A unique solution to solve the pending medical school tuition crisis

[filter07]

http://www.ajog.org/article/S0002-9378(09)02139-5/fulltext

Any thoughts?

First question is how to reconcile increasing tuition with decreasing reimbursement. At this pace, the cost of medical education will be increasingly larger than the amount that doctors will have to pay. If a higher percentage of money is taken to adjust, it places undue pressure on doctors to repay a higher percentage of their income while their income also decreases. A double hit.

I think this also penalizes those who do long residencies. Subspecialists like interventional cardiologists, electrophysiologists, pediatric cardiac surgeons, etc. are in training for far greater number of years than the primary care physicians. In exchange for further delaying rewards, they usually earn a higher salary. This plan would penalize those who sacrifice early income for higher salaries later. I think the number of years in residency or fellowship should count towards the repayment time period. Maybe put some correcting factor so that each year of residency counts 1/2, so that someone who does 10 years of training would only have a payoff period of 5 years instead of 10.

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[DoctwoB]

http://www.ajog.org/article/S0002-9378(09)02139-5/fulltext

Any thoughts?

First question is how to reconcile increasing tuition with decreasing reimbursement. At this pace, the cost of medical education will be increasingly larger than the amount that doctors will have to pay. If a higher percentage of money is taken to adjust, it places undue pressure on doctors to repay a higher percentage of their income while their income also decreases. A double hit.

I think this also penalizes those who do long residencies. Subspecialists like interventional cardiologists, electrophysiologists, pediatric cardiac surgeons, etc. are in training for far greater number of years than the primary care physicians. In exchange for further delaying rewards, they usually earn a higher salary. This plan would penalize those who sacrifice early income for higher salaries later. I think the number of years in residency or fellowship should count towards the repayment time period. Maybe put some correcting factor so that each year of residency counts 1/2, so that someone who does 10 years of training would only have a payoff period of 5 years instead of 10.

A very interesting proposal that actually makes sense in terms of making medical school affordable to all.

Things I liked about this plan:

Because the amount of income received is outside the school's direct control, the school must work harder to control costs, rather than relying on annual tuition increases.

I actually think this rewards people who do long residencies/fellowships. Under this plan, you would pay a percentage of your income for 10 years. If you are residency for 7 of those years, then the total amount you repay is less than someone in a 3 year residency, as you're paying 10% of a resident's salary, not 10% of an attending's salary. Assume for a second (I know its not true) that a neurosurgeon and a PCP could expect to make equal amounts of money in their lifetime. The surgeon would make less money initially and more money later on, while the reverse is true for the PCP. As such, the surgeon would pay back a lower total amount, as their repayment occurs when their salary is lower.

That being said, this would allow people to pursue primary care without fear of drowning in debt, as the repayments are limited to a fraction of income.

Also, this spreads the burden of decreasing reimbursements from just physicians to both physicians and medical schools. While declining reimbursements would hurt medical school's bottom lines under this plan, in the long run, this could make for a much stronger lobby/argument against reimbursement cuts. When medicaid reimbursement gets cut and a few doctor's offices go belly up, no-one really cares except for the patients who need a new PCP. When medicaid reimbursement gets cut and suddenly many medical schools go bankrupt, this will get some notice. It also makes cutting medicaid less lucrative to states, as they would have to partially offset the gain in revenue by shelling out more money to state medical schools.

What I dislike about the plan:

Medical schools would have financial incentive to push you towards the specialties that will maximize the amount you repay.

Doesn't take into account the cost of living during medical school, so some loans would still be necessary.

Economic inefficiency of giving people a free education if they change their mind and decide not to become a doctor, though medical schools would be incentivized to try and screen these people out beforehand.

 

[seelee]

I didn't have time to read the entire article, but at face value it seems pretty reasonable.

In response to your question. Tuition rises because the federal government continues to increase the amount of money available for financial aid. If a college is charging 10K per year, and 20K is available in grants and loans, then the college is essentially losing a potential 10K per year, per student. A cut back on subsidy coupled with a reasonable repayment program like this could work.

The real question is what if a person finishes residency and decides to not practice (as what happens often with women who have children).

 

[dynx]

I didn't have time to read the entire article, but at face value it seems pretty reasonable.

In response to your question. Tuition rises because the federal government continues to increase the amount of money available for financial aid. If a college is charging 10K per year, and 20K is available in grants and loans, then the college is essentially losing a potential 10K per year, per student. A cut back on subsidy coupled with a reasonable repayment program like this could work.

The real question is what if a person finishes residency and decides to not practice (as what happens often with women who have children).

yeah this is brilliant. Instead of attacking the root of the problem make a more complicated scheme to be gamed.
Now people can hide income.
tuition will have to be adjusted for expected inflation from the in-effect interest free loan that is being given by delaying payment.
there will be a "generational" gap in funding
We'll have to find jobs for a good percent of the student loan industry workers.

Yeah, this is going to happen. Maybe we can pay tuition in rainbows and smiles.

 

[hithere3387]

I didn't have time to read the entire article, but at face value it seems pretty reasonable.

In response to your question. Tuition rises because the federal government continues to increase the amount of money available for financial aid. If a college is charging 10K per year, and 20K is available in grants and loans, then the college is essentially losing a potential 10K per year, per student. A cut back on subsidy coupled with a reasonable repayment program like this could work.

The real question is what if a person finishes residency and decides to not practice (as what happens often with women who have children).

The article implies that such a small percentage of medical students don't enter the profession, that there is no need to address this. Further, the article suggests that those students should not have to pay back any loans as related directly to medical school tuition.

I think this is an interesting notion, but there are some holes. Certainly, this is an issue that needs to be addressed soon. The urgency of which might be great enough to warrant an imperfect change.

 

[DoctwoB]

The article implies that such a small percentage of medical students don't enter the profession, that there is no need to address this. Further, the article suggests that those students should not have to pay back any loans as related directly to medical school tuition.

I think this is an interesting notion, but there are some holes. Certainly, this is an issue that needs to be addressed soon. The urgency of which might be great enough to warrant an imperfect change.

One could argue that the reason such a small percentage of med students don't enter the profession is that the majority of them have hundreds of thousands of debt, and need to work in medicine to pay it off. The vast majority of people would still go into medical fields, but I bet the "drop out" rate would increase if the debt went away. There could be stipulations, however, that if you don't work in a medical field for X number of years you owe the full amount of tuition.

 

[hithere3387]

One could argue that the reason such a small percentage of med students don't enter the profession is that the majority of them have hundreds of thousands of debt, and need to work in medicine to pay it off. The vast majority of people would still go into medical fields, but I bet the "drop out" rate would increase if the debt went away. There could be stipulations, however, that if you don't work in a medical field for X number of years you owe the full amount of tuition.

I agree; and, based on the history of debt forgiveness programs in the United States, I suspect that something like this would happen if legislation were proposed along the guidelines suggested in the article.

 

[seelee]

The bottom line is that as long as loans and grants are available (courtesy of Uncle Sam), there is little incentive either for schools to limit their tuition, or for students to seriously demand that they do so.

 

[avatarftw]

The bottom line is that as long as loans and grants are available (courtesy of Uncle Sam), there is little incentive either for schools to limit their tuition, or for students to seriously demand that they do so.