Free Medical School!

[LucidSplash]

If you forgo a stipend in "specialty" residency training.

http://www.nytimes.com/2011/05/29/opinion/29bach.html

Discuss. I'm going on record as calling these guys idiots - I'm not sure what they expect me to do to pay rent, buy groceries, etc during the privilege of training in a "non-primary care" field if they take away all or even "most" of my lavish stipend, and I'm single without kids. Guess we'll all need to forgo families and life and move back into the hospital as true residents again.

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[Pir8DeacDoc]

The article seems to indicate that loans could be taken out for living expense, etc while in speciality training. The article fails to fully grasp that the reasons to avoid primary care are multiple, and money is only one of the issues. If I had no debt from med school I still wouldn't have chosen to be a family doctor (and I went to a VERY primary care oriented school).

 

[Winged Scapula]

Exactly.

I didn't avoid PC because of debt, I avoided it because I didn't like it and it wasn't where my talents lied.

Of course, the medical students on FB are all over this "great" idea. I say they've got it backwards. Incentivize people to go into PC with loan payment programs.

 

[Amy]

Exactly.

I didn't avoid PC because of debt, I avoided it because I didn't like it and it wasn't where my talents lied.

Of course, the medical students on FB are all over this "great" idea. I say they've got it backwards. Incentivize people to go into PC with loan payment programs.

Ditto.

I think if I had to take out loans during residency to pay for my living expenses, I'd be worse off than "just" paying for med school.

 

[filter07]

x

 

[ESU_MD]

You cant get something for nothing.

 

[LucidSplash]

Ditto.

I think if I had to take out loans during residency to pay for my living expenses, I'd be worse off than "just" paying for med school.

Agreed. I think the authors entire plan is to make it financially difficult to go into anything BUT primary care, which they believe will shunt more people to primary care which will have the ripple effect of fixing every problem in American medical care. It also has the effect of culturally devaluing the importance of "specialists" in care. I hope anyone who favors this plan never needs an appendectomy, cholecystectomy, heart cath, never perfs an ulcer, never has a stroke, gets a solid or viscous organ cancer, has a vascular complication of diabetes... etc.

 

[Maybeknot]

Surprise. Both authors of this ridiculous proposal are internists.

 

[filter07]

I did some math here. I take NYT math of 50k a year for residency salary. I also take 155k loans. I assume 6% capitalized interest on debt and 6% capitalized earnings on investments. I assume cost of living fixed at 50k (everyone is equally miserly) and no inflation for sake of simplicity.

For PCP I assume 3 years of training, a salary thereafter of 150K - 50K cost of living = 100K plus 6% compounded annually
For fellowship trained GS, I assume 7 years of training, a salary thereafter of 300K - 50K cost of living = 250K plus 6% compounded annually

Results:

Surgery before and after: We start losing money at PGY4 year, and worsen each year due to compounded interest/gains.
PCP before and after: PCP start out ahead obviously under the new plan, and continue adding to advantage with compounded gains.

Surgery vs PCP before: we start having greater assets at PGY11 year
Surgery vs PCP after: we start having greater assets at PGY15 year

tl;dr: Internists want to take ~800k from surgeons and give it to PCP, over a 30 year period after medical school*

*assumes salaries (or proportional differences) for specialists and PCP remain the same, which is unlikely. Most likely scenario is that specialists will be paid much less, PCP maybe more... result: differences will be even more substantial.

The carrot is free tuition, the stick is lower income; at least in every other country where medical school is free. Any scheme where medical school tuition is paid for will be accompanied or followed by reimbursement decline. It's the backdoor to cost control and greater socialization of medicine.

 

[filter07]

For S&G, here is what it would look like for a surgical specialist vs medicine specialist making the exact same salary, but with their IM years being paid for.

 

[filter07]

Noticed NYT says specialists earn 325K, PCP earns 190K. Re-did the math with those assumptions. Looks even worse for surgeons but overall pretty similar to original analysis.

 

[Chirurgia magna]

Discuss. I'm going on record as calling these guys idiots - I'm not sure what they expect me to do to pay rent, buy groceries, etc during the privilege of training in a "non-primary care" field if they take away all or even "most" of my lavish stipend, and I'm single without kids. Guess we'll all need to forgo families and life and move back into the hospital as true residents again.

Idiots, is the correct term in this case.

We can't attract residents to save our lives because our specialty blows and we don't make any decent money so let's FORCE more students to join us instead of making our profession more appealing. The last thing we need is a bunch of primary care physicians with the attitude of postal workers hating their life and committing shooting sprees.

Toward the end of primary care in med school, I was close to stabbing myself in the eye with an HIV infected #11 blade, just so that I could get out of clinicals. If I was forced into that field I would fly across the country to San Fran just so that I could jump off the Golden Gate bridge while setting myself on fire with a block of concrete tied to my legs and a plastic bag over my face.

 

[Chirurgia magna]

The thing about salary is also misleading. My friend and I were talking about this. He is a hospitalist. He did a three year residency and works 7 - 12 hour shifts a week with a week off. His salary is like $180K. So he works 84 hours in a 2 week period which is 42 hours/week at a salary of $180K. Surgeons work more than double the hours at $350.

 

[Doctor Bagel]

What about specialists and subspecialists who don't make more (or at least much more) money? Psychiatrists, neurologists, rheumatologists, endocrinologists, ID docs .... It's not like the world is divided between primary care docs who are struggling and specialists who are pulling in tons of money. And how available would loans for specialty training be? As it is, we can get pretty good terms on guaranteed loans from the federal government. Would the same system transfer over to loans for resident physicians who don't get a salary. If not, that would make the penalty for not doing primary care even more steep.

And getting back to it, as some of you have mentioned, I bet a lot of us did not pick our specialties based largely on future income.

 

[covegirl15]

And how available would loans for specialty training be? As it is, we can get pretty good terms on guaranteed loans from the federal government. Would the same system transfer over to loans for resident physicians who don't get a salary. If not, that would make the penalty for not doing primary care even more steep.

I think that is where the people who wrote this article really failed. Let's see a bank give a loan to someone for "living expenses". I suppose we could use our souls for collateral.

Maybe it's just a eugenics experiment encouraging those who want to be specialists to seek out mates with high paying jobs to support them through their extended residencies.

 

[Pir8DeacDoc]

I was contemplating this more this AM. If the roles were reversed and I would make $180-200 for being an ENT and could make $300-400 for being a family doctor, I still wouldn't do it. I enjoy the work I do. I like operating on patients, seeing them in clinic, and seeing tangible results of my work. I would scream to think my best outcome would be years and years of medications to prevent an outcome 30 years down the road. Money is one of many, many reasons to choose a speciality. Heaven forbid we choose something that we like. Luckily for me that as it stands now I can get paid well for what I do (so I am told, I'm still a resident)

 

[Substance]

Ha! Idiots!

If family medicine is "free" and specialties require "payment" to enter, then that must mean that specialties are more valuable than family medicine since one must pay to obtain a specialty position.

This further devalues the already devalued-beyond-repair field of family medicine.

I would bet that with a move like this, even LESS people would go into family medicine.

 

[Ronin2258]

I didn't avoid PC because of debt, I avoided it because I didn't like it and it wasn't where my talents lied.

Did GP/PC for a few months. If I didn't see the light at the end of the tunnel with breaking into my desired specialty, I think I would have had a serious problem *not* opening a major artery, running in front of a bus, or playing hopscotch in a minefield. Those would be preferable than more than a year or two doing PC. My talents are definitely not in primary care.

I have respect for PC, but I don't want to be one of them. To be forced into the field would be an easy way to lose even more physicians, as once they are done with residency, they will bolt somewhere, probably out of medicine. No one who was forced into the field would want to stay. So, there is 4 years of school, 3 years of residency wasted, wasting more money because they aren't staying in PC.

Surprise. Both authors of this ridiculous proposal are internists.

This was written by internists?
...

Sorry, I am not going to comment. It would probably violate TOS and honk of more people in the process.

 

[MossPoh]

I'm going to graduate medical school with very little debt relative to the average graduate. I still am not that interested in primary care. I have no doubt that debt does change people's minds...if they are on the fence with what specialty to go. If one enjoys family medicine only slightly more than anesthesia, yet they are $300,000 in debt and don't want to move to the country, then why not go to the field that makes more with only a small decrease in satisfaction?

There are a few things that need to be done to really sway people into primary care. The first is to offer better incentives obviously. The second thing is really on a systemic and attitudes level. Choosing primary care can't be viewed as a failure or a "waste of talent". I have heard from far too many people that they were told they'd waste their talents by going into primary care. Oftentimes, people do not realize how much influence words like that have. It is easy to say they shouldn't listen to that and to do what is right for them, but it plants the seed. Med students and premeds have to get off this fixation that the difference between a good medical school and a bad medical school is how many people matched derm/plastics/rad onc, etc. versus family med, psych and peds.

I feel that many med students discount primary care before even giving it a chance. They go into rotations beleiving it is going to be boring and painful, so that is what they see first. If they do feel that they want to jam that scalpel in their eye by the end of rotation, then yea...probably not for them.