'Working 80 Hours a Week Leaves Very Little Time to Waste Money'

A doctor of disadvantaged patients details her long and arduous path to financial security:

I grew up in a lower-middle class setting: My father was an engineer, my mother a teacher’s aide, then a teacher. I never had to worry about food on the table, much less a roof over my head, but there was no room for extras. By the time I was in high school, we were settled very comfortably in middle class.

Then the recession of the early 2000s hit, the company my father worked for closed down, and I graduated high school and started college, with my parents living on a single income and my elementary school-aged brother still at home.

By nature (and perhaps a little by nurture as well), I was always a frugal person, but knowledge that my parents were borrowing almost $40,000 a year to pay my college tuition kept me on the very straight and narrow. I only ate the two meals a day that were included in my room and board. I walked everywhere. The rare trips into the city were done via public transportation.

After I graduated from college, I attended medical school, and this time, the student loans were in my name.

I lived with a roommate in a 750 sq ft convertible apartment to cut down on costs. My living costs at that time were kept to an absolute minimum despite living in one of the most expensive cities in the country, but I still got a little sick every time I signed the paperwork to borrow yet another year’s worth of tuition. By the time I graduated, I had paid over $180,000 in tuition at a handsome 6.8% interest rate. My parents had graciously covered my living costs. My friends who were not as fortunate owed nearly $250,000.

In the United States, you are not allowed to practice medicine until you have completed a training period called residency. Residency can vary between 3 to 7 years depending on your career decisions. It is essentially a period of indentured servitude, during which you work 80 hours a week for 49 weeks a year, and receive a federally set stipend in exchange.

The year I started residency, my salary was approximately $45,000 per year—an hourly wage of just over $11. Despite this, I was able to save 30% of my take-home pay. The positive effect of working 80 hours a week is it leaves very little time to waste money.

I started on income-based repayment of my student loans as soon as my grace period ended, but the monthly payments weren’t even covering one-third of the accruing interest. Following residency, some people choose to pursue further training during a period call fellowship. Fellowships vary from 1 to 4 years, during which you work almost as much as in residency and receive a slightly higher stipend. I continued to save as much as possible, and my husband and I were able to pay for our small wedding in cash. I continued income-based repayment, but the student loan principal kept growing, with interest capitalizing year on year.

Finally, after 6 years of post-graduate training, I took my first job at a university hospital almost a year ago. Physicians who practice medicine in an academic setting generally make substantially less than their private practice counterparts. While I make a very handsome salary, it is still only two-thirds of the salaries of my friends in private practice.

My husband, who has a doctorate, is still looking for employment, 9 months after our relocation. [See here for a reader discussion centered on the question, “Is a Ph.D. Worth It Anymore?]

We continue to rent, but we’re hoping to buy a house in the next several years; we have saved enough for a full 20% down payment. We are both in our 30s, and have deferred having children due to school and training, are anxious that attempting to have children will incur yet another cost in the form of high-risk pregnancy or IVF.

This year, I will max out my 403(b) and Roth IRA. The principal on my student loans have capitalized year upon year, and now are almost $200,000, despite being on income-based repayment for 6 years.

I logically understand that my financial future is secure. We are still on track to be financially independent by the age of 50, even if we do have children. The years of setting a budget and saving like a fiend during residency (and during graduate school for my husband) has left us in an enviable position. Because I work in an underserved area, the balance of my student loans will be forgiven after 120 payments, approximately 4 more years. I have no undergraduate student loan debt. My husband, mercifully, does not have any student loans, nor any other debt.

But despite making a salary that puts me comfortably in the 1% of earners in the state, I remain anxious about money. My husband is unemployed. My student loans exceed the size of the mortgage that my parents borrowed for their house.

Although my parents and my husband’s parents are financially secure, I know how quickly one hospitalization can completely destroy financial stability. My brother is finishing college, and I intend to pay for his graduate school costs so that my parents won’t enter their retirement years with that burden.

My in-laws are still paying off the student loans that they incurred for my husband and his siblings. Retirement plans were not available to us during residency and fellowship and I certainly wasn’t contributing during medical school, so I have 10 fewer years of retirement savings than my college classmates who did not pursue my path.

I am certainly grateful for the opportunities afforded to me by my parents, and I am extremely fortunate to be able to work every day in a position I love, impacting people in a very important and direct way. I wouldn’t say I made any huge financial missteps in my life, although I do wish I had started investing sooner and more aggressively. If retirement plans had been available to me, I certainly would have started saving specifically for retirement sooner.

The biggest financial lesson I have learned, though, is that lifestyle inflation is dangerous. I am still able to aggressively save because I never felt the need to upgrade just because I could. Because of that fundamental belief, I will always be able to work at a job I love, even if it is not as lucrative.