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What Is The Average Debt Of Medical Students? Plus 3 Ways To Offset

Financial literacy can help you offset medical school costs and student debt.

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The escalating costs of medical education have become a significant concern. Aspiring medical professionals must understand and mitigate these expenses with financial literacy to avoid long-term financial burdens and maintain focus on their primary goal: providing quality healthcare.

Medical Education And Student Debt In The U.S.

According to analysis by the Education Data Initiative, the average debt for medical students in 2023 is $250,995. This figure significantly shapes young doctors' professional and personal lives.

Incorporating this data into the broader financial picture of medical education, a separate report mentioned that tuition fees in the U.S. Average $51,812 annually at public institutions and $63,337 at private institutions.

Students must also budget for textbooks, medical equipment, and technology, which can add thousands to their total expenses. Additionally, the cost of living, especially in major urban areas, can demand a significant portion of a student's budget.

Beyond the immediate costs, the long-term financial implications are profound. With a standard loan term of 20 years and an average interest rate of around 6%, graduates face monthly loan payments of approximately $1,800. Over two decades, this equates to a total repayment of about $430,000, comprising over $250,000 in principal and roughly $180,000 in interest. This daunting sum represents a significant commitment for young physicians, extending into midlife.

According to the American Medical Association, the average age of a first-year medical student is 24, graduating at 28 with a substantial financial burden. Loan repayments typically start just six months after graduation, at around 28.5 years old. During residency, which lasts at least three years, the AMA estimates the average income is about $60,000 annually. It translates to roughly $4,000 monthly after taxes, from which $1,800 is allocated to loan repayments, leaving only about $2,200 for other expenses.

Managing such a large debt load while earning a modest salary as a resident is a challenging part of a medical professional's journey. Consistent and on-time payments will see an average medical graduate concluding loan repayments around age 50.

This long-term commitment underscores the need for strategic financial planning, as it will significantly influence the personal and professional aspects of a physician's life for decades.

Strategies For Offsetting Medical Education Expenses Apply For Scholarships and Grants

Numerous organizations and institutions offer scholarships for medical students. These can be based on academic achievement, community service, or specific medical interests. It's crucial to research extensively and apply to as many relevant scholarships as possible to maximize your chances of receiving financial aid.

Remember to prepare strong application essays, maintain excellent academic records, and obtain compelling recommendations to stand out in your scholarship applications.

Grants are another avenue that can significantly reduce the money needed to be borrowed. Many medical schools, non-profit organizations, and government agencies provide grants to students demonstrating financial need. It's essential to investigate these options early, as some grants require applications before the start of medical school.

Budgeting and Financial Planning

A realistic budget should include rent, utilities, groceries, transportation, insurance, and personal expenses. Budgeting tools and apps can aid in monitoring expenses and setting spending limits. It's also beneficial to plan for unexpected costs by setting aside a portion of funds for emergencies.

Identifying areas where expenses can be reduced is crucial. It might involve choosing more affordable housing, using public transportation, cooking meals at home instead of eating out, and limiting discretionary spending on entertainment and travel.

Prioritizing financial goals is also essential. It might include setting short-term goals, like saving for board exams, and long-term goals, such as paying off student loans or saving for a medical practice. Setting clear financial goals can also help in staying focused and motivated.

Explore Income-Generating Opportunities

Although challenging due to the demanding nature of medical studies, there are ways to generate income during medical school.

Some students opt for part-time work or freelance gigs that can fit around their study schedule. Opportunities include roles in healthcare settings, such as medical scribing or working as a certified nursing assistant. Other options include tutoring, freelance writing, or other flexible remote work. The key is to find a job that offers flexibility and doesn't interfere with academic responsibilities.

Additionally, many medical schools offer student positions as research or teaching assistants. These roles often provide a stipend and can sometimes offer tuition remission. Besides the financial benefits, these positions provide valuable experience in research and teaching, skills that benefit a medical career.

For those with a business mindset, pursuing entrepreneurial ventures can be a lucrative way to generate income. It could range from starting a small business to developing an innovative medical product or offering consulting services. Entrepreneurship may require a more significant time investment compared to other strategies but it can also offer substantial financial rewards and professional development.

Case Study: Hanna Shanar's Initiatives – Medicine Unlocked And PubHub

Hanna Shanar, a fourth-year medical student, has made significant strides in combining his medical education with entrepreneurial ventures to offset school costs.

He founded Medicine Unlocked, an interactive and accessible non-peer reviewed publishing platform for medical students and professionals, and The Publicity Hub, a public relations and consulting firm. These ventures are alternative income sources that reduce his reliance on student loans and other traditional financial burdens.

"I began my public relations firm as a way to make some extra money while studying full time," says Shanar in an email interview, "but it grew into something much more lucrative, opening the door for early loan repayment, investing, and additional business ventures."

By establishing and leading these initiatives, Shanar has demonstrated how entrepreneurial skills and financial literacy can be effectively leveraged to offset the substantial costs associated with medical education.

Shanar encourages other medical students to pursue entrepreneurial endeavors while in school. "Even if you dedicate 5 to 10 hours per week, you can trim the debt you graduate with substantially. If you're entrepreneurially savvy and are able to capitalize on that, you may be able to erase it altogether."

Shanar's story shows that with creativity, hard work, and strategic planning, students can find innovative ways to fund their education while contributing positively to their fields and future financial success.

Final Thoughts

While the path to becoming a physician is steeped in financial and academic challenges, it is also ripe with opportunities for innovation and strategic planning. The key lies in leveraging available resources, being financially literate, and thinking outside the box where possible to create new pathways for financial sustainability.

Ultimately, the journey is about overcoming obstacles and seizing opportunities to grow as a professional and financially savvy individual. This holistic approach will not only benefit aspiring medical professionals but will also positively impact the healthcare system and society at large.

Opinion: The Life-and-death History Lesson That Doctors Aren't Learning

CNN  — 

The Hippocratic oath serves as a mission statement for physicians, articulating principles that guide their work. Its tenets include beneficence, nonmaleficence and confidentiality, but they are often summed up by one simple phrase: "Do no harm."

It may seem unthinkable, then, for a doctor, guided by this oath, to knowingly put a person's life at risk. But history has proven that it can happen — and on a grand scale.

In Nazi Germany, many physicians who supported the Nazi ideology carried out dangerous and torturous medical experiments on concentration camp prisoners. Drugs and medical treatments were tested on them before being used on military personnel. Sterilization experiments were conducted to identify the most efficient way to control the population of Jews, Roma and other groups. And, most famously, Dr. Josef Mengele carried out cruel experiments on twins.

Dr. Robert Klitzman, director of the masters in bioethics program at Columbia University and author of The Ethics Police?: The Struggle to Make Human Research Safe, says that to make sense of the cognitive dissonance required for a doctor to act with such malice, we must recognize that people have a tendency to rationalize their behaviors. He spoke with CNN Opinion recently about a growing call among physicians and medical institutions around the world to learn from history so we don't repeat it.

Indeed, as retired physician Raul Artal, who was born in a concentration camp, wrote in a 2016 article published by the Association of American Medical Colleges (AAMC): "Nazi physicians claimed the moral high ground by transforming the Hippocratic Oath from a doctor-patient relationship to a state-Völkskorper—or nation's body—relationship. They justified the sterilization or elimination of 'lives not worth living' as a merciful preventive measure, simultaneously ending the suffering of the genetically inferior and preventing transmission of their presumably hereditary harmful traits."

After World War II, nearly two dozen physicians, scientists and public health officials were among the Nazi leaders who were tried for their role in the holocaust at the Nuremberg Trials. This represented a moment of reckoning for the global medical community. How could medical crimes against humanity be prevented from ever happening again? The answer, the court decided, was to create 10 directives for human subjects research: the Nuremberg Code.

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We still rely on this code today, and have created additional regulations and ethics bodies to review the conditions of medical research. Nonetheless, experts have warned that we mustn't be complacent.

"The history of medicine during Nazism and the Holocaust can support such critical reflection at all stages of the professional life cycle. It can help us recognize patterns to avoid or aspire to, and thus support us in the development of our own stories of ethically responsible health care," wrote doctors Hedy Wald and Sabine Hildebrandt in an editorial published by AAMC in 2022.

The Lancet Commission on Medicine, Nazism, and the Holocaust argued in a lengthy report, "The core values and ethics of health care are fragile and need to be protected." The commission has called for health care education to include a history-informed framework "to emphasise the unique opportunities and responsibilities of health professionals in the elimination of antisemitism and racism and the protection of vulnerable populations against stigmatisation and discrimination."

For Klitzman, these are much-needed calls to action. "[The Holocaust] reminds us how fragile our ethical and moral standards can be," he says, noting that one important way for us to keep our values in check is to examine history — study the Holocaust and other instances of moral failing in medicine — and for medical professionals to be vigilant about checking their own biases.

Learning from the past is not a radical idea. But, as so many experts are reminding us, if done earnestly, it could have a radical effect on the future.

The following interview has been edited for length and clarity. 

Robert Klitzman: Examining these issues is important for several reasons. Paraphrasing from the philosopher George Santayana: Those who do not learn from history are destined to repeat it.

A major problem is that physicians in the Nazi era, who were trained to follow the Hippocratic Oath and to abide by high moral standards, abandoned those principals under political and social pressures. The reason that's important is that it reminds us how fragile our ethical and moral standards can be. And, unfortunately, there have been times — and there are still times — when physicians have not followed the ethical and moral standards they should.

For instance, there is still racism in healthcare. If you look at outcomes during the Covid-19 pandemic, people of color were at higher risk of dying from Covid. The evidence suggests that it's not due to something biological, but rather access to care and, in some cases, the treatment they received. 

So, we know that biases, racism, antisemitism, etc., can creep into health care. We've seen repeated examples of it since the Holocaust. Physicians need to be aware of that history so they can avoid repeating it.

Klitzman: What the Nazis did made us more aware of the importance of bioethical principles and led to the development of better guidelines to try to ensure that doctors follow the ethical guidelines they should.

The Hippocratic Oath that doctors take doesn't cover research ethics. It does not touch on risk-benefit ratios for research participants – the assessment of the potential risks and the potential benefits for the participant. It doesn't touch on informed consent – the idea that participants consent to being part of the study, with full information of what it means for them. It doesn't touch on equity – the idea that you do not want to disproportionately burden or benefit any particular groups through the research.

After the horrific Nazi experiments, it was overwhelmingly clear that the medical experimentation performed by the Nazis needed a response and so, during the Nuremberg Tribunals a set of guidelines was developed for medical research. So, the events of the Holocaust have already informed our bioethics, but it's important to continue examining this history as the world evolves and our medical ethical principles need to evolve along with it.

CNN: The Lancet Commission, among other institutions, has voiced concerns that medical curricula don't sufficiently teach about Nazism, the Holocaust and ethical failures throughout medical history. What do you feel is the most appropriate way for medical education to impress upon doctors that the need to be ethically vigilant is an inextricable part of practicing medicine?

Klitzman: I think that the curriculum in many medical schools would benefit from providing more information on the Holocaust and Nazi experiments, and other violations of research ethics that have occurred. This heightened awareness could change the ways medical students appreciate medical ethics because bioethical principles can seem very straightforward, uncontroversial and easy to follow, and, therefore, easy to dismiss as not requiring particular attention.

However, the Nazis and the Holocaust vividly and dramatically illustrate how physicians can come to deviate from ethical standards and justify to themselves egregious ethical failures – how "blind" doctors can become when they face conflicting pressures and goals.

CNN: I'd like to talk about the Hippocratic Oath. Reciting it may seem like a ceremonial part of becoming a doctor, but the message it carries underlies a doctor's fundamental mission. Can you explain to me what the Hippocratic Oath says and why is it so important in the context of bioethics?

Klitzman: The Hippocratic Oath is a statement that emphasizes the fact that practicing medicine is a moral enterprise.

Medicine involves people putting their bodies and private information in your hands as a doctor. If someone says, "'I've had four miscarriages," or "I am an addict," or "I'm gay," they're trusting you that their body and their privacy are safe. There is an implicit social contract. And because of this, society has decided not to overly regulate doctors with laws. Instead, doctors have a great deal of discretion. And in return, doctors are committed to following a very high moral standard. In the West, parts of that standard are articulated in the Hippocratic Oath.

CNN: The idea of eugenics was key to the medical experimentation carried out by Dr. Mengele and other health professionals during the Holocaust. Can you explain what eugenics is and how it became a tool in the Holocaust?

Klitzman: Eugenics is the notion that you can improve the genes of individuals or society. It's very much aligned with racism and prejudice.

Hitler's idea was to "improve" the genes of the German people, which meant that if someone was disabled, gay, Jewish, etc., he wanted to get rid of them. I should make very clear that eugenics is completely warped and not based on anything scientific; in the case of the Nazis, it was used as a weapon against anyone Hitler's regime deemed "inferior."

Eugenics is not to be confused with public health; it's one thing to want to improve the health of a country. But that's extremely different than saying, "Let's improve the genes of the country by getting rid of certain people."

Klitzman: There are several ways gene editing could lead to eugenics, with parents who can afford it paying to create children with the most socially desirable traits. But there are also more complicated scenarios that could arise.

Let's take the example of using gene editing technology to remove from an embryo genes associated with various diseases – whether cancer or Alzheimer's. This may, on the surface, seem like a good thing. But, in fact, this raises a number of concerns because wealthy people could pay to remove these genes, while poor people likely could not. This could lead to more disparities in society; certain diseases, which now unfortunately affect many people, whether rich or poor, could increasingly become diseases of the poor. And, of course, that's a problem because then there would likely be fewer resources for people with these conditions, less money devoted to research, etc.

One of the bioethical principles, as I said, is to avoid unfairly burdening or benefiting one group or another. Eugenics threatens that bioethical principle of social justice.  So, we need to be very careful.

CNN: The Holocaust is the most notorious example of medical experimentation — and perhaps for Americans it's easy to assume that what happened in Nazi Germany could never happen in the US. But the US, too, has engaged in unethical medical experimentation. One of the most well-known instances was the Tuskegee Study. Can you tell me about that study and how the lack of informed consent created unethical experimental conditions?

Klitzman: The Tuskegee study was one of the most egregious examples of medical experimentation, with grossly inadequate informed consent. Starting before World War II, The Tuskegee Institute and the US Public Health Service, wanted to understand the natural course of a syphilis infection. So researchers decided to follow a group of poor, Black sharecroppers in the South, many of whom were semi-literate, and decided to see how untreated syphilis affected their bodies over time.

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One of the problems with the study was that, after World War II, when penicillin was discovered to be the definitive cure for syphilis, the researchers decided not to offer penicillin to the study subjects because that would have inevitably ended the experiment. They decided that the value of the experiment was worth the suffering of and risk to the subjects.

The Tuskegee study went on for decades until the 1970s, when a story about it came out in the press and led to an advisory panel reviewing the study. This shows us that, even after the Holocaust, here in the US there were still instances of unethical medical research.

As a result of the Tuskegee study, the National Research Act was passed in 1974, which was key in establishing modern research ethics as we know them today. Since then, we've also developed research ethics committees or Institutional Review Boards (IRBs), to help ensure that research is carried out ethically.

But even with these formalized research ethical standards, it is often a fight to make sure that guidelines are followed.

CNN: Trust in science and scientists is on the decline, and we've seen this distrust lead to dangerous trends in vaccine hesitancy and pushback on public health guidance. For instance, when Covid-19 vaccines initially became available, the mistrust of health professionals among Black Americans in Tuskegee, Alabama, the place where the Tuskegee study was carried out, likely contributed to the fact that less than 6% of vaccine doses initially went to Black Americans while over 60% went to White Americans. So, how do we address this lack of trust, while also acknowledging that it is valid and is steeped in history?

Klitzman: When it comes to combating distrust in the public health system we have to ask: What is the message? Who's giving it to whom? And how is it being given?

If we have White doctors telling everyone, "You need to do this, you need to do that," and people who don't have trust in the system aren't given much choice in the matter, that's problematic.

Trust is easily broken and once broken, hard to reestablish, but having the message come from people who understand that distrust, and who are willing to listen to what people's concerns are, is important. And, of course, the first step is acknowledging the fact that bad things have been done in the past that have understandably led to distrust.

Continuing Medical Education

Saint Louis University School of Medicine's Continuing Medical Education (CME) program provides high-quality, unbiased educational activities based on the best evidence available to help participants improve patient outcomes within their scope of practice.

Saint Louis University School of Medicine's Continuing Medical Education (SLU CME) program provides high-quality, unbiased educational activities based on the best evidence available to help participants improve patient outcomes within their scope of practice. As part of a team of collaborative stakeholders, we help plan, implement and evaluate educational activities to reduce gaps in knowledge, increase performance and skills that will lead to improvement of patient outcomes. Included in our educational activities are updates in clinical medicine, updates in surgical procedures, review of surgical instrumentation, ethics, end-of-life palliative care, faculty development, communication, patient safety, and interprofessional collaborative practice.

We identify gaps most often by using expert opinion, article reviews, new surgical procedures or instrumentation, updates to recommended guidelines and review of outcome data. Course directors and planning teams are coached to find the best available source of data to prove the need for the educational strategies as they plan activity format and content.

We expect our participants to add quality educational strategies to their life-long learning portfolio by choosing the activities that best suit their needs and educational goals through self-assessment. The SLU CME program is designed to provide learners with the tools they need to improve their knowledge, skills and performance to achieve better patient outcomes. Activities include Regularly Scheduled Series (RSS), Practical Anatomy and Surgical Education (PASE, hands-on cadaver lab skills training), annual meetings, and enduring materials.

Our main participant base is physicians, fellows and residents within our School of Medicine, but we also support regional, national, and international participants at the PASE Lab and through joint provided activities. Many of our activities include a multidisciplinary aspect that includes nurses, social workers and other healthcare professionals such as Physical and Occupational Therapist and EMS to provide networking and learning environments for a team training approach.

Program results are evaluated through a sampling of post-activity evaluations, change-of-practice surveys, yearly surveys of the RSS activities, and an overall review of the CME program. Evaluation data is shared with course directors, department chairs, the CME committee, the Dean of the School of Medicine and the CME directors to help improve the overall CME Program.

The SLU CME Program changes with the needs of the learners as well as population health crises or issues taking place within our hospital system. We plan and implement activities that will move outcomes in a positive direction.

Below is a list of programs offered by, or in conjunction with, SLU CME. 

Live CME Conferences

Live CME activities take place at a specific time, date and location. They can occur either in person or as live webcasts.

Regularly Scheduled Series Activity (RSS)

Ongoing live conference series with a broad set of objectives that span the course of a calendar year. They can occur weekly, monthly or quarterly. Examples include Grand Rounds, journal clubs, or morbidity and mortality conferences.

Enduring CME Materials

These learning experiences can take place at any time, in any place via online modules, pre-recorded webcasts or physical workbooks.

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