Yeah, the only people that I know who don't have >400000 in loans with a >5% interest rate coming out of residency have wealthy parents who paid for everything, did the military's HPSP program [1], or did a free 7-year MD/PhD program. It's an interesting process.

[1] https://www.medicineandthemilitary.com/joining-and-eligibili...

Plenty of medical schools give need-based financial aid. So those folks who took out loans probably came from pretty well-off middle class families.

Can you explain your logical reasoning for why you believe most folks with medical school debt come from well off middle class families?

I'm confused because need based financial aid for medical schools is still mostly loans. My partner who comes from a relatively poor family (they used to be on welfare) had most of their need based financial aid in the form of loans. Out of her residency class the highest % of folks taking out loans were from low to middle income families not well off families. So I'm curious where you got that stat from?

Anecdotally, I know some people who did not come from well off families who got need-based financial aid that covered the entirety of their medical school tuition. There was still some loans for living expenses but that’s about it.

There is well off, and then there is paying 400+k to several schools while also supporting their other kids and retirement savings etc.

A family in the top 5% of incomes with one child and zero financial issues and can pull it off. But, that’s well past just middle class.

It's interesting because you know we are weeding out talent that comes from low socio economic backgrounds and who need cash flow to support their families. At end of the day, we shouldn't be weeding out our doctors to only be folks who don't need to support their families for the next 10 years.

There is a limit put in place on supply (seats at medical schools) already. Weeding out is part of that system already. The question is should cost be part of that.. we decided somewhat yes which is fair if you decide to limit supply in the first place.

To limit supply is mostly to control price, like how OPEC controls oil. Current doctors have a vested interest in remaining a scarce commodity and lobby accordingly on the boards it matters.

The actual limit is residency slots. Every year there are many students who graduate from medical school but are unable to practice medicine because they can't get matched to a residency program.

Yep, that's the true barrier to entry. The main issue is there is that Congress has capped the Medicare funded residency roles to the same number since 1997 (Balanced Budget Act of 1997). In that time period, the US population has grown 21%.

Many people fail to become doctors and or lose their license for various reasons. So, it’s a huge gamble in the US that can easily cause massive financial issues.

What's interesting is that student pilots face those same issues now.

To go from ab initio to an airline pilot role, the cost is in the area of $200,000 - $250,000 now and there's a lot of ways to end up not getting picked for an airline job.

Entry salary is up from $18,000 to $40,000 or so now, but that's not much improvment considering the cost of training.

Part of the issue is the 1,500 hour experience rule, which is government-imposed. (There's an option for 1,200 hours, but then your major has to be airline-focused., preventing them from wisely diversifying their career options.)

US airlines are in a bind because their policy is to not subsidize initial training, but cannot fly without pilots.

And students are getting sticker-shock, and thinking about other careers with better ROI and certainty.

Yea, but that’s only half the story. Military pilots get training for free, which is vastly more and has massively suppressed airline pilot salaries. There are a few other approaches that can similarly reduce costs, but sticker shock is huge.

A friend of mine flies island-hopping cargo/shipping in the Puerto Rico area which is a common route to make money, live well, and get enough flight time to land a commercial pilot job in the future.