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


9 Comments / Post A Comment

thegirlieshow (#5,285)

Meghan’s dad you are the best.

Marille (#5,933)

This is really great! Admittedly, I’m not in medicine, but I am still starting out financially, and figuring out where my money should be going in terms of charitable giving takes some thought. This was a really thoughtful, considered response. Lovely.

LookUponMyWorks (#2,616)

Pretty sound advice, per usual, from both Nesmiths.

boringbunny (#3,260)

I understand that this is the “right” advice financially but it’s not the advice I would give at all.

Can you be a good person if you don’t give to charity? Absolutely. Is giving time just as useful as giving money? Sure (although I’ve never met a med student with extra time). The most compelling advice I’ve ever seen about giving to charity is that it makes you focus on your abundance, rather than your scarcity. Now I’m not saying you should “make it rain at the homeless shelter” but I’ve found that even when I was a poor student or even when I was drowning in student loan debt, giving to the less fortunate alleviated some of my stresses at making ends meet. It helped me think, hey I’m so lucky, I have so much and I can make this work. And I have never regretted it.

So my advice is find one charity that you really love and support it – even if it’s $5/year. Ignore the other asks for money – you can’t do everything and you shouldn’t. I think the important thing is that you look outside yourself, that you find something you love, and you don’t give so much that you’re going to be in a financial pickle. I hope it serves you well and that you can feel the abundance of giving.

Allison (#4,509)

@boringbunny I think I’m with you on this. I don’t think the letter writer should stress too hard about not being able to help every charity, but when I started my job, there was the opportunity to donate to charity (pretax!) directly from my pay check. It started out SO negligible, but I’ve been slowly increasing it as my salary has and at this point I don’t think I could leave a $0 in there at the end of the year.

Nesmiths, thanks for choosing this great question and smart, savvy answers.

Whether the guy gives to NPR or his friends ___ walk or not has a very limited impact. Though the stakes don’t matter much for a 30-year-old med student, how that student acts has a big impact on the 45 year old doctor in the future. The bigger impact in these situations is the power of habit forming. One can always come up with a good rationalization of why one shouldn’t give in any given circumstance. The more we succumb to that temptation, the easier it is every subsequent time. Generosity is like a muscle, resist using it, and it becomes harder and harder–get used to using it and you always will.

Tithing, I think, is the best general approach. No matter one’s income, some should be given with a generous and open heart. Start early, when the money isn’t much and it will come easily when it is.

boringbunny (#3,260)

@Zach Teutsch@facebook I also agree with this. People always say “shame on rich people for not giving to charity” but they’ve been practicing scrimping for 40 odd years. If you’re constantly focusing on yourself, you’ll likely never hit the point where you think, at last! I have enough to give to charity. Giving is about your mind, not your money.

eatmoredumplings (#3,808)

@Zach Teutsch@facebook I almost totally agree, but I don’t think tithing is always possible. Sometimes it’s an issue of not being willing to make enough sacrifices. For instance, 10% of my income IS available for spending and saving now, so I could technically do it if I were OK with little to no savings or luxuries, and I admit that trying to balance those things instead of prioritizing charity above all is a less generous choice. But sometimes it’s actually an issue of really not being able to pay for necessities on 90% (or more depressingly, 100%) of your income, which is the situation I expect to be in during upcoming stints of supporting a family on one grad student or postdoc salary, and I really don’t know what to do about charity then. One person I know says take the money out of savings so you don’t reduce your giving rate, and I think doing that would show an enormous amount of faith that your situation will improve shortly or that you’ll always have enough (i.e. it depends on having a decent amount of savings already, and it would be really, really painful for people who try to plan for worst case scenarios).

My advice would be to spend the money you have in ways that are (a) necessary and (b) in line with your values. You need to spend a certain amount of money on rent, food, etc. to maintain your physical and mental health. You may find it necessary to spend some amount on entertainment for the sake of your mental health, though if you contemplate it you might decide that you’re spending more than yours needing. If you don’t need to spend as much as you are, and giving to charity is part of your value system, then make that switch!

I’m very cautious about money so spending loan money on brunches OR charity would stress me out. I personally would live cheaply for the sake of more freedom later, but I enjoy going out much less than most people, so I wouldn’t consider that to be the “right” choice.

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