Why do we pay tuition for 3rd and 4th years?

[DaddyD91]

I'm honestly just curious as to why there is tuition for 3rd and 4th years of medical school. I'm sure there are administration costs, but essentially we are providing work in the hospital. Residents and attendings don't get paid extra to teach specifically while they're doctoring on the floor do they? Can anyone provide some insight as to how schools get away with this.

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[kenjixshadow]

You are essentially paying for the access to residency and because medical schools say so, plus there will always be someone else willing to take your seat if you don't want it.

 

[costales]

It's an old med school tradition.

 

[GUH]

As someone who has just started third year, I'm about 90% certain that my attending could work faster without me around.

 

[postbacpremed87]

I'm honestly just curious as to why there is tuition for 3rd and 4th years of medical school. I'm sure there are administration costs, but essentially we are providing work in the hospital. Residents and attendings don't get paid extra to teach specifically while they're doctoring on the floor do they? Can anyone provide some insight as to how schools get away with this.

At the expense of productivity

 

[DaddyD91]

But are attendings getting compensated with that tuition money for being slowed down? It seems like that money should be going to an increase in resident salary especially if they are the ones taking the time to teach the students. I understand it's been that way forever, but seems to me like there should be a push to have this looked at. Especially with tuition costs rising as much as they have. Money shouldn't be a deterrent for someone wanting to start medical school --- seems detrimental to their desire to promote diversity.

 

[DOFOSHO]

.

 

[chizledfrmstone]

the hospitals and attendings get paid to have you in the hospital with them. they are not doing it for free. they are not doing it out of good will. they are doing because they are getting paid. don't let anyone lie to you.

I have a few family members that teach medical students. They don't get paid anything. I think they said they might get CME credit or something.

 

[InvegaSustenna]

I'm guessing for all those coordinators and admin people to set up our rotations and write our deans letters and all that paperwork junk

 

[alpinism]

As someone who has just started third year, I'm about 90% certain that my attending could work faster without me around.

This.

And, unless your school is different, nearly every single 3rd year rotation still has lectures/small group discussions/assignments that need to be completed along with the clinical requirements.

 

[DrEnderW]

I have a few family members that teach medical students. They don't get paid anything. I think they said they might get CME credit or something.

My understanding is that the hospital is payed which indirectly ends up contributing to their salary. That could be completely inaccurate though...

 

[nardini46]

Paying for administration salaries.

 

[Roxas]

As someone who has just started third year, I'm about 90% certain that my attending could work faster without me around.

Isn't that one of the laws from The House of God? "Show me a med student that only triples my work, and I'll kiss his feet"

 

[cbrons]

Paying for administration salaries.

bingo.

We pay an enormous amount in tuition ($15,000 for just 1 summer month of tuition). This is an MD school.

Sad thing is like 90% of physician preceptors are not paid a dime to teach. Its all volunteers. The very few who are paid get something like $300 a month (i.e. clerkship director).

NO idea where all the money goes, but likely to worthless administrators who do nothing useful and couldn't get a job in a slop house if it wasn't for so-called public education.

 

[user3]

All schools receiving federal loan (taxpayer) funding should be audited annually and have annual reports published detailing where exactly all of their revenues are going.

 

[kbeitz]

Why is medical school so expensive? Why is any professional school expensive? Because another person is more than willing to pay that entry fee if you aren't.

How badly do you want this?

 

[hallowmann]

the hospitals and attendings get paid to have you in the hospital with them. they are not doing it for free. they are not doing it out of good will. they are doing because they are getting paid. don't let anyone lie to you.

My understanding is that the hospital is payed which indirectly ends up contributing to their salary. That could be completely inaccurate though...

This really varies by school. My school makes it a point not to pay for any rotations at all. The main benefit is from side deals, like say a hospital system insurance company insures all students (students pay for that) and students get rotations in the system, or say a school admin helps a hospital without residencies organize/build a bunch of them, then that hospital gets fed money for said residencies, and the school gets a new rotation site for its students.

The only benefit actual preceptors and residents get is teaching and CME credit.

 

[iceman720]

This really varies by school. My school makes it a point not to pay for any rotations at all. The main benefit is from side deals, like say a hospital system insurance company insures all students (students pay for that) and students get rotations in the system, or say a school admin helps a hospital without residencies organize/build a bunch of them, then that hospital gets fed money for said residencies, and the school gets a new rotation site for its students.

The only benefit actual preceptors and residents get is teaching and CME credit.

Hallow, I totally agree. I think in terms of benefits, us students really only provide a physician with personal reward of contributing to the field of medicine.
In regards to the schools who do pay for preceptors time... I've heard the amount is trivial, its more of a "thank you". Hence, we need to be considerate of physician's time. Showing appreciation and gratefulness all times especially when I had 1 on 1 attention worked well for me on rotations.

So, I don't think preceptors are taking on students and "teaching for the money". All the preceptors I worked with seemed very passionate about their profession and felt they had something to offer students in terms of education. Maybe I was lucky and never had a doc that didn't like to teach.
But, aside from administration fees, hospital fees, housing, there is liability insurance. I'm 99% certain hospitals require a >$3mil coverage per student. Don't forget salary and wages for staff...

This is data from 2011 and some data is from Bureau of Labor and Statistics, so be mindful of reliability:

1. According to a study released by the College and University Professional Association for Human Resources, or CUPA-HR, the average annual salary of associate deans in schools of medicine was$188,206, the highest salary reported by associate deans in any college department.
   The Salary of an Associate Dean in a School of Medicine ...
   work.chron.com/salary-associate-dean-school-medicine-10185.html
   References (5)
   • The Chronicle of Higher Education: Median Salaries of Senior College Administrators by Job Category and Type of Institution, 2010-11
   • Willamette University: Role of the Associate Dean
   • University of New South Wales: Associate Deans
   • U.S. Bureau of Labor Statistics: Postsecondary Education Administrators
   • U.S. Bureau of Labor Statistics: Wages for Postsecondary Education Administrators

 

[YankeeCandle1141]

You are paying for your school's million+ dollar relationships with hospitals.

 

[CopToEM]

I'm honestly just curious as to why there is tuition for 3rd and 4th years of medical school. I'm sure there are administration costs, but essentially we are providing work in the hospital. Residents and attendings don't get paid extra to teach specifically while they're doctoring on the floor do they? Can anyone provide some insight as to how schools get away with this.

Our school pays the attending $500/month per student.

 

[MiaMia14]

Our school pays the attending $500/month per student.

I'm pretty sure I went to the same school and that is wrong. I think there might be some money that goes to the hospital (and the hospital decides to give the preceptors money or not) but that's just for the core rotations. Selective and electives don't get anything. Every preceptor I had said they didn't get anything from the school....my dad was also a preceptor for them and never got anything.

 

[simbad8]

It's for our malpractice insurance...at least that's what we were told.

 

[Pisiform]

My attending just drops in for couple of hrs for morning rounds. The rest of the time I learn from PAs and nurses

 

[NurWollen]

My attending just drops in for couple of hrs for morning rounds. The rest of the time I learn from PAs and nurses

What rotation are you on?

 

[Pisiform]

What rotation are you on?

NICU. There are two attendings there. One recently went on vacation - he used to take me every where. This one is chill. He shows up for couple of hours, I present patient and then he leaves. Comes he lives down the street from the hospital so he comes in whenever there is an emergency or nurses couldn't understand something

 

[CopToEM]

I'm pretty sure I went to the same school and that is wrong. I think there might be some money that goes to the hospital (and the hospital decides to give the preceptors money or not) but that's just for the core rotations. Selective and electives don't get anything. Every preceptor I had said they didn't get anything from the school....my dad was also a preceptor for them and never got anything.

They do get paid for CORE site rotations as long as they've went through the process to turn in the adjunct faculty paperwork. I've not only had a friend who's an attending tell me this but have been on several rotations where the rotation coordinator brings the check by for them to sign for. On my EM rotation they had me keep a log of who I worked with and for how many hours. They told me it was specifically so they could split the money appropriately. So yes, it's correct.

 

[Goro]

Like the School of Music, School of Education, etc...

A tuition bill isn't an itemized receipt from the grocery store.

Tuition is what it is in order to cover all the overhead, personnel, and administrative costs of running the school. Plus whatever margin the school needs to diffuse out and make up for other areas that lose money, plus whatever margin they choose to run their business at.

 

[gyngyn]

the hospitals and attendings get paid to have you in the hospital with them. they are not doing it for free. they are not doing it out of good will. they are doing because they are getting paid. don't let anyone lie to you.

We don't pay our clinical faculty for teaching medical students.
Every one is expected to teach if they want to be faculty, it's part of the job.

 

[DOFOSHO]

.

 

[22031 Alum]

if a faculty member decided to stop teaching med students, would they still be paid?

Yes-- their new, non-faculty job would pay them.

 

[gyngyn]

if a faculty member decided to stop teaching med students, would they still be paid?

We don't pay them for teaching.
The department allocates teaching responsibilities so that those who are good at it have more leeway on their clinical productivity to make up for the "weak-teachers."
When it comes time for promotion, I'll bet you can guess who wins.

 

[DOFOSHO]

.

 

[gyngyn]

isn't that the same thing as getting paid....
if a doc without teaching responsibilities had the same clinical productivity (assuming we're talking about lower productivity) as a doc with teaching responsibilities they'd be fired (and not paid).

There are three pillars of academic medicine.
Faculty are expected to excel in at least two of them.
Departments allocate resources such that all are served.
Teaching is not a carve out for which one is paid. It is part of the expectation for faculty members.

 

[NontradCA]

I was told that 3rd and 4th year tuition offsets the costs of 1st and 2nd year

 

[gyngyn]

I was told that 3rd and 4th year tuition offsets the costs of 1st and 2nd year

Actually, it costs a lot more to find meaningful training for the last two years.
The first two are almost break even.
Every medical school I've worked for lost money on the medical students.
They make up for it elsewhere (research and clinical).

 

[W19]

....

 

[kenjixshadow]

Actually, it costs a lot more to find meaningful training for the last two years.
The first two are almost break even.
Every medical school I've worked for lost money on the medical students.
They make up for it elsewhere (research and clinical).

What about in the case of students who don't spend their last year at their home institution? In my 4th year, I'll have only two required rotations - family and rural. Aside from them, I'll be a thousand mile away. I don't see how in anyway can that justify for $50,000 of tuition, though what SS wrote makes sense.

 

[group_theory]

We don't pay them for teaching.
The department allocates teaching responsibilities so that those who are good at it have more leeway on their clinical productivity to make up for the "weak-teachers."
When it comes time for promotion, I'll bet you can guess who wins.

Let me guess - the ones who can bring in $$$ of external funding for research, and is good at backroom politics and didn't piss off the tenured professors/department chair/dean, and the dossier is full of glowing praises about cutting edge research/leader of the field/how many visiting grand rounds were given

Oh, somewhere in that dossier, it is noted that outside of protected research time, there is mention of clinical services with mentorship of residents and academic advising of medical students, as well as how many committees (or administrative obligations) this person participated in

/assuming the assistant professor is on a tenure-track role (not on the clinician-educator track)

 

[user3]

A tuition bill isn't an itemized receipt from the grocery store.

Tuition is what it is in order to cover all the overhead, personnel, and administrative costs of running the school. Plus whatever margin the school needs to diffuse out and make up for other areas that lose money, plus whatever margin they choose to run their business at.

but is it too much to at least ask for more transparency regarding how our tuitions are being used? Many people seem inclined to give the schools the benefit of the doubt with respect to such matters, I am not.

 

[gyngyn]

Let me guess - the ones who can bring in $$$ of external funding for research, and is good at backroom politics and didn't piss off the tenured professors/department chair/dean, and the dossier is full of glowing praises about cutting edge research/leader of the field/how many visiting grand rounds were given

Oh, somewhere in that dossier, it is noted that outside of protected research time, there is mention of clinical services with mentorship of residents and academic advising of medical students, as well as how many committees (or administrative obligations) this person participated in

/assuming the assistant professor is on a tenure-track role (not on the clinician-educator track)

Those you describe get fired every year. All it takes is uncivil behavior, especially to a medical student.

 

[gyngyn]

but is it too much to at least ask for more transparency regarding how our tuitions are being used? Many people seem inclined to give the schools the benefit of the doubt with respect to such matters, I am not.

I think tuition money should only be spent on education.
Apparently it's the only discretionary fund the dean has in many cases, though.

 

[Goro]

QTF. A single decent research department at a medical school can make just as much money in indirects from R01s than it can from a med school class of 100+ students paying tuition.

Actually, it costs a lot more to find meaningful training for the last two years.
The first two are almost break even.
Every medical school I've worked for lost money on the medical students.
They make up for it elsewhere (research and clinical).

 

[Doctor Bob]

Our school pays the attending $500/month per student.

Ohhhh... I wish I could get this deal.
Every teaching program (civilian and military) I've been at has expected me to teach out of the goodness of my heart.