By Timothy Laux, 2015-2017 HEAL Fellow
FULL DISCLOSURE: I am a HEAL alumnus from a privileged background.
During the first month of medical school, I remember the various Interest Groups had lunches, vying for the affections of us newly minted students. Many of the lunches happened on the same day, creating an informal competition between, say, the Orthopedic Surgery Interest Group and the Gastroenterology Interest Group. Bones or bowels – you had your pick.
I tended to go to almost all of them, largely out of curiosity (and hunger). Most tended to have half a dozen students, which seemed like a reasonable estimate of how many would be interested with an incoming class of ~150 people. I suspected a similar number represented how many people would one day pursue that line of work.
I remember being very excited the day the Global Health Interest Group held its lunch, as I would be going out of passion and not curiosity. I had already made a few like-minded friends in the class, and I imagined a similar, intimate group of us thinking seriously about how to meaningfully weave global health into our medical educations.
You can imagine my astonishment when half the class attended. The lunch was held in the same room as the lecture hall, and when the morning lectures ended, it felt like almost no one got up to leave! While there were probably a few curious onlookers, there was no shortage of serious interest.
It saddened me to watch this number rapidly dwindle over the course of my medical education, a sadness made more acute by how this dwindling felt inevitable. The pressures to get into a competitive residency, to publish, to subspecialize all overwhelmed what I – to this day – believe was a deep and penetrating impulse among new medical trainees to address the profound inequities in healthcare seen both at home and abroad. If we fast forward to the end of residency almost a decade later, my global health community – both mentors and peers – was sparse.
Further, at that same time, I was acutely aware of the educational debt I had accrued. I was lucky enough to leave medical school with below average debt (again, privilege), but that did not change the fact that my debt was the greatest animating impulse regarding all my life decisions throughout residency and beyond. I struggled deeply with whether or not to apply for a global health fellowship simply because that would be two more years of “financial irresponsibility” (i.e. I could be making an attending salary of at least $200K, but would be making a fellow’s salary of $60K). To justify joining, I promised myself I would pay the US Government $1,000 / month throughout fellowship (as I had during residency) and would make a lump sum payment of all savings I had left over at the end of each December (which generally amounted to $20K, which I had not done during residency). I continued this until my debt was gone even post fellowship.
So why did I continue to subject myself to what could only be called a monastic lifestyle? Because – simply put – I knew it would be very difficult to meaningfully pursue global health equity work while I remained in debt. I say this as a privileged white, American, heterosexual male who comes from a long line of the well-educated. If I had to live like this, I can only imagine how incredibly difficult acquiring that freedom from debt (and that freedom to work where and as one wishes, including at home or abroad) would be if you are an Underrepresented in Medicine (URM) candidate whose family and dependents count on you for financial support. By the time – likely decades later – you come up for air from your debt, the system all but has its meat hooks in your heart. The embers of your burning passion for global health equity work remain. You still have that 30 year old optimistic, passionate soul, but your 50 year old body and responsibilities maybe cannot find the space to reignite the flame.
For me, it took 8.5 years to get debt free – July 3, 2019! I celebrated by applying for the global health jobs I really wanted and resigned from the job I did not want – but which helped me pay off my debt – two months later. It was a long 8.5 months, but my financial freedom meant I could get back to doing what I had wanted to do all along.
I would love for future global health advocates to be able to avoid that 8.5-year period.
I want to say thank you in advance to anyone and everyone who reads this and considers making the reality of loan forgiveness possible for those pursuing careers in global health equity.
Loan repayment would have made it so much less stressful to join HEAL, and global health work. This effort by HEAL on Loan Repayment will draw more people into this work.
Timothy Laux, MD, MPH is a general Internal Medicine doctor splitting time evenly between the Dine (Navajo) Nation and rural India.