As a topic of discussion, financial burden is popular among my cohort and medical students across the nation. The following will explore the effect of unexpected expenses during undergraduate medical education on mental well-being, with emphasis on the perception of self-determination and the range of solutions to improve financial wellbeing.
First, a brief description of a day all-too familiar for many students: My Monday contains a quiz to prepare for, a cadaver lab to complete, a return home to pending laundry, further study, and an apparent lack of groceries. I do not have time to shop for groceries tonight, as I must launder soiled clothes and continue my coursework preparation. The next day, I inevitably spend far more on a single meal for the sake of convenience and satiating a gnawing hunger than I would have spent per meal had I simply retrieved groceries the night prior. Rinse, repeat. Meticulous schedules and financial planning combat these unexpected expenses. But I am both fallible and a victim to circumstance.
Some weeks are better than others. Perhaps there’s a day where lecture material is particularly difficult for me, and to remain caught up with my coursework, I study. This time was supposed to have been spent preparing meals for the coming days, so I end up eating out more than I had planned. Or, if I do decide to prepare my meals, then I lose out on time to study. Or I pay for visitor parking because that saves the fifteen-minute walk to take my morning quiz. All this to say, the unexpected expenses of medical education lie in places outside of costs even latently related to our courses.
As we accumulate these expenses, either willingly, reluctantly, or forcibly, we perceive an increasing lack of control over our lives. I can no longer control my spending the way I wanted to, and now I believe it to be a futile effort to regain control. Thus, I continue to spend for convenience and feel worse about the circumstance that I am actively perpetrating. This is not my first choice, but something I feel that I am forced to do. It feels that I no longer hold my financial well-being in my own hands; I’m half-heartedly claiming to save money, all the while, my actions dictate otherwise.
In some of us, the surrender may have happened almost immediately following the acceptance of student loans. Already staring down the barrel at hundreds of thousands of dollars, it is an accepted and expected trade to make. I spend government money for four years so that I may focus solely on my studies, and I will repay the looming sum of the loan itself and its interest - variable and fixed. So, what more are the minor expenses I accrue each month? If the cause is lost anyway, what difference does it make if I must pay half a million dollars in four years anyway? Is there a point in worrying about the extra $100-200 now? It appears financial literacy is all but lost. We gave it away upon loan disbursement. The stress of school trumps penny pinching, and if I can use money to assuage it in any way, then that is what I will do.
In this dramatization of a common plight, I have described a dimension of expense that can exacerbate feelings of helplessness. Agency is paramount to mental health; our perceptions of how much control we have over our lives drastically affect happiness and contentment. A four-year program that, for most graduates, will eventually necessitate another three years (minimum) of training is disadvantageous to the promotion of feeling manifestly independent. This is a commitment we all knowingly and lovingly make. Unexpected medical education expenses are a symptom of that commitment, but mitigation of that stressor is important. Ideas for reform are being pushed forth constantly, and I am hopeful for salient solutions in our future.
But it would be both facetious and defeatist to claim that control over our own futures lies entirely outside of our hands. Solutions we have control over range from individual initiatives we can take daily all the way to policy-level choices we may help affect. Let us zoom in. There are things we can do as individuals to address stressors related to unexpected expenses. I will share two strategies that I have successfully relied on thus far. First: at the start of each semester, it is useful to allow yourself grace. Adjustment periods help me to learn and anticipate the areas in which I find myself spending the most. For example, I notice my new course schedule causes me to lose the time previously allocated to both walking my dog and preparing dinner, creating the expense of quick dinner a couple of nights a week. My personal routine can then be adjusted to walk my dog in the morning, shifting the order of responsibilities so that I regain the time to cook dinner. Though this is not foolproof, remaining adaptable and flexible within strict scheduling has been a great asset.
Second: do not be afraid to stray from routine. It can be scary to do so, especially when many of us rely on routine not only to remain financially in check, but also to keep up with the demands of medical education. But straying from routine could mean identifying a lull in coursework - and rather than following the title “Library” coded yellow in my calendar for that day, going back home to organize my living space or do laundry. This promotes flexibility for the future me and optimizes efficiency for the current me.
Both strategies presented have the bridging essence of opportunism and dynamism, for the sake of economy and sovereignty. All of us are self-starters. Be unafraid to change your routine and recognize that rigidity may - at times - be disadvantageous.
Zooming back out, we are presented with assorted options to offset the costs of medical education on much larger scales. These address the root cause of expense stressors: student loans. The choices range from loan forgiveness programs to repayment assistance to service commitments to scholarships, whether merit- or need-based. Existing programs within these categories can be granted from the federal level, such as Public Service Loan Forgiveness (PSLF). There are also options from the state level and local funds that hold scholarships for qualified students, such as school-specific scholarship essay contests.
But this range of choice does not negate the necessity to push for top-down reform. Recently, the Department of Education rolled out the Saving on a Valuable Education (SAVE) plan. Federal district courts in Kansas and Missouri led the effort in blocking the new provisions of SAVE set to begin July 1st of this year, such as reducing income-dependent payments and loan forgiveness itself. The reasoning in both cases holds that the Biden administration overstepped its authority; loan forgiveness is under Congressional discretion.
Soon after, an August appellate decision from the 8th Circuit backed Missouri’s preliminary injunction. The Biden administration responded to these rulings with a plea to the Supreme Court but was promptly rebuffed. Currently, the SAVE plan is on hold as nearly 8 million borrowers have already enrolled. As plans for federal loan forgiveness are implemented, rejected, and argued over, livelihoods hang in the balance of constitutionality.
Our government’s foundation is upheld by the citizens’ acquiescence to our social contract; that is, democratic rule. Loan forgiveness is a sweeping topic, affecting many. It is of utmost importance to pay attention to policies and platforms that affect us individually, because each voice and opinion do matter. As previous elections and current events have proven, political participation affects changes that impact us all. And pertaining more specifically to us, the medical field and the very nature of practice are directly impacted by legislative activity. As aspiring and current physicians, we are exposed to settings in which we can fight for patients and community and care. This can manifest in the forms of civic duty, volunteering, donations, and even directly speaking to policymakers. Advocacy for others is a pillar of the medical profession, and that ought to translate to advocacy for ourselves. Power truly is of the people.
About the Author: Emma Tao is first-year medical student at Long School of Medicine. She completed her undergraduate studies at University of Texas at Austin in government and classical texts.