Should medical school be free? Op-ed from NYTimes

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Heh..this will obviously give birth to some good discussion.... 🙄

My opinion : It's a horrible idea.
 
Weird... It would almost definitely entice more med students to go into primary care, but this would only be fair to specialists if those in specialist residencies were still eligible for the same student loans and rates that they would have been in medical school, as this is essentially only shifting the period of living on loans forward four years for anyone wanting to specialize. If you don't allow them the same access to the loans they'll need then as you would if they took them out as med students, then this seems really unfair. Assuming they can get the same loans four years later, it's an interesting concept, though it would mean insane amounts of compounded interest for long residencies like neurosurgery, where one would be living off loans for almost twice as long as they would if they took them out for med school.

Edit: I agree with serenade though, I think it's bound to be an insult to residents to ask them to pay for their 80 hour work week just because primary care doesn't appeal to them.
 
Honestly, if I was gonna specialize, I would gladly forego a stipend in order to avoid a huge, looming interest-laden debt in the future.

But wouldn't foregoing a stipend for a lifetime of service be way more than the cost of a medical school education? I say this stipend should be reinstated to specialists after X years.
 
Andnosoupforyou said:
Honestly, if I was gonna specialize, I would gladly forego a stipend in order to avoid a huge, looming interest-laden debt in the future.

But wouldn't foregoing a stipend for a lifetime of service be way more than the cost of a medical school education? I say this stipend should be reinstated to specialists after X years.
Click to expand...

Except you'd be stuck with more debt in this situation. You're completely ignoring room & board for all of those years of training. 4 years of medical school + 4-7 ( I'll calculate it as 4) years of residency. Room & Board at 20k ( Really low estimate) = 8 x 20,000 = 160k debt without any interest. Now if you're going to do a fellowship or become a surgeon the amount of debt will increase to far beyond what 4 years of medical school would ever cost.
 
This plan of theirs also ignores fellowships that require a primary care residency (cardio, endo, etc.). That entire system would have to be changed too.
 
Long Way to Go said:
This plan of theirs also ignores fellowships that require a primary care residency (cardio, endo, etc.). That entire system would have to be changed too.
Click to expand...

Aren't there already programs that lessen debt for PC residents? Why not just have those programs expanded and have 3rd year medical students sign a contract to practice as PCP's for ... lets say 5-10 years and have those programs cover either most or all of their debt?
 
Long Way to Go said:
This plan of theirs also ignores fellowships that require a primary care residency (cardio, endo, etc.). That entire system would have to be changed too.
Click to expand...

That's a good point as well, as those docs definitely wouldn't be fulfilling the gap the authors are intending to fill with this plan, yet would get completely free training. Now that you mention this, I can imagine this would counteract the draw to primary care by enhancing the draw to specialize OUT of primary care.
 
I almost believe a simpler plan would be to

  • Keep tuition
  • Have a loan repayment plan for primary care practice
  • Have said loan repayment plan be paid for by eliminating or reducing specialist stipends

I think having tuition remain is a necessary incentive to prevent students from dropping out of the medical system so easily. If they paid no tuition, too many students would simply jump ship after 4th year or whatever and that would leave a lot of wasted money being spent to train them when they will not even be feeding back into the system. Also, I believe medical students do need to have more invested in their education but for the potential for that investment to be paid back (through primary care service or large salaries).

Of course there's a bunch of details that would cause trouble but I don't think these would be terribly difficult to find a work around for. For example, do hospitals still receive funding for Primary Care residents? Or specialists? How to handle fellowships that feed from primary care residencies? I think these and other concerns might be a reasonable cost for the potential benefits if they would indeed manifest as we expect.
 
Many are predicting that the gap between specialists and primary care docs will narrow in the future, which would negate some of the NYT arguments.
 
To me, this article seems a bit out of touch with reality. The article implies that any stage of post-graduate medical training is just like any other stage and that med school, residency, and fellowships are interchangeable in the nature of what they involve. Thus, you can charge tuition for one and waive it for another vice versa.

But from what I've seen, residency and fellowship are more like jobs where you get on-the-job training than med school, where the environment is more "school-like." While I wouldn't profess to know what it's like being in any of those situations first hand, the fellows that I have shadowed see patients, do rounds, staff clinics, do calls, etc and I'm sure residents also do some combination of the above. But most importantly, they shoulder much more responsibility and often fill roles that regular physicians do except they have supervising attendings and usually do not practice independently.

Given that, it would be unreasonable, IMHO, to essentially ask fellows to pay for the privilege of getting to work like a dog.

Furthermore, the article also ignores personal contexts. Fellows are often in their 30s, many with families and dependents that they must support, whereas the proportion of med students who have that kind of responsibility is relatively smaller (not counting non-trads). Therefore, the costs that they must incur to do a fellowship (ie the loans they must take out to support themselves and their families) are much larger than would be required of med students in earlier stages of their lives. In essence, this would make specialization so unattractive to anyone who wants or has a family that we'd probably have a dire shortage of every kind of specialists within a few years of implementing this plan.
 
The only thing reasonable about this proposal is making medical school free-It's a good assumption that the absence of tuition debt would make many aspiring doctors more comfortable choosing a primary care or lower paying specialty. The relative cost of medical tuition of only 2.5 billion is also quite affordable for the government considering the idea is to reduce the trillions in healthcare costs. Another option is ensure complete tuition forgiveness for those who enter primary care or just pay their tuition upfront to avoid giving the deferred interest to Wall Street. If the student chooses a specialty he would have to repay the tuition with interest or whatever.

Now the CRAZIEST thing I have ever heard coming from a policy maker is that residents in specialty training should not receive a stipend! I was disappointed to learn that the contributing authors are actually MDs. Either they were independently very wealthy during their own residency or their current income blinds them to reality. It's a real shame that so many doctors forget what medical training really is like especially the sacrifices made by students-shame shame shame! Do these folks know the difference between a stipend such as residents and graduate students receive vs a grant/fellowship? This is money paid in exchange for WORK performed -not some hand out! Many graduate students in the sciences do their Phds on free tuition AND a stipend. Residency in very analogous to graduate school research in that in both cases the candidate is a student as well an employee working under supervision but contributing to the productivity of the institution-and therefore should be paid. In fact residents are grossly underpaid for the slave labor they put in. I figure these guys must have had such excruciatingly painful residency experiences, that now they have selective amnesia on the whole process-and how useful a stipend can be for paying for things such as housing, food, clothes...
And of course many resident are in their 30s and have families and other responsibilities along the way -but that shouldn't even count. They could not seriously have spent much time thinking about this "proposal"-but why publish it in NY times?
 
aphelion1736 said:
And of course many resident are in their 30s and have families and other responsibilities along the way -but that shouldn't even count. They could not seriously have spent much time thinking about this "proposal"-but why publish it in NY times?
Click to expand...

The point of publishing in the NY Times is to generate conversations like this one.

The point of having people borrow living expenses (or live on a spouse's income) during subspecialty training but not for med school is that it would shift the motivation for choosing a specialty from needing to choose a high income producing subspecialty in order to pay one's medical school loans to being (almost) debt free and perhaps more inclined to go into primary care versus going into debt in order to get subspecialty training that might (should) lead to a higher income which in the early years would go toward paying off that debt.

You may find it hard to believe but many International Medical Graduates come to the States every year to volunteer in academic research settings in dermatology, anesthesiology, etc with the hope of attaining a letter of recommendation and a residency slot. So there is precedent for working hard at no pay for the chance to move up in the world.
 
While I can understand incentivizing choosing primary care over specializing, to do it at the expense of punishing specialists seems a little over the top (a la A Modest Proposal). As I said before, the "costs" of med school and the "costs" of subspecialty training can be drastically different. While I agree that med school costs are more than ridiculous in many cases, to say that incurring one or the other would have similar impact on later life and thus require similar efforts to pay off seems far off the mark.

What should be done is to decrease the disparity between the financial rewards or consequences of specializing and going into primary care. We already know that for many med students (at least the non-jaded ones), monetary rewards aren't their primary motivation for entering the medical profession. We just need to make primary care less financially punishing so that it becomes a truly viable option (aka no crushing load of debt for PCPs). There's no need to completely erase the difference, since, in an ideal world, one should be rewarded for being more highly trained rather than punished with a crushing load of debt all in the name of being fair and equal.

On a side note, while there are many international medical graduates who volunteer in clinical and research positions, their circumstances cannot be said to be similar to domestic medical school graduates in several ways.

1) Their volunteering usually do not last more than a year or two, usually until they are able to secure a residency. This makes it more like a postbac for premeds who just need that final push to get into med school. For most people it's a "I'll-just-bite-the-bullet-because-I-have-no-other-choices" kind of thing to get it over with. It's not a long term option for situations like residency and fellowship which can last 3-4+ years each.

2) Foreign medical students typically have spousal income support because that's one of the criteria for them to be able to get a visa to come to the US. They or their SO must be able to demonstrate the ability to support themselves or their families. While this may be true of foreign medical graduate this is not currently a requirement for domestic medical graduates some of whom may be single or have spouses in the same situation. In that case, such options could not even be entertained. I'd hate to see subspecialty training be mostly restricted to just people who happens to be married to lawyers or CEOs.

3) Finally, as I mentioned in the first point, the motivations of foreign medical graduates to volunteer is completely different from the motivations of medical graduates to specialize in most cases. I doubt many people, when they consider what to specialize in, say to themselves "I just want to find whatever I can to get it over with so that I can have what I need to move onto what I really want to do." This makes it somewhat inappropriate to use foreign medical graduates' choices as a model for everyone considering specializing.
 
SBR249 said:
1) Their volunteering usually do not last more than a year or two, usually until they are able to secure a residency. This makes it more like a postbac for premeds who just need that final push to get into med school. For most people it's a "I'll-just-bite-the-bullet-because-I-have-no-other-choices" kind of thing to get it over with. It's not a long term option for situations like residency and fellowship which can last 3-4+ years each.
Click to expand...

My reading of the NYTimes article was that residents would be compensate but fellows would not. Most fellowships I'm familiar with are 2 years and a few are 3 years. So, it is not that much different from an IMG coming to the US to volunteer for 2 yrs.
 
I thought the article was somewhat vague. It seemed at times to advocate doing away with fellowship stipends and at others to advocate doing such also for non-primary care residencies.

In any case, I think, given the type and amount of work that fellows are expected to perform as part of their training, there is no precedent in history or logical reason to not pay them for their services. For instance:

1) When you start a new job and get trained, the company will usually pay you during your training which often involves you doing all or a portion of your regular duties

2) Historically, apprentices and journeymen, despite sometimes not being paid, are given room and board as living support and are sometimes paid in the last few years of their training. Their modern equivalents are also paid.

3) Graduate students usually receive stipends and tuition waivers in exchange for doing research and performing teaching duties.

The only modern supporting example that I can think of besides the IMGs would be the proliferation of unpaid internships, many of which are in the "glamor industries" such as fashion, arts, politics, etc. In fact, it was the NYT that published a series of OP-EDs last month that questioned the exploitation and dubious quality/rewards of the modern unpaid internships that are so prevalent these days. And of course, it must be said that these interns are not usually at the same stage of their lives as fellows.

NYT Op-eds:
http://www.nytimes.com/2011/04/03/opinion/03perlin.html?scp=1&sq=internship&st=Search
http://www.nytimes.com/2011/04/11/opinion/l11interns.html?scp=2&sq=internship&st=Search
 
As a medical student who is entirely dependent on loans for tuition and living expenses-and barely scraping by financially after serious budgetting and discipline I find it very disheartening to hear policy makers and administrators etc even contemplate not paying residents for their services. How would people from poor backgrounds go into a specialty field if that's what they genuinely feel fit for? At this point in my life I can only imagine what it feels like to have an income-because living on loans while receive foodstamps etc sure isn't fun. Everyone seems to think that because we are destined to make a decent wage in the future we should go through unlimited financial burdens-loans all sorts of punitive exam fees and costs etc- to get there without complaining. Wow. To me this is personal. It's as though a certain segment of society delight in our suffering. Even the IRS recognizes all residents as employees in a recent ruling on loan repayment/taxes. Since when is it that the IMGs approach to the US system is what AMG should follow and not vice versa? I'm in tears...
 
Strange. On the one hand, you can have A. specialists pay 50k a year for four years of med school , and then being paid 40k a year for a 5 year residency, or B. having specialists not paying tuition, and not being paid for residency.

Both are financially equivalent, yet somehow, the second seems ridiculous.
 
If they want to encourage more people to do primary care, why not just give more financial incentives for those who go into primary care, rather than give all med students free tuition?
 
LizzyM said:
My reading of the NYTimes article was that residents would be compensate but fellows would not. Most fellowships I'm familiar with are 2 years and a few are 3 years. So, it is not that much different from an IMG coming to the US to volunteer for 2 yrs.
Click to expand...

Essentially all pediatric fellowships are 3 years. Recent data indicate that doing a fellowship in most pediatric areas leads to a net loss in income. There is a huge well-documented shortage of pediatric subspecialists in many of these same areas (wonder why?). Any proposal that does not take into account the need for certain subspecialists after primary care (e.g. pediatrics) residencies, will be rather unhelpful in this regard. Good luck finding a pediatric rheumatologist under this proposal.
 
oldbearprofessor said:
Essentially all pediatric fellowships are 3 years. Recent data indicate that doing a fellowship in most pediatric areas leads to a net loss in income. There is a huge well-documented shortage of pediatric subspecialists in many of these same areas (wonder why?). Any proposal that does not take into account the need for certain subspecialists after primary care (e.g. pediatrics) residencies, will be rather unhelpful in this regard. Good luck finding a pediatric rheumatologist under this proposal.
Click to expand...

I'm very skeptical when people talk about a shortage of a (relatively) low-income job. If there was a shortage of pediatric subspecialists or primary care doctors or whatever, then salaries for those professions should rise until the shortage was alleviated.
 
Am I the only one here who isnt even worried about this loans business? Yeah perhaps owning a home already "got that worry out" but I just cant get myself worried about loans or my ability to repay them...because I know I will be able to as will all of you if you are arent financially idiotic like that ross grad in that article from a year or two ago. (The one where shes like over half a mil in debt and got charged massive fines etc).
 
I'm not sure why so many of you are getting all up in arms about this.

Right now we have a system where most medical students have to pay most of the costs for their own medical school (generally via extensive loans which the government helps support), but then the government (via Medicare) pays for most of the costs of their residency, and then the government or a well-funded charitable organization pays for most of the costs of their fellowship.

There are several (probably unintended) consequences of this system. Even though loans for medical school are fairly available for students with decent credit, and even though there are loan forgiveness plans for serving in certain areas, the large price tag of medical school doubtless scares of many students from modest backgrounds. There is an extensive body of research analyzing programs to encourage poorer students to go to college, and it pretty unambiguously shows that the availability of scholarships and/or loan forgiveness is much less effective at getting poorer students to go to college than programs that guarantee free or reduced tuition for students who meet simple, clear criteria. Poor students are typically very risk averse, and will avoid a situation that leaves them with even a slight change of getting stuck with a huge tuition bill or loan.

With medical school being the main cost bottleneck, once a student finishes medical school the incentives are for them to continue on and specialize as much as possible. They've already accumulated most of their debt, which they will have to pay back whether they become a general practitioner or a pediatric onco-cardiodermanesthetist. Both the GP and the superspecialized doctor will have roughly the same amount of debt, but the superspecialized doctor will likely earn a salary many times higher. The financial incentives clearly push any student that has an opportunity to specialize to do so.

Take a step back for a moment, and consider how we would design the system if we had a clean slate. There's a large sum of government money to spend on the training of doctors, as well as a large government organization to get loans to students who are pursuing their medical studies. There are three main stages of medical training. The first stage is medical school, which lasts 4 years, which everyone needs to complete, and which is the same regardless of one's ultimate specialization. The second stage is residency (for simplicity's sake, I'm including internship in here), which typically lasts for 3-7 years. Every doctor needs to complete one, although the residency for each specialization is different. Some residencies clearly put their residents on a track to very highly paid fields, and some on a track that includes much needed, poorly paid primary care. Then there's fellowship, which only a small fraction of doctors will do, and which lasts from 1-3 years. Most fellowships increase one's earning power substantially. For all three of these stages, the institution doing the training needs to somehow get money to cover the costs of training (which we'll call tuition), and the students who are being trained will need to somehow get money to cover their living costs.

What the authors of this editorial are proposing is to use the government medical-training money to pay tuition for students in medical school and residency. Medical students would remain on the hook for their own living expenses. Residents in the poorly paid and understaffed primary care fields would receive a stipend to cover living expenses as well as tuition, while residents in other specialties would be on the hook for their own living expenses. It's not as clear to me what they are proposing for fellowships (many of which are funded by private organizations anyway), but is seems they want to have the government pay for tuition but not living costs there as well. They don't directly address this, but one would assume that government sponsored loan programs would evolve to offer loans for living expenses to students in all three stages of training.

Ignoring for a moment that some students may be able to pay for living costs with savings or support from family, this means that students would accumulate an amount of debt roughly proportional to their earning potential. This would reduce the absurdity of having a system where a family practice doctor and a neurosurgeon carry roughly the same debt load, despite wildly different salaries. It would reduce the financial incentives that encourage doctors to specialize as much as they possibly can, and encourage doctors to go into much-needed primary care fields. It would make medical school much more appealing to poor and debt-averse students.

And it would reduce the silliness of the government handing hundreds of thousands of dollars in free training _and_ hundreds of thousands of dollar in stipends to surgery residents who are about to enter into one of the most highly payed professions known to man. Instead, the government would only give hundreds of thousands of dollars of free training to them.

This isn't a fully fleshed out plan, and it's not perfect, but I think this is a totally reasonable proposal.
 
Dr Love said:
I'm very skeptical when people talk about a shortage of a (relatively) low-income job. If there was a shortage of pediatric subspecialists or primary care doctors or whatever, then salaries for those professions should rise until the shortage was alleviated.
Click to expand...

In a market economy, it would but medical care is not a market model. Almost all payment for service is by a third party and what the physician charges for services is not what is paid given "negotiated" discounts (which are not always negotiated in a transparent manner). Pediatrics suffers from an unfortunate "case mix" issue; the children who use the most services are most often covered by government plans (Medicare, Medicaid, Children's Health Insurance Program) that pay a fraction of what the physician bills. It makes no difference if the price charged by the specialist (or primary care provider) increases, the payment the provider gets is going to be what it is. Furthermore, certian types of visits (well baby, for example, or a follow-up visit of moderate intensity with a pediatric rheumatologist) are paid at a lower rate than procedures provided by surgeons and interventionists. If you don't like the payment, you don't have to take that insurance plan but if you don't take that plan, you won't have many patients to see.
 
Dr Love said:
Strange. On the one hand, you can have A. specialists pay 50k a year for four years of med school , and then being paid 40k a year for a 5 year residency, or B. having specialists not paying tuition, and not being paid for residency.

Both are financially equivalent, yet somehow, the second seems ridiculous.
Click to expand...

I seriously think it's because residency (including residents in non-primary care specialties & fellows after primary care training) involves actual work, albeit under supervision, significantly contributing to the productivity of the hospital. The amount they are currently paid (relatively little compared to their knowledge and skills) already takes into consideration that are simultaneously in training. To pay them nothing instead, would be tantamount to slavery.
 
aphelion1736 said:
I seriously think it's because residency (including residents in non-primary care specialties & fellows after primary care training) involves actual work, albeit under supervision, significantly contributing to the productivity of the hospital. The amount they are currently paid (relatively little compared to their knowledge and skills) already takes into consideration that are simultaneously in training. To pay them nothing instead, would be tantamount to slavery.
Click to expand...

Would you call a college student with a full scholarship a slave just because he doesn't also get money for living expenses, but is still expected to do work for his classes? No, because that's ridiculous.

In 2008, Medicare payed $2.7 billion dollars to residents for stipends, and $5.7 billion in payments to hospitals for training. Residents are better thought of as students who need to be taught then cheap labor to be exploited. The government is currently picking up the tab for both their tuition and also giving them a stipend for living costs. The tuition is by far the larger of these two costs. If the government decided to cut residents who are going into highly payed specialties back to only a full scholarship, without an additional stipend, I'd say they're still being quite generous.
 
The problem is that many subspecialties (e.g. endocrinology) don't pay significantly more than generalist positions. Any proposal which further burdens lower-paying specialties is going to create unwanted shortages. With this in mind, I agree with those above that suggest tuition-forgiveness for primary care physicians. It is better to incentivize a smaller group rather than penalize a larger one.
 
phltz said:
Would you call a college student with a full scholarship a slave just because he doesn't also get money for living expenses, but is still expected to do work for his classes? No, because that's ridiculous.
Click to expand...

No, because a college student isn't doing useful work for an institution the way a grad student (by teaching lower level classes, which allows a university to increase enrollment) or a resident (providing a large portion of care with some supervision). It would be more appropriate to think of a resident as an NP or PA that is giving somewhat independent care with supervision- having residents at a hospital allows the hospital to serve significantly more patients than if they only had the attending much in the same way physician extenders allow for an increased patient load and therefore more revenue for the hospital.
 
Mattchiavelli said:
No, because a college student isn't doing useful work for an institution the way a grad student (by teaching lower level classes, which allows a university to increase enrollment) or a resident (providing a large portion of care with some supervision). It would be more appropriate to think of a resident as an NP or PA that is giving somewhat independent care with supervision- having residents at a hospital allows the hospital to serve significantly more patients than if they only had the attending much in the same way physician extenders allow for an increased patient load and therefore more revenue for the hospital.
Click to expand...

It's not clear to me that residents allow hospitals to get more done with fewer staff and less money. If they did, why would medicare need to pay hospitals so much money in order to get them to take on residents? Why would there be a limited number of residency spots? Plenty of overworked hospitals would love to have useful workers who cost little if any money. Tons of IMGs are clamoring to get into US residencies. The only way this makes sense is if residents don't actually earn their own keep.
 
phltz said:
Would you call a college student with a full scholarship a slave just because he doesn't also get money for living expenses, but is still expected to do work for his classes? /QUOTE]

No. I fear you are missing a critical point my friend.

Please read carefully what I said. A college student "working" (studying is a better word here) for classes does not directly contribute to the productivity of the institution in the sense that a professor, researcher or graduate student (working in a lab) does. Note the critical phrase "contribute to the productivity of the institution."
You have to "get with it," slavery HAS been abolished in this country centuries ago-sorry! In all walks of life Americans expect, and need to be fairly compensated for their labor.
I have been a graduate student before medical school and residency is a very similar process. We were paid stipends to do experiments (which contribute to publications which contribute to grant money from which the University gets over 50% as overhead (can be substantial)!). Of course the student learns along the way- the research is part of the student's thesis etc. Many graduate students may also teach a class under supervisor of faculty for which they get a stipend and tuition paid-essentially cheap labor for the university.
What you need to realize is that residents accomplish two main things at the hospital, stated simply as:
1) Learn under supervision
2) Cheap labor for hospital

Many hospitals would simply HAVE to hire more staff AND pay them more along with benefits etc, without residents. In fact this highly subsidized labor (from Govt) is a why many hospitals seek to have residency programs of their own in the first place.

Well it seems like "they" are not being successful fast enough at decreasing specialty pay (perhaps because specialty boards are so influential). So guess what? They are attempting to go after the defenseless residents! "Let's get the cubs before they grow up...," the mentally here?

This whole argument/attitude about "taking away" in hopes of twisting people's arm to do something that "big brother" wants is just fundamentally wrong and borders on maliciousness.
You will find that in life it is often much better to give chocolate to those who wish to do what you want. 🙂
Click to expand...
 
phltz said:
It's not clear to me that residents allow hospitals to get more done with fewer staff and less money. If they did, why would medicare need to pay hospitals so much money in order to get them to take on residents? Why would there be a limited number of residency spots? Plenty of overworked hospitals would love to have useful workers who cost little if any money. Tons of IMGs are clamoring to get into US residencies. The only way this makes sense is if residents don't actually earn their own keep.
Click to expand...

I don't have information on the entire equation of the cost to the hospital of a resident vs a similarly skilled employee.
However for starters-do you know how a physician assistant's salary and benefits compare to those of a resident's?
Medicare give hospital money to give to residents (salary, benefits etc). It is not promising that you seem to think that residents don't earn their own keep, or are not useful...
 
You must log in or register to reply here.

Similar threads

C
NYT op-ed on ethical training in medical school
Replies
12
Views
2K
Mr.Smile12
Mr.Smile12
Z
Free time during medical school?
Replies
9
Views
2K
lioneljohn
L
P
  • Locked
  • Question Question
Should I withdraw from OOS schools?
Replies
2
Views
694
Hollow Knight
Hollow Knight
M
Undergrad classes that would be helpful for medical school
Replies
9
Views
999
LunaOri
LunaOri
K
SDN Article: From Special Operations to Medical Operations
Replies
0
Views
606
Kyle Magatelli
K
Top