Karen Siebert MD calls out the "mommy-trackers"

[Raryn]

Not sure I believe that - the current overall acceptance rate to medical school (positions available / applicants) exceeds 40%. Individual schools may be far less than that, but taken as a whole nationwide, it's not bad, and certainly a far cry from the overall 10% rate when I was applying in the late 70's.

You've stated that point over and over again but I'd like to see a citation for it. Yes, it's true that there is approximately a 40% selection rate right now, but if you look at the data going back, that's approximately as low as it has been. At least since 1982. Review https://www.aamc.org/download/153708/data/ and compare "all matriculants" to "all applicants" in chart 3. In 1982, not so far off from the late 70s, there was still approximately a 45% selection rate. In 1988, eyeballing the numbers because the raw data is only available on the website back to 2004, it looks like it was 65%! Only in ~1994-6 was it lower than it is now, and even then it looks like the acceptance rate bottomed out at ~35%. Now, it's possible that it was a bit lower in the 70s, but 10%? I call bull****.

Also, you're completely ignoring self-selection. 91% of US graduates who apply dermatology match dermatology. But most likely 80% of US medical students would fail to match dermatology if it wasn't for self-selection, not 9%. People who apply to medical school (and certainly people who apply to residency) are smart enough that they will often cut their losses before they even submit the application.

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[Psai]

Not sure I believe that - the current overall acceptance rate to medical school (positions available / applicants) exceeds 40%. Individual schools may be far less than that, but taken as a whole nationwide, it's not bad, and certainly a far cry from the overall 10% rate when I was applying in the late 70's.

Oh really? A 10% acceptance rate when you were applying in the late 70's?

Estimating about 15,000 allopathic matriculants in the late 1970s and about 30,000 applicants, more like a 50% rate. But you probably walked uphill both ways when you were going to school

 

[deleted171991]

That graph doesn't show the number of accepted applicants, hence the acceptance rate. I tend to believe jwk, until you PROVE him/her wrong.

The dotted line is the number of first-time applicants, not of the matriculants.

 

[Psai]

I looked for number of seats but couldnt find anything concrete. I wasn't around back then so I can't speak from experience but the article I got that graph from said allopathic spots roughly doubled from 1960 to 1980. According to the aamc there were around 16600 spots in 1982 so unless med school seats more than quintupled in five years from 3,000 med students in 1977 to 16,600 in 1982, I'm not buying his story.

 

[IlDestriero]

Does it really matter?

 

[Silent Cool]

I don't feel any obligation to work any specific amount of time or number of years. I could go 80% right now and consider it often. That's probably 15-20 years too early for the author. Oh well. The only people that are inconvenienced are my colleagues. If they're fine with it, that's all the OK I need. I trade income for time. Income used to hire another physician. Little Johnny will still get his surgery.
People going part time are actually good for the job market.
We should all go part time, spend quality time with family, walk in the park and smell the roses. I think of our fallen brother often and his lesson for us all.
That author can go work 60+ hours a week for 35 years. I'll pass. Oh man will I pass.

QFT.

"One of the most tragic things I know about human nature is that all of us tend to put off living. We are all dreaming of some magical rose garden over the horizon instead of enjoying the roses that are blooming outside our windows today."

--Dale Carnegie

 

[aneftp]

Bottom line was my years 1995-1996 was the most ridiculous years to enter med school. Our med school class was top notch. Than my buddy class 2 years later were slackers.

Quality went down towards end of tech bubble. Sure you still have your cream of the crop in every class. But overall quality down.

Best and brightest were going into the tech industry 1997-2000. Than internet busted.

You look at trends.

Only time will tell will how the ACA reimburses physicians. Consider debt load as well. Much more expensive than when I went 1996-2000.

 

[Baller MD]

Does it really matter?

Yes bc the old timers are trying to take a **** on the new guys.

 

[Baller MD]

Bottom line was my years 1995-1996 was the most ridiculous years to enter med school. Our med school class was top notch. Than my buddy class 2 years later were slackers.

Quality went down towards end of tech bubble. Sure you still have your cream of the crop in every class. But overall quality down.

Best and brightest were going into the tech industry 1997-2000. Than internet busted.

You look at trends.

Only time will tell will how the ACA reimburses physicians. Consider debt load as well. Much more expensive than when I went 1996-2000.

I know you guys had tougher training back before the 80 hours per week law was implemented. But without hesitancy I would trade that for a less student debt burden that I will have upon graduation. 300-400k when it's all said and done. Probably much more when I'm finally able to pay it off after residency. The cost of medical education now is infuriating.

 

[Silent Cool]

Bottom line was my years 1995-1996 was the most ridiculous years to enter med school. Our med school class was top notch. Than Then my buddy class 2 years later were slackers.

Quality went down towards end of tech bubble. Sure you still have your cream of the crop in every class. But overall quality down.

Best and brightest were going into the tech industry 1997-2000. Than Then internet busted.

You look at trends.

Only time will tell will how the ACA reimburses physicians. Consider debt load as well. Much more expensive than (oh, that's the one!) when I went 1996-2000.

 

[Silent Cool]

I know you guys had tougher training back before the 80 hours per week law was implemented. But without hesitancy I would trade that for a less student debt burden that I will have upon graduation. 300-400k when it's all said and done. Probably much more when I'm finally able to pay it off after residency. The cost of medical education now is infuriating.

@Baller MD ,
will you most likely owe 500K at the completion of residency training?

 

[IlDestriero]

If he did, he wouldn't be much of a baller, would he?
That level of debt makes the military option look much better.

 

[nimbus]

Medicine still attracts some ballers.

http://dornsife.usc.edu/news/stories/1731/valedictorian-and-salutatorians/

My residency class of 11 had 3 high school valedictorians.

 

[AlmostAnMD]

On track to graduate in 2016 with ~$310,000 of debt.

Then, factoring in interest, I'm going have to moonlight a lot. And by moonlight, I mean rob banks. Because that's the only way ~$500,000 total is gonna get paid off.

Money isn't everything, but gosh I'd like to own a house someday.

 

[aneftp]

If he did, he wouldn't be much of a baller, would he?
That level of debt makes the military option look much better.

Military option stopped being popular around the time Iraq invasion happened.

It was a good option between after the Vietnam war and the 2003 Iraq invasion.

It's one thing to sign up thinking your chances of being deployed were low.

But I'd like to see the stats from military signs up to pay for med school from 2003-2010.

 

[pgg]

Military option stopped being popular around the time Iraq invasion happened.

It was a good option between after the Vietnam war and the 2003 Iraq invasion.

It's one thing to sign up thinking your chances of being deployed were low.

But I'd like to see the stats from military signs up to pay for med school from 2003-2010.

The HPSP recruiting pipeline was full for several years after OIF kicked off in 2003. But 2006ish was a lean time. Navy HPSP did not fill. A lot of that was due to the wars, of course. There were other factors too.

A couple or three years after that HPSP increased the amount of money offered, adding a $20K signup bonus and greatly increasing the monthly stipend while in school. That, the rising cost of medical schools, rising student loan interest rates, and of course Iraq/Afghanistan winding down have resulting in HPSP filling the last 5 or 6 years. Moreover, the stats of matriculants have improved the last few years. It's actually becoming moderately competitive again.

Financially, HPSP looks very good for all but the highest paying specialties these days, especially if one is going to an expensive medical school.

Of course, it's not just about the money.

 

[aneftp]

I know you guys had tougher training back before the 80 hours per week law was implemented. But without hesitancy I would trade that for a less student debt burden that I will have upon graduation. 300-400k when it's all said and done. Probably much more when I'm finally able to pay it off after residency. The cost of medical education now is infuriating.

That's a crazy amount of debt.

When I went to school. Midwest state medical school. Tuition was $10k flat all four years. So that's $40k total. Plus housing and basic expenses so I owed about $80k plus interest (8.25%) from 1996-2000. . Than I got lower 4.5% in 2002 and it went down to 3.5% in 2004 after 24 months payments.

I went to state school (1992-1996) for college also. Dirt cheap. $900/semester (unlimited credits). So it was flat $900 tuition. I could take as many credits as I wanted to 12-21 credits a semester same $900 TOTAL. RIDICULOUSLY cheap.

I feel bad for you guys.

 

[Silent Cool]

That's a crazy amount of debt.

When I went to school. Midwest state medical school. Tuition was $10k flat all four years. So that's $40k total. Plus housing and basic expenses so I owed about $80k plus interest (8.25%) from 1996-2000. . Than I got lower 4.5% in 2002 and it went down to 3.5% in 2004 after 24 months payments.

I went to state school (1992-1996) for college also. Dirt cheap. $900/semester (unlimited credits). So it was flat $900 tuition. I could take as many credits as I wanted to 12-21 credits a semester same $900 TOTAL. RIDICULOUSLY cheap.

I feel bad for you guys.

 

[Baller MD]

@Baller MD ,
will you most likely owe 500K at the completion of residency training?

Yeah man. FML.

 

[Silent Cool]

Yeah man. FML.

It seems like a lot of people will be in that boat. It's just one more example of a failed government program--in this case, the federal student loan program. Is it even worth entering FM, IM, Peds, Psych with that kind of debt?

Historically people finished these training pathways will a debt load well below their first year income. Now, people are coming out owing 3x their income--and at 7.4% interest, no less. I read recently that the gubbmint, in its infinite wisdom, is expected to *increase* interest rates in the coming years, such that the average interest rate on student loans peaks out at 9.x% in 2020.

WTF.

 

[pgg]

It seems like a lot of people will be in that boat. It's just one more example of a failed government program--in this case, the federal student loan program. Is it even worth entering FM, IM, Peds, Psych with that kind of debt?

Well ... it's not complete crazy talk to speculate that in a few years a hospitalist right out of residency could pull in $250-300K in some markets. That's not far off the gloom-n-doom projections some have for anesthesia.

I wonder, if in 2020 or thereabouts, someone from the FM forum will drop in here to ask why we're settling for $250K in anesthesia when $300K is out there in the FM/IM world.

Either way though, that kind of debt is a life changer. Past $500K I have to think the historically optional FU-account-builder plan (moving out to BFE and working like a dog while living like a resident for a few years) gets to be a little less optional. The $250K job in an expensive desirable city just won't do it.

 

[Silent Cool]

Well ... it's not complete crazy talk to speculate that in a few years a hospitalist right out of residency could pull in $250-300K in some markets. That's not far off the gloom-n-doom projections some have for anesthesia.

I wonder, if in 2020 or thereabouts, someone from the FM forum will drop in here to ask why we're settling for $250K in anesthesia when $300K is out there in the FM/IM world.

Either way though, that kind of debt is a life changer. Past $500K I have to think the historically optional FU-account-builder plan (moving out to BFE and working like a dog while living like a resident for a few years) gets to be a little less optional. The $250K job in an expensive desirable city just won't do it.

@pgg ,

Has primary care EVER done better than anesthesia? I mean if they did, would that be an historical precedent?

 

[deleted171991]

Has primary care EVER done better than anesthesia?

Yes, in the 90's.

 

[Silent Cool]

Yes, in the 90's.

Wow. I didn't know that. I was always under the impression that primary got the shaft. @FFP , would you still choose anesthesia today given what other fields may or may not offer?

 

[deleted171991]

I think it's a matter of priorities. If money is important, the answer is no (for the foreseeable future). If being respected is important, the answer is no. If lifestyle is important, the answer is becoming no. If one cannot even imagine doing anything else, then the answer is maybe yes (although somebody who went through medical school should be smart enough not to choose based on likes only). I used to think that anesthesia is worth doing if one is interested in critical care; now I would recommend EM for that pathway.

The question a fresh medical graduate should ask is: which medical specialty has the lowest chances of being commoditized in my lifetime? If a tech can do a big part of your work, you're an overpaid tech, for the beancounters' purposes. If a nurse can do it, you're an overpaid nurse. If nobody else can do it, you're a doctor. The public is not much different; most of them are uneducated when about medical degrees and competences, and wouldn't know the difference between a psychologist and a psychiatrist. That's why the beancounters want every "provider" to wear a white coat. The public associates white coats with doctors the same way they associate soda with Coke.

I think "professional employee" is an oxymoron. It's a lose-lose situation; one takes most of the risks, while somebody else skims most of the profits. I strongly recommend Googling and reading "The rape of emergency medicine"; it should be an eye opener.

If one has the digestive system, the talents and especially the connections required to become an administrator, then the best medical specialty by far is MBA. Now that's where I would recommend anesthesia as a "subspecialty".

 

[Ipassgas]

[QUOTE="Historically people finished these training pathways will a debt load well below their first year income. Now, people are coming out owing 3x their income--and at 7.4% interest, no less. I read recently that the gubbmint, in its infinite wisdom, is expected to *increase* interest rates in the coming years, such that the average interest rate on student loans peaks out at 9.x% in 2020.

WTF.[/QUOTE]

And the best part is, there are only 3 types of debt not dischargable in bankruptcy.
1. Back taxes. God may forgive, but not the IRS.
2. Fraud judgements. See #1
3. Student loans. Once upon a time (10 years ago) student loans were capped at rather low interest rates, and weren't risk adjusted. So the banks got a helping hand - a guarantee they would get paid. Otherwise they'd never loan to barely passing Renaissance art history majors. Then, they managed to remove the artificially low interest rates, but not the payment guarantee. Some risk is priced back in, but there is NO risk. It's one of the sweetest scams I've ever heard of. If you want to steal thousands, rob a bank. If you want to steal millions, break into a banks computers. If you want to steal billions, become a banker.

I'm still amazed at the way these conversations evolve away from the initial post.

 

[gasdoc77]

To expand upon the student loan bubble (not unlike housing), the abundance of government money has made the student little more than the "mark" in the eyes of higher education. Can you fog a mirror? Than you qualify for cheap abundant money. Does that benefit you? Not in the least. They simply jack up tuition and reap that much more. You were just the monkey in the middle.

 

[deleted126335]

[QUOTE="
And the best part is, there are only 3 types of debt not dischargable in bankruptcy.
1. Back taxes. God may forgive, but not the IRS.
2. Fraud judgements. See #1
3. Student loans.

[/QUOTE]

You forgot alimony.

 

[deleted171991]

http://www.nolo.com/legal-encyclopedia/nondischargeable-debts-chapter-7-bankruptcy.html

Some types of debts are deemed nondischargeable if they fall within one of a list of prescribed categories. Debts falling in one of these categories do not require a court hearing to determine dischargeability status.

Unless the debtor can demonstrate extraordinary circumstances to override public policy, the following debts are deemed automatically nondischargeable:

• unscheduled debts (any debts the debtor fails to list on the bankruptcy petition or include on the mailing list), unless the creditor had actual notice or knowledge of the bankruptcy filing. Also, many jurisdictions allow discharge of otherwise dischargeable debts not listed in the petition due to an innocent mistake when there are no assets to distribute.
• certain taxes (for details, see Tax Debts in Bankruptcy)
• debts for spousal or child support or alimony
• debts owed to a former spouse or child if they arose out of a divorce or separation
• debts to government agencies for fines and penalties
• student loans (with a few rare exceptions)
• debts for personal injury caused by the debtor’s operation of a motor vehicle while intoxicated
• debts owed to certain tax-advantaged retirement plans
• debts for certain condominium or cooperative housing fees (such as homeowners association fees)
• attorney fees in child custody and support cases, and
• court fines and penalties, including criminal restitution.

 

[Ipassgas]

Doze, you're right. I did. Child support goes along with that too.

 

[Mad Jack]

The "debt to society" has more to do with the fact that a large portion of our training is subsidized by the Federal Government, a point Siebert makes in her article. Plus, more time spent practicing makes for a stronger clinician. There's no room for tourists in our profession.

When I've got 410k in debt, all of which is unsubsidized and I must pay back, I think it is fair to say that I'm paying for a substantial portion of my training. My student loan interest will more than compensates the federal government (all of my loans are direct federal loans) for the costs incurred during residency. From a financial perspective, I think it's safe to say that they're making, not investing, money by training me.

On the ethics side of things, physicians, and particularly anesthesiologists, have steadily diminishing salary, autonomy, and prestige. The difference in pay and autonomy between a CRNA and an anesthesiologist certainly isn't enough for you to bear the attitude of some indentured servant.

 

[deleted126335]

Yeah man. FML.

The inevitable response is, " you don't have to do it." Nobody forced you to take out those loans. Nobody is forcing me to write a $250,000 check for my kids undergrad either. I do it because I choose to. Because I have considered the options and find it least unpalatable.

 

[Random Anesthesiologist]

Yeah man. FML.

I will be close to that as well. Nope, no one forced me, but I don't have to like it either.

 

[BuzzPhreed]

Wow. This thread got totally derailed.

 

[deleted126335]

http://money.cnn.com/2014/08/24/news/economy/social-security-student-debt/index.html?iid=HP_LN

Retirees' Social Security checks garnished for student loans

Joshua Cohen works with troubled student loan borrowers.
What's surprised Cohen lately is the increasing number of gray-haired people walking in his doors with a problem: A portion of their meager Social Security benefits are being taken by the government to pay for old student loans they had mostly forgotten about.

It's a growing national trend. Last year, 156,000 Americans had their Social Security checks garnished because of student loans they had defaulted on. It's tripled in number from 47,500 in 2006, before the Great Recession. That's according to analysis done by the U.S. Treasury for CNNMoney.

More from Ozy: Mom, dad, grandma and grandpa all under one roof

Like Cohen, other groups have noticed the increase too. A leading nonprofit group that works with students on repaying loans, American Student Assistance, has worked this past year with over 1,000 Americans who have had their social security payments garnished to repay outstanding student loans. That's a sharp increase from 200 people in the previous year.

For retirees, any cuts to their Social Security benefits really hurts.

"Social Security means survival. It means food, shelter, medication," said Cohen, a Connecticut attorney, who works with people on debt collection harassment and student loan repayments.

What's worse is that even if the unpaid student loan was small, the amount they owe now is usually a lot larger because of compounding interest rates.

Older Americans are hit

Retired Americans can start collecting Social Security benefits at 62. However, the folks that Cohen has worked with are in their 70's and 80's.

It's a substantial amount

The amount taken from these checks isn't small. The average Social Security monthly check is $1200, the typical amount taken is $180.

Refinancing not possible for most

Very few student loans can be refinanced and many people have outstanding loans with interest rates locked at over 7%, even though rates have fallen in recent years to below 3%.

Repayment terms on student loans are extremely rigid. They are rarely forgiven even in bankruptcy and people can have their wages garnished if they default.

Elizabeth Warren

The issue caught the attention of Senator Elizabeth Warren, who introduced a billearlier this year to allow millions of people like Anderson to refinance their student loans. However, the bill was blocked in June.

Disabled not spared

Social workers are also seeing an increase in the number of people with mental and health issues having their Social Security disability checks garnished.

"I had a Korean War veteran in his 80's who had taken out a student loan for his son and then began having health problems. The government took money from his Social Security disability checks - money that he needed to buy medications," said Deanne Loonin, a director at the National Consumer Law Center, which works to provide economic security to low income and disadvantaged people, including the elderly.

According to the government data, the total amount garnished from social security checks last year came to $150 million.