Our friends in Kenya and North America have had great questions about how this whole "medical missions" thing works. So this month, I thought I'd give a run down of how our family, at least, has navigated medical school loans, licensing, board exams, finding a job/organization, and support-raising. There's a lot of detail - feel free to skim through it!
1. Medical School Loans: If you are unfamiliar with medical education and careers in the US, let me start by saying that it is very expensive. At the end of medical education, however, most physicians are well-compensated, and can afford to pay back their student loans (admittedly, some do that more quickly than others, but in most circumstances it is not an unreasonable burden). However, some of us have chosen to work in jobs that are not well-compensated, comparatively. That may include physicians who work with immigrant, Medicaid/Medicare or low-income populations in the US, or people who choose to work in the developing world especially for non-governmental organizations. On moving from residency to the Post-Residency Program with World Medical Mission, my salary dropped by half (although to be fair, I get free housing, travel and other benefits and of course, our cost of living here is low). On moving from the Post-Residency Program to Serge, my salary will stay about the same - but Kris and I will be sharing the same salary instead of each having an income. All that to say - we're not in this for the money, but I've still got an enormous pile of medical school student loan debt. Like, ENORMOUS.
There are three main ways that people in our situation deal with their debt. The first is to work for several years and pay down the debt from a "normal" physician's income. That option did not appeal to Kris and I for several reasons - since Dominic was 4 years old when I graduated from residency, we were ready to start him in school. Even if we paid off my loan debt in an amazingly fast 5 years, he would be midway through elementary when we finally made it to Africa, which would be a much more difficult transition than moving BEFORE starting school. Frankly, we also didn't want to get accustomed to a US physician lifestyle before moving to the developing world.
The second option for dealing with debt is to apply with an organization such as MedSend, which receives donations and then uses them to help pay off medical school debt for physicians and other health care professionals. Its a great organization, and they have many other programs and opportunities to support health care providers in the developing world.
The third option, which we have utilized, is to enroll in the Public Service Loan Forgiveness program. In summary, after making income-based loan repayments for 10 years (residency was included in that time) while working for a qualifying organization (not-for-profit among others), I can apply to have the remaining balance on my loans forgiven. Since our income is comparatively low, our payments are also low. So far, we've made about 70 payments out of the required 120, and should be eligible to apply for loan forgiveness in 2026. (Another silver lining of covid - payments were not required during approximately a 2-year period, but as long as one was working for a qualifying employer, those months counted as "payments" AND interest was not accruing during that time.)
2. Licensing: Well, I messed this one up. Many people keep both a US medical license and a foreign medical license at all times. However, I don't have any intention to work as a physician in the US, so I let me US medical license expire AFTER checking to make sure I would still be eligible to take my OB/Gyn oral board exams. (The main motivation to NOT renew my US medical license was having to pay fees AND having to meet a certain amount of documented Continuing Medical Education, which I didn't otherwise have to do to be eligible to take that board exam.) Turns out, I received some incorrect information, and so I had to renew my US medical license and delay my oral board exam for a year (see below). Overall not the end of the world, as 2021 would have been a really difficult year to get away to take my board exam anyway.
3. Board Exams: I can't speak to every specialty, but for OB/Gyn, a written exam is required immediately on completing residency, and then an oral board exam needs to be taken within 8 years of completing residency. Before taking the oral board exam (called the "certifying exam") one has to practice as an OB/Gyn and collect cases - basically, record information about every inpatient that they have cared for and many outpatients. After passing the certifying exam, an OB/Gyn receives the designation "board certified" and has to meet certain continuing education requirements to maintain their certification.
4. Choosing an organization: I've written about this before, but long story short, I entered college knowing that I wanted to be a physician in the developing world - not knowing ANYTHING about medical education, residency, let alone how to get a job as a physician in the developing world. For the first 7 years of medical school and residency, I learned a lot about medicine - but still didn't know ANYTHING about how I was going to get a job after residency. World Medical Mission's Post Residency Program was perfect for our family. In an effort to help new physicians and dentists (within about 5 years after residency) get started and well-established in medical missions, the PRP stations doctors in hospitals where there are (usually) other physicians and mentors. I say usually because the PRP obviously can't control if the other physicians/mentors stay in that location, but the intention for mentorship is there. The PRP also provides a salary and other benefits for the physician, and tons of logistical support and member care. They also help with finding and transitioning to another long-term "sending agency." The big down-side to the program is that it is time-limited - two years in most cases, two-and-a-half if you ask nicely for an extension due to extenuating circumstances such as a worldwide pandemic.
Long-term sending agencies are many and varied. We looked primarily at faith-based organizations, but there are other NGOs as well (I'm not as familiar with them). Some of these sending-agencies are quite hands-off, while others have more requirements and internal programs. We chose Serge for many reasons, but the first thing that attracted us to them was that they try to send teams - not all doctors, all pastors, or all teachers, but a team that is balanced to meet needs both internally, and in the broader community.
5. Support-raising: Again, this is probably largely dependent on each orgaization so I can only speak to our experiences. As I said with World Medical Mission, my salary and benefits were covered, but we raised money for special projects, extra expenses, Kris and Dominic's travel, medical licenses and board exams, work permits - many different things. Kris joined Resonate after we had arrived in Kenya, so he had an account and raised money for a salary and other work-related expenses, but he didn't have to meet his budget before he started drawing that salary. If his donations amounted to 70% of his budgeted amount for his salary, he received 70% of his salary that month.
With Serge, we are looking for individuals and churches who are willing to commit to monthly or annual donations, who will consider partnering with us for the next 5 years. That is to say - we don't need to have our total budget for 5 years in our account with Serge before we return to Kenya, we just need to have "pledges" or commitments from enough people to meet our monthly budget. The account is with Serge - they collect the monthly pledges, and then out of our account, pay our health insurance, salary, release or reimburse money for expenses like travel, work visa, professional licenses and development, school fees or homeschool supplies for Dominic, etc. Our term with Serge will be 5 years - four years here in Kenya, and then 1 year (maybe continuous, maybe divided up) for personal/professional development and support raising for our next term.
I think a lot of people are intimidated by support-raising; either being the person asking for money, or being asked. I started fundraising early - I think the first thing I raised money for was when I was 10 years old, for the "Calvinettes Rock-A-Thon" (that's a story for another blog post!). Without going too deep into it - it's just money. Kris and I believe in what we're doing here. We know we could make more money doing something else, somewhere else in the world. We know the salary we're raising is sufficient for our needs, but it is by no stretch of the imagination extravagant. We know that some people will be able to help support what we do here with financial contributions - and other people will support us in other ways. We know that being told "no" or "not now" doesn't mean that someone doesn't care about the work that we're doing - in the same way that receiving a huge financial contribution from someone doesn't mean that they care more about what we're doing. We are excited about the opportunity to tell people about Kapsowar, about the needs of the people in Kenya and throughout this region, about the way God is working and about the challenges we still face, and about the hopes we have for our future, and Kapsowar's future.
In our last 16 days of work here in Kapsowar, in our last month before we return to Seattle and start the next season of sharing stories and asking for support, please join us in praying for Kapsowar and the community here. We still don't know who will provide OB/Gyn services after I leave. There are so many logistics that we need to work out. We want to do our first "home leave" well - and we want to be able to return to Kapsowar soon.
We look forward to seeing many of you in the months ahead. If you want to get in touch - leave me a private message here or send me an email!
Kim
