15th of 2010) students will receive an email informing them of whether or not that matched. Then that afternoon the match program will release what programs still have openings so that the students who did not initially match can "scramble match." This scrambling process happens in a matter of days and results in people matching at programs that they didn't apply to, interview with, or rank. Then later that week, on the third Thursday in March (the 18th of 2010) most schools will host a match day reception where all the students will gather with friends and family. At the reception all students will be handed an envelope which contains their future. They have no idea what it is going to say, it could include any of the umteen (however many) programs they rank. And that's it... nine months of applying, interviewing and worrying and you find out where you are going in an instant.

Residency Match Resources
For those of you who want to know more about residency programs, here is a great website: Freida Online Search . Here is another link of deadlines and dates for this years upcoming match.
*This is just my basic, informal, and lay-person's understanding of the process - do not rely on my statements or representations. Also the process will vary for medical students in the military and those applying for certain specialties such a urology.

Northwestern Residency Showcase

(Written by Marissa; edited by the medical student)
This past Saturday Northwestern hosted a "Residency Showcase" or informational about their residency program. I found the information online several weeks ago and had Drew RSVP because we figured it would be a good experience. Drew took the train into Chicago and then walked 1.7 miles along the lake to Northwestern's campus. The invitation said the dress code was "business casual" so Drew decided to wear a dress shirt and bring a tie. When he arrived he noticed most people were in ties so he ducked into a bathroom before he was spotted and put on his tie. Most of the other male students erred on the side of caution and had ties on and some even wore suits. The faculty however was a little closer to the dress code, Drew described an attending as wearing jeans with a sport coat.
The first forty-five minutes they broke up into two groups (of about 75) with two different panels. One was a panel of faculty and the other was a panel of residents. It was a question and answer session. Then the two groups switched and attended the other panel. After this there was a lunch or refreshments and all the programs were set up by table. Rather that getting something to eat right away Drew went straight to talk to staff. He met the chief resident and an attending. Drew said he found both of them to be very down to earth and easy to relate to. The attending even mentioned that he was looking forward to getting something to eat because he had been running around chasing his kids all day. They also talked about their hobbies and interests. I think Drew found this encouraging because it meant that while their jobs were a huge part of their lives it wasn't all of their lives - something that is important to us because while we know medicine is going to be a priority we still want to have a family. One of the two even mentioned that they have "no divorces," while I am sure he meant it somewhat jokingly it is actually somewhat comforting. One of them even spoke about how the road is tough and that there will even come a day where you want to flush your pager and throw in the towel, but he said that everyone goes through this and you get through it. I liked hearing this because I thought it was nice that they weren't negative but they also didn't sugar coat anything. Drew also observed that none of the residents or staff looked ragged or miserable. Although I am sure they work ridiculously long hours he said that they still seemed genuinely happy. This is something important because I think it can be an indication of the program. Residency is going to be hard anywhere but I think that some programs are going to make it more bearable.

Loan Repayment (during residency)

Please know I could be WAY off with my thoughts/ideas/conclusions - I tend to rant and expect the worst - I also gathered some of my information from message boards which are in no way a reliable or accurate source!
Okay I think I may, (and I emphasize may) have figured it out... This has seriously been so frustrating. I know I posted before that I you could forbear your loans for the entirety of residency but since then I have heard a number of conflicting things. On various boards (namely iMSN) they keep talking about this new 15% rule. Various MS4s (fourth year medical students) who have been through their loan exit interviews have been saying that there is no more deferment/forbearance and that it has been replaced by this new 15% rule. Well after a few weeks of various inquiries and searches I have found this article.
To my now limited understanding the government has eliminated economic hardship forbearance. The economic hardship forbearance was nice because all residents qualified due to their modest incomes and it allowed residents to make NO payments their first three years of residency; also during this time interest did not acquire (or if it did I think the government paid it). After these three years of economic hardship forbearance were up residents could simply defer their payments if they wished and interest would continue to acquire on their loans.
Now this new plan does not allow residents to forbear at all and they can either defer and interest acquires (which I guess can be dangerous because interest continues to acquire and can capitalize and whatnot) or enter repayment. (This is the part where the information is even more sketchy are less reliable)
So if you ask me these new plan stinks! Consider that a $200,000 loan debt is quite normal for the average medical student. A 10-year repayment plan at the 6.8% interest rate amounts to.....
.............................
...............
......
...
$2,300 a month
The average residency salary is around $42,000 - this leaves a resident with approximately $500 a month to live.... (I'm not sure if you can put medical school loans on longer terms).... so obviously if a resident doesn't want to defer and have interest accrue and capitalize their only option (unless they have a sugar-daddy/momma or another massive source of income) is Income Based Repayment (IBR/the 15% rule). So this 15% rule looks pretty good... for a minute.... and if your not married to someone with student loan debts...
If your married (I was told that) your spouse has to sign onto this agreement and the problem can be that you are stuck paying 30% of your income (15% of both of your incomes towards each loan). While I am not sure if this is accurate - I was also told that an option to avoid this is to file separate taxes. (Which then causes you to lose out on several tax benefits - resulting in a different cost). But with the separate taxes then you would only each pay 15% of your own loans? I dunno this is all confusing stuff. While I would have no problem paying 15% of Drew's residency salary during his residency, I don't like the idea of having to pay 30% of both of our salaries, especially if we live in an expensive city. Based on my unscientific, uneducated, calculations, even if I was hypothetically making a meager $40,000 salary we could still be responsible for $2,000 a month payments ($80,000 * 15% then divided by 12 months). Then again I would hope the 15% rule is only based on take home pay, rather than before taxes salary.
Perhaps we can defer but still make optional payments? I just don't like the idea of having to pay a large payment every month. Good thing I have more than a year to figure (worry about) this thing out!
And since I was trying my hardest to find everything wrong with IBR I forgot to mention that the another advantage of it is that (again I think) that if your payments are still less than the rate that interest is acquiring then the government pays that interest. So I guess my final conclusion is that this IBR plan may not be a bad plan for single/unmarried residents but I think it could potentially be bad for married couples who both have student loans.
If you stayed with me this long - thanks for your patience... please leave comments or email me if you have more accurate information/corrections! Thanks!

Best News Ever!

(Or at least in a little while - in terms of Medical School news)... So I was obviously disturbed after my last post and was really struggling with the concept of making mortgage size-loan payments during Drew's residency while he will be on a moderate salary and we will be trying to afford little kiddos. So I kept searching online - and low and behold.... although they have eliminated the "residency deferment" there is still this fabulous thing called "residency forbearance" - The only difference is that the forbearance allows interest to accrue but you still don't have to pay! Po-tay-to, pa-tah-to, I don't care. I'm just ecstatic that there should be no requirement that we make payments on Drew's loans during residency. Thank you Lord. I cannot express what a relief this is. A huge burden has been removed. I truly was doing a little dance inside all day yesterday! Drew thought it was great but really wasn't as excited as I was because (surprise) he wasn't really worried about it anyway!

I had a mini panic attack

today when I was talking to a coworker about loans. She was telling me how her loans are in deferment for a year due to "economic hardship." I guess this is an option I could have taken as well but I chose not to. This option allows you to take this option if your income is low (or you loan payments are high) and it puts off your payments while the interest continues to accrue. I was discussing to her how I hope there is some kind of deferment for Drew's residency. (Gosh it is making me so anxious just talking about this). Turns out that they used to have such a deferment but it no longer exists. While we will still qualify for the economic hardship for the maximum length (3 years) after that we will have to begin repayment... and this is what really freaked me out... my co-worker was telling me that her boyfriends loan payments are $600 a month - six hundred dollars a month! The horrifying part is that I am sure that his loans are not nearly as much as the amount Drew will have acquired for four years of medical school. (And don't get me wrong his going to a STATE school means he has still only acquired a fraction of the loans he would have acquired at a private medical school - and the same goes for my education as well). It just has me thinking - how much will our loan payments be? And even more I wonder how do people do it? Families in particular. I mean if you go to a private medical school you can rack up two hundred or three hundred thousand in debt very easily. And then you figure the average residency pay is $45,000... how on earth would you manage to make those payment and live on that salary if you had KIDS - especially if you were the sole provider? These things are all beginning to cross my mind because I have started to realize that with a residency of 6-8 years, Drew and I will not be able to wait to have kids until after he is out. We realistically do not want to wait until we are 34 or 35 to start having kids. Which these thoughts only get the wheels spinning and I begin to wonder how on earth we are going to afford day care with our salaries and those ridiculous loan payments that I have dreamed up in my head. . .
Surprise - I've gotten ahead of myself. And so I must constantly continue to remind myself that I shouldn't worry over potential problems that may not exist. I also have to remind myself that God will always provide. All I do is have to look around right now, and although things are tight, He has managed to give us enough that we can take care of all our bills and most importantly we are truly RICH where it counts - with love from family and friends.
After reading this post aren't you glad you don't live in my brain? In my defense - being an extreme worry wart runs in my family!

Married to McDreamy?

If you don't watch Grey's Anatomy, that is the nickname for the neurosurgeon played by Patrick Dempsey. So I guess this is my very unofficial, unpublic announcement that Drew has chosen his specialty. We are very excited, but Drew still has trouble saying it outloud and personally I am still wrapping my head around it. I've known it was his first choice for a while, but we have kind of been waiting to make the official decision. The reason why it is such a big deal is because it means that we will most likely be saying goodbye to Springfield as long as (God willing) Drew gets accepted into a neurosurgery residency program. This is because SIU (Springfield) does not have a neurosurgery program.

I've only been at my job for nine months now, but the thought of leaving there makes me sad. And I feel guilty admitting Drew's selection because it is far too premature to say anything to them. Afterall the residency process does not officially begin until August; we will not know where we are going until March of 2009 and we will not actually be moving until the end of May 2009. So you can see my dilemma because it serves no purpose to tell them yet, but at the same I want to share the news.

The reason why we are ready to admit this big decision is because Drew has started his applications for sub-Internships (sub-Is). These are basically 4-week "away" rotations that he will do this fall or sometime in his fourth year. So right now Drew is in the process of filling out applications to do neurosurgery sub-I's at Northwestern, University of Chicago, Rush and University of Illinois - Peoria. The hope is that if you do sub-I's with a hospital, and make a good impression it will increase your chances of getting a residency there. As of now our hope is to end up in Chicago, but we will also be looking at programs throughout the midwest and possibly in Florida. And as a backup Drew will probably apply for the general surgery program in Springfield. There is a lot more info as far as what all this means now that he has decided, but I think I've covered enough for tonight!

Can you believe it - Drew is gonna be (God willing) a brain surgeon!?

Lots of snow...

at least for the city of Springfield! We got several inches of snow today, and of course although it ended in the early afternoon by 5:30 the roads were hardly plowed. Our apartment parking lot was clearer than the roads. I don't expect them to get every road but I take 6th street home and that is the main road running south through town- I would have thought they could have at least plowed one of the four lanes of that major road. And unfortunately although the snow has stopped, a slow drizzle has started... which means ICE tomorrow... and surprise... Springfield is not very good at salting either! Although the good thing is that the snow doesn't usually last here.

We are still waiting to hear Drew's test results from surgery. Last week Drew met with Dr. Espinoza (I probably spelled that wrong), the neurosurgeon Drew shadowed. Dr. E answered some of Drew's questions and he told him about Peoria's neurosurgery residency program. Although I am not particularly (at all) interested in Peoria I found it interested that the program sticks to the law that limits residents to working no more than an average of 80 hours a week over a 4 week period. Dr. E said that in his 13 years at SIU only ONE student has gone into neurosurgery! Next month Drew is going to meet with another Dr. from SIU to try and get contacts from other programs. We are hoping this research will give him a better idea of whether any of the programs interest him and more importantly whether neuro is what he wants to do.

P.S. I am feeling much better with the help of my z-pack!

Mark your calendars!

well, not really...but I will definitely be doing so! We have the official dates for the two very important dates for the year of 2010. March 18, 2010 is "match day" and May 22, 2010 is Drew's graduation (also his Mom's b-day). I told him to tell her he is giving her the best gift she could ask for! To explain match day, it is the biggest day of all of medical school. That day is when you officially find out where you were matched for residency. Everyone gathers and announces their placement and the rest of the day is spent celebrating with other students, family and friends.

With surgery over, Drew began his two weeks of "doctoring" yesterday. While Drew complains and finds this program pointless and boring, I actually think it has some value. My understanding is that the purpose is to educate and encourage medical students to develop and improve their bedside manner. For example yesterday they talked about listening to patient's stories and "feelings." Drew is not a fan of these sessions because he claims they make them talk about their feelings. I try to explain to him that while he may have people skills, that is not necessarily the case with other medical students. Personally I give the medical school props for at least trying to discuss and raise the issue with students.

Also as part of getting important dates for the upcoming year or two they gave Drew a timeline for applying for residency programs. There are a number of steps that he will have to take this spring and summer but he won't officially sumbit his applications until August through September. They also gave Drew some resources to look at in choosing his specialty. And of course me the over-eager planning wife has already spent time on various websites. I was very excited to find that RUSH's neurosurgery programs is only SIX years! Which was somewhat exciting because U of C's program is 8 and all the others are seven... but I will admit I am getting waaaaaay ahead of myself (and more importantly Drew) because he hasn't narrowed down his specialty yet, let alone a location or protection. But it was somewhat encouraging! Just to recap, the short list of specializations are: orthopedic surgery (6 year residency program), neurosurgery (6-8 year residency programs), and cardio thoracic surgery (7-8 year programs).

Below is a photo from Katie and Jeremy Huss' wedding - it was a beautiful event!

Back in Crystal Lake again...

This weekend we are town for a college friend's wedding (the bride is from Crystal Lake, but I did not meet her until college). We gladly checked into hotel Bianchi last night where we are well-fed and the price is right!

This week wrapped up the end of Drew's surgery clerkship. Those ten weeks really flew by! On Thursday he had his clinical exam (where they saw fake patients and had to summarize a diagnosis and treament/management plans). Then on Friday he had his written test. We are hoping he did well because although you can still get into a surgical residency without surgical honors, it makes it a little more difficult. We should have the results of the test in about two weeks, but it will be about 4-6 weeks before we find out his clerkship grade (they factor in his doctor evaluations into his grade).

The last two weeks (half-weeks really with the holiday and then his exam) he was in colorectal. Surprisingly Drew actually found these surgeries interesting, but not interesting enough for him to want to put them on his "list." He simply says he can't see himself working on that end of the body his whole life.

Last week at Thanksgiving Drew got to talk to my cousin's wife Julie about her experience as a physician's assistant in neurosurgery at the University of Iowa. After his conversation Drew said he thinks that it is something he can manage. I don't doubt that he can manage anything - what I doubt is if I can handle the hours he is gone. What freaked me out was when Julie said that her residents usually work about 120 hours a week on average, but it was reassuring when she told us that Iowa is one of the more intense residency programs. In fact she said that they usually lose at least one resident a year. I think the key (for me) will be trying to find a surgical residency program that is closer to averaging 80-100 hours a week (if they do in fact exist). Which now that Drew is no longer in his surgery rotation he should have a lot more time to actually research the diffferent types of surgical residency programs.