The Cost of Being
a Resident
Jill E.
Beland, M.D.
Alternate Delegate to the AMA Resident and Fellow
Section
When I made the choice to attend a private medical
school rather than my state university, I knew that
I would need financial assistance. I did not think
twice about the cost. After all I assumed everyone
accrued debt during medical school. The day before
graduation, I attended a financial aid debriefing
where I was handed a purple folder with my grand total
of debt. I nearly choked as I saw a figure just under
$200,000. My fear literally doubled as I looked at
my physician-husband of three weeks who was holding
a purple folder identical to mine. We had no idea
where to begin, having received little to no education
regarding money management during medical school.
Three years later, the monthly loan payments exceed
our net income. Two resident salaries are just enough
to pay the mortgage, two car payments, monthly bills
and an occasional night out together. Therefore we
continue to postpone the inevitable by completing
annual deferment and forbearance applications as our
debt continues to grow. There is little left over
for additional expenses such as medical licenses and
board application fees, which will total approximately
$6,500.
We are not alone in this situation. Almost every resident
I have encountered has similar issues, just trying
to make it to the day that he or she sends in the
final loan payment and feels free. The cost of being
a resident goes far beyond the grand total found in
a purple folder, however.
The choice to pursue a medical education and career
demands sacrifices that touch every part of one’s
life. The time constraints alone can often be overwhelming.
It is not unusual for residents to work several weeks
in a row before getting a weekend off. This schedule
can be further complicated by spouse and family commitments.
Even vacations can be difficult to plan due to competition
from fellow colleagues. When residents do find themselves
at home, they often have to balance their time between
studying and family. Many residents with children
find this challenge to be one of the more dear costs
of residency. Even the choice to start a family during
residency can be complicated. I am often advised that
there is never a perfect time for having children.
Although there is some truth to this statement, I
honestly do not know how I could manage. Many women
in medicine share this concern. The stress to be the
perfect career woman, wife and mother can be overwhelming.
As more and more women enter the medical field, this
is becoming a common scenario and an additional cost
of being a resident.
My husband and I will both continue our training through
the fellowship level. This is an uncommon decision
in the field of anesthesiology. The high demand for
general anesthesiologists coupled with lucrative financial
packages offered by private practices have greatly
reduced the number of residents entering fellowships.
This has become a serious problem in many, if not
all, academic centers where the deficit of fellowship-trained
anesthesiologists is tremendous. Many residents have
genuine interests in the subspecialties of anesthesiology.
They cannot justify adding another year of long work
hours and postgraduate salary, however, when there
are a multitude of golden opportunities in the private
practice arena.
To deal with the costs of residency, several programs
provide benefits that improve the quality of life
for each resident. Anesthesiology has maintained the
reputation of a “friendly” residency compared
to other programs such as surgery. Our field has been
an advocate for resident work hours, including 24-hour
call shifts and postcall days off, protecting both
patient and resident interests. Several anesthesiology
programs also provide educational stipends, compensate
for board fees or offer in-house moonlighting, all
of which can be a means of alleviating financial costs
of residency. There are even current discussions in
the academic field regarding loan pay-back programs
and higher fellowship salaries to compete with the
financial lure of private practices.
We can all agree that the life of a resident has improved
dramatically over the last 20 years, but there continues
to be new financial and social challenges for residents
that demand attention. These issues must be addressed
to protect our residents and ensure an infinite supply
of successful anesthesiologists.
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Jill
E. Beland, M.D., is Chief Resident at the University
of North Carolina, University of North Carolina
Hospitals, Chapel Hill, North Carolina. She
is the Alternate Delegate on the ASA Resident
Component Governing Council. |
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