How to get your loans forgiven in your own ideal clinic →

My med school was 5k/year. At graduation, I left with 22K of loans. That was 1993. University of Texas Medical Branch at Galveston—still one of the best deals in medical education (current tuition is 24K). During my first two years of family medicine residency on a salary of 30K/year, I paid off my loans. By age 36, I owned my house and was living debt free.

Now med students have 300K loans—or more. One mid-career physician friend has a debtload of 1 million—and growing. With compound interest it takes a lifetime to pay down med school debt. Some never do. I know trainees who have died by suicide next to unpaid med school bills, in essence their suicide note.

How can our doctors care for the most vulnerable and underserved patients when they themselves are so stressed by unmanageable debt? How can doctors live their dreams in medicine when many choose specialties based solely on perceived earning potential?

I’ve been running a doctor suicide hotline since 2012 and I hear from so many suicidal physicians and med students drowning in debt that I published their letters (with permission) in a section of Physician Suicide Letters—Answered entitled Death by Debt:

“I’m in my first year of practice and I can’t begin to tell you how often I think of death. Not because I hate my life—I have a wonderful husband and family. But the pressures of daily life as a doctor are overwhelming. I work constantly! Even on my days off, I’m working. When I take a day off, I pay for it later by double the amount of work waiting for me. I have patients yelling at me when all I wanted to do was help. They try to fool me and manipulate me. Insurance companies deny my patients help—leaving me with no resources to help. My boss is a douche—unethical and dangerous. I want to build relationships and do what’s right for my patients, but the company pushes me to see more and more patients in less and less time. I cry at work, I cry myself to sleep sometimes. I don’t feel depressed, and I know my life has value, but sometimes the thought of suicide is just to escape the pressure of the profession. It’s not like I can realistically give up the job, my calling. I’m neck deep in debt and will never be able to pay it back if I leave the profession. ~ Michelle”

“The decision to go to medical school was wrong. The idea that I could use the talents I have been blessed with to make a difference was a sham. I am called obscene names on satisfaction surveys by patients for not filling their prescriptions for narcotics/tranquilizers/amphetamines; called to task by supervisors for my arrogance at adhering to medical standards of care; and drowning in debt I can’t escape by bankruptcy. I am in the process of stacking my life insurance to adequately care for my wife and children. I know how and where. Knowing I am not alone does not change things. ~ Dylan”

“I’m a fourth-year med student in a below-average school on the East coast. I performed well throughout medical school (top 20%), and have above-average board scores. I’ve applied for residency positions in three different fields. Unfortunately, I’m not getting interviews like I thought I would. I was advised that my application is rock solid; in fact, competitive. Doesn’t seem to be the case given no interviews. I’m in significant debt (about $350,000), and though this is nothing foreign to med students, I come from a poor family and I would need to secure a residency to pay this back. Now here’s the thing. I don’t anticipate matching into a residency program and I’ve made the decision to possibly end it all once I don’t match. I have worked hard all my life. I did everything to get into the fields I’ve applied for (two of which are not even very competitive at all). Nothing has ever gone my way before or since starting medical school. I have gotten to this point after pushing through one struggle after another. During med school I had many significant tragedies in my family (deaths, illness, financial issues, to name a few). I fought through them. But I had to be cold to do it. I had to act like I did not care. I can’t keep doing that to my family. I changed careers to go to med school. I pushed them into debt that never existed before school. Now I am facing the possibility of having an MD with no job. ~ Kulthum”

Okay so what if you could live your dream in medicine, be your own boss, and get your loans forgiven. You CAN! Even without completing residency!

Fed up with assembly-line medicine in big-box clinics, I quit 6 jobs in 10 years. I was so disillusioned in my career, I became suicidal. The cure for my suicidal thoughts—was to open my own ideal medical clinic. I’ve been happy ever since. The crazy part is I earn three times as much per patient. I explain how I tripled my income in this wild Las Vegas keynote.

I’ve been in my own ideal clinic for 15 years and have now helped hundreds of doctors launch their own ideal clinics in almost every state of the country (even Canada & New Zealand). Now here’s the deal . . . if you launch your clinic in the USA as a nonprofit, you can get your loans forgiven in the the a program called PSLF (Public Service Loan Forgiveness). Here’s how it works. . .

Your loans are wiped clean after 10 years of loan payments. You must make a total on 120 payments to qualify. Yet these payments don’t have to be huge; they can be just a few hundred dollars when you take advantage of reduced payments through IBR (Income Based Repayments). Obviously it is best to start making these payments when your income is low. Like as a student or resident. If you are in residency at a nonprofit institution then you should definitely start IBR while in residency. Do not defer your payments.

Continue making payments as soon as you open your own nonprofit or work for another nonprofit or government job (and it doesn’t even have to be in health care!). Plus during COVID your loan payments are now zero!  Yet you are still getting credit for having made a payment so definitely take advantage of this pandemic payment pause.

As a trainee, you are essentially paying a few hundred dollars with IBR during residency (and even less in med school IF you can start that soon – not sure about this but I bet if you are determined you can figure out how).

So if you have a 4-year residency at a nonprofit institution, you can pay a few hundred per month and get 4 years credit toward PSLF. IF (not sure depends on your loans) you start in med school your IBR would be near zero and you’d get 4 more years credit—again not sure about this though worth checking). Regardless you would only need a few more years at your own nonprofit, another nonprofit, or a government job like the VA to qualify for total forgiveness.

To qualify for PSLF, you have to work an average of 30 hours per week for a nonprofit (that would be a pretty relaxed residency). You can see patients in your own nonprofit clinic or do primarily telemedicine. Or you don’t even have to see patients. You can do administrative work and run the nonprofit and hire other docs to see patients and still get credit. You could do group visits or community education. As long as it is a nonprofit, you qualify.

You do not have to keep the same job at the same nonprofit. You could do your residency at a nonprofit institution, then join the VA or a nonprofit hospital, or decide you don’t like medicine and become a park ranger or work at the YMCA or a food bank and still get your loans forgiven. You just need a total of 120 payments over 10 years. You can have gaps.

You have SO many choices and there is so much more to share about launching a nonprofit. You just start by filing paperwork with the IRS for your 501(c)(3) nonprofit. Use LegalZoom and costs about $500. It’s not any more complicated that applying to med school. Just filling out forms.

Nonprofit Advantages/Disadvantages:

Some Advantages:
1) You are mission-driven and get community perks (free booths at fairs, all sorts of discounts); 2) You have more autonomy than an employee position; 3) Tax-exempt (federal/state, sales tax); 4) Can accept grants, tax-deductible donations; 5) Liability protection; 6) Public Service Loan Forgiveness; 7) Your salary can be as much or as little as you and your board decides (some nonprofit medical institutions pay their CEOs millions); 8) You can leave a legacy that outlasts your lifetime.

Some Disadvantages:
1) You are not the sole owner. You need board members; 2) IRS application takes one year for approval (retroactive); 3) Must submit annual filings; 4) Must find 100% trusted board members; 5) Must have board meetings & minutes (you can streamline and make this easy via Zoom or other apps.); 6) Public scrutiny (transparent financial reports).

The bottom line is you do not need to be miserable because of debt. You do not need to lose your precious life by suicide or live a life of silent desperation in a job you hate. You have choices! LOTS of choices.

If you want to launch your own ideal clinic, contact Dr. Wible here. Or join our Fast Track Course (discounts for med students/residents) with step-by-step instructions on how to launch your dream clinic (even without completing residency).

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What NOT to do after a medical error →

If you are a doctor (or med student/health professional) and you are human, you’ve probably made a medical mistake. You’ve probably not received emotional support for the mistake. Maybe you’ve never told anyone about a mistake that still haunts you today. 

The truth is most all physicians have admitted to medical mistakes sometime in their careers. Depending on the patient outcome, many doctors carry the distress of medical errors for months, years, even a lifetime. Some may even develop PTSD.

If you’ve experienced anxiety, depression, guilt, loss of confidence, or were haunted by intrusive thoughts in the aftermath of a medical error, you are normal. In fact, you’ve had second victim syndrome—a real condition that describes the psychological trauma a physician (or health professional) experiences as a result of an error.

I just got off the phone after speaking with a highly-skilled specialist suffering in isolation with grief, shame, and guilt after a recent medical mistake. During our hour long conversation she recalled another mistake from several years prior. I then shared de-identified case studies of other physicians I know (including my own) as examples of what not to do. 

Top 3 ways NOT to respond to a medical error:

1) Do not die by suicide. I know of several physicians who have taken their own lives in the aftermath of making even a minor medical mistake. Do not kill yourself. Please. Call someone. Call me.

2) Do not respond with self-abuse. Do not take the patient’s chart home to punish yourself by obsessing on your mistake over and over again for years to remind yourself that you are not as smart as you think you are (like one doctor I know who did this). Do not allow a mistake to overshadow your years of excellent care.

3) Do not wait decades to share your trauma. One physician broke down in tears in front of me about a medical error she experienced 30 years ago. She then apologized for crying. Then she told me she had not been able to cry in 10 years! 

After a decade helping doctors heal from suicidal thoughts, self-abuse, and isolation from recent and remote medical mistakes, I’ve discovered what actually works.

Top 5 ways to respond to a medical error:

1) Talk about your mistake. The most important thing you can do after a mistake is to talk to a trusted colleague (not a spouse, not even a nonphysician). If possible choose someone within your specialty who understands innately your experience. Your conversation should be 100% confidential. You deserve psychological support. The sooner you talk, the better. Do not isolate. Please.

2)  Forgive yourself. Avoid self-punishment by recognizing that you can not be a perfectionist in an imperfect world. You are human. You have often been subjected hazardous working conditions, even human rights violations in medicine involving sleep deprivation and overwork. To understand the widespread risk of medical errors, please view award-winning film, Do No Harm: Exposing The Hippocratic Hoax, that exposes how our working conditions lead to medical mistakes and doctor suicides.

3) Have faith. No matter what your spiritual or religious beliefs are, it is important to realize that there is a a force greater than us in this world. I personally love the quote, “Do your best and let God do the rest.” As long as you tried your best under the circumstances and were not malicious in your actions, please do not punish yourself.

4) Love your imperfections. Perfectionism is impossible to achieve. Be vulnerable and admit when you need help. You are human. Embrace your humanity. Have self-compassion and teach your colleagues to do the same.

5) Become an expert. Our most difficult cases teach us the most. Honor your patient by learning how to prevent future errors. Accept your error and grow professionally. Reframe your mistake as a positive teaching moment for your team and help other doctors prevent similar mistakes. Be a voice of inspiration and education for others.

You can not only survive a medical mistake, your mistake can make you a better doctor. Above all, please don’t give up on yourself or your career.

To join a 100% confidential peer-to-peer support group retreat for physician struggling with medical errors, contact Dr. Wible.

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55 orthopaedic surgeon suicides. How to prevent #56. →

Since my original keynote 2 years ago: 33 orthopaedic surgeon suicides: How to prevent #34, we’ve lost 22 more orthopaedic surgeon to suicide. On September 10, 2020, at the American Orthopaedic Foot & Ankle Society, I share why each of these 55 doctors died died and how we can prevent future suicides among doctors. Afterwards we had 3.5 hours of Q&A and continued conversation (confidential, not recorded). Need to talk? Contact Dr. Wible here.

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Coronavirus pandemic increasing already high risk of doctor suicide →

Listen to the interview on Oregon Public Broadcasting here.

Rates of suicide for physicians are among the highest for any profession. And the strain of the coronavirus pandemic is making already strenuous working conditions nearly impossible to bear for some and impossible for others. We talk with two Oregon doctors involved in responding to the mental health crisis in medicine and ask what is being done to prevent it. Pamela Wible practices medicine in Eugene and is the author of “Human Rights Violations in Medicine: A-to-Z Action Guide.” Don Girard is professor emeritus at Oregon Health & Science University and chairs the executive committee of the Oregon Wellness Program.

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September 17th is Physician Suicide Awareness Day. Join me in honoring 93 doctors we lost to suicide. →

View the Wall of Remembrance (above) at the end of the newly released award-winning documentary, Do No Harm: Exposing the Hippocratic Hoax, a film that exposes our doctor suicide  crisis and honors nearly 100 doctors who have died by suicide. Join me today in remembering them. View full-feature film by Emmy-winning filmmaker now on Amazon Prime.

Greg Hamlin Miday, M.D., Internist

Kevin Thomas Dietl, D.O., Degree Awarded Posthumously

Kaitlyn Nicole Elkins, Medical Student

Sean Michael Petro, Medical Student

Emily Ariel Bamberger, M.D.,Ph.D. Candidate

Jacob “Dr. J” Neufeld, M.D., M.P.H, Pediatric Physiatrist

John Chuan Loh, Medical Student

Gabriel Goodwin, M.D., Anesthesiologist

Evan Astin, M.D., Internal Medicine Resident

Gregory Andrew Collins, M.D., Family Physician

Lara Barnett, M.D., Internal Medicine Resident

Charles Christopher Martin, M.D., Family Medicine Resident

Carrie Ann Largent, Medical Student

William Samuel Brown, M.D., Radiologist

Robert Karoly Chu, M.D., M.P.H., Aspiring Radiologist

Jeremy Egnatios, Medical Student

Steven G. Ortiz, M.D., Orthopaedic Surgeon

Alan R. Rowlan, M.D., Surgeon

Kim Marie Walsh, M.D., M.P.H., Family Physician

Ross Alan Gallo, M.D., Psychiatrist

Abdurrahman Unal, M.D., Radiation Oncologist

Alain Bolduc, M.D., Dermatologist

Alex Djuricich, M.D., Internist and Pediatrician

Amanda Liu, D.O., Radiology Resident

Andrew Bryant, M.B.B.S., Gastroenterologist and Hepatologist

Benjamin Shaffer, M.D., Orthopaedic Surgeon

Boyd Dan Batla, Medical Student

Bryan Whitemarsh, M.D., Family Physician

Captain Michael McCaddon, M.D., Obstetrics/Gynecology Resident

Carol D. Lee, M.D., Emergency Physician

Chloe Eliza Abbott, M.B.B.S., Medical Registrar

Christine E. Petrich, M.D., Psychiatrist

Christopher Dawson, M.D., Surgeon

Corbin Shawn, M.D., M.S., Pathology Resident

Daniel Gunther, M.D., Pediatric Endocrinologist

David Gersztenkorn, M.D., Ophthalmology Resident

David Scott Brooks, M.D., Family Physician

Deelshad Joomun, M.D., Interventional Nephrologist

Douglas F. Meyer, M.D., M.P.H., Gastroenterologist and Hepatologist

Eric S. Steichen, Medical Student

Greg Feldman, M.D., Vascular Surgeon

Hans Christopher Machula, M.D., Degree Awarded Posthumously

Jack Andrew Singer, M.D., Ophthalmologist

James C. Kelly, D.O., Family Physician

James K. Bauman, M.D., Obstetrician/Gynecologist

James Ray Anderson, D.O., General Practitioner

James Wilson Dow, M.D., Cardiologist

Janet Y. Christophel, M.D., Anesthesiology Resident

Jeffrey Knobloch, D.O., Family Physician

John D. Wilson, Sr., M.D., Family Physician

John Franklin Dorsey, Medical Student

John Mark Baar, M.D., Psychiatrist

John Mark Madsen, Medical Student

John McNaugher Stang, M.D., Cardiologist

Jon Azkue, M.D., Internist

Jonathan J. Drummond-Webb, M.D., Pediatric and Congenital Cardiac Surgeon

Jonathan W. R. Davies, M.D., Obstetrician/Gynecologist

Kelly Werlinger, M.D., Aspiring Dermatologist

Kurt A. Swanson, M.D., Anesthesiologist

Lee Ray Winkler, D.O., Obstetrics/Gynecology Resident

Leslie Gale Bluman, Medical Student

Marc E. Wise, M.D., J.D., Anesthesiology Resident

Mark A. Gonsky, D.O., General Practitioner

Mark William Sebastian, M.D., Vascular Surgeon

Matt Wittman, Medical Student

Matthew Carl Bishop, M.D., M.B.A., Emergency Physician

Mitchell D. Hardison, M.D., Internist

Myles K. Gaupp, Jr., M.D., Family Physician

Natalie Carol Sieb, D.O., Family Physician

Nehal A. Shah, M.D., Aspiring Family Physician

Neil Grover, Medical Student

Noah Chase Beadell, M.D., Neurologist

Paki Myers, M.D., Emergency Physician

Patrick Glenn Daus, D.O., Emergency Physician

Ramsey Oliver Coles, Medical Student

Richard Irwin Caesar, M.D., Addiction Specialist and Emergency Physician

Richard “Pete” Dickson, M.D., Family Physician

Rita E. Leighton, M.D., Anesthesiologist

Rita Kay Payne, M.D., Obstetrician/Gynecologist

Robert E. Elliott, M.D., Radiologist

Robert Shaw Bowling, Jr., M.D., Family Physician

Robert Wolyn, M.D., Cardiologist

Ronald Chance Brown, M.D., Internist

Roseanna Polge, B.M.B.S., Medical Intern

Russel J. Vancoevering, II, M.D., Obstetrician/Gynecologist

Scot Pencil, M.D., Ph.D., Pathologist

Shawn C. Kelley, M.D., Internist

Stephen P. Kelleher, M.D., Nephrologist

Steven L. Anthony, D.O., Otolaryngologist

Ted Eastburn, M.D., Cardiologist

Varun Babu, M.D., Cardiology Resident

Wayne Allen Hendrix, M.D., Anesthesiology Resident

Wayne M. Gunckle, D.O., Orthopaedic Surgeon

                            . . . and the thousands of unnamed doctors . . .

View documentary and help stop the crisis.

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