Debt, Jobs, & the FutureRobert G Good, DO, MACOI

Chief Medical Officer

Carle Health System

Health Alliance

Average Medical Student Debt

Undergrad

Medical School

STUDENT DEBT

Association of American Medical Colleges 2018

Cost of Debt

PMT NO PAYMENT DATEBEGINNING

BALANCE

SCHEDULED

PAYMENT

EXTRA

PAYMENT

TOTAL

PAYMENTPRINCIPAL INTEREST

ENDING

BALANCE

CUMULATIVE

INTEREST

1 8/17/2019 $235,000.00 $0.00 $0.00 -$1,175.00 $1,175.00 $236,175.00 $1,175.00

2 9/17/2019 $236,175.00 $0.00 $0.00 -$1,180.88 $1,180.88 $237,355.88 $2,355.88

3 10/17/2019 $237,355.88 $0.00 $0.00 -$1,186.78 $1,186.78 $238,542.65 $3,542.65

4 11/17/2019 $238,542.65 $0.00 $0.00 -$1,192.71 $1,192.71 $239,735.37 $4,735.37

5 12/17/2019 $239,735.37 $0.00 $0.00 -$1,198.68 $1,198.68 $240,934.04 $5,934.04

45 4/17/2023 $292,667.56 $0.00 $0.00 -$1,463.34 $1,463.34 $294,130.89 $59,130.89

46 5/17/2023 $294,130.89 $0.00 $0.00 -$1,470.65 $1,470.65 $295,601.55 $60,601.55

47 6/17/2023 $295,601.55 $0.00 $0.00 -$1,478.01 $1,478.01 $297,079.56 $62,079.56

48 7/17/2023 $297,079.56 $0.00 $0.00 -$1,485.40 $1,485.40 $298,564.95 $63,564.95

49 8/17/2023 $298,564.95 $0.00 $0.00 -$1,492.82 $1,492.82 $300,057.78 $65,057.78

Cost of Debt

LOAN AMORTIZATION SCHEDULE

ENTER VALUES LOAN SUMMARY

Loan amount $235,000.00 Scheduled payment $1,983.06

Annual interest rate 6.00% Scheduled number of payments 180

Loan period in years 15 Actual number of payments 180

Number of payments per year 12 Total early payments $0.00

Start date of loan 8/17/2019 Total interest $121,951.44

Optional extra payments $0.00 LENDER NAME THE BEST DEAL LOAN

PMT

NOPAYMENT DATE

BEGINNING

BALANCE

SCHEDULED

PAYMENTEXTRA PAYMENT TOTAL PAYMENT PRINCIPAL INTEREST ENDING BALANCE

CUMULATIVE

INTEREST

1 8/17/2019 $235,000.00 $1,983.06 $0.00 $1,983.06 $808.06 $1,175.00 $234,191.94 $1,175.00

2 9/17/2019 $234,191.94 $1,983.06 $0.00 $1,983.06 $812.10 $1,170.96 $233,379.83 $2,345.96

3 10/17/2019 $233,379.83 $1,983.06 $0.00 $1,983.06 $816.16 $1,166.90 $232,563.67 $3,512.86

4 11/17/2019 $232,563.67 $1,983.06 $0.00 $1,983.06 $820.25 $1,162.82 $231,743.42 $4,675.68

5 12/17/2019 $231,743.42 $1,983.06 $0.00 $1,983.06 $824.35 $1,158.72 $230,919.08 $5,834.39

6 1/17/2020 $230,919.08 $1,983.06 $0.00 $1,983.06 $828.47 $1,154.60 $230,090.61 $6,988.99

7 2/17/2020 $230,090.61 $1,983.06 $0.00 $1,983.06 $832.61 $1,150.45 $229,258.00 $8,139.44

8 3/17/2020 $229,258.00 $1,983.06 $0.00 $1,983.06 $836.77 $1,146.29 $228,421.22 $9,285.73

9 4/17/2020 $228,421.22 $1,983.06 $0.00 $1,983.06 $840.96 $1,142.11 $227,580.27 $10,427.84

10 5/17/2020 $227,580.27 $1,983.06 $0.00 $1,983.06 $845.16 $1,137.90 $226,735.10 $11,565.74

11 6/17/2020 $226,735.10 $1,983.06 $0.00 $1,983.06 $849.39 $1,133.68 $225,885.72 $12,699.42

12 7/17/2020 $225,885.72 $1,983.06 $0.00 $1,983.06 $853.63 $1,129.43 $225,032.08 $13,828.84

13 8/17/2020 $225,032.08 $1,983.06 $0.00 $1,983.06 $857.90 $1,125.16 $224,174.18 $14,954.00

14 9/17/2020 $224,174.18 $1,983.06 $0.00 $1,983.06 $862.19 $1,120.87 $223,311.99 $16,074.88

15 10/17/2020 $223,311.99 $1,983.06 $0.00 $1,983.06 $866.50 $1,116.56 $222,445.48 $17,191.44

16 11/17/2020 $222,445.48 $1,983.06 $0.00 $1,983.06 $870.84 $1,112.23 $221,574.65 $18,303.66

17 12/17/2020 $221,574.65 $1,983.06 $0.00 $1,983.06 $875.19 $1,107.87 $220,699.46 $19,411.54

18 1/17/2021 $220,699.46 $1,983.06 $0.00 $1,983.06 $879.57 $1,103.50 $219,819.89 $20,515.03

19 2/17/2021 $219,819.89 $1,983.06 $0.00 $1,983.06 $883.96 $1,099.10 $218,935.93 $21,614.13

20 3/17/2021 $218,935.93 $1,983.06 $0.00 $1,983.06 $888.38 $1,094.68 $218,047.54 $22,708.81

21 4/17/2021 $218,047.54 $1,983.06 $0.00 $1,983.06 $892.83 $1,090.24 $217,154.72 $23,799.05

22 5/17/2021 $217,154.72 $1,983.06 $0.00 $1,983.06 $897.29 $1,085.77 $216,257.43 $24,884.82

23 6/17/2021 $216,257.43 $1,983.06 $0.00 $1,983.06 $901.78 $1,081.29 $215,355.65 $25,966.11

24 7/17/2021 $215,355.65 $1,983.06 $0.00 $1,983.06 $906.29 $1,076.78 $214,449.36 $27,042.89

25 8/17/2021 $214,449.36 $1,983.06 $0.00 $1,983.06 $910.82 $1,072.25 $213,538.55 $28,115.14

26 9/17/2021 $213,538.55 $1,983.06 $0.00 $1,983.06 $915.37 $1,067.69 $212,623.18 $29,182.83

27 10/17/2021 $212,623.18 $1,983.06 $0.00 $1,983.06 $919.95 $1,063.12 $211,703.23 $30,245.94

28 11/17/2021 $211,703.23 $1,983.06 $0.00 $1,983.06 $924.55 $1,058.52 $210,778.68 $31,304.46

29 12/17/2021 $210,778.68 $1,983.06 $0.00 $1,983.06 $929.17 $1,053.89 $209,849.51 $32,358.35

30 1/17/2022 $209,849.51 $1,983.06 $0.00 $1,983.06 $933.82 $1,049.25 $208,915.70 $33,407.60

31 2/17/2022 $208,915.70 $1,983.06 $0.00 $1,983.06 $938.49 $1,044.58 $207,977.21 $34,452.18

32 3/17/2022 $207,977.21 $1,983.06 $0.00 $1,983.06 $943.18 $1,039.89 $207,034.03 $35,492.07

33 4/17/2022 $207,034.03 $1,983.06 $0.00 $1,983.06 $947.89 $1,035.17 $206,086.14 $36,527.24

34 5/17/2022 $206,086.14 $1,983.06 $0.00 $1,983.06 $952.63 $1,030.43 $205,133.51 $37,557.67

35 6/17/2022 $205,133.51 $1,983.06 $0.00 $1,983.06 $957.40 $1,025.67 $204,176.11 $38,583.33

36 7/17/2022 $204,176.11 $1,983.06 $0.00 $1,983.06 $962.18 $1,020.88 $203,213.93 $39,604.22

Cash flow

Student 2373 281200

house 1773 350000

car 872 30000

5018 661200

take home

salary 251600 155992 $ 12,999.33

available $ 7,981.33

Does not consider

Spouse or partner

Debt.

medical doctors in established practices who had graduated prior to 2015.

Weatherby Healthcare surveyed more than 500 actively practicing physicians

Weatherby Healthcare surveyed more than 500 actively practicing physicians

Options to reduce debt

National Health Service Corp

State Loan Repayments for shortage practice

Students to Service Loan Repayment Program

Indian Health Service

Military Healthcare Loan Repayment

$50,000 for 2 years service

$120K last year of

COM to serve 3 yrs

Loans

Stafford Loans

GradPLUS Perkins

HRSA Primary Care Private

Max $224K @ 5.84%7% but no limit Exceptional $ need. 5%

$60K max

Cost of attn 5%. Primary

Care for 10 years.Variable rates

Repayment Plans

Income Based (IBR)

• 10% of DI

• 20 year plan

Income Contingent (ICR)

• 20% DI

• 25 years

Pay as Earn (PAYE)

• 10% DI

• Never >10 yrpmt

Revised Pay as Earn (REPAYE)

• 10% DI

• 20 yrs

DI= Discretionary Income (income left over after living expense). Use calculators.

If income $250K, married and spouse earn $50K + 1 child = $269370. 2 children=$263100

Avoiding Debt

Avoiding Debt

•Understand debt

•Good vs bad

• BUDGET

•Mindful spending

•Keep Up to Date, even if negative

•Keep FICO score

Pay bills on time

Know your Net Worth

Think BIG picture

Maximize Cash FlowDoes purchase

Advance the goal?

cars not good invest but

have a need for function

Set Your Priorities

Save over spend

Think Long Term

Start Retirement

Fund

Maximize your

benefits

What is your Mission & Goals

Prepare a CV

•Have one always available and updated

•Limit to 1-2 pages

•Professional appearance• Grammar and spelling

Recruiters

• In-house recruiters vs recruitment firms• May work on contingency

Benefits

Compensation Changes

Specialty 2017 $ 2018 $ % changePsychiatry 256400 296388 15.6

Endocrinology 252111 269750 7.0

Family Medicine 244799 260108 6.3

Internal Medicine 258027 273254 5.9

Cardiology 497888 519964 4.4

Pediatrics 245153 245043 -0.4

Gastroenterology 529880 527998 -0.4

Diag Radiology 487239 482599 -1.0

OB/GYN 345908 340388 -1.6

Ophthalmology 450500 385168 -5.0

Medical Economics - September 2019

Future needs in health care

• Primary care Internal Medicine• Endless opportunity

• Severe nationwide shortage with high demand

• Greatest job security

• Flexible schedules

• Limited call responsibilities

• Increasing compensation as valued based care is required by CMS

• Future of Hospital at Home and advanced ambulatory care

Future needs in health care

• Hospital medicine• Still a demand but starting to see market saturated

• Compensation has leveled

• Shift work – generally 12 hour – 7 day on then off 7 days

• Because of deficiency in internal medicine ambulatory care, some hospitalist roles are being shifted to ambulatory medicine

• Transitionist

• Sniffist

• Future needs to inpatient medicine will decline as value based medicine becomes a reality

Future needs in health care

• Cardiology• Demand is being met – most areas of the country have sufficient cardiology

• Compensation has leveled though still good

• Call schedule can be severe

• Pulmonary• Critical care and sleep needs seem to be met

• Compensation stable

• Rheumatology• Increased demand with aging population and disease altering medicines

• Income has increased

Future needs in health care

• Gastroenterology• Demand still high. As value based compensation becomes prevalent and

alternatives to procedures become available, expect decreased demand

• Compensation still high

• Highly competitive fellowships

• Palliative Medicine• Demand will increase along with value based medicine

• Salaries may not correlate with demand

Future needs in health care

• Oncology & Genetics• Demand will increase with new techniques that are disease changing

• Genetic therapy will become dominant feature in future

• Requires substantial population base

• Limited Genetic training programs currently