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Food For thought

Discussion in 'Re-Applicants [ MD / DO ]' started by ozzie20, Dec 15, 2008.

  1. ozzie20

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    I thought this might be the best forum to place this,

    Really its more food for thought than anything else, and a bit of venting as well.

    To all those people that are applying to med school and waiting to get in. Ask yourself, do you have the whole story? Do you REALLY know what you're getting into? Sure people tell you "medicine isn't what it used to be" etc etc.
    You think to yourself, sure, I know, whatever, I want in med school, thats my goal.


    Speaking as a resident, now done with med school and looking at my career choices, I made a good choice with my specialty, but I think in terms of medicine in general, I'm not so sure:

    1. When you're done, you WILL be in debt close to 200,000$, maybe more. When you factor in Interest (which lets face it, not many people tell you this), you're talking more in the neighborhood of 300,000 in total payments. Are you sure you want to be paying this for 10-15 years AFTER residency?

    2. To those that think this will make you a lot of money (come on, the thought hadn't crossed your mind that it at least could afford you and your family things?) I've got news for you, It doesn't. TRUE, the average doc will make around 150,000 in salary per year, but lets break this down: Being a doctor puts you in a unique tax bracket, the LOWEST end of the HIGHEST tax bracket, meaning you get taxed A LOT, and you don't end up with much in the end. So, that 150,000 you THOUGHT you had, is really around 105,000. Don't believe me?
    http://www.paycheckcity.com/NetPayCalc/netpayCalcResult.asp
    Calculate it yourself and see.

    3. Now that you've seen how much is lost in taxes, lets break down something else, something that not many people are looking at, your hours worked for the money you make. The AVERAGE Surgeon is working Close to 70 HOURS PER WEEK. Thats AFTER residency. Think about that. Lets say you worked 10 hours a day, from 7am till 5pm EVERY DAY, WITHOUT lunch, you STILL have to work an additional 20 hours ON YOUR WEEKEND to get to the 70 hour average. So, even if you make big time surgeon money, you won't be able to spend it, cause you'll be too busy working in the hospital. Nights, weekends, your family's birthday's, xmas, thanksgiving, say goodbye to it all. (and don't think you'd be able to be any different, these are AVERAGE worked hours, some work more, some work less, but there isn't a surgeon i've heard of that works the magical 40 hours a week)

    4. This time for money issue brings another point: If you've got kids, family, a wife/husband, all those hours in the hospital are hours you'll NEVER get back with your family. Period. If an emergent patient comes in who 'needs' to have antibiotics right in the middle of your son/daughter's graduation, too bad, you're the one who's gotta do it.

    5. You're not 'practicing medicine' anymore. Don't believe what people say, you just aren't. You're practicing cookbook medicine. Don't know what I mean? well, lets just put it this way, you learn all this stuff in med school to be able to figure out what is wrong with the patient, and how to fix it, and what medications to give. When you get out, you are TOLD by hospital administration (usually social workers, nurses, pharmacists) what medications to give, what to tell the patient, how to write an order, all in prefabricated forms. So, if a patient comes in with chest pain, YOU DO NOT THINK, you just check off the boxes for 'chest pain protocol'. You'd think this would make it easier, but in fact, this brings 10x more paperwork.

    6. You're RIDDLED with paperwork. I MEAN COVERED IN IT. Imagine coming in every day, and having to handwrite 1 page on EVERY PATIENT YOU SEE (usually around 12) EVERY SINGLE DAY. On top of that, then you've gotta write 2 pages every time a patient comes in and leaves the hospital (H&P's and Discharge summaries). And remember, none of these papers actually help at all except to make lawyers happy. You will write the same thing every day, again and again and again.....

    7. "Midlevels" are taking over! AHHH! Well, I'm sure you've heard at least a LITTLE bit about this. The fact is, Nurses these days can become Nurse Practitioners, which means that they can do pretty much everything (with some small exceptions) that a Family Practice Doctor can do. So, Basically a nurse can come in, make 135-150,000/year, come out with 1/6th the debt as a doctor, NOT go through the brutality of residency, AND make JUST AS MUCH AS A DOCTOR. Lets not forget CRNA's and AA's, which I've seen make as much as 230,000/year!!! Don't believe me? Can't be true?
    http://gaswork.com/search/CRNA/Job/All
    Check it out yourself. Those are job postings. For Midlevels. Who are being offered more than some doctors will ever make.

    Now I know that after reading this people will have rebuttals, and no, its really not all doom and gloom, but I just want to point out the sucky things about medicine that I didn't know about before I applied, and yes, I'm truly happy in the specialty that I have.
     
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  3. J ROD

    J ROD Watch my TAN walk!!
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    Great post!

    I have heard the same exact sentiments from other MDs. Some have even begged me not to go that are friends.

    One reason it has taken me several years to apply and go for it.

    In the end, even though I know it is going to probably be more "crap" than I ever wanted, I still want to call myself a MD and have a chance to make a difference. For myself, I can not be a midlevel. I wish I could. It would be SO much easier. I am a leader and have to be the "executive" so to speak and MD is still the top medical personnel. Take out the insurance companies, lol!!

    It is the only thing I have ever seen that makes me want to get up and do it everyday. I like a challenging and demanding job and usually it is my main focus. It is not only my job but hobby. I actually really like this stuff. So, I think it works well for me. With that said, I expect to do better hour specialities so that I can have some balance.

    Simply, I asked myself if I could live without it and feel accomplished. The answer was "no" without hesitation. I have always wanted to be doctor since I was little and I regret not going for it when I was in my early 20's.

    So, bring it on! I willingly accept my fate as bleak as it may be from what I have heard.
     
  4. dragonfly99

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    OK, a little bit of a bleak post, but basically there is a lot of truth there.
    Docs do relatively better financially outside the large metro areas and in the South and Midwest, in general. Not because they necessarily earn more, but because the cost of living (and doing business) is lower.

    If you are in your 30's and/or 40's, I would seriously think hard about the financial aspects of going for an MD or DO, and how you are going to dig yourself out of that financial hole you'll be in after going to med school. It's at least a good reason to think about going to a cheaper school, if not reconsidering the viability of doing a residency. Also, you will be TIRED during residency...I was 25 when I started med school, 29 when I finished and I honestly can't imaging doing a residency in my 40's...I think it would be total hell. There are some specialties like psych and physical medicine/rehab that have better hours during residency and practice, though.

    As far as j dub's desire to go into specialties with "better hours", besides psych and physicial medicine/rehab, a lot of the "good hours" specialties (radiology, ophthalmology, dermatology, maybe ER and anesthesia [though they don't necessarily have as cush hours as you'd think all the time]) are hard to get in to and it's definitely true that quite a few of the students who want to go into those specialties won't be able to (see thread in General Residency about 'forced primary care').

    I think medicine was right for me, and I doubt this post will dissuade many from medical school, but I do think it's worthwhile to consider alternatives (i.e. optometry, PA, NP, others) particularly if you want to know you're going to have reasonable work hours.
     
  5. bigpharmD

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    C'mon why knock pharmacists? We cant even prescribe. We don't know anything.:laugh: As a pharmacist all the above reasons are why I am on the fence about going back. I have a pretty good job now as far as pharmd jobs go with a large amount of debt from private pharm school.
     
  6. ozzie20

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    You're right, Its not a knock on pharmacists at all. In fact, I rely on them CONSTANTLY when I don't know things about medications. In that, I leave to them the managment and specific dosing of certain medications (renal dose adjustments etc). A physician's expertise is supposed to be in management of the overall patient, how to treat diseases, etc. When that gets taken away from the physican, what are you left with? Some guy who writes on a piece of paper all day and takes a lot of malpractice.
     
  7. J ROD

    J ROD Watch my TAN walk!!
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    I consider Psy to be a "ROADE" and one of my choices. I even have a BA in Psy and act as an amateur psychologist for friends.

    I will be happy in there somewhere. EM, Anes, Psy, Cardio are my favs for now. I am finishing my PharmD too as we speak.

    I think I have the drive to finish. We shall see.....
     
  8. dragonfly99

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    OK. That's good. I just get nervous about applicants to med school who are only interested in 1 or 2 highly competitive specialties. That could be a recipe for unhappiness.

    Cardiology has not good work hours, by the way, and the residency + fellowship is 6-8 years.
     
  9. bigpharmD

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    I overheard a cardiologist yesterday telling his NP that he took a day off last week (during the work week) for the first time in over year and "felt like a human again" for the first time in along time. He went on to say that he stayed at home and did paper work all day long.......

    I am currently rounding with an ID fellow. We round on approx 15 transplant patients. He writes the same note on each patient and makes the same recs everyday that are rarely followed by the primary team. I dont know how he does it.
     
  10. dragonfly99

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    LOL @the ID fellow. Hospital rounding for ID folks pretty much consists of giving antibiotic recommendations and a few other things (like recommending to take out infected hardware and/or central venous catheters - duh!). However, their clinic is more interesting and some also do international work abroad.

    Some private practice cardiologists and surgeons definitely work like that - almost never take days off. However, that's definitely not the norm.
     
  11. J ROD

    J ROD Watch my TAN walk!!
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    Yeah, I know a cardio's life sucks, but I do find the medicine in that area interesting.

    I mainly have EM, Anes, Hospitalist, and Psy in mind. I probably would do a fellowship after working some as a hospitalist. Pain fellowship sounds interesting too.

    I guess first let me get in and then I can decided. :D
     
  12. dragonfly99

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    <I guess first let me get in and then I can decide. :D >

    That's a good plan. It's good to have ideas about what you want to do, but not to get too married to them because a lot of people change their minds along the way (about specialty).
     
  13. Jack Daniel

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    What a great post. Even if it is bleak as dragonfly suggest, I think this is something more people should hear. I think an honest premed would "know" all of these points, but it helps to drive the points home when someone on the other side of the training makes them.

    Unless you have physician parents, medicine is one of those career fields that you must nearly submerge yourself into before you can get away from the myths and superficial glamour. By the time you personally have a good understanding of what you're in for, you're practically vested and it's hard to turn back. In other words, you quickly pass the point of no return and have no other choice but go forward. So, great post and I'd like to see it as a "sticky" for the premed forums and the high school forum.
     
  14. Fakesmile

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    These are not rebuttals or anything. I just wanted these clarified.

    1. Does it really take 10-15 years to pay off the debt? I thought it would only take about 3-5 years, especially because docs make a lot of money.

    2. But isn't $105,000 still considered enough to live a good life while paying off your debt at a good rate?

    3 and 4. But not every medical student wants to be a surgeon. There are other specialties like ophthalmology and anesthesiology that make lots of money while giving you a good life.

    5 and 6. Doesn't that vary greatly by specialty?


    If what you said applied to all the other specialties, then I would immediately change my mind and pursue another career.
     
  15. dragonfly99

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    Well we may have overstated our case a little, but I think we were basically correct.

    <1. Does it really take 10-15 years to pay off the debt? I thought it would only take about 3-5 years, especially because docs make a lot of money.>
    Residents and fellows do not make "a lot of money" and you will be a resident or fellow for 3-10 years after you finish medical school. I'm in my 5th year of residency/fellowship right now (so 9 years since starting med school), and even paying $540/month my 132k medical school loan has only shrunk to 122k or so. For you all the situation will very likely be much worse...1/4 of grads this year apparently had 200k debt or more, and I believe the interest rate is fixed at 6.5 or 6.9% now, not the 2.85% I was able to get. I don't think 10-15 years is a bad estimate for someone entering a primary care field, though ortho/radiology/derm etc should be able to to pay it off faster. It depends on a lot of things...where you live, your family size, whether the spouse works, etc....$100,000 in New York buys a lot less than in Iowa. A single 35 year old guy will be able to pay off loans faster than a married guy w/3 kids.

    2. But isn't $105,000 still considered enough to live a good life while paying off your debt at a good rate?
    If you are single I would say yes, particularly if you don't live in the middle of San Francisco or something...but remember the amount of debt that current premeds will have is unknown. What if you borrow 300,000 at 6.9% interest? What will the payments on that be for a 30 year fixed rate loan? You go do the math...I haven't but I'm sure it's not as pretty as you think. Also remember you won't be getting to the $105,000 for many, many years...

    <3 and 4. But not every medical student wants to be a surgeon. There are other specialties like ophthalmology and anesthesiology that make lots of money while giving you a good life.>
    Anesthesiology isn't as cush as some people make it out to be...the stress of making sure nobody crumps/dies on the OR table is not minor. The rate of "washing out" of gas residency appears higher than some other fields (anecdotally from what I have seen). Ophtho is quite hard to get into...lots of med students won't have the opportunity (ditto for anesthesia, though it's somewhat easier to find a spot). And if optometrists start doing surgery, look out...

    <5 and 6. Doesn't that vary greatly by specialty?

    If what you said applied to all the other specialties, then I would immediately change my mind and pursue another career.>

    If you don't think you'll be doing a lot of paperwork, you are misinformed. That's common to many/most jobs and professions currently, though, so I don't know that you can avoid it by not doing medicine. Also, medicine is highly regulated so the part about having to follow checklists and/or hospital rules about prescribed care is likely to remain true in the future. There will be continued encroachments by administrators, gov't entities, etc. You have to decide if you like medicine enough to deal with this - I do.
    There are some fields that are more like this (ER especially) but it hold in fields like internal med, cardiology, etc. Though we still have quite a bit of leeway as far as what we do, if we don't write things a certain way in the chart the hospital will not get paid, and potentially we will not get paid.
     
  16. ProLogic

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    Wow.. I just did the math on that calculator and someone earning $130k a year would be pulling in $73k AFTER taxes. That is some major BS. Does this mean Physician assistant is the way to go? :D

    EDIT: In California.. taxed out the butt. Literally.
     
    #15 ProLogic, Jan 1, 2009
    Last edited: Jan 1, 2009
  17. Chocolate Bear

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    Thanks for the honest, rarely-heard truths from the other side.

    I agree whole-heartedly and have said it a hundred times that it's unfortunate how extremely difficult it is to get an accurate view of what life will be like when one completes his/her medical training. You're usually beyond the point of no return when you realize exactly what you've gotten yourself into.
     
  18. Doc WV

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    I may be a bit crazy in saying this.... but are you sure you aren't a bit out of touch on the worth of 105k take home. Thats a good chunk of change anyway you split it.

    Of course, how far ya stretch it will depend on where you live, but in most places (as in away from the major coastal cities), you could put 50K a year down on a loan and still live very comforably.

    I think it comes down to living within your means. There are lots of folks out there working just as many, if not more, hours for much less- and still living comfortably on it.
     
  19. ProLogic

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    I guess my question is.. if you want to become a general surgeon.. Is it really worth everything you went through?
     
  20. oldbearprofessor

    Administrator Rocket Scientist Physician Faculty SDN Advisor 10+ Year Member

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    I have been practicing the same subspecialty as an attending for about 20 years. I never fail to be challenged by the complexity and challenge of taking care of multiple organ failure in critically ill infants. This complexity has increased, not decreased over time, as new therapies become more available (e.g inhaled nitric oxide). Although, we have guidelines for practice based on the evidence and on the importance of consistency across physician care-givers, management of such patients is, in my view, not cookbook in any way.

    There is a huge difference between what I would consider "cookbook" medicine and the actual care decisions needed to get a small infant through a critical illness. Others are welcome to disagree with that assesment, but I recommend caring for a few of these babies before making that judgment. I expect this is true for adults and other disease processes as well, but I wanted to limit my comments to my personal experience.

    Never am I told by administrators, pharmacists, social workers or nurses what medicines to give or how to provide care as long as I am not making a mistake (e.g. dosing error) that they should let me know about or attempting to provide care that is outside the bounds of what the hospital I am working in is capable of providing.

    There is no check off box for "septic shock in 800 g infant" or "pulmonary hypertension with congenital diaphragmatic hernia." Rather, I must, using basic guidelines and my knowledge and experience, decide when and for how long to offer a large range of therapies, each with risks and benefits as well as interactions.

    There are some conditions, for example, non-hemolytic early feeding jaundice, that are fairly "rote" and the management of which requires relatively little "wisdom." I don't mind such patients as it is rewarding to do simple things that help patients and their families. Failure to provide appropriate therapy, in this case, phototherapy, can lead to a lifetime of disability. I have no problem with spending some of my time preventing that while teaching future pediatricians about this condition and its causes and management.

    It is fine to challenge premeds and others with the negative side of medicine, but I love what I do and do not find it intellectually unchallenging.
    Hopefully, this perspective has a place here as well.
     
  21. nontrdgsbuiucmd

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    Thanks for posting!

    One aspect that I very much appreciate, being a late bloomer in entering medicine, is having plenty of experience being well paid to do simple tasks as well as handling very interesting projects - I've never experienced or worked alongside others in a job that was enjoyable always; each position involved "good" projects and less interesting work, good managers and boorish ones; bright people and individuals who shot down ideas because they could not understand them.

    In my many years working in the public sector, private sector, large firm, and small firm environments this was a constant - there was always plenty of work that involved crossing t's and similar tasks that seemed to be low-value added, but that still needed to be done. Is it surprising medicine has this too?

    And some of the hardest working people I've known were making 35K or so a year - take out taxes (social security + medicare is due regardless of earnings level) and that may be 32K? 105K takehome may seem low, it would not be low to many workers even after taking out another 15K a year for student loans.

    Regardless of financial aspects, I'm largely attracted to the aspects of medicine that will cause it to continue to be an intellectually stimulating field going forward. It's great to hear from someone who's had this experience over their medical career!
     
  22. dragonfly99

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    I agree that a lot of medicine is still not "cookbook". I agree with that. I think the NICU is an extreme example of medicine that is NOT cookbook...there just isn't research (at least not research involving large numbers of patients) that covers what they do, or tells NICU docs exactly what to do with all the various tenuous situtations those patients can get into. However, I agree somewhat with the above post that there has been, and likely will be more, encroachment by nonphysicians into decision making in certain specialties. Emergency medicine is probably one of the worst ones, but in cardiology it has also become a big factor. The hospital accrediting body JCAHO has made numerous rules about what has to be done with various types of patients, which has led to various "checklists" of things that have to be done with hospitalized patients. Some of this may be for the greater good as it tries to take the lower-achieving docs and hospitals and bring them up to the level of the higher-achieving ones to achieve certain patient care benchmarks. However, there is no doubt in my mind

    And for the people who keep repeating the "105k takehome pay" thing, that is fine and I agree that 105k is a lot of money, but what you need to realize is you won't be getting that money for 7-13 years after you enroll in medical school, and you might never be getting that money. Lots of pediatricians, fp docs, etc. are NOT getting 105k after taxes...they just aren't. If you are a subspecialist then yes you can, most likely.

    I agree with living within ones means and at age 34 have never owned a house, condo, new car or living in an apartment costing >$750/month. Even despite this my 132k med school loans have only gone down to 121k or so after paying them off for 4 years. So you all may find it harder than you are thinking/believing to make those student loans disappear.

    You all need to take into the account the costs of your education and do calculations of how much debt you will be in by the end of medical school (and also the end of residency) in order to understand the financial repercussions and inpact on your future lifestyle. All the 30-something docs I know who are residents/fellows are having to moonlight to supplement their income if they are married and have kids...moonlighting can be run but I wouldn't want to be a position where I felt like I HAD to do it on top of my normal job. I think for you folks with kids and/or married, I hope your spouse is planning to work while you are in school, and probably residency.
     
  23. ozzie20

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    You're absolutely right, 105K is a LOT of money no matter which way you cut it. That wasn't my point however. My point was that you're in the LOWEST end of the HIGHEST tax bracket. Meaning that although you make a lot of money, a LOT of it will leave you in taxes.

    Again, you're right, there are a lot of people making less for more or the same amount of work, coal miners for instance. But you never heard of a college graduate wanting to go into that. We take the higher education in the hopes that you'll have a better life in the future for you and your family.

    What good is the huge salary if you're too old, too tired, work too many hours to spend/enjoy it? It's kind of like a blind man being given a 60" plasma TV with all the bells and whistles, it'd sure be nice if he could use it.
     
  24. error404

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    I've always viewed being a physician as something you do ONLY when nothing else would make you happy.

    If you could be happy as a nurse, or a lawyer, or anything else-- do that instead. Medicine is hard, often unrewarding work with minimal pay compared to the effort. It requires sacrifice, determination and a certain amount of stubbornness. Don't go in expecting respect, either. There are a lot of unhappy docs out there who look enviously at the administration and positions of lower training/debt/responsibility/hours.
     
  25. ozzie20

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    to the person wanting to know about being on the lowest end of the highest tax bracket:
    http://en.wikipedia.org/wiki/Tax_bracket#Tax_brackets_in_the_USA

    ok, so you're not at the SUPER lowest end now, you're at the lowest end of the SECOND highest tax bracket if you're in primary care, but if you go into a higher paying specialty (derm/optho/anesthesia/radiology) you WILL be in the lowest end of the highest tax bracket.

    The problem with the whole tax issue is that being taxed 35% isn't terrible if you're making the money of an NBA player, millions and millions, but if you're a doc pushing 80 hours a week, having so much taken away is not exactly the thing you want to come home to.

    PS this tax bracket thing does not take into account state taxes, which obviously vary.
     
  26. 229141

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    What will happen once Obama takes control? Won't this problem get a lot worse than it already is? (no flaming I'm being serious..)
     
  27. 229141

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    Great point...this is very true in my opinion. I know if I did anything else I would always wonder "what if" I had become a doc. I'm already sacrificing a lot in undergrad to get in and its only going to get worse...but the funny thing is the harder I have to work the more I enjoy it. I have virtually no free time this semester and I've never been happier...I just feel really satisfied and accomplished.
     
  28. FuturaDocta

    FuturaDocta Pop_Princess_MD
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    Great job at putting things in perspective. Some people are blinded by the money, and that is the main reason they want to become a doctor. So, having this post kinda makes those people want to turn around and look for another more-than-enough paying job. Then, there are people, like the one's in this post, that still sincerly want to be doctors. Really what does money really mean in life. Besides, my mom just worked weekends as a nurse making 60 grand a year, and that was more than enough for my family. And, really, if we think about the poorer countries, we could all just be happy that we have fresh water and food on our table. I still think it is a pity that it is sooo hard to get into medical school... Again, great post! :)
     
  29. dragonfly99

    10+ Year Member

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    do it for love!

    p.s. love the avatar futuradocta!
     
  30. Carlsbad1919

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    As somebody thinking about the enormous debt achieving my goal will grant me, I was wondering why this issue hasn't been addressed in a more proactive environment. It seems physicians have excellent lobbying groups in the government but students do not. Specialists outnumber primary care physicians so they tend to have a more powerful voice regarding policy. This country's healthcare system is extremely good for those who can afford it and nonexistent for many who cannot. I have many college-educated friends with catastrophic-only or no health insurance. I have graduate-student health insurance that is so awful I cannot even come close to affording the physical therapy recommended to me. The entire culture of charging physicians ridiculous amounts of money for their education because of an income they will not receive for ten years is preposterous. In Israel (only example I know well although I would like to know more) they have socialized medicine so physicians have a definite salary cap. Their medical school education averages around $2500 A YEAR. As somebody who would like to become a physician I believe everyone deserves healthcare and everyone should pay what they can afford. What many in healthcare do not seem to realize is that (1) the most expensive population by far to care for is already covered by the US government via Medicare (and Medicaid for much of the nursing home care) (2) Taxing everyone for healthcare means that those who choose not to get health insurance and rather spend their money on say a new pair of earrings will be forced to contribute to the cost of care rather than allowing them to pay nothing and file for bankruptcy when they cannot pay for a surgery or car accident or delivery (3) The largest number of uninsured are the cheapest to insure - those just out of college without long-term employment or many just after their parent's coverage ends. I would be perfectly happy to receive a smaller salary IF that means I receive an incredibly smaller tuition in return. Any other ideas, perhaps a way to change the system that is obviously not working?
     
  31. FuturaDocta

    FuturaDocta Pop_Princess_MD
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    [​IMG]

    Thanx! :D
     
  32. FuturaDocta

    FuturaDocta Pop_Princess_MD
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    [​IMG]

    Seriously, they need to tune down the tuition rates. They increase a bazzizle every freakin' year. I heard that the average debt of a med student is around 100g. Great. So looking forward to that. At the same time, people need more and more doctors. We need more teachers in medicine...
     
  33. dragonfly99

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    100k is a large underestimate.
    There are statistics published about this every year.
    I graduated in 2004...the average debt for graduating medical students that year was $120k or $125k or something. I know that a couple of years ago it was $140k. I don't know what it is now, but you should really check and educate yourselves so that you can have a realistic estimate for yourselves...
     

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