Are you in favor of public MD schools being required to take 90%+ instate?

[Mazdave]

Just have NY state impose a miniscule tax on NYSE transactions, and with that money, give free scholarships covering cost of attendance(~55k value? I know tuition is ~29k) to the SUNY students that agree in writing to do a primary care (IM, peds, family care, psych or OB/gyn for purposes of this discussion) residency after graduation, and also to serve in an underserved area of NY for 4 years. If they renege and decide to specialize instead after graduating, they owe the entire amount and it would be non-dischargeable. If they only serve 2 years after residency, then they owe 2 years of cost of attendance, etc. That would probably help alleviate the shortages. With 600 students graduating from the public MD schools each year, hopefully at least some would take the deal. Obviously most of the people already planing to go into primary care would. Now how can Jane Lynch disagree with that?

Programs like this already exist both on the federal level (NHSC) and at individual schools. Most people don't take the deal, even if they might already be leaning towards primary care.

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[DanGee777]

Programs like this already exist both on the federal level (NHSC) and at individual schools. Most people don't take the deal, even if they might already be leaning towards primary care.

Well it sounds like the amount of money needs to be increased. I understand the reason that specialists make more on average than primary care docs. If you are in residency for 6-7 years vs 3, leaving money on the table, etc., but something needs to be done. Medical dollars are obviously limited in our system so it's tough to increase primary care reimbursements without decreasing specialist reimbursements. If specialist reimbursements are decreased drastically, then you end up with specialist shortages. Some balance has to be found, and it appears that no one really knows the correct balance. One thing we do know is that we have massive shortages of primary care physicians and one of the reasons is that lots of them are making 180-200k a year for a stressful 55 hour work week when some specialists are making double that and working less hours per week. Obviously money isn't the sole reason for choosing a specialty, but when pharmacists can start out at 100k after a 4 year graduate degree with no residency required (or 6 years total in BS/PharmD programs, but leave those aside) and average 120k in today's dollars for the rest of their career, and primary care docs who have to do 7 years after college graduation are starting at 160k and capping out at about 200k, you have a big problem. This isn't news to anyone, but if we have massive shortages of primary care physicians in certain areas despite the incentive programs you're talking about, then the only answer is to subsidize them more heavily. The money has to be found somewhere, because if nothing is done, in 15 years from now, one of two things will happen: either large swaths of the population won't be able to find a primary care doctor to treat them, or NPs will simply have take all of these patients. Maybe that's the grand plan -- make it so unattractive (both financially and lifestyle-wise) to be a primary care physician that they simply disappear.

We do know one thing -- if primary care doctors averaged 300k a year and 250k a year starting in underserved areas instead of 200k and 150k a year starting seemingly no matter where they practice, we could really alleviate the shortages. The only question is where to get the money.

 

[Mazdave]

Well it sounds like the amount of money needs to be increased. I understand the reason that specialists make more on average than primary care docs. If you are in residency for 6-7 years vs 3, leaving money on the table, etc., but something needs to be done. Medical dollars are obviously limited in our system so it's tough to increase primary care reimbursements without decreasing specialist reimbursements. If specialist reimbursements are decreased drastically, then you end up with specialist shortages. Some balance has to be found, and it appears that no one really knows the correct balance. One thing we do know is that we have massive shortages of primary care physicians and one of the reasons is that lots of them are making 180-200k a year for a stressful 55 hour work week when some specialists are making double that and working less hours per week. Obviously money isn't the sole reason for choosing a specialty, but when pharmacists can start out at 100k after a 4 year graduate degree with no residency required (or 6 years total in BS/PharmD programs, but leave those aside) and average 120k in today's dollars for the rest of their career, and primary care docs who have to do 7 years after college graduation are starting at 160k and capping out at about 200k, you have a big problem. This isn't news to anyone, but if we have massive shortages of primary care physicians in certain areas despite the incentive programs you're talking about, then the only answer is to subsidize them more heavily. The money has to be found somewhere, because if nothing is done, in 15 years from now, one of two things will happen: either large swaths of the population won't be able to find a primary care doctor to treat them, or NPs will simply have take all of these patients. Maybe that's the grand plan -- make it so unattractive (both financially and lifestyle-wise) to be a primary care physician that they simply disappear.

We do know one thing -- if primary care doctors averaged 300k a year and 250k a year starting in underserved areas instead of 200k and 150k a year starting seemingly no matter where they practice, we could really alleviate the shortages. The only question is where to get the money.

Well, yes, where to get the money is a big question. But the reality is that even if rural primary care paid a lot better than it does, I'm not so sure that too many more people would go into it. There's a certain value people place on going into the specialty they want to and living where they want to and it's worth it to them to have those even if rural primary care would pay more. People who go into rural medicine do it because that's what they want to do, and while increasing compensation will be good for them, they'll probably go into it regardless.

Also, all of this has to do with paying for medical school, not residency preference for admissions. Even if your passion is primary care in an underserved area, it doesn't matter if you don't get into med school first.

 

[FutureCTDoc]

Just have NY state impose a miniscule tax on NYSE transactions, and with that money, give free scholarships covering cost of attendance(~55k value? I know tuition is ~29k) to the SUNY students that agree in writing to do a primary care (IM, peds, family care, psych or OB/gyn for purposes of this discussion) residency after graduation, and also to serve in an underserved area of NY for 4 years. If they renege and decide to specialize instead after graduating, they owe the entire amount and it would be non-dischargeable. If they only serve 2 years after residency, then they owe 2 years of cost of attendance, etc. That would probably help alleviate the shortages. With 600 students graduating from the public MD schools each year, hopefully at least some would take the deal. Obviously most of the people already planing to go into primary care would. Now how can Jane Lynch disagree with that?

If you tax those transactions they will move to other exchanges, other states or other countries.

 

[Prncssbuttercup]

Not sure if this has been said, but: some state schools get almost no funding from their state, MN is a good example, should the be required to take any percentage of IS students?? It depends on the funding... At least to me...

 

[mrmatt]

Just going off the thread title, I'd say yes I am in favor of that. The whole point of a state school is to provide education for the in-state students.

 

[JackShephard MD]

2/3 (66%) seems like a good minimum.

After that, they should decide. Only exception is if the primary care physicians in state were low, then maybe 80%+ would be good.