What Financial Freedom Means to Tomorrow’s Doctors

Mary Killackey finished medical school at Columbia in 1998 with $80,000 in student loan debt. That might sound like a lot, but she considered herself lucky to get out with a relatively small amount of debt.

Now chair of surgery at Tulane University in New Orleans, Dr. Killackey grew up in Philadelphia, the fifth in a tight-knit family of six children. She credits her parents for encouraging her and her siblings to pursue their dreams, no matter the upfront cost. Deciding between two strong choices for medical school—Columbia, where tuition ran about $45,000 a year, and Temple University in Philadelphia, which was about one-third the cost because she was eligible for in-state tuition—Dr. Killackey didn’t hesitate. "People say, ‘Go to a state school; it’s cheaper,’” she says. “But I cannot tell you how many doors have been opened for me because of the schools I went to, ultimately landing at Columbia for medical school. The truth is, schools like Columbia have funding to allow students with financial need to attend.”

Because of her family’s modest income, about half of her medical school tuition was covered through grants. Even so, her debt weighed on her as she mapped out her career path. Although she was always drawn to the procedural nature of surgery, she also considered internal medicine. Transplant surgery, she says, turned out to be the ideal combination of both. “But at the time, I thought about it,” she says. “I thought, ‘If I go to primary care, if I go into family medicine, I’m going to be saddled with this debt forever.’” Mary Fairbanks’87 graduated more than a decade before Dr. Killackey and did go into family medicine. “Honestly, in 1987, the kind of indebtedness we were getting into was nothing like what students take on today,” she says. She received grants from several sources but still had to borrow about $30,000 to finance her medical degree. With the help of a grant she received after graduation and the support of her family, she was able to pay off her loans within six years. That meant that when a friend suggested opening a practice together, she could jump at the opportunity. “We had no money to start with,” she says. “If I had been burdened by a big monthly loan payment, there’s no way I could have done that.”

“Debt makes an incredible difference,” agrees Elvis Camacho’17. “It definitely influences you when you’re applying for different specialties.” This is exactly the kind of burden that Roy Vagelos’54 and his wife, Diana, intend to vanquish with their historic $250 million gift to the medical school, which was renamed in their honor in December 2017. Some $150 million of the donation announced in December will fund an endowment that will replace loans with scholarship support for medical students who qualify for financial aid. Starting with the 2018-19 academic year, VP&S will eliminate need-based loans from the financial aid packages that students receive. That means that all students eligible for financial aid, which includes more than half the student body, will receive some assistance, and about 20 percent of students—those with the most need—will receive scholarships covering their full tuition. And although the school cannot award scholarships retroactively to replace loans made in previous years, it did manage to help students who graduated in May 2018 by replacing a portion of their need-based loans with scholarships of $5,000 each.

The Tradition of Debt

Hefty debt is perhaps as much a staple of medical school as is dissecting a cadaver. Indeed, almost 75 percent of all medical students in the United States graduate with debt; in 2016, the median amount of debt nationally was $190,000, including undergraduate debt. VP&S has long tried to meet its students’ needs by limiting loans for students with limited financial means to less than $30,000 each year and providing the rest as need-based scholarships. The school also has a strong commitment to educating students about managing the debt they take on. “The financial aid office was incredibly user-friendly and really on the students’ side,” says Dr. Killackey. “They really took care of me.”

“I had students call me after they received their financial package, just crying. It’s a dream come true. They’re going to be able to graduate from Columbia with no debt.”

“For students who come from lower-income families, $100,000 in debt may appear to be as much as a million,” says Hilda Hutcherson, MD, senior associate dean of the Office of Diversity and Multicultural Affairs. “The thought of taking on six-figure loans was always a shock. It used to cause a lot of angst and anxiety and worry about how they were ever going to be able to pay that amount of money back.”

For the Vagelos family, the generous gift is also a fitting one: When Dr. Vagelos was in medical school in the 1950s, he was a scholarship student, as was his wife in her time at Barnard College. Neither Roy nor Diana had accumulated any student debt by the time they graduated, allowing them to pursue their dreams. Dr. Vagelos has said that the aim is to give students the opportunity to follow their true calling in medicine and to provide the opportunity for more students to forge paths in fields such as family medicine, pediatrics, and geriatrics, specialties that often provide salaries far lower than those earned in most lucrative specialties. The scholarship program also will allow more medical students to enter careers in biomedical research that pay less but are vital to the future of medicine. The scholarship program is a first among mainstream U.S. medical schools.

After the Vagelos gift was announced, Dr. Hutcherson says, “I had students call me after they received their financial package, just crying. It’s a dream come true. They’re going to be able to graduate from Columbia with no debt.”

Not only will the new funds help aspiring doctors focus on being successful medical students, she predicts it also will help change the demographics of incoming students. Just look at what happened when Ivy League colleges started replacing loans with scholarships in financial aid packages for prospective undergraduates from low-income families, she says. “Students who before would have found it difficult to attend an Ivy League school now saw it as a possibility.

“Columbia is a special place. The education that students have access to is unparalleled,” she says. “So it’s nice that we can now offer this education to more students from needy families.”

Dr. Camacho, who plans to go into academic medicine, wholeheartedly agrees. Even college was not on the radar when he was a child growing up in Miami, having moved there from Puerto Rico with his family. Medical school was even less a possibility. At age 17, he joined the Marines, where combat and time as a volunteer in hospitals made him realize that his passion lay in medicine. By the time he was in college and medical school, Dr. Camacho says, Columbia showed strong support for a diverse student body. “But to open up opportunities for people who come from very impoverished backgrounds, regardless of their color, will make an even richer environment for everybody.”

Despite the great need for doctors in the United States, the barriers to becoming one are growing. “The reality right now is we have an aging population, we have fewer doctors, and costs are very high for becoming a health care practitioner,” says Alex Porter’93. Dr. Porter is chief medical officer for Sui Generis Health, a medical products and policy company based in Atlanta. Because paying for health care is in flux, the financial costs of medical education add a level of uncertainty to pursuing a career in medicine. “The large cost of medical school is a deterrent, especially for people who want to go into general practice or work in underserved areas or conduct research. That’s not conducive toward us getting completely caring and motivated people who dream of caring for patients.”

Also, he adds, the steep increase in the cost of college over the past two decades means that most students are already carrying significant debt by the time they apply to medical school. Cristina Carpio’09 notes that medical school debt is especially long-lasting. The daughter of Ecuadorian immigrants who came to the United States so she and her siblings could have more opportunities, Dr. Carpio is now a trauma surgeon and critical care doctor at South Shore Hospital, part of the Brigham and Women’s network in the Boston area. She feels fortunate to have received grants from Columbia to cover half of her tuition. Yet almost a decade after graduating she expects to be paying loans for another 10 years; many classmates are looking at 20 or 30 years, and she knows of two people from her medical school class who still owe more than $250,000. “That debt is the longest-term relationship you’ll ever have. It could be longer than a marriage.”

Dr. Carpio, who grew up in Queens, knew she wanted to be a doctor at around age 10, when she began accompanying her diabetic grandmother to a Spanish-speaking doctor in Manhattan so her grandmother could communicate in her own language. After college, Dr. Carpio made a beeline for her goal, heading straight to medical school. At such a young age, though, it’s hard to appreciate how much long-term planning that medical school debt demands, she says, including the role it plays in planning milestones such as starting a family, buying a home, or saving for the future. Her relatively small debt has been helpful for her family, since she can see a future without debt in a short time. “It will have a generational impact because I’m able to save to help my daughters go to college.”

For Dr. Killackey, a tremendous stroke of fortune a few years into her career showed her just how constraining medical school debt could be. After a general surgery residency at the University of Rochester, then a fellowship in transplant surgery at Mount Sinai, she was recruited to the transplant program at Tulane in the aftermath of Hurricane Katrina. She had a gut feeling, she recalls now, that she could really have an impact there.

She benefited from a federal program designed to retain doctors in New Orleans in the aftermath of the hurricane. The government program paid off her higher education debt. Overnight, her debt was gone. “The weight that lifts off of you—it’s indescribable,” Dr. Killackey says.

With that financial freedom, the prospect of staying in academic medicine—where salaries are significantly lower—became more viable. Perhaps more importantly, she experienced a dramatic shift in her outlook. “Once that debt was gone,” she says, “I felt I could really be true to the profession.”

She involved herself in teaching and in the quality and regulatory issues that affect transplant medicine. “That allowed me to progress, to get visibility, and to learn leadership.” Two years ago, she became the first woman appointed chair of the Department of Surgery at Tulane, although she was more than a decade younger than most people are when they become chairs.

“It’s just incredible,” says Dr. Killackey, musing on the fact that the careers of all qualifying graduates of VP&S—and, perhaps, all graduates someday—will benefit from those scholarships. “It makes me really proud to be a Columbia graduate, and it certainly makes me want to give back and support this effort, because it meant so much to me.”

As featured in Columbia Medicine