Debt vs specialty.

[Handsome88]

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I was wondering if debt is a major factor affecting students' decisions about their specialty.

For example, say you have zero debt, would you do family practice?
Some of us do not mind working 55hrs/week, $170k per year, but if you have a 250k+ in loans then that would be a problem.

What are your thoughts on that?

 

[Yope]

I'm open to FP, but if debt weren't an issue, I wouldn't absolutely do it.

 

[medstudent87]

I was wondering if debt is a major factor affecting students' decisions about their specialty.

For example, say you have zero debt, would you do family practice?
Some of us do not mind working 55hrs/week, $170k per year, but if you have a 250k+ in loans then that would be a problem.

What are your thoughts on that?

This is an easy one. That answer is a flat-out YES..it is a HUGE factor when deciding ur specialty. Although most people still go into what they enjoy, even if it isn't the most financially sound decision.

 

[Narmerguy]

Polls like this suck. 2 options?

 

[reedman]

this poll is bunk. clearly it will make family medicine look less desirable than it really is.

but yeah, no debt would get me thinking about primary care a lot more. when i first decided to go into medicine i just wanted to be a family doc.

 

[AlexMorph]

I was wondering if debt is a major factor affecting students' decisions about their specialty.

For example, say you have zero debt, would you do family practice?
Some of us do not mind working 55hrs/week, $170k per year, but if you have a 250k+ in loans then that would be a problem.

What are your thoughts on that?

you are ignoring the fact that some people just find family medicine to be unappealing

maybe if you generalized it to something that is low-paying instead of just family medicine

 

[Barcu]

you are ignoring the fact that some people just find family medicine to be unappealing

maybe if you generalized it to something that is low-paying instead of just family medicine

Truth. I'm going to come out with no debt.

Still, I have very little interest in FP. Primary care like IM? I am quite interested. And no debt does make that much more likely.

 

[mdeast]

I really enjoy the dynamics of research, etc. Family medicine has it's advantages and uniqueness, but I'd be bored of it too quickly to want to pursue it as a long term career. So, to be honest, it really has nothing to do with money.

 

[Handsome88]

Truth. I'm going to come out with no debt.

Still, I have very little interest in FP. Primary care like IM? I am quite interested. And no debt does make that much more likely.

So what I get from this is that the unpopularity of FP is not because of money. And students would actually go for lower paying specialties (Psych/Neuro/Peds/IM..etc) if they had no debt.

Sorry to phrase my poll so horribly, should have thought about it more.

 

[MediCynical]

Read something relevant on MedScape last week...

Acad Med. 2011 Feb;86(2):187-193.
Effect of Financial Remuneration on Specialty Choice of Fourth-Year U.S. Medical Students.

Abstract

PURPOSE: To investigate whether financial incentives could reverse the trend of declining interest in primary care specialties among U.S. medical students.
METHOD: An electronic survey was sent to all U.S. fourth-year MD and DO medical students in 2009 with a Department of Defense service obligation. Students not selecting a primary care residency were asked if a hypothetical bonus paid before and after residency or an increase in annual salary of attendings in primary care specialties would have resulted in these students selecting primary care. Logistic regression was used to determine student characteristics associated with accepting a financial incentive.
RESULTS: The survey response rate was 56% (447/797). Sixty-six percent of students did not apply for a primary care residency. Of these, 30% would have applied for primary care if they had been given a median bonus of $27,500 (interquartile range [IQR] $15,000-$50,000) before and after residency. Forty-one percent of students would have considered applying for primary care for a median military annual salary after residency of $175,000 (IQR $150,000-$200,000). Students who considered primary care but chose a controllable lifestyle specialty (e.g., radiology) were nearly four times more likely to name an influential hypothetical salary than were students who did not consider primary care and chose a noncontrollable lifestyle specialty (e.g., surgery) (67% versus 17%, P < .0001).
CONCLUSIONS: U.S. medical students, particularly those considering primary care but selecting controllable lifestyle specialties, are more likely to consider applying for a primary care specialty if provided a financial incentive.

http://www.ncbi.nlm.nih.gov/pubmed/21169785
http://journals.lww.com/academicmed...=2011&issue=02000&article=00015&type=abstract
http://www.medscape.com/viewarticle/736509?src=mp&spon=25

 

[Dwindlin]

you are ignoring the fact that some people just find family medicine to be unappealing

This. I will come out with significant debt, but I plan on doing what i enjoy, even if it's not the most lucrative specialty.

 

[sunset823]

you are ignoring the fact that some people just find family medicine to be unappealing

maybe if you generalized it to something that is low-paying instead of just family medicine

I'm with this. I am going to be graduating with a crapload of debt (250k+). However, this has little to no effect on what my interests are. I have never had any interest in family medicine primarily because I dislike outpatient work, and I like research and want an academic career (which, incidentally pays less). Currently, based on how the rest of my med school career goes, I'm deciding between a high paying specialty in which I would pursue an uncompetitive fellowship that would actually decrease my income, or IM, where I would specialize but in an area that is not known to pay handsomely (though I've heard reimbursements are increasing in my area of interest and there's a whole lot of demand, unlike most specialties).

When I came to medical school I thought long and hard about the financial sacrifice I would be making, but in my position it made sense. I have no intention of ever having kids (may or may not get married, but financially that isn't a big deal if spouse is making their own money), and am the type of person who doesn't really see myself having a house with a white picket fence, I'm fine with apt/condo living. So given that, I felt taking out a student loan as big as a mortgage made sense as long as it gave me an interesting and most of all, stable, career. There are a lot of fields in medicine that I wouldn't call 'stable' right now, but fortunately, the field I'm interested in is growing with lots of job opportunities, and I'm flexible to live most places in the country.

Okay, that was long winded, but in the end, don't come to medical school with tons of debt expecting to get derm or plastic surgery. First off, there's always a chance your grades will force you into a 'lower paying' specialty (may or may not be FP, there are other options), and secondly, nothing is guaranteed income wise in the future with all the health care changes.

 

[Handsome88]

I'm with this. I am going to be graduating with a crapload of debt (250k+). However, this has little to no effect on what my interests are. I have never had any interest in family medicine primarily because I dislike outpatient work, and I like research and want an academic career (which, incidentally pays less). Currently, based on how the rest of my med school career goes, I'm deciding between a high paying specialty in which I would pursue an uncompetitive fellowship that would actually decrease my income, or IM, where I would specialize but in an area that is not known to pay handsomely (though I've heard reimbursements are increasing in my area of interest and there's a whole lot of demand, unlike most specialties).

When I came to medical school I thought long and hard about the financial sacrifice I would be making, but in my position it made sense. I have no intention of ever having kids (may or may not get married, but financially that isn't a big deal if spouse is making their own money), and am the type of person who doesn't really see myself having a house with a white picket fence, I'm fine with apt/condo living. So given that, I felt taking out a student loan as big as a mortgage made sense as long as it gave me an interesting and most of all, stable, career. There are a lot of fields in medicine that I wouldn't call 'stable' right now, but fortunately, the field I'm interested in is growing with lots of job opportunities, and I'm flexible to live most places in the country.

Okay, that was long winded, but in the end, don't come to medical school with tons of debt expecting to get derm or plastic surgery. First off, there's always a chance your grades will force you into a 'lower paying' specialty (may or may not be FP, there are other options), and secondly, nothing is guaranteed income wise in the future with all the health care changes.

I'm curious as to what these two specialties that you are deciding between are. If you mean Critical care then it is definitely high paying. What's the other one?

It is hard for IMGs to not consider competitive but high paying specialties when they have considerably higher debt. But you still see them matching mostly in IM, and I'm sure they do fine. So why can't an AMG do that? That's why I think more AMG should be thinking like you!

 

[johnmendes]

IMG usually have no debt. I pay 10k for med school, and it is considered expensive by european standards. FMG on the other hand, coming from the caribeans and all of that have bigger debts. Plus, for an IMG, making 150k in family medicine is more than what he would make as a derm or rad in pretty much any other country in the world (except Canada).

EDIT: and the cost of living in america is pretty nice.

 

[Handsome88]

IMG usually have no debt. I pay 10k for med school, and it is considered expensive by european standards. FMG on the other hand, coming from the caribeans and all of that have bigger debts. Plus, for an IMG, making 150k in family medicine is more than what he would make as a derm or rad in pretty much any other country in the world (except Canada).

EDIT: and the cost of living in america is pretty nice.

IMG=FMG, what is the difference?!
Are you kidding me? IMGs mostly come from the Caribbeans, and their tuition fees are high. I come from Ireland and my tuition fees are $45k a year! I don't know what school you go to, but it is not representative of IMGs who go to top notch western European universities. You are probably European and paying European fees (basically free education), and people like you don't make up most of IMGs.

Sure PDs in the US make more than specialists in other countries, but you cannot compare the two. Cost of living in India is way lower than the US. 50K there probably equals 200k in the US.

 

[johnmendes]

IMG=FMG, what is the difference?!
Are you kidding me? IMGs mostly come from the Caribbeans, and their tuition fees are high. I come from Ireland and my tuition fees are $45k a year! I don't know what school you go to, but it is not representative of IMGs who go to top notch western European universities. You are probably European and paying European fees (basically free education), and people like you don't make up most of IMGs.

Sure PDs in the US make more than specialists in other countries, but you cannot compare the two. Cost of living in India is way lower than the US. 50K there probably equals 200k in the US.

An IMG is an international medical graduate... Indian doctors and all of that. An FMG is a foreign medical graduate. An american that went to school abroad. Since they aren't residents of the EU, they pay big bucks (45k like you said). But the IMG have virtually no debt.

Compare the cost of living in London with NY. Not that different. But the salaries of the doctors working at each of these places are.

 

[DoctwoB]

An IMG is an international medical graduate... Indian doctors and all of that. An FMG is a foreign medical graduate. An american that went to school abroad. Since they aren't residents of the EU, they pay big bucks (45k like you said). But the IMG have virtually no debt.

Compare the cost of living in London with NY. Not that different. But the salaries of the doctors working at each of these places are.

Actually you're right. PCPs in london can make around 250k these days.

 

[johnmendes]

Actually you're right. PCPs in london can make around 250k these days.

I don't dispute your numbers, however I am absolutely positive that the average salaries for most (I even risk saying all) specialties is lower in Europe than it is Stateside...

And the ones doing those 250k work over 85 hours a week... If you did that in the States, I believe you would be banking quite a bit more.

 

[sunset823]

I'm curious as to what these two specialties that you are deciding between are. If you mean Critical care then it is definitely high paying. What's the other one?

It is hard for IMGs to not consider competitive but high paying specialties when they have considerably higher debt. But you still see them matching mostly in IM, and I'm sure they do fine. So why can't an AMG do that? That's why I think more AMG should be thinking like you!

I want to end up in critical care, but I'm deciding between anesthesia (high paying ROAD specialty) or IM (not as high paying). It'll depend on board scores, third year, etc, but either way I'm not really looking at money as my end goal. I'm definitely not complaining about CC's remuneration, but it's no cardio or GI, and therefore not as competitive. But things are going to look a lot different in the future since intensivists are in high demand and very short supply while there is a surplus of other specialties

As for the IMG/FMG thing, I have never figured out what the definitions are, and in the end I think US-international graduates (e.g., caribbean) probably end up with the same debt load as an average american school these days (I think with my out of state tuition I'll be higher than most carib grads). But you're right, most of them don't have the luxury of matching into something like derm or radiology but they still make things work.

 

[johnmendes]

But trying to get back on topic, I find it quite... Interesting that despite all the "support" and loan repayment and forgiveness programs that you guys have, you still flee FM like the plague. I know it's neither high paying nor glamorous, but I find it quite interesting... At least here in Europe, the patient population is quite diverse. But for what I hear, the thing seen the most are obese patients with diabetes... 👎thumbdown👎

 

[BigRedBeta]

I know you're trying to tease out one component of specialty choice, but this poll ignores everything else that goes into choosing a field. I'm going into pediatric critical care, and one of the most important reasons is so I can avoid clinic at all costs...hell, you could offer to make me a radiologist, dermatologist or any other "lifestyle" specialist, put my salary in the top 1%ile in that field and pay off all my debt and I'd turn you down. These fields just don't intrigue me intellectually or offer me the sort of experiences that I find particularly rewarding. They're just not right for me. I may be well within the minority of residents in saying that, but that's the God's honest truth.

 

[hrandani]

You actually have the terms backwards. IMG means American citizenship, foreign education. FMG means foreign school, non-citizen.

Not that it matters, they go through the same process we all do now.

 

[johnmendes]

You actually have the terms backwards. IMG means American citizenship, foreign education. FMG means foreign school, non-citizen.

Not that it matters, they go through the same process we all do now.

damn man, now I'm confused! sorry about it though

 

[islandCrazy]

Most of my classmates are coming out of medical school with at least 200k in loans as IMG. Some have much more as they have undergraduate debt that carried over. Now I go to one of the cheaper Caribbean schools and I don't even want to imagine the debt from one of the more expensive Caribbean schools. Granted those students usually place better in residency then my current school but the vast majority end up in primary care.
If you look at stats most IMG end up in family, psychiatry or pediatics. I'm lucky considering that my family has taken over a lot of cost and I have learned to live with the bare minimum. While its a major struggle right now I am estimating a debt of roughly 60k, which is interest free right now. This great considering that I love family medicine as it is my number one goal. I also would love a modest lifestyle with maybe a condo and a car in a safe area. The only other expense I would have would be my parents retirement and making sure they are comfortable.

 

[islandCrazy]

damn man, now I'm confused! sorry about it though

Yup that's right! IMG usually means American citizens who went aboard for medical school while FMG means foreigners who are not citizens of America or were not citizens at the time of studying medicine in another country.

 

[dank204]

I was told by my physician mentor, who is a radiologist, in 2001 not to pursue a career in medicine if I had no plans on specializing. He said "it's just not worth it."

 

[johnmendes]

Most of my classmates are coming out of medical school with at least 200k in loans as IMG. Some have much more as they have undergraduate debt that carried over. Now I go to one of the cheaper Caribbean schools and I don't even want to imagine the debt from one of the more expensive Caribbean schools. Granted those students usually place better in residency then my current school but the vast majority end up in primary care.
If you look at stats most IMG end up in family, psychiatry or pediatics. I'm lucky considering that my family has taken over a lot of cost and I have learned to live with the bare minimum. While its a major struggle right now I am estimating a debt of roughly 60k, which is interest free right now. This great considering that I love family medicine as it is my number one goal. I also would love a modest lifestyle with maybe a condo and a car in a safe area. The only other expense I would have would be my parents retirement and making sure they are comfortable.[/QUOTE
👍👍👍👍

to that list I would just add the money to let my kids attend any university they would want.
which school do you go to btw?

 

[johnmendes]

I was told by my physician mentor, who is a radiologist, in 2001 not to pursue a career in medicine if I had no plans on specializing. He said "it's just not worth it."

Noctors and Medicare reimnursements, making life grand!

 

[Daedra22]

I may be a little naiive here, but does income-based repayment make any difference? I know that going with IBR might mean you pay off your loans slower, but I think it's pretty good at ensuring you will never be paying so much out per month that you're destitute.

 

[Perrotfish]

But trying to get back on topic, I find it quite... Interesting that despite all the "support" and loan repayment and forgiveness programs that you guys have, you still flee FM like the plague. I know it's neither high paying nor glamorous, but I find it quite interesting... At least here in Europe, the patient population is quite diverse. But for what I hear, the thing seen the most are obese patients with diabetes... 👎thumbdown👎

From a third year med student: It seems to me that US emphasizes a model where a primary clinic acts mainly as a screen. The population is as diverse as yours, but anyone with anything interesting is going to be managed by a specialist. In an urban area, especially, what that leaves for FP to actually manage are common infectious diseases, asthma, diabetes, some basic sports medicine, a disturbing amount of psych, basic Peds, and common Gyn issues. All at 15 minutes a patient or less.

If you go out to the country is can be better, since there aren't as many specialists to manage conditions. An FP out in the middle of nowhere can do the full range of OB/Gyn, manage the country ER, do Botox, do minor surgery, and manage the more interesting patients that can't drive to the tertiary care center. Technically, of course, an FP can do that anywhere but it's just harder to make the business model work in the city. Most of the things I mentioned have a fixed minimum cost due to equiptment, required training, and malpratice, so it doesn't make sense to do them at all unless you're going to do a significant amount of them.

 

[johnmendes]

From a third year med student: It seems to me that US emphasizes a model where a primary clinic acts mainly as a screen. The population is as diverse as yours, but anyone with anything interesting is going to be managed by a specialist. In an urban area, especially, what that leaves for FP to actually manage are common infectious diseases, asthma, diabetes, some basic sports medicine, a disturbing amount of psych, basic Peds, and common Gyn issues. All at 15 minutes a patient or less.

If you go out to the country is can be better, since there aren't as many specialists to manage conditions. An FP out in the middle of nowhere can do the full range of OB/Gyn, manage the country ER, do Botox, do minor surgery, and manage the more interesting patients that can't drive to the tertiary care center. Technically, of course, an FP can do that anywhere but it's just harder to make the business model work in the city. Most of the things I mentioned have a fixed minimum cost due to equiptment, required training, and malpratice, so it doesn't make sense to do them at all unless you're going to do a significant amount of them.

thanks for the input. I am actually planning on practicing in the Midwest, and family medicine is one of my interests (along with competitive ortho👎) but i still have a long road ahead. BTW, do you need to be a PCP to get those loan forgiveness things or can you be a specialist working in underserved areas and still get your debt wiped out?

 

[Bernie3144]

Loan forgiveness is for primary care. Not sure if there are any state/local/health network loan forgiveness programs that do not require specialization in primary care.

I also thought ortho but will be doing family med and sports med fellowship. Primary Care Sports med fellowship (non-ortho) still qualifies as primary care for loan forgiveness programs.

Check out Future of Family Medicine Blog about all of these topics - written by medical students committed to family medicine:
"Family Medicine Is A Waste of Your Talent"
What Is Family Medicine?

 

[Yope]

IMG=FMG.

If one graduates from a medical school in a different country than the one in which s/he practices, one is an international or foreign medical graduate.

Country of origin is of no significance.

 

[johnmendes]

IMG=FMG.

If one graduates from a medical school in a different country than the one in which s/he practices, one is an international or foreign medical graduate.

Country of origin is of no significance.

Some programs don't sponsor visas, so if you are american, you have the advantage.

 

[Yope]

Some programs don't sponsor visas, so if you are american, you have the advantage.

Irrelevant.

 

[Bernie3144]

It is also a good opportunity to show you the 20th Report by the Council on Graduate Medical Education (COGME). This is a government entity that makes recommendations about GME. Politicians have access to this information - medical organizations use it to educate politicians and their staff as a 3rd party document. Of course they are recommendations and may never be fully implemented, but if they were, I'm sure students interested but unsure about primary care would take notice.

It is titled "Advancing Primary Care."

Link to COGME 20th Report in its Entirety

The COGME report calls for "dramatic" policy changes that would have "immediate effect," and it proposes five recommendations:
1. Increase the number of primary care physicians from the current level of 32 percent of U.S. physicians to at least 40 percent through new policies and programs.
2. Raise the average incomes of primary care physicians to at least 70 percent of the median income for all other physicians, and reward practices that change their infrastructure to improve chronic care and care coordination. According to data from the Medical Group Management Association cited in the report, primary care physicians' median annual compensation was $186,044 in 2008 versus $339,738 for physicians practicing in other specialties.
3. Require medical schools and academic health centers to develop "an accountable mission statement and measures of social responsibility to improve the health of all Americans," and to alter their selection processes and educational environments to support the goal of producing a physician workforce that is at least 40 percent primary care physicians.
4. Change graduate medical education regulations and significantly expand Title VII funding for community-based training to support the goal of producing a physician workforce that is at least 40 percent primary care physicians. This includes requiring more residency training in outpatient settings. The report acknowledges the Affordable Care Act Primary Care Residency Expansion (PCRE) Program, a new $168 million, five-year program aimed at expanding enrollment in primary care residency programs.
5. Increase incentives for physicians to serve medically vulnerable populations throughout the country. The report cites the Affordable Care Act's provision of $1.15 billion in funding for the National Health Service Corps to recruit more primary care physicians. COGME also recommends increasing funding for Title VII, section 747, to $560 million in Primary Care Medicine and Dentistry cluster grants and increasing funding for Community Health Centers and Area Health Education Centers.

 

[islandCrazy]

IMG=FMG.

If one graduates from a medical school in a different country than the one in which s/he practices, one is an international or foreign medical graduate.

Country of origin is of no significance.

This term isn't a made up term that is thrown around SDN its a term that has been used in several journal articles where they note the significance. I was reading one on Med scape just a day ago.... will look to find it.

 

[Yope]

This term isn't a made up term that is thrown around SDN its a term that has been used in several journal articles where they note the significance. I was reading one on Med scape just a day ago.... will look to find it.

And I'm an author of one of those journal articles. Next!