I need to decide in the next two weeks which medical school to attend. My two top candidates are both state universities. The relevant factors to consider are cost (medical school is appallingly expensive), program quality (reputation and resources), and location/convenience.
Florida International UniversityCost: I have been offered a full tuition scholarship (worth about $125,000 over four years), but this does not cover $8,500/yr in “fees” and the cost of living in Miami is high. The FIU College of Medicine’s estimated yearly cost of attendance (including all living expenses) is nearly $69,000; if I multiply that by four years and subtract the value of my scholarship I get about $145,000. However, my husband will continue working during all four years, defraying some of my expenses, so I hope to keep my actual indebtedness at graduation under $100,000 if I attend FIU.
Program Quality: This is difficult to gauge, because the program is very new, having only graduated its first class of MDs this year. Their reputation is necessarily unestablished. All of their graduates successfully matched into residencies this year (a few in prestigious hospitals and competitive specialties), but this is reassuring rather than impressive. They only graduated 33 students although they matriculated 40 in their first year; not sure if that represents a worrying rate of attrition or what became of the other students (though I plan to ask). Another consideration is that although FIU is affiliated with many well-known hospitals in South Florida, they do not have a dedicated teaching hospital.
Location/convenience: Already mentioned the higher cost of living. Miami is also farther from where we are currently living and working (over 3 hours away vs under 2 for Gainesville). My husband could probably find work in Miami, but it might be less desirable or pay less than his current job, and we would probably need to live apart during the week until he does. Also, the widely-scattered hospitals through which FIU students rotate, as well as South Florida traffic, make me worry about my quality of life during my third year.
The University of FloridaCost: I have been offered $7500 per year in aid. The rest of the $50k/year cost of attendance (including living expenses) would be loans. Again, my husband would continue to work and pay some of my expenses. In all I estimate a $30k-$60k difference in indebtedness at graduation between the two programs (in FIU’s favor).
Program Quality: UF is Florida’s oldest and best-respected medical school, which is to say good but not elite. UF also has a reputable teaching hospital on campus, and a larger research budget, which would help build my resume if I decide to try for a very competitive specialty. They graduate 95% of their students within 4 years (98% in 5 years), and their residency match list looks a bit nicer than FIU’s on average. For what it’s worth (probably not much), I have a better feeling about this program’s “culture” based on the events I’ve attended.
Location/Convenience: Gainesville is closer. It might be feasible for my husband to stay at his current workplace for all four years if we find a good place to live around midway between.
Other advice I have received: Jess Whittlestone at 80,000 Hours suggested I’d do best, impact-wise, to consider which school would maximize my earning-to-give potential. This would mostly depend on the specialty I go into—based on how I feel now, I’m most likely to try for an Internal Medicine subspecialty, which would mean doing a fellowship after residency. A good residency match would position me well for a fellowship in a competitive field. Physicians whom I have asked for advice tell me that people commonly match into even very competitive residencies from lower-ranked US MD schools, but it takes more work (better test scores, stronger evaluations). They also tend to say “OMG take the money” when I say the words “full tuition scholarship”.
You can probably tell that I lean towards UF, but I don’t want to make a bad call. What am I missing? What should I be asking the schools? Where should I go?
Although the FIU is new, its curriculum seems to fit the old Flexner I mold. I cannot tell the state of UF’s program from the site.
Research options at FIU appear limited, but if you have an interest in one among those available, this concern does not hold.
What do you want to pursue in a medical career? Research? Patient Care? Whatever earns the most money?
To find the necessary information if the answer is:
Research—Visit the school and investigate the status of its research department. Learn about ongoing studies, the attention ratios of the Principal Investigator to Junior Investigator to students, and the amount of freedom allowed in pursuing research interests.
Patient Care—Ask existing students of all years what their curriculum has been, and how much time they have spent with patients. Flexner I involves two years of study, then two years of practical application; Flexner II (an informal moniker) isn’t a set system as individual schools are slowly implementing and trying new and different things, but generally differs from Flexner I—for example, involving patient care as part of the first two years.
Money—There are many avenues to approach this. Naturally the more prestige your school has the better, as that will help determine the quality of your first post; however, with enough research publications you can make your own prestige, and research will always be a value marker. Your alma mater on the other hand matters less and less as time passes and jobs accumulate.
I plan on a career in patient care. I will almost certainly do research in medical school, but based on past experience I don’t expect to find it extremely compelling or to be extraordinarily good at it. Money concerns me if only for philanthropic purposes. The field that interests me most now (infectious disease) does not pay especially well, but I have decided that I really should seriously consider more lucrative paths that might let me donate enough to save twice as many lives in the developing world.
Both schools seem to have pretty solid clinical training and early patient exposure, to hear the students tell it (though they have little basis for comparison). I don’t have a strong preference between their curricula, except my worries about driving around between hospitals in Miami.
To me it then appears you have two (clear) paths in line with your preferences. Your emotional preference, what makes you happy, sounds like helping people in person (fuzzies). Your intellectual preference, goal, or ambition, could be paraphrased as, “Benefit to the highest possible positive degree the greatest number of people.” Your ideal profession will meet somewhere between the optimal courses for each of these two preferences. I list these to avoid misunderstanding.
The first course is the one you’re pursuing—get an MD, work with patients to be happy, and donate to efficient high-utility charities in order to live with yourself. If the difference in cost will really only come out to 30-60k $US, you will be able to live with your husband while attending UF, UF is more prestigious, would cause you less worry, and if matriculating to UF makes you happier—then by all means attend UF! I’d be quite certain about the numbers, though.
The second course isn’t unique to medical professionals, but they do have special skills which can be of unique use. Go to a developing country and solve medical problems in highly replicable and efficient manners. This course probably meets your two preferences with the least amount of compromise.
If you’re unfamiliar with Paul Farmer, he went (still goes, maybe) to Haiti and tried to solve their medical problems—he had some success, but unfortunately the biggest problem with Haiti was governmental infrastructure, without which impact cannot be sustained.
The second course would involve you using medical expertise to solve medical problems, and acquiring either additional knowledge or a partner with knowledge of how to establish infrastructure sufficient to sustain your solution.
The final step involves writing Project Evaluations on your endeavours so that others can replicate them in wide and varied locales—this is how you make an impact.
Not knowing anything about your husband, the above reasoning assumes he doesn’t have any impact upon the decision.
Thanks, your advice more or less coincides with what I was planning up until Ohio State confused me again. I certainly have not ruled out international medicine and nonprofit work as some part of my career, but I don’t see that any of the schools that has accepted me has a clear advantage on that front.
Perhaps one of the schools has someone on the faculty with experience in that area, and could mentor you. If I may inquire, how did Ohio State confuse you?
On Wednesday they awarded me a scholarship covering full in-state tuition, making them probably my least expensive option (since it’s easy to establish residency for tuition purposes in Ohio after a year or two). It’s an excellent program, but moving would be hard and Columbus is cold and far from both our families.
A good residency match would position me well for a fellowship in a competitive field.
Do competitive fields tend to be the highest-paying? I would have assumed that the fields where there were more people going in to them than spots available had relatively low pay due to supply and demand, and the highest pay was to be found by going in to a field that was somehow difficult, boring, or distasteful in a way that discouraged people from entering it.
Fair question. It seems that compensation is determined largely by what Medicare/insurance companies are willing to pay for procedures etc. I believe unfilled fellowship spots aren’t really a problem in any field, but the highest-paying subspecialties attract the most applicants. For example, cardiologists are very well-compensated, and cardiology fellowships are among the most competitive.
Right now I’d be leaning towards UF if I were you, I think, since my intuition is that $30-60K isn’t much debt relative to what physicians typically make. But have you thought about using instacalc.com or some other spreadsheet to actually tally up all the numbers related to fees, cost of living, expected career earnings, time value of money/disconting, etc.?
Congratulations on getting admitted to medical school, btw.
I had just about settled on UF when I was suddenly struck with SERIOUS FIRST WORLD PROBLEMS as Ohio State, the highest-ranked school that accepted me, offered me a scholarship covering full in-state tuition. Ohio is quite easy to establish residency in, so I’d probably only be out of pocket the difference between in-state and out-of-state tuition for the first year, but of course I’d have to move, and we’d be far from both our families.
I put together a spreadsheet taking into account the cost of moving, transportation costs, estimated change in rent, tuition and fees, and potential lost wages—and it looks like OSU could actually be the least expensive of the three, depending on whether I manage to establish residency in time to get in-state tuition my second year (I’m told this is the norm). My estimate for the difference between UF and FIU increased slightly to $40k-$70k. I am not sure what to do about estimated career earnings—lots of variance there, and I’m having a hard time weighing it against the costs, which I can be much more confident about.
I’m suggesting that you spend some time writing down what your third options are. Seems like a good thing to do in general. I don’t know what your third options are or how they compare to medical school, so I can’t say anything about that.
Ok, I agree that’s probably good advice in general. I’ve tried to avoid premature closure throughout the process of making this career change, but I’ll explicitly list some third options when I journal tonight. The bulk of my probability mass is in these two schools, though, so I am especially interested in advice that would help me choose between them.
Request for advice:
I need to decide in the next two weeks which medical school to attend. My two top candidates are both state universities. The relevant factors to consider are cost (medical school is appallingly expensive), program quality (reputation and resources), and location/convenience.
Florida International University Cost: I have been offered a full tuition scholarship (worth about $125,000 over four years), but this does not cover $8,500/yr in “fees” and the cost of living in Miami is high. The FIU College of Medicine’s estimated yearly cost of attendance (including all living expenses) is nearly $69,000; if I multiply that by four years and subtract the value of my scholarship I get about $145,000. However, my husband will continue working during all four years, defraying some of my expenses, so I hope to keep my actual indebtedness at graduation under $100,000 if I attend FIU. Program Quality: This is difficult to gauge, because the program is very new, having only graduated its first class of MDs this year. Their reputation is necessarily unestablished. All of their graduates successfully matched into residencies this year (a few in prestigious hospitals and competitive specialties), but this is reassuring rather than impressive. They only graduated 33 students although they matriculated 40 in their first year; not sure if that represents a worrying rate of attrition or what became of the other students (though I plan to ask). Another consideration is that although FIU is affiliated with many well-known hospitals in South Florida, they do not have a dedicated teaching hospital. Location/convenience: Already mentioned the higher cost of living. Miami is also farther from where we are currently living and working (over 3 hours away vs under 2 for Gainesville). My husband could probably find work in Miami, but it might be less desirable or pay less than his current job, and we would probably need to live apart during the week until he does. Also, the widely-scattered hospitals through which FIU students rotate, as well as South Florida traffic, make me worry about my quality of life during my third year.
The University of Florida Cost: I have been offered $7500 per year in aid. The rest of the $50k/year cost of attendance (including living expenses) would be loans. Again, my husband would continue to work and pay some of my expenses. In all I estimate a $30k-$60k difference in indebtedness at graduation between the two programs (in FIU’s favor). Program Quality: UF is Florida’s oldest and best-respected medical school, which is to say good but not elite. UF also has a reputable teaching hospital on campus, and a larger research budget, which would help build my resume if I decide to try for a very competitive specialty. They graduate 95% of their students within 4 years (98% in 5 years), and their residency match list looks a bit nicer than FIU’s on average. For what it’s worth (probably not much), I have a better feeling about this program’s “culture” based on the events I’ve attended. Location/Convenience: Gainesville is closer. It might be feasible for my husband to stay at his current workplace for all four years if we find a good place to live around midway between.
Other advice I have received: Jess Whittlestone at 80,000 Hours suggested I’d do best, impact-wise, to consider which school would maximize my earning-to-give potential. This would mostly depend on the specialty I go into—based on how I feel now, I’m most likely to try for an Internal Medicine subspecialty, which would mean doing a fellowship after residency. A good residency match would position me well for a fellowship in a competitive field. Physicians whom I have asked for advice tell me that people commonly match into even very competitive residencies from lower-ranked US MD schools, but it takes more work (better test scores, stronger evaluations). They also tend to say “OMG take the money” when I say the words “full tuition scholarship”.
You can probably tell that I lean towards UF, but I don’t want to make a bad call. What am I missing? What should I be asking the schools? Where should I go?
Although the FIU is new, its curriculum seems to fit the old Flexner I mold. I cannot tell the state of UF’s program from the site.
Research options at FIU appear limited, but if you have an interest in one among those available, this concern does not hold.
What do you want to pursue in a medical career? Research? Patient Care? Whatever earns the most money?
To find the necessary information if the answer is:
Research—Visit the school and investigate the status of its research department. Learn about ongoing studies, the attention ratios of the Principal Investigator to Junior Investigator to students, and the amount of freedom allowed in pursuing research interests.
Patient Care—Ask existing students of all years what their curriculum has been, and how much time they have spent with patients. Flexner I involves two years of study, then two years of practical application; Flexner II (an informal moniker) isn’t a set system as individual schools are slowly implementing and trying new and different things, but generally differs from Flexner I—for example, involving patient care as part of the first two years.
Money—There are many avenues to approach this. Naturally the more prestige your school has the better, as that will help determine the quality of your first post; however, with enough research publications you can make your own prestige, and research will always be a value marker. Your alma mater on the other hand matters less and less as time passes and jobs accumulate.
I plan on a career in patient care. I will almost certainly do research in medical school, but based on past experience I don’t expect to find it extremely compelling or to be extraordinarily good at it. Money concerns me if only for philanthropic purposes. The field that interests me most now (infectious disease) does not pay especially well, but I have decided that I really should seriously consider more lucrative paths that might let me donate enough to save twice as many lives in the developing world.
Both schools seem to have pretty solid clinical training and early patient exposure, to hear the students tell it (though they have little basis for comparison). I don’t have a strong preference between their curricula, except my worries about driving around between hospitals in Miami.
To me it then appears you have two (clear) paths in line with your preferences. Your emotional preference, what makes you happy, sounds like helping people in person (fuzzies). Your intellectual preference, goal, or ambition, could be paraphrased as, “Benefit to the highest possible positive degree the greatest number of people.” Your ideal profession will meet somewhere between the optimal courses for each of these two preferences.
I list these to avoid misunderstanding.
The first course is the one you’re pursuing—get an MD, work with patients to be happy, and donate to efficient high-utility charities in order to live with yourself. If the difference in cost will really only come out to 30-60k $US, you will be able to live with your husband while attending UF, UF is more prestigious, would cause you less worry, and if matriculating to UF makes you happier—then by all means attend UF! I’d be quite certain about the numbers, though.
The second course isn’t unique to medical professionals, but they do have special skills which can be of unique use. Go to a developing country and solve medical problems in highly replicable and efficient manners. This course probably meets your two preferences with the least amount of compromise.
If you’re unfamiliar with Paul Farmer, he went (still goes, maybe) to Haiti and tried to solve their medical problems—he had some success, but unfortunately the biggest problem with Haiti was governmental infrastructure, without which impact cannot be sustained.
The second course would involve you using medical expertise to solve medical problems, and acquiring either additional knowledge or a partner with knowledge of how to establish infrastructure sufficient to sustain your solution. The final step involves writing Project Evaluations on your endeavours so that others can replicate them in wide and varied locales—this is how you make an impact.
Not knowing anything about your husband, the above reasoning assumes he doesn’t have any impact upon the decision.
Thanks, your advice more or less coincides with what I was planning up until Ohio State confused me again. I certainly have not ruled out international medicine and nonprofit work as some part of my career, but I don’t see that any of the schools that has accepted me has a clear advantage on that front.
Perhaps one of the schools has someone on the faculty with experience in that area, and could mentor you. If I may inquire, how did Ohio State confuse you?
On Wednesday they awarded me a scholarship covering full in-state tuition, making them probably my least expensive option (since it’s easy to establish residency for tuition purposes in Ohio after a year or two). It’s an excellent program, but moving would be hard and Columbus is cold and far from both our families.
Do competitive fields tend to be the highest-paying? I would have assumed that the fields where there were more people going in to them than spots available had relatively low pay due to supply and demand, and the highest pay was to be found by going in to a field that was somehow difficult, boring, or distasteful in a way that discouraged people from entering it.
Fair question. It seems that compensation is determined largely by what Medicare/insurance companies are willing to pay for procedures etc. I believe unfilled fellowship spots aren’t really a problem in any field, but the highest-paying subspecialties attract the most applicants. For example, cardiologists are very well-compensated, and cardiology fellowships are among the most competitive.
Interesting.
Right now I’d be leaning towards UF if I were you, I think, since my intuition is that $30-60K isn’t much debt relative to what physicians typically make. But have you thought about using instacalc.com or some other spreadsheet to actually tally up all the numbers related to fees, cost of living, expected career earnings, time value of money/disconting, etc.?
Congratulations on getting admitted to medical school, btw.
Thank you!
I had just about settled on UF when I was suddenly struck with SERIOUS FIRST WORLD PROBLEMS as Ohio State, the highest-ranked school that accepted me, offered me a scholarship covering full in-state tuition. Ohio is quite easy to establish residency in, so I’d probably only be out of pocket the difference between in-state and out-of-state tuition for the first year, but of course I’d have to move, and we’d be far from both our families.
I put together a spreadsheet taking into account the cost of moving, transportation costs, estimated change in rent, tuition and fees, and potential lost wages—and it looks like OSU could actually be the least expensive of the three, depending on whether I manage to establish residency in time to get in-state tuition my second year (I’m told this is the norm). My estimate for the difference between UF and FIU increased slightly to $40k-$70k. I am not sure what to do about estimated career earnings—lots of variance there, and I’m having a hard time weighing it against the costs, which I can be much more confident about.
Congratulations on your first world problems! I don’t have any brilliant ideas on estimating career earnings, sorry.
Take a third option?
Do you have one in mind? Or are you just advising against medical school, and if so, why?
I’m suggesting that you spend some time writing down what your third options are. Seems like a good thing to do in general. I don’t know what your third options are or how they compare to medical school, so I can’t say anything about that.
Ok, I agree that’s probably good advice in general. I’ve tried to avoid premature closure throughout the process of making this career change, but I’ll explicitly list some third options when I journal tonight. The bulk of my probability mass is in these two schools, though, so I am especially interested in advice that would help me choose between them.