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About those Letters of Recommendation

02.11.20 // Medicine

This study was from 2014 and titled, “What Aspects of Letters of Recommendation Predict Performance in Medical School? Findings From One Institution.”

Do you have a guess?

Being rated as “the best” among peers and having an employer or supervisor as the LOR author were associated with induction into AOA, whereas having nonpositive comments was associated with bottom of the class students.

Best = good

Nonpositive comments = a nice way of saying you don’t really know someone or think they were lame = bad

Now, this was in reference to medical student performance based on college LORs, but some parallels exist in any situation where the current evaluation and the future task are not substantially similar, and—most importantly—bias knows no bounds.

Almost all LORs are positive, even if most people will, by definition, end up somewhere closer to average.

And because most LORs are based on classroom performance, they’re useless. We have more objective measures of classroom performance. They’re called grades (and—blech—the MCAT), and even those aren’t very good at predicting outcomes. At least your boss, whether in the lab or at a paying job, actually knows if you can show up to work and get stuff done.

I’d almost completely forgotten about the LOR process in applying to medical school. I remember I had one from my lab PI/thesis advisor. And then…I honestly have no clue.

When Danger is Only Online

02.10.20 // Miscellany

Jonathan Haidt, author of The Coddling of the American Mind: How Good Intentions and Bad Ideas Are Setting Up a Generation for Failure, in an interview for Next Big Ideal Club:

Back in the 1990s, the Cold War was over, the fear of nuclear war was gone, the [United States] ran a surplus, the crime rate plummeted—and the music was pretty good, too. The risks kids were at from diseases, car accidents, and crime were all plummeting. It was the safest time ever.

But because of changes in the media environment, we were divorced from reality—we got a steady diet of stories about childhood abductions. Almost nobody gets abducted in the United States—there are about 100 true kidnappings a year in a country of 350 million people. It almost never happens, but each time it happens, especially if it happens to a middle-class white kid, there’s constant coverage.

…

Throughout history, there have been innovations that link us closer together, and whenever that happens, there are all kinds of unforeseen effects. Take the automobile—people can move around, so it changes sex life, and dating, and marriage. The automobile, the telephone, the airplane—all of these things have effects on society, and it takes decades for that to work out. But with social media, we’ve never had something come in so fast that was so transformative in changing social relationships.

And the problem is not the internet, and it’s not screen time. Research that I’m collecting shows that it’s not time spent watching Netflix, and it’s not even time on the computer. It’s specifically social media that has pushed us over the edge, and I think it is a major cause of the rise of depression and anxiety, [especially] for girls.

Had Facebook, Instagram, and Twitter never been invented, I do not think our politics would have blown up. I do not think Donald Trump would be president. I do not think Brexit would have happened. I do not think that our democracy would be as imperiled as it is. Of course, Facebook and Twitter do a lot of good things, too, but the downside is so severe that I’m beginning to worry that social media is incompatible with a functioning democracy.

I wonder.

Social media is seductive even though it’s most effective as a way to literally waste time. But I’m older than the generation Haidt is worried about. And even to me—as someone who has written exclusively on their own platform for over a decade and grew up with just AOL instant messenger—it’s amazing how easy is it to fall prey to the endless feed.

The Rise of the Consultancy

02.07.20 // Miscellany

Management consultants insist that meritocracy required the restructuring that they encouraged—that, as Kiechel put it dryly, “we are not all in this together; some pigs are smarter than other pigs and deserve more money.” Consultants seek, in this way, to legitimate both the job cuts and the explosion of elite pay. Properly understood, the corporate reorganizations were, then, not merely technocratic but ideological. Rather than simply improving management, to make American corporations lean and fit, they fostered hierarchy, making management, in David Gordon’s memorable phrase, “fat and mean.”

From “How McKinsey Destroyed the Middle Class” by Daniel Markovits, subtitled “Technocratic management, no matter how brilliant, cannot unwind structural inequalities.”

I do enjoy his inclusion of Kiechel’s apt Animal Farm reference.

On the WCI Podcast

01.31.20 // Finance, Miscellany

I had a lot of fun talking to Dr. Jim Dahle on this week’s episode of the White Coat Investor Podcast about student loans:

 

 

I honestly think we may have talked more about my journey on this episode than I have with my actual writing on this site for the past eleven years, but I hope listeners found the contribution of another writer/blogger to be interesting  (also, don’t turn up the volume or you may hear my sniffles; kids…).

As Jim mentions, he actually started The White Coat Investor a couple of years after I started writing here. But he’s since built an impressive empire, steadily produced a ton of content, basically singlehandedly changed the level of discourse for physician finance, and taught/inspired a generation of young doctors to think critically about money. It’s just an incredible achievement.

I’m really looking forward to speaking at WCICON20 this March and meeting some of you there!

 

 

Student Loans: In Print and Online

01.29.20 // Finance, Writing

I published the first edition of Medical Student Loans: A Comprehensive Guide in 2017. Waiting almost three years to put out a print version is what happens in the perfect storm of total DIY, extreme retentiveness, and being a generally lazy procrastinator. Oops!

But I’m happy to say I finally put the finishing touches on the print editions for both of my loan books this month, so those of you hankering for the perfect beach read need wait no further:

  • Medical Student Loans (for medical students & physicians)
  • Dealing with Student Loans (for everyone else)

Hurray!

Even better?

But in what is surely a terrible business move, I’ve also put the entire text up online at benwhite.com/studentloans/.

So yes, you too can join the ranks of folks still exchanging money for that hard-fought knowledge (thanks!).

And yes, you definitely still download a nice ebook file in the format of your choice in temporary exchange for your email address so I’ll have a nice big audience for that infrequent newsletter I’ll probably never actually start. (PS I even put the unsubscribe link in the first sentence of the download email; did you know it actually costs a bunch of money to have an email list? Crazy.)

But if you just want to scroll through 45k words in a web browser, now you can do that too.

Student loans are crippling a generation of Americans and have a chilling effect on personal+financial wellbeing. I’m just trying to do whatever I can to help you get the information you need to make thoughtful decisions about managing your debt.

Match Fever, AAMC Apply Smart, and Oodles of Bias

01.28.20 // Medicine

Brian Carmody is a pediatric nephrologist, associate program director, and man after my heart. He’s been publishing an impressive series of excellent, well-researched, and well-argued articles about basically everything wrong with the current medical school-industrial complex and the biases of its major players that have resulted in the general crapifying of medical education.

And here is a great investigative video/podcast to boot.

It’s an excellent video that illustrates one way in which the people who should know better (the AAMC, who own ERAS) subtly encourage students to overapply to residency programs, wasting valuable time, money, and stress in the process (and under the guise of trying to fight against the growing cluster of application shotgunning that has proliferated in recent years no less!)

If you haven’t seen any of his articles, check out his site. It’s excellent and is a must-read for anyone involved in medical education or residency training.

If You Have a REPAYE Subsidy: Maximize It, Don’t Pay Extra

01.22.20 // Finance

A general rule of debt repayment is that it’s never a bad idea to put extra money towards paying down your debt faster. More money means getting out of debt faster and less money spent on interest. This is true for credit cards, most student loans, car loans, etc.

However, this is actually not necessarily the case in the context of income-driven repayment in the setting of negative amortization (i.e. when calculated monthly payments are unable to cover the amount of accruing interest).

If you can’t dent the principal, then there’s no point rushing to put extra money toward your federal loans. But why?

How Much Will It Take to Make Real Progress?

The average medical resident has big loans and relatively low income. While some intentional living can certainly free up some extra money for debt payoff, it’s much harder to have enough extra to completely mitigate negative amortization, let alone begin actually making progress on paying those loans down.

For example, $200k at 6% accrues $12,000 interest a year. A single resident earning $60k in PAYE/REPAYE has a monthly payment of around $344/month, or $3,864 for the year. In order to break even, you’d need to spend over $8,000 extra. Not chump change, especially on a resident salary.

Leverage Instead

Leverage the extra money you can earmark for loans to earn some interest elsewhere. A tax-advantaged retirement account (at least get the company match from work if available) or a Roth IRA are great options. When the question is between investing vs. paying down loans, the real answer is yes.

But if you specifically want to put money toward those loans, put it somewhere safe for now that earns some interest and then use it toward your loans. Don’t rush; it’s a waste.

To understand why you should wait, you need to have an understanding of how interest works with federal student loans and how payments get applied.

How Federal Student Loan Interest Works

1. Loans grow with simple interest, and capitalization is only triggered by very specific events. Capitalization is when accrued interest is added to the principal, thus resulting in a bigger loan accruing more interest at a faster rate. The main triggers are loan consolidation, the end of the grace period, changing repayment plans, and if/when you lose your partial financial hardship while in the IBR or PAYE plans.
2. You can’t pay down the principal by making extra payments until you’ve paid off all the accrued interest for a specific loan.

What this means is that once you begin repayment, you should never be surprised by a capitalization event. Your interest will continue to accrue every single day but it will not be added on to the principal unless one of the above factors takes place. Because the principal does not change, the amount of interest accruing remains constant. No matter how big the number gets, the rate of interest accrual remains the same until a capitalization event occurs. Paying down a little extra interest itself now as opposed to later does not change the natural history or your loans or alter the amount needed to pay them down.

In the REPAYE program, half of any accrued interest that is not covered by your monthly payment is forgiven. Therefore, the lower your monthly payment, the lower your effective rate. That doesn’t mean you shouldn’t still set aside more money every month toward debt repayment, just that there is a real financial benefit to paying as little as possible directly to the servicer in the short term until you are able to dent the principal.

That Money is Still Spoken For

To reiterate, I am not suggesting that you take this extra money that you could otherwise put your loans and spend it toward lifestyle inflation.

That money should be in some kind of loan payoff slush fund, such as a CD or interest-bearing online savings account like Ally Bank.

Earning 1 or 2% risk-free in a savings account will make that money go further when you finally use it on your loans. A lot different? No, of course not. But it does help just a little bit to mitigate what can be relatively high federal loan rates. Sure, it can function as an emergency fund too, but you should give that account a name like “loan money.” It’s not for vacations.

When to Deploy

If you’ve been saving money on the side for loan payoff, there are several situations in which it’s time to pull the trigger and make a large lump sum payment.

  • Right before a capitalization event, such as losing your partial financial hardship in IBR or PAYE.
  • Right before a private refinance.
  • When your income increases enough that you’re actually able to start making substantial progress on your loans, then you can jumpstart it with your slush fund.

Caveat: if you have not consolidated your loans and have some plus loans at a higher interest rate, one could conceivably put all extra funds into paying off that loan first. Given that an individual loan will be a smaller amount, it may be feasible to make progress on it. However, in general, I recommend most people consolidate for the reasons outlined in this post.

Maximizing the REPAYE Subsidy

One of the common REPAYE questions has been if I pay extra will it eat into my repaye subsidy and thus ultimately lose money? There has been some discussion, but the answer is supposed to be that you can. That said, I would almost never trust a servicer to ultimately apply these things correctly. As we’ve discussed above, there isn’t a great reason to do this on a routine basis. In most cases, you’d be better off leveraging that money elsewhere.

One thing to consider is that placing money into a traditional pre-tax retirement account like a pretax 401k/403b reduces your adjusted gross income (AGI), which reduces your payments by 10% of the contributed amount the following year, which in turn increases your amount of unpaid interest thus increasing your unpaid interest subsidy and ultimately lowering your effective rate. That’s a mouthful, but it means that the more you can lower your AGI, the less interest accrues on your loan.

That said, the income-lowering strategy is much more effective in reducing payments toward PSLF than in saving money on the accrued interest. For example, a $100 pre-tax contribution will lower payments the next year by $10 and would thus result in $5 of forgiven unpaid interest.

Lastly, if you are considering the possibility of PSLF

Never spend a dollar more than absolutely necessary directly on your loans until you are ready to permanently give up that plan. Any dollar extra you pay is a dollar wasted in the event of achieving loan forgiveness. Again, if you are nervous about the PSLF program, then you hedge your bets by being financially prudent in other ways, not by tilting at your loans.

Will I qualify for PSLF?

01.16.20 // Finance

After some high profile new stories about the initial 99% rejection rate for PSLF application, I wrote back in 2018 about how using that number as a means of summarizing the PSLF program was essentially clickbait.

I still see the 99% figure used all the time by ill-informed people in arguments about how everyone should abandon all hope and rush to the arms of an immediate private refinance without any consideration of critically important details such as the size of an individual’s crippling debt or how that relates to their current or expected income. Dunning-Kruger in action.

That said, the high rejection rate does illustrate the need for due diligence and careful planning, because what it really signifies is a lot of people’s general lack of attention to detail when it comes to critically important financial matters (e.g. the impact of investment fees on retirement planning):

Wrong loans. Wrong repayment plan. Wrong/unconfirmed number of payments. And (more rarely) wrong job.

A small fraction of that 99% also probably included some people who actually did know better but we’re hoping for a windfall. No harm in asking right?

Current borrower, the program is safe

If you’ve already borrowed loans, you’ll note that the master promissory note you signed includes this:

A Public Service Loan Forgiveness (PSLF) program is also available. Under this program, we will forgive the remaining balance due on your eligible Direct Loan Program loans after you have made 120 payments on those loans (after October 1, 2007) under certain repayment plans while you are employed full-time in certain public service jobs. The required 120 payments do not have to be consecutive. Qualifying repayment plans include the REPAYE Plan, the PAYE Plan, the IBR Plan, the ICR Plan, and the Standard Repayment Plan with a 10-year repayment period.

The MPN is a binding contract between you and the lender (the federal government). It cannot be legally changed. This is why all new proposals, from the Obama-era PSLF cap to the Trump’s hoped abolition, have always specifically excluded current borrowers. They have to. To change the rules of the game for an old borrower runs afoul of the common law doctrine of estoppel. In layman’s terms, you can’t go back on your word.

I know that sounds good in theory, but everyone who reads internet forums, social media, or the annual PSLF clickbait articles (even from major news outlets) is leery. Thankfully, there’s already some existing case law!

The Department of Education under Trump-appointee Betsy DeVos could at best be charitably described as the perfect example of how cabinet-level executive departments can be politically undermined while being used as political bait for horrible and/or clueless people. Under DeVos, the DOE did try to change the rules after the fact for a tiny number of people with non-501(c)(3) nonprofit jobs that did (and then “did not”) provide qualifying services. These jobs are approved on a case by case basis by FedLoan, and the DOE tried to retroactively undo FedLoan’s approvals.

So how did it turn out? The government basically lost. You can’t do that. I explained the details of the case here (I think they’re interesting).

The PSLF program is an entitlement. Entitlements are hard to change and hard to get rid of, and you can’t simply pull the rug out from under folks who made decisions based on you holding up your end of the bargain.

So, with that long preamble, I’d like to answer the question at the title of this post:

Will I qualify for PSLF?

I’ll answer with another question:

Well, are you doing the things that it says on literally every single document that you need to do?

Then yes!

After a 10+ year boondoggle of administrative suffering, you too can enjoy your free money.

You need:

  • Qualifying loans (Direct, not FFEL)
  • Qualifying repayment plan (REPAYE, PAYE, IBR, ICR, or 10-year Standard)
  • Qualifying full-time employment (Government or 501(c)(3) non-profit are the most straightforward)
  • 120 on-time monthly payments

That’s it.

You don’t need to wonder; you should know at every point during the process. Check out the Official PSLF Help Tool. If you have any doubts, keep submitting those employment certification forms to FedLoan. If there’s an unanticipated problem, you can find out within months. Unless you’re trying to get a non-501(c)(3) non-profit job approved (like in that lawsuit), there really shouldn’t be any question.

Yes, FedLoan can be terrible. And yes, sometimes you need to submit a CFPB complaint to get those manual payment recounts done when it seems that basic arithmetic is beyond their reach. No one said the process was pleasant.

But at this point, no one else needs to be surprised after a decade.

Gratified

01.05.20 // Radiology

I don’t normally talk much about the places I work or the institutions I’ve been affiliated with on the site. After all, these views are my own.

But I’m just going to drop this here briefly because I’ll freely admit that I was honored and gratified to win Teacher of the Year my first full year as faculty at Baylor Dallas. Great group of residents.

 

 

Also, crystal apples are surprisingly heavy.

What I Read in 2019

12.31.19 // Reading

Continuing my tradition of posting my annual book diet, this year wasn’t nearly as good of a reading year as 2018. 2019 was (extremely?) busy with the birth of our baby daughter, the continued raising of our four-year-old son, my wife starting a solo private practice (that’s another post), and my first full year as an attending (and winning teacher of the year to boot!).

  1. Get Jiro! by Anthony Bourdain (weird)
  2. How to Talk So Little Kids Will Listen by Joanna Faber and Julie King (kids are ruthless)
  3. War of the Blink by Michael Nicoll and Yahgulanaas
  4. Anthem: The Graphic Novel by Ayn Rand
  5. Voice Lessons for Parents by Wendy Mogel
  6. Power Moves by Adam Grant
  7. Replay: The History of Videogames by Tristan Donovan (very interesting, at least if you’re me)
  8. Meet the Frugalwoods by Elizabeth Willard Thames
  9. Contact by Carl Sagan (classic)
  10. Heart: A History by Sandeep Jauhar (no Emperor of All Maladies, but pretty good)
  11. Junk by Les Bohem
  12. Company of One by Paul Jarvis (synopsis: there’s more to business than growth; something hospitals and academic centers would do well to remember)
  13. The Dispatcher by John Scalzi
  14. Black Crow, White Snow by Michael Livingston
  15. The Rule of One by Ashley and Leslie Saunders (near-future dystopia, but the twist is that the main characters are twins [and the authors are twins!]. The protagonists aren’t awesome athletes or killers, but it’s also not as good as [the first two books] of The Hunger Games or the [first two books] of Divergent.)
  16. The Rule of Many by Ashley and Leslie Saunders (the conclusion)
  17. Skyward by Brandon Sanderson (he’s better at fantasy, but still highly enjoyable YA light-sci-fi.)
  18. The Physician Philosopher’s Guide to Personal Finance by James Turner (reviewed here)
  19. Educated by Tara Westover (excellent memoir)
  20. The Yiddish Policemen’s Union by Michael Chabon (Chabon is my Jewish writer spirit animal.)
  21. The Vexed Generation by Scott Meyer (Magic 2.0 #6) (meh)
  22. Everything is F-cked by Mark Manson (though neither really treads new ground, his first book was much better and genuinely enjoyable. This one suffers from sequelitis.)
  23. Digital Minimalism by Cal Newport (Be thoughtful in how you use technology. Hint: Less is more. The weakest of his books, but still has enough meat to have warranted several blog posts.)
  24. Fall by Neal Stephenson (Long, good. What happens when people figure out how to live as digital avatars after death?)
  25. Chop Wood, Carry Water by Joshua Medcalf
  26. Space Force by Jeremy Robinson (hilarious, page-turning shoot ’em up thriller. I don’t laugh out loud very often, but I did a lot with this one. What happens if we create Trump’s Space Force,  everyone realizes how dumb it is, we cancel the program, and then immediately experience an alien invasion?)
  27. The Mage Fire War by L.E. Modesitt, Jr. (Sage of Recluce #21[!])
  28. Level Five by William Ledbetter
  29. Keep Going by Austin Kleon
  30. Bushido Online: War Games (#3) by Nikita Thorn (I’d never heard of let alone read a “LitRPG” book before this series, and I’ll probably never read another one. But I like this series! Yes, it’s silly. And yet.)
  31. Small Fry by Lisa Brennan-Jobs (A really good memoir; also, Jobs seems like a pretty not nice guy.)
  32. Make it Stick by Peter C. Brown (Probably the definitive book on modern learning science)
  33. The Toll by Neal Shusterman (Arc of a Scythe #3)
  34. The Others by Jeremy Robinson
  35. Indistractable by Nir Eyal (meh)
  36. Ultralearning by Scott Young (more anecdotal than #31)
  37. Strange Planet by Nathan W. Pyle (hands-down best thing on Instagram)

I think 2020 is going to be a good year. I already know what my first book is going to be.

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