Here's the reason med students are drowning in debt

[Med Ed]

---

Members don't see this ad.

Honestly, I think students could do 80-90% of M1/M2 learning online and at-home. The remaining 10-20% (clinical/PD skills) that they need prior to M3 could be taught in a 2-3 month bootcamp. This bootcamp would run a few thousand dollars and save students a ton of money.

I also think medical schools, especially public one, need to be a whole lot more transparent.

The cost structure is such that cutting out two years of medical school would simply make the remaining two (almost) twice as expensive.

The system you are proposing would greatly favor children of affluence, who likely already have enough advantages in this process.

 

[Ho0v-man]

I think there is value in the first two years. But that value is not so much the education provided, so much as the pressure to learn it all in such a small time frame. Without med school breathing down my neck I never could have synthesized the info at that pace. It never would have even occurred to me to do so. I begrudgingly admit I needed that insanely stupid high pressure curriculum to do what I did.

While BnB and Pathoma etc are indeed wonderful, I truly think their greatest utility is as a second pass to see the info from a different perspective. While I love these guys, it’s just not true to say that they were superior to every lecture I got from my school.

So my school definitely had value in the first two years. Just not at that price.

Personally, I think we shouldnt do labs (save anatomy),small groups or clinical skills for 1.5 years. Just straight study then take boards. Then spend a semester getting ready for wards and take CS/PE. Then move onto third year.

 

[Angus Avagadro]

I don't think anyone is railing about fairness.
People are railing about wasteful money spent on first 2 years when they can be studying on their own. I don't want access to the med school library or the huge auditoriums or other wasteful resources when I can study from my home or the community library from boards and beyond and pathoma.
Unfortunately we are still stuck in this notion of huge traditional college spaces which worked 20 yrs ago when there was no access to internet.
I don't think anyone many people would be opposed to be paying 100k for the last 2 yrs when we get access to the wards.
Just because something is one way right now doesn't mean it has to stay this way for eternity.
I am sure this post will have some faculty members come up with the argument "who asked you to come to med school" but that's okay.

I disagree , it sounds like you are complaining about how much you spend for pre clinical years when you could study on your own. Since the current system is the only game in town, only you can decide if the cost is worth it to you. Everything has a price. Are you willing to pay the price is the question. Sure you can spend time trying to change the system, or be a doctor, or be something else. Life is full of choices. Make good ones.

 

[BorderlineQueen]

I disagree , it sounds like you are complaining about how much you spend for pre clinical years when you could study on your own. Since the current system is the only game in town, only you can decide if the cost is worth it to you. Everything has a price. Are you willing to pay the price is the question. Sure you can spend time trying to change the system, or be a doctor, or be something else. Life is full of choices. Make good ones.

Why can’t you change the system and be a doctor? Yes we’ve had the same system for a while and obviously it’s not efficient. So we need to fix it so medical education is better. I've seen posts here on SDN apparently the clinical education and medical skills are a joke. I was a scribe at an academic institution. The ER docs would frequently complain that interns had no clue to do an HPI. Obliviously if an intern can't do a proper HPI their schooling has failed them. Which is why we need to change the system.

 

[VA Hopeful Dr]

Why can’t you change the system and be a doctor? Yes we’ve had the same system for a while and obviously it’s not efficient. So we need to fix it so medical education is better. I've seen posts here on SDN apparently the clinical education and medical skills are a joke. I was a scribe at an academic institution. The ER docs would frequently complain that interns had no clue to do an HPI. Obliviously if an intern can't do a proper HPI their schooling has failed them. Which is why we need to change the system.

Except plenty of interns can do a decent HPI, so maybe the schooling isn't the problem.

Heck I've had 3rd year students who could do a pretty decent one.

 

[BorderlineQueen]

Except plenty of interns can do a decent HPI, so maybe the schooling isn't the problem.

Heck I've had 3rd year students who could do a pretty decent one.

That’s not even the whole point of my post. Don’t you agree medical education needs to be reformed and cost less? There’s going to be a day when the cost of med school is going to outweigh the salary. That’s going to be a sad day. We badly need doctors in rural cities and in certain specialties. Midlevels will never be on par with treating complex pts. But if we don’t have enough doctors they will have to “fill” in.

 

[VA Hopeful Dr]

That’s not even the whole point of my post. Don’t you agree medical education needs to be reformed and cost less? There’s going to be a day when the cost of med school is going to outweigh the salary. That’s going to be a sad day. We badly need doctors in rural cities and in certain specialties. Midlevels will never be on par with treating complex pts. But if we don’t have enough doctors they will have to “fill” in.

Reformed? I mean I won't say a hard no, but we still produce fine doctors. If it ain't broke...

Price? That's absolutely a problem. I graduated in 2010. My instate school's tuition is now per semester what I paid per year. I sincerely doubt the education is twice as good now compared to then.

 

[Med Ed]

Price? That's absolutely a problem. I graduated in 2010. My instate school's tuition is now per semester what I paid per year. I sincerely doubt the education is twice as good now compared to then.

The most common reason for this is a reduction of state support to the institution. When tax dollars recede something has to take their place, and unfortunately it's usually tuition.

 

[VA Hopeful Dr]

The most common reason for this is a reduction of state support to the institution. When tax dollars recede something has to take their place, and unfortunately it's usually tuition.

Yep, but by 2010 the economy was recovering and there weren't any additional cuts to higher ed in my state. So the increase from 2008-2010 made sense in that regard (same in 2000-2002).

 

[Franzd'Epinay]

Why can’t you change the system and be a doctor? Yes we’ve had the same system for a while and obviously it’s not efficient. So we need to fix it so medical education is better. I've seen posts here on SDN apparently the clinical education and medical skills are a joke. I was a scribe at an academic institution. The ER docs would frequently complain that interns had no clue to do an HPI. Obliviously if an intern can't do a proper HPI their schooling has failed them. Which is why we need to change the system.

I was a scribe at an academic institution. The ER docs would frequently complain that interns had no clue to do an HPI.

I was a scribe at an academic institution.

Is this the world's worst Appeal to Authority?

 

[BorderlineQueen]

Is this the world's worst Appeal to Authority?

Yep you got me.

 

[RNthenDoc]

Anybody want to report from the NRMP conference on this topic? 🙂

 

[goatmed]

If LCME requirements of more small groups and SP use are the culprit for the skyrocketing of tuition prices in recent decades, is there empirical evidence that they have resulted in better physicians (less medical error, more collaborative environment, better patient care metrics, etc?) By now multiple batches of doctors educated with these innovations and saddled in corresponding debt should be residents and attendings. And, is there a comparison in the cost of these developments and physician quality metrics between the US and other developed countries?
I've been unable to find either and I realize they're both incomplete answers to the underlying and morally loaded question of how cost-effective this reform has been. But it seems to me at least a valid question since that debt is what eventually justifies our higher salaries (and perhaps with good merit) and it ends up going to either the patient/inaurance holder and/or the taxpayer. One wonders if they think a (possibly) small decrease in error would be worth that money to the patients who end up paying it.

A while ago I read this article ( How Government Regulations Made Healthcare So Expensive | Mike Holly ) from Mises while arguing about medical licensing laws with a very libertarian friend, and after I was able to contain my involuntary eye-rolling I started wondering whether its argument about how limiting the number of physicians increased medical error by overworking those who can become doctors holds some water, even if indirectly.
Is devoting so many resources to individual students who will be overworked residents and attendings really higher yield than devoting funds to more physicians?

 

[ace_inhibitor111]

If LCME requirements of more small groups and SP use are the culprit for the skyrocketing of tuition prices in recent decades, is there empirical evidence that they have resulted in better physicians (less medical error, more collaborative environment, better patient care metrics, etc?) By now multiple batches of doctors educated with these innovations and saddled in corresponding debt should be residents and attendings. And, is there a comparison in the cost of these developments and physician quality metrics between the US and other developed countries?
I've been unable to find either and I realize they're both incomplete answers to the underlying and morally loaded question of how cost-effective this reform has been. But it seems to me at least a valid question since that debt is what eventually justifies our higher salaries (and perhaps with good merit) and it ends up going to either the patient/inaurance holder and/or the taxpayer. One wonders if they think a (possibly) small decrease in error would be worth that money to the patients who end up paying it.

A while ago I read this article ( How Government Regulations Made Healthcare So Expensive | Mike Holly ) from Mises while arguing about medical licensing laws with a very libertarian friend, and after I was able to contain my involuntary eye-rolling I started wondering whether its argument about how limiting the number of physicians increased medical error by overworking those who can become doctors holds some water, even if indirectly.
Is devoting so many resources to individual students who will be overworked residents and attendings really higher yield than devoting funds to more physicians?

Yes. The reason that residents are “overworked” is so they get enough experience and training to actually use it confidently in practice without killing someone. Attending a lifestyles are relatively cushy in comparison. Increasing the amount of physicians does absolutely nothing except reduce the training quality of residents. This is already a meme over at Emergency Medicine where so many low quality residencies in low acuity EDs have emerged. Imagine if instead of 20 AAAs a year for vascular surgeons, they each did only 5? I definitely would have much less confidence in their abilities if that were the case

 

[goatmed]

Yes. The reason that residents are “overworked” is so they get enough experience and training to actually use it confidently in practice without killing someone. Attending a lifestyles are relatively cushy in comparison. Increasing the amount of physicians does absolutely nothing except reduce the training quality of residents. This is already a meme over at Emergency Medicine where so many low quality residencies in low acuity EDs have emerged. Imagine if instead of 20 AAAs a year for vascular surgeons, they each did only 5? I definitely would have much less confidence in their abilities if that were the case

So is there no way you can think of we can train residents well without working up to 80 hours a week? I defer to you and other people with experience on this one, but I imagine there's some benefit in limiting working hours to some extent if the ACGME decided to cap them at 80/week.

 

[Obnoxious Dad]

If LCME requirements of more small groups and SP use are the culprit for the skyrocketing of tuition prices in recent decades, is there empirical evidence that they have resulted in better physicians (less medical error, more collaborative environment, better patient care metrics, etc?) By now multiple batches of doctors educated with these innovations and saddled in corresponding debt should be residents and attendings. And, is there a comparison in the cost of these developments and physician quality metrics between the US and other developed countries?
I've been unable to find either and I realize they're both incomplete answers to the underlying and morally loaded question of how cost-effective this reform has been. But it seems to me at least a valid question since that debt is what eventually justifies our higher salaries (and perhaps with good merit) and it ends up going to either the patient/inaurance holder and/or the taxpayer. One wonders if they think a (possibly) small decrease in error would be worth that money to the patients who end up paying it.

A while ago I read this article ( How Government Regulations Made Healthcare So Expensive | Mike Holly ) from Mises while arguing about medical licensing laws with a very libertarian friend, and after I was able to contain my involuntary eye-rolling I started wondering whether its argument about how limiting the number of physicians increased medical error by overworking those who can become doctors holds some water, even if indirectly.
Is devoting so many resources to individual students who will be overworked residents and attendings really higher yield than devoting funds to more physicians?

OK, I will jump back in. You haven't found any empirical justification for this small group business because these types of policies have never been empirically justified in any of the health care professions. In every case it's a matter of people being deputized by the states to police their own profession and it's the people who are being regulated who benefit rather than the public. This is what economists and lawyers call "regulatory capture".

The mass execution of hospital based nursing diploma programs, the extension of average training time for pharmacists to eight years, the 3 year DNP for nurse anesthetists, the DPT for physical therapists are all examples of the leaders of these professions doing their best to make training as long, expensive, exclusive and aggravating as possible. Why do they do this? They do it to create empires, create artificial shortages and drive up salaries. Patients don't benefit. They suffer.

 

[ace_inhibitor111]

So is there no way you can think of we can train residents well without working up to 80 hours a week? I defer to you and other people with experience on this one, but I imagine there's some benefit in limiting working hours to some extent if the ACGME decided to cap them at 80/week.

Yup, you can have extremely long residencies like in the U.K. where primary care is like 6 years and more for specialist care. If you ask me, I’d MUCH rather have the American system as hard as it is. It’s not like all residencies have you work 80 hours. it is really their choice if they want to do something like Vascular surgery 80 hour weeks or an easier 50 hr residency like fam med.

 

[nimbus]

Yes. The reason that residents are “overworked” is so they get enough experience and training to actually use it confidently in practice without killing someone. Attending a lifestyles are relatively cushy in comparison. Increasing the amount of physicians does absolutely nothing except reduce the training quality of residents. This is already a meme over at Emergency Medicine where so many low quality residencies in low acuity EDs have emerged. Imagine if instead of 20 AAAs a year for vascular surgeons, they each did only 5? I definitely would have much less confidence in their abilities if that were the case

If you’re talking about open AAAs, most don’t even do 5 nowadays.

 

[goatmed]

Yup, you can have extremely long residencies like in the U.K. where primary care is like 6 years and more for specialist care. If you ask me, I’d MUCH rather have the American system as hard as it is. It’s not like all residencies have you work 80 hours. it is really their choice if they want to do something like Vascular surgery 80 hour weeks or an easier 50 hr residency like fam med.

I see your point about desirability, especially in America since we put 4 years of undergrate on top of our medical education.

But does it translate to an equivalent number/rate of medical errors if you're doing more hours per week?

I mentioned that last part of my first post (what you're replying to) in the context of one of the arguments in the article I linked, which somewhat goes like this: Since the 60s/70s, the demand for medical care has been steadily increasing, while the supply hasn't been able to catch up with that demand resulting in more strenuous work for physicians and therefore more medical error (the article's claim is that this is because of the AMA's draconian lobby to control and restrain medical education for profit, but I'm putting it in the context of this thread with the rising cost of medical education to the student and donor and taxpayer limiting how many students we can educate).

I can't falsify the argument that error is at least in part the result of a supply/demand mismatch and it sounds somewhat logical, and if so in the interest of reducing it lengthening the time of residencies may still be a reasonable goal despite its inconvenience to us. Does that hold any water in your opinion?

 

[ace_inhibitor111]

I see your point about desirability, especially in America since we put 4 years of undergrate on top of our medical education.

But does it translate to an equivalent number/rate of medical errors if you're doing more hours per week?

I mentioned that last part of my first post (what you're replying to) in the context of one of the arguments in the article I linked, which somewhat goes like this: Since the 60s/70s, the demand for medical care has been steadily increasing, while the supply hasn't been able to catch up with that demand resulting in more strenuous work for physicians and therefore more medical error (the article's claim is that this is because of the AMA's draconian lobby to control and restrain medical education for profit, but I'm putting it in the context of this thread with the rising cost of medical education to the student and donor and taxpayer limiting how many students we can educate).

I can't falsify the argument that error is at least in part the result of a supply/demand mismatch and it sounds somewhat logical, and if so in the interest of reducing it lengthening the time of residencies may still be a reasonable goal despite its inconvenience to us. Does that hold any water in your opinion?

Any critical thing the resident does has to be reviewed by the attending anyway. So while residents may be more prone to errors in the few specialties working 80+ hours (surgical), these are caught or corrected by the attending in charge. Once again, as an attending the hours are much more forgiving than it is in residency so I doubt that plays a role in number of errors.

Making residency longer is not worth it because age also increases number of errors after a certain point. Honestly, the way American healthcare is practiced right now is actually pretty good. The main problem is with preventative health, and that has more to do with American “culture” in my opinion than the number of physicians.

 

[Feelgood MD]

Thats the point. You dont have to go to med school. You could apply to lecom if you are competitive for OOS state schools.
The costs are not hidden , and are fairly clear from day one. As you mentioned you could not apply to OOS schools and strengthen your app to reapply to state schools.
It is a choice at the end of the day.

This was exactly what I did and I am glad I did it.

 

[Obnoxious Dad]

This was exactly what I did and I am glad I did it.

You are one smart doctor. There may have been little hassles associated with attending LECOM, but you will be out of the debt hole faster than your colleagues.

 

[Med Ed]

This is my last post on this thread.

You are one smart doctor. There may have been little hassles associated with attending LECOM, but you will be out of the debt hole faster than your colleagues.

Never declare your last post.

 

[goatmed]

Never declare your last post.

I hate to do thread necromancy, but I've been giving this topic a lot of pillow time thought during the week.

You seem like a guy who's familiar with all the LCME mandated TBL curricula and administrative personnel which, unless I'm mischaracterizing your earlier posts, are one of the primary drivers of the cost of education today vs when you or your older colleagues were studying medicine.
In your anecdotal view, are these really making better doctor "batches"? In other words, do you think because of these changes people graduating with an MD today are better equiped to practice medicine than they were back in the 80s and 90s (putting new health tech and pharmaceuticals aside)?

 

[libertyyne]

I hate to do thread necromancy, but I've been giving this topic a lot of pillow time thought during the week.

You seem like a guy who's familiar with all the LCME mandated TBL curricula and administrative personnel which, unless I'm mischaracterizing your earlier posts, are one of the primary drivers of the cost of education today vs when you or your older colleagues were studying medicine.
In your anecdotal view, are these really making better doctor "batches"? In other words, do you think because of these changes people graduating with an MD today are better equiped to practice medicine than they were back in the 80s and 90s (putting new health tech and pharmaceuticals aside)?

I do not think that adminstrative or lcme guidelines are the only forces making medical school more expensive.

Our college education system much like our healthcare system is broken.

 

[Med Ed]

I hate to do thread necromancy, but I've been giving this topic a lot of pillow time thought during the week.

You seem like a guy who's familiar with all the LCME mandated TBL curricula and administrative personnel which, unless I'm mischaracterizing your earlier posts, are one of the primary drivers of the cost of education today vs when you or your older colleagues were studying medicine.
In your anecdotal view, are these really making better doctor "batches"? In other words, do you think because of these changes people graduating with an MD today are better equiped to practice medicine than they were back in the 80s and 90s (putting new health tech and pharmaceuticals aside)?

Interesting question, and one that I have also been pondering as curricula continue to evolve further away from the one I experienced. My anecdotal opinion is that students now have better opportunities to become cognitively equipped to practice medicine. Relatively few of them, however, actually maximize these opportunities, and the remainder have arguably gotten worse than their predecessors. Most of us blame this on Step 1, and note that even 5-10 years ago medical students seemed to have somewhat different learning priorities than they do now.

With regard to clinical skills, students now have much better preparation for third year than in decades past, but this has been offset by more variable clinical education. Simply put, the number of medical students in the country has expanded much faster than the capacity of teaching hospitals to accommodate them. I suspect due to overcrowding and liability concerns, skills that would have been learned in medical school in the 1980's are now getting learned in internship or residency. [insert image of old man shaking cane]

The cost drivers are multifactorial. Accreditation certainly contributes, as does technology, administration, small group teaching, etc. With regard to tuition, up to the 90's most every medical school in the country was heavily subsidized by clinical revenue and/or public funding. This helped keep tuition much lower than it is now. Since then students have been hit with a triple whammy: increased costs, declining public support, and tightening of clinical revenue as reimbursement changed and RVU's became king. This latter element has also contributed to the erosion of clinical teaching time (see above).

 

[nimbus]

I do not think that adminstrative or lcme guidelines are the only forces making medical school more expensive.
View attachment 283949
Our college education system much like our healthcare system is broken.

It’s just like the real estate bubble. Easy financing terms====>higher prices. It’s crazy that a 22yo can borrow 400k with a school admission, a signature, and no credit testing.

 

[Chibucks15]

It’s just like the real estate bubble. Easy financing terms====>higher prices. It’s crazy that a 22yo can borrow 400k with a school admission, a signature, and no credit testing.

Exactly. The bubble is gonna burst and it’s gonna blow up hardcore. Worse than the housing probably. It’s a timebomb

 

[RNthenDoc]

Lenders know the vast majority of medical students will be able to pay their loans back.

The outcome of the next election could drastically alter a physician’s compensation, though, and while I’m sure educational costs would eventually decrease to compensate, I worry that there will be a donut of students with huge debt loans who see their salaries deflated with the oncoming single-payer slashes.

 

[Med Ed]

It’s just like the real estate bubble. Easy financing terms====>higher prices.

The real estate bubble was fare more than "easy financing terms." The 2000 Commodity Futures Modernization Act allowed for the creation of the credit default swap market, which provided incentive for mortgage brokers to do something generally considered unwise: loan money to people who had no realistic ability to repay.

It’s crazy that a 22yo can borrow 400k with a school admission, a signature, and no credit testing.

It's not crazy at all. It is well proven that a 22-year-old who can get into medical school has a very high chance of graduating and eventually getting a high paying job. One of the prime reasons that residents have access to zero-down home loans is the fact that physician default rates are much lower than the general population.

 

[Med Ed]

Exactly. The bubble is gonna burst and it’s gonna blow up hardcore. Worse than the housing probably. It’s a timebomb

The total amount owed is around $1.5 trillion, spread among ~45 million borrowers (13.7% of the population). The fiscal year 2020 federal budget deficit stands at around $1.1 trillion.

A trillion here, a trillion there, before long you're talking about real money.

 

[nimbus]

The real estate bubble was fare more than "easy financing terms." The 2000 Commodity Futures Modernization Act allowed for the creation of the credit default swap market, which provided incentive for mortgage brokers to do something generally considered unwise: loan money to people who had no realistic ability to repay.



It's not crazy at all. It is well proven that a 22-year-old who can get into medical school has a very high chance of graduating and eventually getting a high paying job. One of the prime reasons that residents have access to zero-down home loans is the fact that physician default rates are much lower than the general population.

I’d argue that 400k is still crazy for US medical grads and really crazy for off-shore medical schools, chiropractic schools, vet schools,etc. The kids are hosed for at least a decade if not more.

 

[Med Ed]

I’d argue that 400k is still crazy for US medical grads and really crazy for off-shore medical schools, chiropractic schools, vet schools,etc. The kids are hosed for at least a decade if not more.

Witness the power of lobbying and income-based repayment plans.

 

[BorderlineQueen]

The real estate bubble was fare more than "easy financing terms." The 2000 Commodity Futures Modernization Act allowed for the creation of the credit default swap market, which provided incentive for mortgage brokers to do something generally considered unwise: loan money to people who had no realistic ability to repay.



It's not crazy at all. It is well proven that a 22-year-old who can get into medical school has a very high chance of graduating and eventually getting a high paying job. One of the prime reasons that residents have access to zero-down home loans is the fact that physician default rates are much lower than the general population.

That’s a good argument but a Caribbean med student can take out loans and most of them wont become practicing physicians. Match rates are 40-54% at some of these schools and don’t forget the weeding out that takes place in the first two years.

 

[Medic741]

Did you learn clinical skills during the first two years? Or do anything in small group?

The clinical skills ‘education’ I received was taught by 2nd year medical students supervised by a PA who stood in the corner and watched non-experts with no clinical experience teach clinical skills.

Small groups were similarly not well leveraged to be useful.

 

[Cornfed101]

The total amount owed is around $1.5 trillion, spread among ~45 million borrowers (13.7% of the population). The fiscal year 2020 federal budget deficit stands at around $1.1 trillion.

A trillion here, a trillion there, before long you're talking about real money.

Is there really any consequence of the federal budget deficit? It's not like another country is going to send collections agents after the fed. If my life doesn't change at a trillion-dollar deficit, is it really going to change at 100 trillion?

 

[electropartyogram]

Is there really any consequence of the federal budget deficit? It's not like another country is going to send collections agents after the fed. If my life doesn't change at a trillion-dollar deficit, is it really going to change at 100 trillion?

Larger deficits lead to an increased inflation rate. A deficit is good to some extent, but it needs to be reasonably sized, relative to the economy. Too large of a deficit, then inflation outpace the growth of the economy, leading to poor dollar value. And the solution is not just printing money.

The U.S. has debt with many countries, but countries want to own our debt, because we can back it up. Essentially, if the U.S. goes through inflation, our money has less value, thus other countries will try to unload our debt, but they will be stuck with it, and it would be harder for us to pay it back. Bad cycle that will eventually damage the world economy and allow other countries to step up and fill that void. Bad for the U.S. if we let that happen, which is why we need to have stronger fiscal policy compared to countries like Greece, Venezuela. We are significantly larger and will cause more damage worldwide.

 

[Feelgood MD]

Interesting question, and one that I have also been pondering as curricula continue to evolve further away from the one I experienced. My anecdotal opinion is that students now have better opportunities to become cognitively equipped to practice medicine. Relatively few of them, however, actually maximize these opportunities, and the remainder have arguably gotten worse than their predecessors. Most of us blame this on Step 1, and note that even 5-10 years ago medical students seemed to have somewhat different learning priorities than they do now.

With regard to clinical skills, students now have much better preparation for third year than in decades past, but this has been offset by more variable clinical education. Simply put, the number of medical students in the country has expanded much faster than the capacity of teaching hospitals to accommodate them. I suspect due to overcrowding and liability concerns, skills that would have been learned in medical school in the 1980's are now getting learned in internship or residency. [insert image of old man shaking cane]

The cost drivers are multifactorial. Accreditation certainly contributes, as does technology, administration, small group teaching, etc. With regard to tuition, up to the 90's most every medical school in the country was heavily subsidized by clinical revenue and/or public funding. This helped keep tuition much lower than it is now. Since then students have been hit with a triple whammy: increased costs, declining public support, and tightening of clinical revenue as reimbursement changed and RVU's became king. This latter element has also contributed to the erosion of clinical teaching time (see above).

Funny, I actually watched a video today where this was verbalized precisely.

 

[Med Ed]

The clinical skills ‘education’ I received was taught by 2nd year medical students supervised by a PA who stood in the corner and watched non-experts with no clinical experience teach clinical skills.

Small groups were similarly not well leveraged to be useful.

Not the point of my question.

 

[NecFasc92]

The clinical skills ‘education’ I received was taught by 2nd year medical students supervised by a PA who stood in the corner and watched non-experts with no clinical experience teach clinical skills.

Small groups were similarly not well leveraged to be useful.

Maybe your school just sucks? You should oust your school so pre-meds can be informed. "Supervised" by a non-physician is embarrassing and quite frankly an insult.

 

[Med Ed]

That’s a good argument but a Caribbean med student can take out loans and most of them wont become practicing physicians. Match rates are 40-54% at some of these schools and don’t forget the weeding out that takes place in the first two years.

Of course, but what are the default rates on loans made to students who attend Caribbean medical schools?