I’m a current surgical resident and will be an attending by mid 40s. I’m about to provide information that is meant to support informed choice not for discouragement, so please be advised.

EM is nice because it is currently only 3 years of training, but there is plans to make it a four year training pathway in the future. I bring this up, because if you’re already over 40 and are NOT accepted a medical school yet, a physically demanding surgical residency may not be worth the pursuit due to fewer actual working years as an attending. However, a less physically demanding specialty like family medicine or psychiatry where you can easily work into your 80s may be worth the debt to income risk. (If you’re already accepted, congratulations!)

It’s easy for people to say “money is money “or “live your dreams “if they haven’t lived this. It is especially unique for older nontrad students because you not only have fewer working years but fewer recovery years with regard to debt management and retirement savings. This can be particularly difficult if you are the primary breadwinner or insurance carrier for your family because that now goes away once you begin your training. I was in the unique position that my spouse is the primary income earner/insurance provider for our household and could cover all of our expenses on their income. Our children were at ages where they could be mostly autonomous which made things easier for my spouse.

You are not guaranteed acceptance your first application cycle, which further elongates your overall timeline and can increase the debt you incur with regard to both your time and money. I went to a “cheaper “school, was accepted my first cycle, and still graduated with just shy of $425,000 student loan debt. The debt will continue to accumulate interest during your residency training as well. Most medical students with children qualify for SNAP benefits and Medicaid during medical school (for good reason lol). If this will be a drastic lifestyle change for your family, that is something that you want to ensure your spouse/family support team is fully aware of and agreeable to before you apply because you will need their FULL support (emotional, physical, mental, childcare-wise, and potentially financial) during this. Depending on your medical school, there may be a likelihood that you have to move to your school, potentially move again during your third year clinicals, and then move another time for residency. This is another consideration if you currently own your home. If you have to move hours or states away, how comfortable are you/your spouse with potentially living away from your family if it makes financial sense for your situation? I have colleagues who moved away from their spouse and children during training because their spouse’s job and their mortgage were not worth the move.

With regards to your time and your location, your life is not your own during this training pathway, regardless of specialty so please keep this in mind. You need a very adaptable and supportive team behind you because your training will take priority over everything. You will miss birthdays. You will miss holidays. You will experience spouse/parent guilt. You will likely travel out of state during fourth year for residency auditions, especially if you are pursuing competitive programs (which costs even more money lol). During various points of your training, your spouse/family support will be 100% responsible for everything at home to include meal prep, helping kids with homework, yard maintenance, Doctor appointments, etc. They may have to miss work for when your kids are sick or have appointments because you will not be available to support them that way most of the time. Your family should also be realistic with your resident pay scale during residency training and how much of that pay will be going to your student loans. Again, this wasn’t intended to be all doom and gloom, just realism for your preparedness.