A Father-Daughter Duo Answers Your Questions: How Generous Can a Medical Student in Debt Be?

Dear Mr. Nesmith and Meghan,

Background: I’m a 30-year-old medical student. I live almost entirely on loans and scholarships, with tiny little bursts of supplements from tutoring, babysitting, and generous relatives. I am completely broke by the end of every semester, partially because my financial aid package is tight, but also because I insist on living alone (I study at home) and having a healthy social life. I’ll graduate in two years and will make around $50K or so for around 3-5 years as a resident and will then hopefully have a strong, stable salary—though I will most likely go into primary care, meaning that my loans will exceed my salary. I have/will have student loans that would give you nightmares (multiple hundreds of thousands of dollars with interest rates that approach 7%).

My question is this: how do I approach donating money to good causes (friends’ marathons, NPR fund drives, projects for teacher friends, etc.) when it feels like my money is not my own? Part of me feels like it’s unwise to donate even small amounts of money with such hefty interest rates, but it’s certainly not as if I don’t spend that money on every other type of purchase (everything from books and gas to happy hour and birthday dinners). At this point it’s easy to see that it’s only two more years with no income, but I’ve been in school for most of my twenties and my loans will kick in when I graduate, aka this is a marathon of weird spending choices. 

I’m tired of feeling like I’m not helping causes I would like to support. What do you think?

– Future MD (Monstrous Debt)  

Meghan says:

Dear Future MD,


Up until a few months ago, the entirety of my working life had been spent in the non-profit sector. This meant that I rarely, if ever, had money to spare. It meant that I gave the bare minimum donation at yoga; that I scrounged cheap books on Amazon rather than buying at my local bookstore; that I gifted the lovely subway violinist my biggest smile (!) instead of whatever I had in my wallet. I had comfort and a measure of luxury, yes (see: yoga), and through a combination of scholarships and parental support (shout out to mom and pops Nesmith!) was debt-free, but the end of the month was a struggle.

What made that life doable—and again, recognizing that it was pretty great, in the grand scheme—was the feeling that I was doing some genuine good. That the act of going to the office each morning was my donation. People who work in non-profit, or who commit their lives to any greater purpose without the promise or expectation of monetary gain, are really good people.

It turns out I am not so much one of those people.

I think you might be. At least a little bit. Sure, not everyone who enters medicine is called by a higher purpose, but by virtue of this letter you have shown that you believe in the grand, hovering moral scale, the one we try our best to weigh down with heart and action and kindness, so that we will be able to know that we gave of ourselves for good, in the end. That’s what I have to tell myself, after having fallen ingloriously into an actually super fulfilling job in a far less altruistic field. That I will pay full price for theatre tickets. That I will donate happily, freely, in a friend’s name. That I’ll find the people doing the good work and ask what I can do to make it easier for them to do it. That all these small giving-backs are the pebbles I lob at the better side of that scale.

As for you: One day, you will be called upon to deliver a friend’s baby, or to please just look at these photos I took on my iPhone of seriously, what is this weird rash, and you will do those things, and no one will remember that time you didn’t donate $20 to NPR. You will save lives. Whole lives! I am not worried about your moral reckoning. Every day, under the weight of all of those loans and the panic they fuel, you are choosing good.

Finally, the thing about books and gas and happy hours and birthday dinners is that those are their own kind of causes. You are imposing some measure of sanity on your very insane life, which presumably allows you to be emotionally and physically present for those very friends you are worried about not supporting. Do not begrudge yourself the things that make you capable of being fully in this world. We need you here.

Meghan’s dad says: 

Jeez—Meg told me no one would read this and if they did, they certainly wouldn’t write in asking a question, the team having revealed itself as bereft of sage advice. But here goes…

You have raised a few interesting points, including one where the perspective of gray-headedness might actually add value.

First—don’t think of that money as not being yours. It is yours. You are paying handsomely for the privilege of digging yourself into a huge hole of debt, so overwhelming that you will despair daily throughout much of the next decade (although trust me, you will get out), so you should enjoy it because you are going to pay for it later—with much blood, sweat and tears.

But that doesn’t really answer the question, because my view of this matter is that you shouldn’t be spending very much money at all on this sort of thing. The sentiment is outstanding, but using your very expensive money to help other people is, at this point in your life, a poor use of borrowed and still very limited proceeds. This is where the perspective of age dribbles out of the dim recesses of a brain stressed by the consumption of many bottles of excellent red wine.

As most of us proceed through life we plan and hope to achieve some level of financial comfort and success, whether that is simply paying off debt incurred for an education, having enough money to have and raise a family, or blowing it on a new Porsche Targa (which, for those of you laudably more transit, Uber or Zip-inclined, is a stunningly beautiful piece of Teutonic hardware). And as one ponders that shift in financial circumstances, one should assume that one’s means to contribute to any of a number of worthwhile causes should also shift in a positive direction. And as that happens, one must get off one’s duff and open one’s wallet in as big a way as possible. It is simply the right thing to do.

However, at the stage of life in which you are currently toiling, you should keep those gifts and donations small and, indeed, consider contributing your time instead; run the marathon and raise some money; answer the phone during the NPR fundraising drive; knit some baby booties for a teacher friend’s project (assuming baby booties have some value in that process, but you get the drift). Donate financially small, if at all.

And also remember that you are in medicine—good for you. You are going to be helping people for the rest of your life. Your sacrifice for and contribution to the general good is well underway.


Want to learn more about Porsche Targas? No, me neither. Email meghanandherdad@gmail.com with your questions.  We’d love to have you at our morally-conflicted table.

Photo: Wikimedia Commons


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