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We sit down with Christina Stach, a medical student who shares her powerful journey of navigating the financial hardships of medical education. Christina’s story sheds light on the unique challenges faced by first-generation, low-income students and the impact of these struggles on mental health, diversity in specialized fields, and the future of health care.

Christina Stach is a medical student.

She discusses the KevinMD article, “Making medicine my home.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. So today we welcome Christina Stach. She’s a medical student, and her KevinMD article is “Making medicine my home.” Christina, welcome to the show.

Christina Stach: Hi, thanks for having me.

Kevin Pho: So I understand you are a medical student. What year are you in?

Christina Stach: I’m a fourth year.

Kevin Pho: And how has your medical school journey been so far?

Christina Stach: It’s been pretty interesting. I had a pretty non-traditional background, so getting into the swing of being very medical and scientific was a little tough, but now that I’m in the clinical years it’s a lot easier.

Kevin Pho: All right, so any particular field or specialty that you’re thinking of applying to for residency?

Christina Stach: Yes, this fall I’m applying into orthopedic surgery.

Kevin Pho: Wonderful. Well, best wishes to you.

Christina Stach: Thank you.

Kevin Pho: Perfect. So your KevinMD article is titled “Making medicine my home.” So tell us what led you to write this article, and for those who didn’t get a chance to read it, then tell us about the article itself.

Christina Stach: Yeah, so at Dartmouth we are allowed to do our rotations all throughout the country. So we can do all of them in the Upper Valley of New Hampshire if we would like to, or we can go to locations throughout the entire nation. So Alaska, Arizona, New Mexico, throughout California, all throughout the East Coast. So when we go to those away rotations we are afforded housing. And for me, I was not actually able to afford housing in the Upper Valley of New Hampshire itself, so I elected to rotate throughout the country so I could have provided housing.

So the thesis of “Making medicine my home,” it started out as like, oh, this is what it was like having to choose to make medical school kind of be my home instead of having a real home for a while. And then I realized that there were a lot of choices that I had to make that a lot of my friends didn’t have to make.

Being a low-income student, I had to work for the entirety of undergrad, for the entirety of my postbac education, and then for the first two years of medical school. And then when I got to the clinical education I couldn’t afford to work anymore, timewise. So then I couldn’t afford to live in a house, so I was, I don’t know if I could technically say homeless, I still had a mailing address, but I lived in my car.

And one of the things I mentioned in the article is I had to choose between taking practice tests and eating a warm meal, and a lot of my friends didn’t have to make that decision. So I thought it was a good time to kind of reel all that in together, talk about how it was interesting to travel around and be a medical student on the road for so long, but also it wasn’t really a choice that I really got to make for myself, and it’s not a choice that other people think about.

Kevin Pho: So give us some context. In general, what is the average cost of a medical education today?

Christina Stach: You know, I’m not too sure. The average debt incurred for a Dartmouth medical student is somewhere between 180 and 200,000 dollars for the entirety of your time there, but it does vary. For me, at the end of my fourth year I will be $280,000 in debt from Dartmouth alone. I have no other debt, my car is completely paid off, I had nothing from undergrad or my postgraduate education. So for me it’s quite high.

There are other students that definitely have a lot more. One of the residents that I’m working with currently says that he has $600,000 of loans, so it’s pretty expensive nowadays. One of my attendings actually, he has been back at Dartmouth, he has been in practice for 16 years, and he just now paid off his med school loans as an orthopedic surgeon, which is kind of wild. So it’s pretty expensive.

Kevin Pho: So tell us maybe a story about how some of these financial considerations kind of influenced your day-to-day life. So what would be an example of some of that influence where you had to make a choice?

Christina Stach: Yeah, I think the first one that comes to mind is the one that I’d mentioned, because it happened on a couple of occasions. I don’t know how familiar people are with how med school works nowadays, but at the end of every rotation we have to take a shelf exam, and the shelf exam is like a final that kind of makes up the grade for this course.

And for something like orthopedic surgery it’s very competitive, you want to have really good grades. So for me I wanted to make sure I had plenty of practice, and those practice exams cost money, sometimes up to $30. And we do get some free ones here and there, but you need to practice more than just the one time, and I couldn’t afford to practice more than just the one time. I had to knock it right out of the park the first time, or I could just decide to allocate my budget elsewhere. So that was a really big one.

On a pretty daily basis, there was a time when I was on my family medicine rotation where I couldn’t afford anything at all. I had to front some of my hotel bills because of some misunderstanding with the financial department at my school, and my credit card was at a limit that I couldn’t really uphold, and I didn’t eat for three days other than like granola bars and the free snacks at the hotel lobby.

So I feel like now it sounds like a lot of it was just me eating, but it comes down to those basic needs. It’s not that I didn’t get to rent a villa when I was at some like luxurious rotation, it was basic needs of mine were not able to be met. I was doing my laundry in the sink so I wouldn’t have to waste the $2 on the credit card reader machine thing at the hotel laundry. So very tough decisions.

Kevin Pho: So when you do these away rotations, just to be clear, things like room and board, your food, that isn’t covered?

Christina Stach: Room and board is. So well, and that also depends. So during the third year, for our required rotations, if it is an established site for my school they absolutely take care of it. So like when I was in Wyoming, when I was in Minnesota, when I was in San Francisco, those places are covered for us, and that’s kind of where it ends. If there’s a rental car that you need, if you decide to, I don’t know, eat, then that’s up to you as well. In San Francisco there was a point where we did have a meal stipend, but that has gone away. But for the most part you’re on your own other than the actual living.

Kevin Pho: And you mentioned there was a period of time where you actually literally had to live in your car for a period of time. What was that like?

Christina Stach: It was pretty tough. I think the toughest part for me was the showering. It was only really in the summers in New Hampshire. I never had to sleep in my car during the winters, because I was able to sleep with all my friends’ couches, or I did sublet for one of the months because it was like, I think 10 or something like that, and really, really snowy. I was on my surgery rotation and I really didn’t want to mess that up.

But it was really, really tough. I did sleep on the floor of my classroom building a couple of times, which was a little embarrassing. I wanted to make sure I was gone before the first years came for their GI conferences in the mornings. And I had to shower at the gym when I went to do my gym sessions in the morning.

And it was pretty tough especially socially. I had to ask a lot of people for a lot of favors that I wouldn’t initially ask for. Like some people that were just acquaintances I would ask, hey, can I crash on the couch this day and this day and this day. And I would be at a new location every single day so I wouldn’t have to just sleep in my Hyundai Elantra with all of my belongings. But sometimes those arrangements didn’t work out.

Kevin Pho: How did your financial situation contrast with those of your peers in general?

Christina Stach: I’m going to be as nonspecific as possible, but one of the things that had come up was, my first year of medical school I had some very personal things going on and also had the financial things. There were a lot of things pending for me during that spring break, and I knew that I was going to have to resolve these personal issues and that there’s no way that I could have afforded to go anywhere even if I wanted to.

And one of my friends asked me where I was going for spring break, and I was like, oh, I just have some things to handle. And they were like, oh, I’m trying to decide between going to this European country and this European country.

And it just made me feel really different than them. This was somebody that I had seen as a peer, someone that I felt moderately close to, I had known them for a couple months at this point. And I just didn’t realize that we had such a stark difference, where I was making this pretty ginormous life change that would shock my finances and kind of my personal life in ways I didn’t really imagine, and they were deciding which five star hotel to wine and dine at.

And that’s like a pretty common thing at my school as well. At least a good handful of my classmates have been able to travel internationally for some reason or another during medical school. And I drove to Canada, so I guess I have also traveled internationally during this time, but it’s just, it’s very different.

Kevin Pho: Is your story common among other medical students? It doesn’t necessarily have to be at your particular school, but have you heard stories of other medical students who also are struggling with basic necessities in some cases?

Christina Stach: Yes. So at my school for sure, during my third year I think there were just under 10 of us that went through the same thing that I did, where we lived kind of extra address, like we did not have. And right now in the current third year class I for sure know of one of them, because that friend is going to be using my, I do have an apartment now, and that person will be using my apartment. So I know that that is still something that’s going on with my school.

And then for other schools, I know that they’ve had some troubles where students aren’t able to find housing because there’s a local housing crisis and the school doesn’t really have a lot of resources to help them, especially with some of my friends that have California medical schools.

Kevin Pho: And in terms of support systems, does the school itself help? Is the school knowledgeable that some students are struggling for basic necessities? What kind of support systems are available to you?

Christina Stach: At my school I was mostly just offered extending my already pretty big loans, and that didn’t really seem like a good option to me. I was looking for not like handouts, but I wanted to have more opportunities for scholarships or grants or something need-based, or even some sort of work study. And all they could offer me was, we can make your loans bigger.

And I think that wasn’t because the school didn’t want to support me, I think that’s just what they had available at the time. They have been able to help me in some regards with helping me get to placements where I would have guaranteed housing. Like I know for my pediatric rotation, initially I was not going to be in Minnesota, I was going to be somewhere in New Hampshire, but it was going to be at a place with housing so I wouldn’t be living in my car for sure during that time. So they did help me kind of arrange with what they had.

Kevin Pho: So it sounds like some of your educational experiences obviously is shaped by some of these financial considerations.

Christina Stach: Yeah, absolutely.

Kevin Pho: So take a step back. What does it say about the current medical education system that you and some of your peers find yourself in situations like this, where financial decisions have to dictate your experiences?

Christina Stach: I think that to me it just shows why it was so unaccessible for so long. Like when we think of doctors we think of this very high caliber, we think of like legacy students, we think of doctors having kids that are also doctors. And at first I thought it was just because they have access to resources such as shadowing and research, but I think it’s a lot more than that too. I didn’t realize how expensive it was just to be a medical student. So I think that it speaks to that part, the accessibility, and why we haven’t seen a lot of socioeconomic diversity in medicine.

Kevin Pho: So it just sounds like it’s just more than the tuition, because sometimes you have this sticker shock with the tuition. But just hearing and listening to you and reading about your story on KevinMD, it’s simply more than tuition. There’s just so much more that goes into the financial considerations and just the sticker price of going to medical school.

Christina Stach: Yeah, for me I didn’t realize, I didn’t do a ton of research on where I applied to medical school. I wasn’t a very competitive applicant as a premed, so I kind of just threw my application wherever the wind took it. So when I had gotten the interview for Dartmouth, I didn’t realize that I’d be paying the same rent that I paid in the San Francisco Bay Area. That’s not something that I had really considered before.

I knew that the tuition was high. I knew that I would be paying for flights to and from the Bay Area so I’d be able to see my family. But I didn’t think about what my monthly price would look like, I didn’t know what the cost of living looked like otherwise. So I think that’s another piece that needs to be considered when choosing medical education, if you get that choice. And that’s the other part of it, is I only got into two schools, both of which were very expensive, so I didn’t really get the choice to have something more affordable.

Kevin Pho: And just for people who don’t know where that Dartmouth area is, in Upper New Hampshire, you’re saying that the prices are comparable to that of the San Francisco Bay area. But what’s it like in Upstate New Hampshire?

Christina Stach: I think when I was doing some digging for this article, I found that most one-bedroom apartments were on average about $1,600 per month, and the ones that were lower did not have things like utilities or even plowing included, so their actual monthly cost was probably on the higher end as well.

I was fortunate enough for my first years of medical school to pay $1,000 per month for a single room in a house that had one bathroom that I shared with two other gals, and luckily we were good friends and close. But I paid $900 for the same situation in California.

Kevin Pho: So from these financial obstacles that you’re facing through your journey, do you think that’s changed you as an aspiring physician and the way you see patients going forward?

Christina Stach: I absolutely do. And I think that part of it is also the access to medical care itself as the more direct impact. So when I see someone in the emergency room, so right now I’m going into orthopedic surgery, I was just on call last night, so excuse my post call brain fog right now. But when I see someone in the emergency department and they’re having this really kind of ravaging infection, the first thing I think of isn’t like, oh well, why didn’t they come in sooner. I know why they didn’t come in sooner. They would have if they could have.

And for me that’s happened with some of my own medical issues, where I haven’t been able to address them because I haven’t been able to afford them. There was a period of time where I didn’t have health insurance during medical school, so I totally get it. And I think that that’s a really valuable perspective for me to have.

But I also think, outside of the actual medical care, I feel like I’m able to see people on a different level. I’m not looking at them as if we’re in a different social hierarchy. I introduce myself as my first name right now because I’m not yet a doctor, but I also see myself eye to eye with these folks, instead of like they’re coming to me as this regal supreme of wealth and knowledge. I am knowledge, but I am not wealth. We are the same.

Kevin Pho: So what is the ultimate message you want people who are watching you and listening to you now and reading your story on KevinMD, what’s the ultimate message you want them to come away with?

Christina Stach: I think there are a couple of main tenets. One of them I think is that medicine can look like anyone. I don’t think it needs to be the same starched linens and beautiful ties and everybody looks amazing all the time because everybody comes from the widest of picket fences. I think that anybody can become a physician, and that we need to kind of break down the barriers and let people that look like me and have my story into medicine, by I don’t know, reducing tuition or increasing grants and scholarships, just making it more accessible for people like me to be part of medicine, because it is valuable to our patients for us to think like them.

And then I think just kind of bringing awareness to how expensive medical education can be. Like I said, it was kind of more than just the tuition sticker shock for me. I wasn’t aware of all the different things that it could cost me. So even folks that are just considering medicine, so if this does reach any premeds, just thinking about what, like four years is a long time, and what those four years are really going to cost you.

And then just kind of a reminder to those who have been in medicine for a while that it’s not the same as when y’all came up, unfortunately. I wish that I could have worked a couple of shifts here and there to pay off my med school tuition, but I don’t get paid $67,000 an hour, unfortunately. So I think those are the main takeaways, that everything is very expensive, we’re trying, and please let us in.

Kevin Pho: During your premedical training and during undergraduate, did you have a sense of the scope of how much the financial burden would be during medical school?

Christina Stach: During undergrad, for sure I didn’t, because I didn’t know that I wanted to go into medicine until the very end. And luckily I was able to graduate from undergrad debt free, so it didn’t really seem like a big deal to me. I was like, oh well, I’m already debt free so I’m fine.

But during my postgraduate education I was scouring every website for free medical schools. And I knew that my parents weren’t going to be able to help me out very much, so it definitely became a very big looming thing for me. Which is why I made sure to get rid of all of my postbac debt and paid off my car before going to med school, so I could be really focused on just the interest of my med school debt.

Kevin Pho: We’re talking to Christina Stach. She’s a medical student, and today’s KevinMD article is “Making medicine my home.” Christina, we’ll end with some of your take-home messages that you would like to leave with the KevinMD audience.

Christina Stach: I think it’s important to recognize that medicine can be very diverse. I think it’s important to recognize that diversity doesn’t just mean one thing. And I think that it is very expensive to become a doctor. It’s definitely an investment, and it’s a worthwhile investment, but just understanding what that investment really means is really important.

Kevin Pho: Christina, thank you so much for sharing your story and perspective, and thanks again for coming on the show.

Christina Stach: Thanks for having me.