6.1) How expensive is medical school?

  Very. According to the AAMC's Medical School Admissions
  Requirements, the range of tuition and student fees for 1996-1997
  first-year students was:

			     Range       Median      Mean
   Private, Resident:     8,152-31,925   24,925     23,835
   Private, Nonresident: 16,403-31,925   25,224     25,407
   Public, Resident:      2,908-20,129    9,107      9,921
   Public, Nonresident:  10,680-51,669   21,129     22,153

  Keep in mind that these figures represent only tuition and
  fees. Other expenses include room and board, books, equipment,
  transportation, insurance, and personal expenses.  In all, these
  additional expenses can easily be up to $15,000 per year.

6.2) How can I pay for medical school?

  The first consideration is to reduce your expenses.  The less
  expensive schools tend to be public schools within your state.  If
  you don't have a medical school in your state, you may be eligible
  to attend other state schools as an in-state resident through an
  exchange program such as WICHE, the Western Interstate Commission
  for Higher Education, which allows students from Alaska, Montana,
  and Wyoming to apply to and attend any western medical school as a
  state resident (with the exception of the University of Washington).
  Another major expense that can be reduced, if you qualify, is the
  cost of application.  Be sure to apply for an AMCAS fee waiver (if
  you qualify), which can save you hundreds of dollars.

  Unfortunately, reducing expenses still leaves, in most cases, tens
  of thousands of dollars to pay.  The most common way to pay this is
  via loans, particularly federal Stafford loans and private
  alternative loan programs.  While some Stafford loans may be
  subsidized (the government will pay the interest while you are in
  school), there is a limit to the amount you can borrow.  Other loan
  programs are often offered by the various schools.

  Grant aid (aid you don't have to repay) is not common.  Most schools
  offer a minimal amount of merit- and/or need-based grant aid.  There
  are also two programs that will cover the entire cost of school plus
  give you a stipend.  The first, the Medical Scientist Training
  Program, is a highly competitive government-subsidized program
  designed to recruit students interested in earning both an M.D. and
  a Ph.D.  The second, the Uniformed Services University of the Health
  Sciences, is the military's medical school.  In return for years of
  service to the military, your education is paid for in addition to
  your receiving a commission in the military and the concomitant
  salary and benefits.

  Another possibility for covering your expenses is to obligate
  yourself to later service.  Two examples of this type of program are
  the Armed Forces HPSP and the Public Health Service program, both of
  which provide payment for medical school in return for a commitment
  to serve in either the military or in underserved public health
  regions, respectively.

  Finally, be sure to search the Web and other sources for private
  scholarship sources.  You may be eligible for free money or favorable
  loans due to your extracurricular activities, ethnicity, religion,
  heritage, or any number of other factors.  Your school's financial aid
  office will be happy to suggest sources to you as well as discuss means
  of payment.

6.3) Can you tell me about Armed Forces scholarships?

  The Armed Forces Health Professions Scholarship Program (HPSP) is a
  scholarship between two to four years in length offered to students
  in schools of medicine, osteopathic medicine, dentistry, and
  optometry.  HPSP students receive full tuition, school-related
  expenses, and a stipend as benefits.  The stipend is currently (as
  of 8/98) around $912/month, paid in two parts on the 1st and 15th
  days on each month by direct deposit.  Expenses are reimbursed by
  the submission on an itemized form with receipts and a signed
  approval letter from your school stating that the expenses you claim
  are reasonable ones for your curriculum; typically, most texts and
  equipment (i.e., stethoscopes, lab coats) are paid without any fuss.
  Tuition is paid directly to your school.

  Basic requirements for the HPSP are that you are a U.S. citizen and
  meet the qualifications for commissioning as a military officer.
  There is an application and interview process which takes place at
  about the same time as med school apps.  (Of course, you do have to
  actually get into med school in order to receive it.)  The HPSP is
  offered through the Navy, Army, and Air Force (the Marine Corps is
  part of the Department of the Navy and is served by Naval docs, and
  the Coast Guard is staffed by docs from the Public Health Service).

  In return, you owe as many years of service to the military as you
  received in support.  Residency does not count towards this payback
  time.  What you actually wind up doing, of course, varies according
  to your specialty; there isn't a huge need for pediatric
  neurosurgery about the average aircraft carrier, for example.

  What are the advantages to this little Faustian bargain?  Well, for
  starters, there are the financial benefits.  The more frugal
  students will emerge from med school debt-free, and those who live a
  little higher on the hog will owe relatively small student loans.
  Salary during residency is about $10,000/yr greater in the military
  (in the neighborhood of $40,000 for interns, $50,000 for more senior
  residents).  Even post-residency, you won't starve; average
  attending salaries vary by specialty, rank, and years of service,
  but most wind up in the neighborhood of $100,000/yr as junior
  attendings (typically O-4 in rank: a lieutenant commander in the
  Navy, a major in the other two).  You are automatically commissioned
  as an O-1 while a med student (ensign in the Navy, 2nd lieutenant in
  the other two) and are promoted to O-3 on graduation
  (lieutenant/captain).  There are some pretty entertaining places to
  work in the military that you might not the chance to work near in
  the future: Europe, Asia, and so forth.  And of course, medicine is
  medicine: patients can be much the same no matter where you work,
  and in any case the majority of patients in the military system are
  not actually active duty troops but retirees and dependents.
  Benefits can be nice as well: 30 days paid vacation each year, no
  overhead, and full medical/dental coverage.

  Military residencies, by the way, are generally quite good.  When
  considering your training site come application time, you do want to
  think about issues like patient volume, didactics, and so forth,
  just as in any residency, but board pass rates for military
  residency grads have been uniformly excellent, and people have
  gotten into fine fellowships with minimal difficulty.
  (Incidentally, if you do a civilian fellowship as an active duty
  officer, the military will still pay you as an attending.  Which is
  pretty sweet.)

  Now for the downside.  You are sacrificing a few years of your life,
  in a sense.  Although a flexible mindset and a willingness to
  compromise will help you get a good posting, not everyone in the
  Navy gets to go to Italy or San Diego.  Internship and residency are
  relatively separate entities and require separate applications, not
  only for fields like anesthesia but even for fields with categorical
  internships like internal medicine or general surgery.  Not only
  that, there is a risk that you will have to spend a couple of years
  away from training between your R-1 and R-2 years as a general
  medical officer, or GMO.  This risk is greatest in the Navy overall
  but present in the Army and Air Force; it is also greater if you
  plan on pursuing a more specialized field like neurosurgery or
  anesthesia.  Medicine, peds, and family med residents are more
  likely to complete their training uninterrupted.  GMO tours vary
  between one to three years in length.

  (A brief proviso on the whole GMO thing.  An anesthesiology
  attending at the National Naval Medical Center in Bethesda spent
  three years as the medical officer aboard the USS Belknap in the
  Mediterranean, and he loved it.  After finishing his tour, he went
  on to his residency at Mass General.  So it's not the kiss of death.
  Also, GMOs are a dying breed.  The DoD is currently working out a
  plan to abolish GMOs and staff those positions with
  residency-trained docs.  So stay tuned.)

  The military is a startlingly bureaucratic organization which has
  little ways of reminding you that it is, in fact, a branch of the
  federal government.  For physicians, though, military medicine is
  actually not really different than working for a good HMO.  Research
  in military medicine is quite impressive, incidentally, although its
  work is often very practical in orientation.  There are good
  research ties with the NIH and CDC, and most residencies are very
  supportive of research (and may in fact require it of residents).

  There are a certain number of people each year in the HPSP who defer
  their commitment in order to do civilian residencies.  The exact
  number varies depending on the year, the specialty, and the needs of
  the service.  If you want to defer, it helps to have a good reason
  (i.e., spouse's job) and to not be rude (e.g., "I want to defer
  because military residencies are inferior").

  If you want to postpone the decision about military service, there
  is a financial assistance program (FAP) available to residents in
  most specialties, wherein you get about $30,000/yr on top of your
  civilian salary to repay loans (or buy a new car, possibly) in
  exchange for an equivalent number of years of service.

6.4) Can you tell me about Public Health Service scholarships?

  The Public Health Service offers a scholarship (The National Health
  Service Corps, <http://bphc.hrsa.gov/nhsc/>) paying full tuition,
  books, and supplies, and a monthly stipend, with the following
  requirements:

   1) You must enter a primary care-type of residency (medicine,
   family med, peds) or at least something that's close (OB/GYN,
   psych), or a residency combining two of the above fields.  A main
   limitation is that the residency not take more than 3 or 4 years.
   After serving your commitment you can undergo further medical
   training (i.e., fellowships).
   
   2) You must serve one year in a federally-designated underserved
   area of your choice for each year the NHSC paid your tuition
   (minimum two years), be it an inner city (30% of sites) or a rural
   cow town (70% of sites).

   3) As of December 1998, the IRS has deemed ALL parts of the NHSC
   scholarship as taxable, including tuition.  So, if you go to a
   school that costs $28,000 per year, taxes will leave you with about
   $350 from your monthly $950 stipend.  The NHSC has been trying to
   get Congress to reverse the IRS's reading of the law, but to no
   avail as of yet.

  There are similar programs available through various state
  governments and the Indian Health Service, some funded by the NHSC.

  Physicians who have completed training in a primary care field are
  eligible for Public Health Service positions, with opportunities for
  loan repayment.  Some feel that this may be a better choice, as you
  are not locked into a primary care field without first going through
  your medical school rotations.  See the NHSC web site for more
  information.
	
6.5) Can I really borrow more than $10K/yr in Unsubsidized
     Stafford Loans?

  With the phaseout of the HEAL program at all schools, the Department
  of Education has now authorized increased unsubsidized Stafford loan
  limits for Health Professions Students.  This limit is now $30K/yr.

  The Student Financial Aid Handbook section detailing these limits
  may be found at:
  <http://ifap.ed.gov/sfahandbooks/attachments/0102Vol8Ch3loanperiodamts.pdf>.