Economically frustrated

[The JockDoc]

So I was going to write this response to the thread on the dermatology match article in the NY times (http://forums.studentdoctor.net/showthread.php?t=505889), but I think it can be its own thread. I think that med students need to pull their head out of the sand and realize that there is nothing right about the way med students and doctors are treated economically - from med school to the way that docs and residents are reimbursed. So many med students are busting a$$ so that they can get their lost time and money back in a lucrative specialty, which they think will fix their problems. The problem is that all specialties are taking a salary hit nowadays from insurance and medicaid/care(unless you're lucky and get cash payment), and we're totally ignoring how big of a problem it is.

I'll reiterate with a metaphor. At the start, med school was an attractive cruise vacation that we were lured into. However, it was only after we got on and the ship left the dock that people figured out that there was a gaping hole that flooded all the common rooms previously occupied by the primary care docs with low reimbursements, nasty hours and sky-high med school loans. Us med students responded by gunning for the ROAD suits so that we wouldn't get wet. Or at least not until later.

Some of us will be able to scrounge up one of the few life rafts and float away from the mess and may even land on an island without insurance and a spring full of cash payment - which is where we all were planning on enjoying ourselves at the start. The rest of us will just accept the inevitable or hope for someone else to fix the hole.

Ok, so i'm being melodramatic, but i still think the metaphor describes the situation well. My point is that med students are too focused on getting to the presently lucrative residencies, and they aren't paying any attention to fixing this hole in the system that punishes you for being a primary care doc and rewards the less valuable (on a public health scale) specialties. The same economic forces are going to wear away at most of the presently sought after specialties anyways, only it will be happening later.

I'm not trying to be greedy, and I don't think I'm asking for more than I should (see discussion in the other thread on opportunity cost and years of compound interest at 6.8-8.5%). I just know I can't be a primary care doc and make a decent living, or even feed myself if I live in the wrong place. The 250k in loans and reimbursement cuts will make that choice for me. I know there are many more med students out there in a similar situation as well.

Thoughts?

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[soeagerun2or]

Part of the solution would be loan forgiveness for Internal Medicine and Family Practice physicians (not for specialists or hospitalists). While still earning less than specialists, the crushing debt burden would be ameliorated and allow more to stay in primary care.

I agree though, most medical students were seduced by the false thought that hard work and intelligence would be rewarded with a comfortable lifestyle.

 

[The JockDoc]

Part of the solution would be loan forgiveness for Internal Medicine and Family Practice physicians (not for specialists or hospitalists). While still earning less than specialists, the crushing debt burden would be ameliorated and allow more to stay in primary care.

I agree though, most medical students were seduced by the false thought that hard work and intelligence would be rewarded with a comfortable lifestyle.

I looked into just how much these programs reimburse, and they vary from 5-30k/year over 3-4 years, depending on what they decide to give you, and it is also taxable income. Most programs are listed on this website.

However, there are still very few of these programs, they don't necessarily cover all the primary care fields, and they only act as a partial band aid to the problem, if that

 

[Nodelphi]

It really all depends on your perspective. I have a Bachelors in science and was stuck in a job where I earned 30k/yr after working my way up for five years and I was totally miserable. So, from my perspective medicine affords major upward mobility for me and my family. I know that's not the case for many people though.

 

[Chemguync]

It really all depends on your perspective. I have a Bachelors in science and was stuck in a job where I earned 30k/yr after working my way up for five years and I was totally miserable. So, from my perspective medicine affords major upward mobility for me and my family. I know that's not the case for many people though.

When you're sitting in your 4th year class meeting staring at that 6 figure debt, and the suits on stage are telling you to defer everything for the next 6 years, interest bedamned... upward mobility isn't the foremost thought on your mind.

 

[sirus_virus]

Medical education costs that much because no one is challenging the medschools about it. They are having a good time stuffing debt down the throats of unsuspecting students. Do you think they cant charge less and still be as effective? It's a sellers market, and medschools are selling, pillaging, and plundering.

 

[Nodelphi]

When you're sitting in your 4th year class meeting staring at that 6 figure debt, and the suits on stage are telling you to defer everything for the next 6 years, interest bedamned... upward mobility isn't the foremost thought on your mind.

My kids make sure that upward mobility is always foremost on my mind. Why defer? I've got it budgeted out so I can pay interest plus a little extra monthly on my resident's salary. As long as I stick to the financial plan I'll be debt free four years out of residency. Sure we'll be living poor but my point is we're used to that. It's all about how poor you're willing to live in the short term to make your long term goals pay off.

But lets not get bogged down in my example. I agree that it's a real bummer we'll all be making less and that medical schools charge you so much; but consider the poor liberal arts majors who graduate from overpriced universities for their major and end up saddled with a debt they have even less chance to pay down. At least we do have a fighting chance.

I submit the problem didn't originate with the schools but with the advent of easily obtainable student loans and until student lending practices are reigned in and regulated much more carefully we'll continue to see soaring tuitions because everyone can afford to pay them... even when they really can't.

 

[Law2Doc]

I think that med students need to pull their head out of the sand and realize that there is nothing right about the way med students and doctors are treated economically - from med school to the way that docs and residents are reimbursed. ...we're totally ignoring how big of a problem it is.

I don't think med students have their head in the sand or are ignoring the problem. I think most of us realize (or have at least been well informed) that the practice of medicine isn't what it was a generation ago. Just that med students aren't the people pulling the strings here. There is no med student lobby. Med students do not have any dealings with insurance companies. Med students don't set tuition. Most med students aren't even paying any taxes. Physicians are in the position to push for change, but once you get past the med school stage, you are going to lose interest in the issues faced by med students, and will be focused on your own cut of the pie (smaller though it may be). So I don't think it's an issue of students ignoring stuff, I think it's an issue of the wrong group to complain to. Sort of like complaining to fellow inmates about the bad conditions in prison.

 

[The JockDoc]

I don't think med students have their head in the sand or are ignoring the problem. I think most of us realize (or have at least been well informed) that the practice of medicine isn't what it was a generation ago. Just that med students aren't the people pulling the strings here. There is no med student lobby. Med students do not have any dealings with insurance companies. Med students don't set tuition. Most med students aren't even paying any taxes. Physicians are in the position to push for change, but once you get past the med school stage, you are going to lose interest in the issues faced by med students, and will be focused on your own cut of the pie (smaller though it may be). So I don't think it's an issue of students ignoring stuff, I think it's an issue of the wrong group to complain to. Sort of like complaining to fellow inmates about the bad conditions in prison.

So far the new and established docs who are done with residency haven't had to deal with similar economic pressures that present medical students will face. Their tuition wasn't has high. Their interest wasn't as high. Their pay has been better. Etc. What I'm getting at is the disinterest in how our future is getting shaped out, and how little it even bothers med students. A lot of kids really don't care, or are uninformed when it comes to how docs get paid, or what they will get paid once they need to take care of their loans. This psychological disinterest is the issue i'm talking about.

If we were actually concerned about what happens, by the time we get out of residency we will either be more politically active, or at least more of us will be able to plan our economic futures realistically, and in advance. That's not to say that we don't have any political power right now either. The prison scenario assumes that we did somethign wrong and theres not much to do about it. However we haven't done jack wrong, really, and arguing over better conditions shouldn't be a mental block. We aren't making problems by getting reimbursed more for what we do. In fact, it would alleviate problems by encouraging more to take on medicaid, but thats a whole nother discussion. And we'll still have those nice high interest loans and low reimbursements to look forward to once we're shiny new docs, so it will still affect us after all our training.

I would argue that most med students don't know that their residency loan deferment has been cancelled, and that their lender probably is suspending most, or all (if you have THE) repayment incentives. And I would also argue that they don't care or know about these issues because by getting into derm or whatever, that they'll have enough money to weather the consequences. There's plenty more examples. We're ignorant about this continual chipping away at our future economic status.

Its also not like we don't have links to big lobbying groups (AMA) either. And its not like the AMA is completely unaware of what's happening (http://www.ama-assn.org/ama/pub/category/5349.html). And don't get me started on students who think that it would be appropriate for docs to take a pay hit becuase they don't need the money.

Bottom line is students just don't care.

 

[Blade28]

If we were actually concerned about what happens, by the time we get out of residency we will either be more politically active, or at least more of us will be able to plan our economic futures realistically, and in advance.

Good advice.

 

[Doublecortin]

So I was going to write this response to the thread on the dermatology match article in the NY times (http://forums.studentdoctor.net/showthread.php?t=505889), but I think it can be its own thread. I think that med students need to pull their head out of the sand and realize that there is nothing right about the way med students and doctors are treated economically - from med school to the way that docs and residents are reimbursed. So many med students are busting a$$ so that they can get their lost time and money back in a lucrative specialty, which they think will fix their problems. The problem is that all specialties are taking a salary hit nowadays from insurance and medicaid/care(unless you're lucky and get cash payment), and we're totally ignoring how big of a problem it is.

I'll reiterate with a metaphor. At the start, med school was an attractive cruise vacation that we were lured into. However, it was only after we got on and the ship left the dock that people figured out that there was a gaping hole that flooded all the common rooms previously occupied by the primary care docs with low reimbursements, nasty hours and sky-high med school loans. Us med students responded by gunning for the ROAD suits so that we wouldn't get wet. Or at least not until later.

Some of us will be able to scrounge up one of the few life rafts and float away from the mess and may even land on an island without insurance and a spring full of cash payment - which is where we all were planning on enjoying ourselves at the start. The rest of us will just accept the inevitable or hope for someone else to fix the hole.

Ok, so i'm being melodramatic, but i still think the metaphor describes the situation well. My point is that med students are too focused on getting to the presently lucrative residencies, and they aren't paying any attention to fixing this hole in the system that punishes you for being a primary care doc and rewards the less valuable (on a public health scale) specialties. The same economic forces are going to wear away at most of the presently sought after specialties anyways, only it will be happening later.

I'm not trying to be greedy, and I don't think I'm asking for more than I should (see discussion in the other thread on opportunity cost and years of compound interest at 6.8-8.5%). I just know I can't be a primary care doc and make a decent living, or even feed myself if I live in the wrong place. The 250k in loans and reimbursement cuts will make that choice for me. I know there are many more med students out there in a similar situation as well.

Thoughts?

agreed, but what sucks is the # of medical school seats is increasing every year and the # of ROAD residency positions isn't, which sucks a$$

 

[Mr. Freeze]

Medical education costs that much because no one is challenging the medschools about it. They are having a good time stuffing debt down the throats of unsuspecting students. Do you think they cant charge less and still be as effective? It's a sellers market, and medschools are selling, pillaging, and plundering.

In a recent meeting we had with our retiring Dean, his exact words: "They'd never tell you this, but most medical schools don't need your tuition at all."

Sweet. That makes the big fat red number looming over its completion even better...

 

[The JockDoc]

agreed, but what sucks is the # of medical school seats is increasing every year and the # of ROAD residency positions isn't, which sucks a$$

What I meant was that you shouldn't even need to think about choosing a ROAD residency just to feel good about your economic future. The number of ROAD residency options is fine. The declining reimbursement for the ROAD and non-road specialties is the problem.

 

[The JockDoc]

In a recent meeting we had with our retiring Dean, his exact words: "They'd never tell you this, but most medical schools don't need your tuition at all."

Sweet. That makes the big fat red number looming over its completion even better...

And when the alumni foundation calls you after graduation asking for a donation, you'll feel even better about giving back to your school.

 

[HQAMIGO]

not to sound cynical but I actually don't mind it when my classmates get super excited about primary care or helping the underserved or traveling to Afghanistan to do medical missions. The way I figure, the more of those people there are, the less competition there is for the rest of us who actually want to get paid. Problem is that a lot of these idealists suddenly wake up before 4th year and switch to derm

 

[Law2Doc]

not to sound cynical but I actually don't mind it when my classmates get super excited about primary care or helping the underserved or traveling to Afghanistan to do medical missions. The way I figure, the more of those people there are, the less competition there is for the rest of us who actually want to get paid. Problem is that a lot of these idealists suddenly wake up before 4th year and switch to derm

They can wake up all they want, but if they don't put up the numbers they wont be getting derm. There is a finite percentage of folks who will have a shot at derm each year. The rest of people in med school had better be happy with the options attainable with their stats.

But in all fairness, the low end specialties in medicine earn an average of $140k. Even if this drops 10% by the time you get there (which is what some of the pundits predict), that's still an average of $126k. That's not a lot for a professional 3+ years out of professional school, particularly if you live in a high cost of living area and are carrying a six digit student loan debt, but you won't be living on the streets either. If you enjoy what you are doing, it isn't so bad. If you had dreams of living the high life, you missed the window of opportunity in medicine by a generation or two.

 

[Its_MurDAH]

They can wake up all they want, but if they don't put up the numbers they wont be getting derm. There is a finite percentage of folks who will have a shot at derm each year. The rest of people in med school had better be happy with the options attainable with their stats.

But in all fairness, the low end specialties in medicine earn an average of $140k. Even if this drops 10% by the time you get there (which is what some of the pundits predict), that's still an average of $126k. That's not a lot for a professional 3+ years out of professional school, particularly if you live in a high cost of living area and are carrying a six digit student loan debt, but you won't be living on the streets either. If you enjoy what you are doing, it isn't so bad. If you had dreams of living the high life, you missed the window of opportunity in medicine by a generation or two.

Agreed, the time to go into medicine for money has passed.

It would have been sweet to be a thoracic surgeon 25 years ago. The best this crop of med students can hope for now is ROAD and you can't get those without a 240+ on your boards. It sucks but what can ya do.

 

[Law2Doc]

Agreed, the time to go into medicine for money has passed.

It would have been sweet to be a thoracic surgeon 25 years ago. The best this crop of med students can hope for now is ROAD and you can't get those without a 240+ on your boards. It sucks but what can ya do.

Well, ROAD is no longer a good acronym because some of those fields are no longer as competitive as they once were. But your sentiment is accurate.

 

[Doublecortin]

not to sound cynical but I actually don't mind it when my classmates get super excited about primary care or helping the underserved or traveling to Afghanistan to do medical missions. The way I figure, the more of those people there are, the less competition there is for the rest of us who actually want to get paid

. Problem is that a lot of these idealists suddenly wake up before 4th year and switch to derm

my feeling exactly