Educational Reform

[physasst]

Anyone who does not think that some of our healthcare problems, are not 100% the result of some of the problems with higher education is simply not paying attention. MD's and PA's are eschewing primary care in droves, not because of the job itself, although that is certainly part of it (hard to convince someone to work 14-16 hours 5 days a week), but because of massive student loan debt, and poor reimbursements for cognitive services.

I've been doing some reading on higher education as a whole, and ran across this article. As we have several professorial types here, I would like their opinion, as well as everyone else here, regarding the cost escalation..

http://www.highereducation.org/pa_college_opp/College_Opportunity.pdfhttp://www.highereducation.org/pa_college_opp/College_Opportunity.pdf

I read that the cost of a higher education has increased by a massive 439 percent since 1982, rising much more than medical care (251 percent) and far more than the Consumer Price Index (106 percent). The study above has surveyed the public, and found that over 50% of the general public does not feel that colleges care about higher education, and that rather, they are concerned only with the bottom line, and feel too much like a business. 9 out of 10 americans also feel that higher education is a right. The surveys also revealed that most americans (>50%) felt that colleges could spend significantly less, and still give an outstanding education. People also feel that there is no significant difference between a community college, and a four year university when discussing the first two years of school.

Essentially the public is dissatisfied, costs are increasing at exponential rates, and have even far exceeded healthcare costs in growth. This is limiting students applications, especially among minorities. 74% of minority parents think that higher education is out of reach of their children.

This does not excuse the middle and high school systems, which need significant changes, as well as cultural beliefs and attitudes towards education as a whole.


From another article..

http://www.highereducation.org/reports/hunt_tierney/Hunt_Tierney.pdfhttp://www.highereducation.org/reports/hunt_tierney/Hunt_Tierney.pdf

1. First, our education pipeline leaks badly. Of
every 100 ninth graders, only 18 come out
the other end 10 years later with a college
degree! Only 68 of every 100 ninth graders
graduate from high school on time; of the 68
graduates, only 40 enroll directly in college;
only 27 are still enrolled the next year; and
only 18 of the original 100 ninth graders
complete an associate’s degree within three
years or a bachelor’s degree within six years
of enrolling. Eighty-two out of 100 ninth
graders don’t make it.

Thoughts, discussion?

Should higher education be publicly funded as it is in other countries, such as Egypt? This would need to be funded through taxes, and would lower mean salaries after graduation, but would allow for greater diversity, equal opportunity, and would encourage more post-graduate attendance.

Any other ideas or thoughts?

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[RGMSU]

Interesting that you would bring this up, as I just found out yesterday my loan repayment for a 4 yr MD program at a state institution will be about 1700 per month for 10 yrs. The suggested income for this loan indebtedness by the bank's calculator was 260,000 annually. It's easy to see why most medical students don't believe they can go into primary care with that kind of indebtedness. I don't believe raising taxes or increasing government funding for education is necessary. If the government just makes sure in the new healthcare system that every physician can earn at least 260,000 annually, then we won't have a problem paying our loans back in any specialty. Somehow, though, I find it strange that in all the discussion of reforming healthcare I never hear anyone mention securing physician salaries or maintaining financial solvency for medical students' futures.

 

[physasst]

Interesting that you would bring this up, as I just found out yesterday my loan repayment for a 4 yr MD program at a state institution will be about 1700 per month for 10 yrs. The suggested income for this loan indebtedness by the bank's calculator was 260,000 annually. It's easy to see why most medical students don't believe they can go into primary care with that kind of indebtedness. I don't believe raising taxes or increasing government funding for education is necessary. If the government just makes sure in the new healthcare system that every physician can earn at least 260,000 annually, then we won't have a problem paying our loans back in any specialty. Somehow, though, I find it strange that in all the discussion of reforming healthcare I never hear anyone mention securing physician salaries or maintaining financial solvency for medical students' futures.

I'd be willing to bet that if EVERY physician agreed to take a yearly SALARIED position for 260K per year, that the government would probably jump at that.

 

[psy]

and I'm willing to bet that after the initial 260k the subsequent years will see a 5% decrease annually as a way to reduce the ever increasing health care cost.

However if that means I would only have to work for 8 hrs per day 5 days per week. I'll sign on =D

 

[lee9786]

check this out

http://www.ibrinfo.org/

 

[RGMSU]

Well, I think we all know that there are different levels of physician commitment/responsibility. Primary care physicians generally make less than 260k, and they should be making more. No, I don't think a neurosurgeon's salary should be dropped down to 260k though. I just think it's a shame that every medical student has to feel pressured to enter into procedural/surgical medicine because of the loans we incur. That's what I was referring to. And, yeah, I second the post that if someone would sign me up for 260k in ANY specialty with a 40 hour a week cap, I'd take it in a heartbeat.

I'd be willing to bet that if EVERY physician agreed to take a yearly SALARIED position for 260K per year, that the government would probably jump at that.

 

[Winter Lily]

You read my mind, physasst. European-style reform will only work once they realize that the problem starts with school.

I don't think it's just bad money management skills: I suspect it's also a rational reaction to USNWR.

 

[Miami_med]

I'd be willing to bet that if EVERY physician agreed to take a yearly SALARIED position for 260K per year, that the government would probably jump at that.

And that position would then pay $240k after 20 years of inflation. That would be sort of the equivalent of, huh, I don't know, medicare.

 

[RGMSU]

We need a system that recognizes specialists for their expertise. It is a good thing to have some MDs around who are highly skilled in a small scope of practice for the unusual and complicated situations that arise. We need a government that doesn't lower specialist compensation through Medicare every time they get a chance. We need to pay primary care folks more so that medical students have a realistic shot at getting into that line of work and making a decent living. Every primary care doc should get used to working with a PA or two to keep their case-load at a manageable and profitable level. What we do not need is a system that tries to substitute primary care as the solution to every problem. There will ALWAYS be disease that requires specialist diagnosis and treatment expertise. ALWAYS. If we don't maintain specialist salaries high enough to encourage people to go into that pipeline, we will lose the expertise that we need to maintain a high quality healthcare system. If we don't start paying primary care docs more than 45 bucks for an office visit, we'll never have quality preventive care. There's only so much you can talk about if you're pressured to have an office visit that is only 5 minutes long per patient. You can increase the number of doctors, PAs, NPs, etc, but until you start providing decent compensation for primary care, all the new folks you bring into the educational pipeline are going to avoid primary care just like the people who are already in the pipeline do now. Causing specialist pay to plummet and primary care pay to remain flat is not the solution to equal out distribution of people into primary care vs. specialist residencies. Forming a bunch of minute clinics where people go for a quick fix rather than continuous care by a qualified provider is not going to yield good preventive care either. In primary care physician extenders are very useful, but we also need to maintain a good number of primary care MDs with whom these physician extenders can collaborate to offer high quality care. To put numbers to this, a primary care doc should average around 200k to 250 annually under a decent system to pay loans back. Yes, I know - ain't gonna happen, but it should! Specialists who require 5 plus years of post-MD training should average more around 300k to 350 to justify the 2 or more years of additional training. Paying a family physician 200k minimum is not outrageous - it is very fair.

 

[VassarLiberal]

What we do not need is a system that tries to substitute primary care as the solution to every problem. There will ALWAYS be disease that requires specialist diagnosis and treatment expertise.

Would you exclude the possibility of maintaining PCPs as "gatekeepers"?

 

[RGMSU]

No, I actually think PCPs can function quite well as gatekeepers, provided they are a well-trained PCP who knows when the proper time to refer is. I don't dispute that PCPs tend to save money either. I think PCPs will benefit from the healthcare reforms about to occur, and I think it will be a good thing. Primary care physicians in particular have been undervalued far too long. I just cringe a bit when I hear politicians act like preventive care is the magic bullet. It helps, but there are still many disease processes we don't know how to prevent, so it won't solve every mallady. The problem with the HMO movement as I recall was that the PATIENT wasn't typically happy with the concept of a gatekeeper. We'll see if that same sentiment crops up again in public opinion. A salary increase to insure a good quantity of good PCPs and empowering the PCP to engage in cost-saving decision making would go a long way toward cutting costs. The only problem there would be freeing them from the burden of practicing defensive medicine and sticking their neck out on the legal chopping block in an attempt to function as a gatekeeper.

 

[VassarLiberal]

If we made the physicians government employees and extended the Feres doctrine and whatnot, maybe that'd protect them. Otherwise, limits on damages are certainly in order.

If it weren't borderline unethical and unconstitutional, it'd be nice to see some sort of tax breaks for the healthy-living.

 

[DO2Be2013]

From another article..

http://www.highereducation.org/reports/hunt_tierney/Hunt_Tierney.pdf

1. First, our education pipeline leaks badly. Of
every 100 ninth graders, only 18 come out
the other end 10 years later with a college
degree! Only 68 of every 100 ninth graders
graduate from high school on time; of the 68
graduates, only 40 enroll directly in college;
only 27 are still enrolled the next year; and
only 18 of the original 100 ninth graders
complete an associate's degree within three
years or a bachelor's degree within six years
of enrolling. Eighty-two out of 100 ninth
graders don't make it.

Thoughts, discussion?

Should higher education be publicly funded as it is in other countries, such as Egypt? This would need to be funded through taxes, and would lower mean salaries after graduation, but would allow for greater diversity, equal opportunity, and would encourage more post-graduate attendance.

Any other ideas or thoughts?

Well, I guess this part is largely off-topic to the point you were making, but as a former public school teacher I felt compelled to comment.

Why is it just assumed on face value that the goal should be for 100% of high school students to enroll in/graduate from college? College isn't the best path for everyone. And if everyone had a college degree, a college degree would become pretty meaningless. What many people need and are lacking are job skills and vocational training. Our economy needs people to work blue collar manufacturing jobs. We need people to fix our cars, collect trash and fix our septic tanks. We really need people to join our military, or police/fire agencies. It's kind of a cliched point, but true.

There has been a shift in public education in recent decades, in the name of "higher expectations" to push more students at an earlier age into college-prep classes. There are many kids who struggle academically and who will always have zero interest in going to college who get turned off, bored and eventually become dropouts. If we could engage them at an earlier age, even starting in middle school, with vocational programs that held their interest and gave them a clear vision for a pathway from education to productive jobs after school, maybe we could save a few from becoming dropouts.

Our education system is always judged in contrast to that of other nations. Well, in most other nations kids are "tracked" from a much earlier age into vocational versus college-prep courses of study based upon their aptitude and interests. And the danger with that system is of course that you pigeonhole some kids. But the danger with our system- one in which the focus is entirely upon preparing kids to enter higher education- is that you alienate a lot of kids whose best bet in life probably isn't to go to college (which is perfectly okay) and maybe we miss the opportunity to educate/train them for skilled vocations.

I'm a big fan of vocational and technical high schools. Our school district's lone school of technology (no longer called vo-tech; guess that's out of vogue) had a very competitive application process and lots of kids ended on their programs' waiting lists. I wish we could offer a seat in those programs to every kid who wanted one. And if they graduate high school with their vocational training certificate and go on to live happy, productive lives making $50k+ per year as electricians or plumbers then great, even if they "fail" to earn a college degree.

 

[VassarLiberal]

Why is it just assumed on face value that the goal should be for 100% of high school students to enroll in/graduate from college? College isn't the best path for everyone.

Zee Germans have an excellent system that seems to work much like what you're suggesting, albeit with a tinge of what might be "unamerican" –*the idea of tracking students as opposed to allowing them to apply to university-level education. It is certainly an interesting idea, ja?

 

[Zoom-Zoom]

If it weren't borderline unethical and unconstitutional, it'd be nice to see some sort of tax breaks for the healthy-living.

I don't see how that's any more unethical than socializing medicine to begin with.

 

[VassarLiberal]

I don't see how that's any more unethical than socializing medicine to begin with.

Hmm...interesting. Though medicine is already quite socialized. Insurance for businesses is heavily subsidized due to the fact that they can deduct it, and because of the many, many programs – the Medicaid, Tricare, etc...