Hippocratic oath controversy

[dantt]

So. What do you all think of the new hippocratic oath at University if Minnesota? Unfortunately reinforces the perception, real or imagined, that medical schools are political.

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[WhereMyLiberalsAt]

Students helped in writing this?! The admin rightfully deserve any future struggle session these students decide to put on…

"honor all Indigenous ways of healing that have been historically marginalized by Western medicine"

Yeah… How about we keep the MS1s away from the oath writing next year.

 

[annoyedpsychiatrist]

what are the indigenous ways of healing? Who decides what a culture of anti racism consist of? Ive noticed that its usually old white people who decide what is considered racist and offensive to others, or young white people.

Ill support their oath, if in turn the school takes an oath to lower the cost of attendance significantly, avoid pushing students towards primary care and setting them up for a life of debt to the government. If they actually cared about minorities instead of just wanting to sound cool, perhaps they wouldn't chain their students to debt and indirectly influence the students decision to gravitate towards higher paying fields, so theres more PCPs/pediatricians out there to treat these communities that often need them.

 

[Mr.Smile12]

MS1s have been writing many oaths for almost a decade. Covered in Becoming a Student Doctor. I will also say that in the shadow of George Floyd, I am not really surprised.

 

[Dral]

"honor all Indigenous ways of healing that have been historically marginalized by Western medicine"

Technically indigenous ways of healing in the US were western medicine before western medicine was.

What about far east ways of healing? Those aren't actually indigenous technically. (unless there is some other line in the new oath addressing that).

"Honor all approaches to healing" and leaving the "western medicine" bit out would be a better line imo that would get the point across and be even more inclusive. If they wanted to, it could also be "Honor all cultural approaches and ways of healing".

Oh well, good for them for trying. 👏

 

[percyeye]

I have a feeling this is going to turn into an oath contest where now schools are going to see who can put out the most "progressive" oath out there all the while the public sees this and makes them shy away from medicine even more.

 

[Octagon]

The real problem is that the public/media has no idea just how meaningless these MS1 oaths are. You have like 5 students cobble together a bunch of sentiments that everyone recites at the white coat ceremony and then never think about again for the rest of your life

 

[Future_Bone_Docta]

Students helped in writing this?! The admin rightfully deserve any future struggle session these students decide to put on…

"honor all Indigenous ways of healing that have been historically marginalized by Western medicine"

Yeah… How about we keep the MS1s away from the oath writing next year.

"my grandma once did acupuncture and her ovarian cancer disappeared"

"Oh yeah well I mean and she went to a surgical oncologist for something.... but im pretty sure it was the acupuncture that healed it"

 

[Future_Bone_Docta]

 

[Future_Bone_Docta]

It's not a "new Hippocratic oath," it's just an oath. Schools have been using student-written oaths for quite some time. They are not legally binding. Nobody is forcing you to say it out loud, cross your heart and hope to die at the white coat ceremony or at graduation. They also use other oaths such as the Declaration of Geneva pretty frequently. If you actually read the Hippocratic oath, it's pretty dated and irrelevant to medicine today, and there are certainly aspects of that oath that many folks disagree with...some schools use it anyway. If this is something that bothers you and you attend a school that has a student-written oath, I'd encourage you to join the oath-writing committee to make your voice heard.

Also, honoring indigenous ways of healing does not mean that you are necessarily prescribing them. We can honor and respect our patients' cultural beliefs related to health and healthcare and incorporate them into an evidence-based plan when appropriate. As long as those indigenous ways of healing are not actively harmful from a medical perspective and used in conjunction with modern medicine in a way that is consistent with the patient's goals and values, it can actually be a huge help in terms of spiritual/emotional healing and support for the patient, and help build a trusting, understanding, and therapeutic physician-patient relationship.

I have a patient who had an A1c of 15% when she received her diagnosis of diabetes. She was terrified of starting any new medications because of worries about side effects. She instead wanted to take some concoction of celery juice, turmeric, cinnamon, raw honey, and some other stuff daily and focus on dietary changes. Now to the best of my knowledge this is not necessarily an indigenous/cultural remedy of any sort, but she does have a cultural background that has a historically challenging relationship with the healthcare field that I think makes her more likely to seek alternative methods of managing her care. I said great, lets talk about some dietary changes, you can try your juice thing and see how it goes - and I continued to educate her at every visit about diabetes management and what role medications play. Because I was open to at least working with her on her point of view, she ultimately let me start her on some metformin and a statin, and followed with me consistently for appropriate preventive care and review of her blood sugar logs so we could work on lifestyle changes together. Her A1c today is 6.5% on half of the max dose of metformin and her juice thing. I don't think the juice brought her A1c down by 9%, and frankly probably neither did the metformin...but I do think my being respectful and understanding of what made sense to her - honoring her ways of healing - helped us build a relationship that facilitated the lifestyle changes that probably made the actual difference and keeps her coming back to me for appropriate care.

"used in conjunction with modern medicine"

This is the key.

 

[Future_Bone_Docta]

Correct me if I'm wrong, but I don't think it suggests anywhere in the oath that this would not be the case. As I mentioned in the post you are quoting, honoring =/= prescribing

True, but I would also say there is a difference between "honoring" them and supporting the process of letting snake oil salesmen take advantage of desperate people without medical education.

Unfortunately in profit driven America there are plenty of people doing the latter, and it is a slippery slope.

It is important to keep an open mind to other peoples cultures, I 100% agree. But when you have people taking advantage of OTHER PEOPLES cultures to make $$$, that is another thing entirely.

The notion is that oath was one of naivety.

 

[Future_Bone_Docta]

Yes, I think there IS a difference between honoring cultural practices and letting snake oil salesmen take advantage of desperate people...so I'll ask also where in the oath does it suggest that the students seek to be in cahoots with the snake oil salesmen? I think you are reading WAY more into the oath than is actually there - perhaps emotions are clouding your judgment here since it is so important to you that these folks not be taken advantage of. And interestingly, "taking advantage of other people's cultures to make $$$" is cultural appropriation, which if I had to guess, the group of students who wrote this oath would be opposed to, right? Respectfully, you seem to be arguing against a strawman here.

I will reiterate.

I admit the oath has good intention, I can see that. But it is a slippery slope.

 

[WhereMyLiberalsAt]

Correct me if I'm wrong, but I don't think it suggests anywhere in the oath that this would not be the case. As I mentioned in the post you are quoting, honoring =/= prescribing

"honor all Indigenous ways of healing that have been historically marginalized by Western medicine"

The word “all” means that would be the case… But you know, it’s quite difficult to put an asterisk into an oath.

“Honor all* indigenous ways of healing”

*as long is it’s not a financial burden on the healthcare system, doesn’t conflict with peer-reviewed journals and the patient takes 100% of the blame when undesirable outcomes take place…

See that whole addendum really ruins the flow of the otherwise perfect virtue signaling oath.

I was on the edge of my seat during your entire post! I was honestly expecting the patient to lower their A1c with this magic potion! I was truly invested in the plot development. But alas the patient took metformin and changed their diet… IMDB rating 3/10, would not read again.

But you do highlight the importance of honoring patient autonomy… And every patient has their own culture, so by honoring the patient’s autonomy you are by default honoring whatever produces their decisions (their culture.) However, “honoring our patients autonomy” scores much less in the virtue signaling Olympics.

I’d love to see these students faces when they do their Rural Medicine rotation on the reservation/territory and they spend all day prescribing fluoxetine, metformin, statins…
“Are you sure you don’t want to use some of your culture’s natural remedies, or perform some ancient ritual?! I do want you to know that I took an oath to honor all forms of indigenous medicine and I’m eminently against the gender binary.”
“Um cool…. Nah I’ll just take the Prozac.”

 

[VA Hopeful Dr]

"honor all Indigenous ways of healing that have been historically marginalized by Western medicine"

The word “all” means that would be the case… But you know, it’s quite difficult to put an asterisk into an oath.

“Honor all* indigenous ways of healing”

*as long is it’s not a financial burden on the healthcare system, doesn’t conflict with peer-reviewed journals and the patient takes 100% of the blame when undesirable outcomes take place…

See that whole addendum really ruins the flow of the otherwise perfect virtue signaling oath.

I was on the edge of my seat during your entire post! I was honestly expecting the patient to lower their A1c with this magic potion! I was truly invested in the plot development. But alas the patient took metformin and changed their diet… IMDB rating 3/10, would not read again.

But you do highlight the importance of honoring patient autonomy… And every patient has their own culture, so by honoring the patient’s autonomy you are by default honoring whatever produces their decisions (their culture.) However, “honoring our patients autonomy” scores much less in the virtue signaling Olympics.

I’d love to see these students faces when they do their Rural Medicine rotation on the reservation/territory and they spend all day prescribing fluoxetine, metformin, statins…
“Are you sure you don’t want to use some of your culture’s natural remedies, or perform some ancient ritual?! I do want you to know that I took an oath to honor all forms of indigenous medicine and I’m eminently against the gender binary.”
“Um cool…. Nah I’ll just take the Prozac.”

In fairness, I think rural America does have its own cultural treatments: don't see a doctor for 30 years and then be surprised when the first time you do they diagnose you with 18 chronic diseases.

 

[Neopolymath]

In fairness, I think rural America does have its own cultural treatments: don't see a doctor for 30 years and then be surprised when the first time you do they diagnose you with 18 chronic diseases.

Intern year I had a guy fall out of a deer stand and managed to get hit in the belly with 0.22 misfire. He came in several days after the incident wondering why we thought that was a strange delay. #rural

 

[Future_Bone_Docta]

In fairness, I think rural America does have its own cultural treatments: don't see a doctor for 30 years and then be surprised when the first time you do they diagnose you with 18 chronic diseases.

Don't forget they also will deny metformin with an a1c of 9%. And then you say "okay well you need to lay off the bread and potatoes" and they go "LAY OFF THE POTATOES... ARE YOU JOKING I WOULD RATHER DIE"

Disclaimer- I am from said rural community

Edit: And that was my uncle

 

[Billiam95]

M1s at Minnesota: "This is exactly what we think."

SDN: "No, this is what they actually meant, and, even if they said the other thing, here is why it doesn't matter. Anyway, rural people are worse."

 

[dantt]

M1s at Minnesota: "This is exactly what we think."

SDN: "No, this is what they actually meant, and, even if they said the other thing, here is why it doesn't matter. Anyway, rural people are worse."

Indeed I was hoping to hear from some students as this was the medical student forum in the student doctor network. Maybe they're all on tik tok these days?

 

[Future_Bone_Docta]

Indeed I was hoping to hear from some students as this was the medical student forum in the student doctor network. Maybe they're all on tik tok these days?

The dances don't rehearse themselves

 

[galaxybrain]

I am a student at UMN, albeit a different class year. Similar to what others have said, the oath is written by a handful of first year students (without input from faculty or anyone else), read out at the white coat ceremony, and not given any thought after that.

I can’t give any input about the intention behind the oath this year as I was not involved with the writing process, but I guarantee that this ~online controversy~ is making the oath a far bigger deal than it ever should have or would have been.

 

[CyrusHabs7695]

This world would be an amazing place if people could just keep to their business, enjoy their families, and not walk around looking for imaginary problems.

 

[ChordaEpiphany]

what are the indigenous ways of healing? Who decides what a culture of anti racism consist of? Ive noticed that its usually old white people who decide what is considered racist and offensive to others, or young white people.

Ill support their oath, if in turn the school takes an oath to lower the cost of attendance significantly, avoid pushing students towards primary care and setting them up for a life of debt to the government. If they actually cared about minorities instead of just wanting to sound cool, perhaps they wouldn't chain their students to debt and indirectly influence the students decision to gravitate towards higher paying fields, so theres more PCPs/pediatricians out there to treat these communities that often need them.

These solutions wouldn't increase students going into primary care. There's no correlation between debt and primary care, and every school that switched to a tuition free model has had absolutely no increase in students pursuing primary care or practice in underserved communities. Also, in my experience the only schools that push for primary care are ones that do so out of concern for their match rate. An unranked school with a class full of aspiring dermatologists just looks like a PR disaster when they have to report a 35% match rate to the next incoming class.

Honestly pushing for primary care is fine. It's needed. It's a way to be effectual in your community. PCPs aren't starving, and the savvy ones are making $350k+ while still paying into loan forgiveness programs. The really savvy ones are out in strategic rural areas living like kings and making $500k+ in private practice.

Also, the effect of debt is so overrated. This needs to be drilled into the head of every medical student. When push comes to shove, debt means at most ~$40-50k off the top of your take home for a decade or two. More likely $20-30k. When the government really starts to buck and use it's negotiating power to the fullest, they'll likely try to pay off doctors with debt forgiveness. It'll be "we'll wipe your debt to make up for these massive reimbursement cuts." So you'll get back $20-30k for 20 years and in exchange you'll pay $100-200k in lost reimbursement for the rest of your career.

What schools need to give back is our time. Time is the #1 expense of any physician, and that includes taxes. While schools push their nonsense about wanting students to take gap years, do special master's programs, pay for an MPH they'll never use, extra research in residency/fellowship for purely clinical programs, and any other ridiculous use of their time, students lose years of income and investment compounding. If schools cared about students, they would optimize the process and send them out trained. If tuition is high... fine. Still worth it. That's the market. Quit robbing me of years of my life though.

Also the oath is dumb. Are we supposed to care about this?

 

[Future_Bone_Docta]

This world would be an amazing place if people could just keep to their business, enjoy their families, and not walk around looking for imaginary problems.

 

[operaman]

I had to look up their oath to find the full text. It’s basically your typical far-left academic drivel and manages to touch on just about every tenet of Wokism. Like if you’re playing woke bingo, this is the oath for you.

What struck me most was what was left out: anything about actually caring for patients.

Not one word about patients.

To my ear, this was the Hippocratic oath to become a Twitter doctor.

The rest of us actually caring for patients will continue to do our best to do no harm.

 

[srirachamayonnaise]

Tbh, undergrad medical education has been overrun by social justice warriors from admissions to the entire preclinical period (interprofessional education and yadda yadda). Thank god, clinical years are kind of spared from extreme wokism.

 

[NITRAS]

Intern year I had a guy fall out of a deer stand and managed to get hit in the belly with 0.22 misfire. He came in several days after the incident wondering why we thought that was a strange delay. #rural

It was only a 0.22lr.

BTW, most of these “misfires” are idiots playing with guns and accidentally pulling the trigger. Low and behold the gun fires in the direction it was pointed.

 

[Neopolymath]

It was only a 0.22lr.

BTW, most of these “misfires” are idiots playing with guns and accidentally pulling the trigger. Low and behold the gun fires in the direction it was pointed.

I'm from the South so I'm intimately familiar with our Darwin award contestants.

 

[Lost in Translation]

In fairness, I think rural America does have its own cultural treatments: don't see a doctor for 30 years and then be surprised when the first time you do they diagnose you with 18 chronic diseases.

You see this a lot in the Midwest, particularly near Appalachia. People are 2h+ from the nearest hospital or 40 minutes from the nearest PCP clinic so they just don’t go. Then they literally get brought in my EMS out of the woodwork with advanced cancer that should have been diagnosed 10 years ago.

It’s really heartbreaking, actually. I’ve not needed to pronounce many patients dead or had patients die on my service however one that sticks out is this one fellow with mesenteric ischemia, hadn’t been to the doctor in like 20 years so no one was checking on his cardiovascular status. We cut out his dead gut, gave him the ostomy and everything. He was in the ICU for 3 weeks on and off pressors before he passed. His brother would visit every other day. You could tell by the end of it the patient was just tired.

I’ve taken care of more NOMI patients than one should ever care for, and I’ve made it known to friends and family that if I ever get NOMI just let me die because at that point I’ve messed up my health somewhere so badly that I’m a lost cause.

 

[annoyedpsychiatrist]

These solutions wouldn't increase students going into primary care. There's no correlation between debt and primary care, and every school that switched to a tuition free model has had absolutely no increase in students pursuing primary care or practice in underserved communities. Also, in my experience the only schools that push for primary care are ones that do so out of concern for their match rate. An unranked school with a class full of aspiring dermatologists just looks like a PR disaster when they have to report a 35% match rate to the next incoming class.

Honestly pushing for primary care is fine. It's needed. It's a way to be effectual in your community. PCPs aren't starving, and the savvy ones are making $350k+ while still paying into loan forgiveness programs. The really savvy ones are out in strategic rural areas living like kings and making $500k+ in private practice.

Also, the effect of debt is so overrated. This needs to be drilled into the head of every medical student. When push comes to shove, debt means at most ~$40-50k off the top of your take home for a decade or two. More likely $20-30k. When the government really starts to buck and use it's negotiating power to the fullest, they'll likely try to pay off doctors with debt forgiveness. It'll be "we'll wipe your debt to make up for these massive reimbursement cuts." So you'll get back $20-30k for 20 years and in exchange you'll pay $100-200k in lost reimbursement for the rest of your career.

What schools need to give back is our time. Time is the #1 expense of any physician, and that includes taxes. While schools push their nonsense about wanting students to take gap years, do special master's programs, pay for an MPH they'll never use, extra research in residency/fellowship for purely clinical programs, and any other ridiculous use of their time, students lose years of income and investment compounding. If schools cared about students, they would optimize the process and send them out trained. If tuition is high... fine. Still worth it. That's the market. Quit robbing me of years of my life though.

Also the oath is dumb. Are we supposed to care about this?

The average salary of a family medicine doctor is 255k. After taxes, that comes to about 168k depending on the state, but asssuming average state income tax. If you were paying 40k a year on loans youd drop your net salary to another 128k. The cost of living in many areas is quite high, in my area you cant even find a decent house for less than 400k and the housing market here has stood firm. Couple that with mortgage rates that are absurd right now, and that 128k gets slowly eaten away. Lets also remember, by the time you're an attend you are early 30s. How is that retirement account working out for you? Probably at zero if youre just starting out as an attending.

Debt does matter, because taking 40k out for loans every year when it could be used for investing in growth stocks or index funds etc adds up a lot more than you realize. You miss out on an average annualized return of 9% that compounds each year with subsequent investments

you can be effectual in your community by being any doctor besides maybe something like i dunno a plastic surgeon? Psychiatrists are high in demand as well. ER doctors. Etc. Dermatologists are needed as well in the area I live.

To say that it isnt a factor depends on how you view financial security. You can not predict the future. Life events happen. Babies happen. College funds are needed. Natural disasters happen. Bear markets happen. Etc.

 

[dantt]

The average salary of a family medicine doctor is 255k. After taxes, that comes to about 168k depending on the state, but asssuming average state income tax. If you were paying 40k a year on loans youd drop your net salary to another 128k. The cost of living in many areas is quite high, in my area you cant even find a decent house for less than 400k and the housing market here has stood firm. Couple that with mortgage rates that are absurd right now, and that 128k gets slowly eaten away. Lets also remember, by the time you're an attend you are early 30s. How is that retirement account working out for you? Probably at zero if youre just starting out as an attending.

Debt does matter, because taking 40k out for loans every year when it could be used for investing in growth stocks or index funds etc adds up a lot more than you realize. You miss out on an average annualized return of 9% that compounds each year with subsequent investments

you can be effectual in your community by being any doctor besides maybe something like i dunno a plastic surgeon? Psychiatrists are high in demand as well. ER doctors. Etc. Dermatologists are needed as well in the area I live.

To say that it isnt a factor depends on how you view financial security. You can not predict the future. Life events happen. Babies happen. College funds are needed. Natural disasters happen. Bear markets happen. Etc.

Need to put this into perspective. At that salary, you shouldn't be dumping 40k into student loans every year. Mortgage rates are historically normal, maybe even low...not absurd. Spouse needs to work like most other families if budget is tight.

 

[annoyedpsychiatrist]

Need to put this into perspective. At that salary, you shouldn't be dumping 40k into student loans every year. Mortgage rates are historically normal, maybe even low...not absurd. Spouse needs to work like most other families if budget is tight.

Mortgage rates are the highest theyve been in >12 years and are climbing as fed raises rates to fight inflation so that is untrue. Hell a little over a year or so ago you could have gotten more than half the rate. Rates were high in the early 2000s and 90s but obviously things were a lot different then. Inflation has had a big impact and there is a lot of speculation of how quickly we will recover from the current bear market. For someone >10 years out of retirement maybe not a big deal, but if you had planned to retire in the near future than the past year would have been hell on your retirement.

Im just going off the proposed numbers. Saying stuff like spouse needs to work is situation dependent. What if you're divorced? What if your spouse has limited income potential? How much is child care in your area?

Generalizations dont account for variables which can and will change. My point to you and others is be careful with assumptions that things like loans dont make a difference because things can and will change, situations can and will change.

 

[evert1de101]

I had to look up their oath to find the full text. It’s basically your typical far-left academic drivel and manages to touch on just about every tenet of Wokism. Like if you’re playing woke bingo, this is the oath for you.

What struck me most was what was left out: anything about actually caring for patients.

Not one word about patients.

To my ear, this was the Hippocratic oath to become a Twitter doctor.

The rest of us actually caring for patients will continue to do our best to do no harm.

Reminds me of one of my medical school interviewers, well-dressed WASP attending who scoffed at my reasoning for applying because I wanted a stable job and to help patients. As an immigrant fighting to make it in america, it was a perfectly legitimate reason to me. Maybe my grandchildren will have the privilege of performative activism.

 

[Lost in Translation]

Reminds me of one of my medical school interviewers, well-dressed WASP attending who scoffed at my reasoning for applying because I wanted a stable job and to help patients. As an immigrant fighting to make it in america, it was a perfectly legitimate reason to me. Maybe my grandchildren will have the privilege of performative activism.

Don’t listen to people who wax poetic about how medicine cannot be about the money. While income may not (and really should not) be the number one reason to go into medicine (and many pre-meds who chase dollar signs end up dropping out before even applying to medical school), job stability and earning potential definitely are legitimate reasons to want to pursue medicine. If I was going to get paid like an NHS doc ($110k/y) after all this personal investment, I would quit and find something less stressful, less demanding on my body and mind, and with more freedom outside of work.

I had to look up their oath to find the full text. It’s basically your typical far-left academic drivel and manages to touch on just about every tenet of Wokism. Like if you’re playing woke bingo, this is the oath for you.

What struck me most was what was left out: anything about actually caring for patients.

Not one word about patients.

To my ear, this was the Hippocratic oath to become a Twitter doctor.

The rest of us actually caring for patients will continue to do our best to do no harm.

As one of my senior residents in the past put it, “This is your ****ing job, so leave whatever **** you have going on at the door.” She was referring to some turmoil in my personal life that was affecting my performance on the wards but the message still holds true for whatever political motivations someone has. Do that activism stuff on your own time, but when you’re inpatient the only thing that matters is that patients are getting the care they need.

 

[nimbus]

"honor all Indigenous ways of healing that have been historically marginalized by Western medicine"

The word “all” means that would be the case… But you know, it’s quite difficult to put an asterisk into an oath.

“Honor all* indigenous ways of healing”

*as long is it’s not a financial burden on the healthcare system, doesn’t conflict with peer-reviewed journals and the patient takes 100% of the blame when undesirable outcomes take place…

See that whole addendum really ruins the flow of the otherwise perfect virtue signaling oath.

I was on the edge of my seat during your entire post! I was honestly expecting the patient to lower their A1c with this magic potion! I was truly invested in the plot development. But alas the patient took metformin and changed their diet… IMDB rating 3/10, would not read again.

But you do highlight the importance of honoring patient autonomy… And every patient has their own culture, so by honoring the patient’s autonomy you are by default honoring whatever produces their decisions (their culture.) However, “honoring our patients autonomy” scores much less in the virtue signaling Olympics.

I’d love to see these students faces when they do their Rural Medicine rotation on the reservation/territory and they spend all day prescribing fluoxetine, metformin, statins…
“Are you sure you don’t want to use some of your culture’s natural remedies, or perform some ancient ritual?! I do want you to know that I took an oath to honor all forms of indigenous medicine and I’m eminently against the gender binary.”
“Um cool…. Nah I’ll just take the Prozac.”

Nothing wrong with ayahuasca or San Pedro and a shaman. Depends on the type of healing you are looking for.

 

[ChordaEpiphany]

The average salary of a family medicine doctor is 255k. After taxes, that comes to about 168k depending on the state, but asssuming average state income tax. If you were paying 40k a year on loans youd drop your net salary to another 128k. The cost of living in many areas is quite high, in my area you cant even find a decent house for less than 400k and the housing market here has stood firm. Couple that with mortgage rates that are absurd right now, and that 128k gets slowly eaten away. Lets also remember, by the time you're an attend you are early 30s. How is that retirement account working out for you? Probably at zero if youre just starting out as an attending.

Debt does matter, because taking 40k out for loans every year when it could be used for investing in growth stocks or index funds etc adds up a lot more than you realize. You miss out on an average annualized return of 9% that compounds each year with subsequent investments

you can be effectual in your community by being any doctor besides maybe something like i dunno a plastic surgeon? Psychiatrists are high in demand as well. ER doctors. Etc. Dermatologists are needed as well in the area I live.

To say that it isnt a factor depends on how you view financial security. You can not predict the future. Life events happen. Babies happen. College funds are needed. Natural disasters happen. Bear markets happen. Etc.

I don't think our posts are in opposition. I just don't see the problem with med schools pushing primary care. It's not like med schools' preferences determine the distribution of physician specialties. I just don't see why it matters or why it's a consideration. No one is forcing you into primary care, and med schools' preferences won't increase the number of derm spots anyway.

I feel (almost) all doctors are underpaid for the work they put in and the opportunity cost of medicine. However, your math and vision of a PCP's lifestyle is objectively off. Post-tax will be around $190K for a family of 4, and $20K/year is a more realistic payment plan as you'll either refinance or be on PSLF or similar. You'll have $170K/year to live on, which we are more accustomed to seeing as $225K gross, which puts you in the market for a ~$800K home. If your spouse works and adds another $75K to the income you can buy a $1M home at 7% interest comfortably. Right now that gets you a 3-4 bd, 2000 square foot home on Long Island or just outside of Boston, or it could get you a bona fide McMansion in the Chicago suburbs.

The real income adjustment isn't the loans, but opportunity cost, which you alluded to. To illustrate this, a doctor who takes no extra years and a 3 year IM residency before taking a $255K/year PCP job at age 29 with no loans could accumulate $8.7M by retirement at 65 by saving 30% of post-tax income. If you did the same with a loan balance of $270K, you could accumulate $8.2M. A doctor who takes 3 gap years as a research assistant and does an MPH before taking the same job but has no loans at all would only accumulate $6.8M under the same circumstances. So these fluff years that are so common in medical training (at the behest of medical school faculty and admins, some of whom are rolling their eyes at my previous post) just cost you $1.4M while the loans only cost you $0.5M. If you use PAYE from PSLF, it will be even less (~$0.25M). Also, as you alluded, you are much more susceptible to adverse life events when income is low. I'd much rather have a baby with an income of $255K and a loan balance of $270K than with an income of $50K and a loan balance of $0.

So yeah, I don't really think loans are the problem. I also don't think med school preferences are the problem. It's training bloat that hurts our bottom line most, and it benefits only the academic system, which needs a steady supply of research assistants and masters students pulled from a crowd of desperate pre-meds.

 

[Goro]

How did money/lifestyle discussion enter the thread? I've always believed that making bank is the baseline for pre-meds, but there has to be something more than that to wanting to be a doctor.

So let's get back to the OP. Yeah, it's that annoying wokeism that everybody in the peanut gallery has to be included or God forbid, someone is left out, but I'm also seeing people actually triggered by meaningless drivel. "Honor this" doesn't mean that shamanism is going to be in U MN-SOM curriculum, kids.

 

[Future_Bone_Docta]

I don't think our posts are in opposition. I just don't see the problem with med schools pushing primary care. It's not like med schools' preferences determine the distribution of physician specialties. I just don't see why it matters or why it's a consideration. No one is forcing you into primary care, and med schools' preferences won't increase the number of derm spots anyway.

I feel (almost) all doctors are underpaid for the work they put in and the opportunity cost of medicine. However, your math and vision of a PCP's lifestyle is objectively off. Post-tax will be around $190K for a family of 4, and $20K/year is a more realistic payment plan as you'll either refinance or be on PSLF or similar. You'll have $170K/year to live on, which we are more accustomed to seeing as $225K gross, which puts you in the market for a ~$800K home. If your spouse works and adds another $75K to the income you can buy a $1M home at 7% interest comfortably. Right now that gets you a 3-4 bd, 2000 square foot home on Long Island or just outside of Boston, or it could get you a bona fide McMansion in the Chicago suburbs.

The real income adjustment isn't the loans, but opportunity cost, which you alluded to. To illustrate this, a doctor who takes no extra years and a 3 year IM residency before taking a $255K/year PCP job at age 29 with no loans could accumulate $8.7M by retirement at 65 by saving 30% of post-tax income. If you did the same with a loan balance of $270K, you could accumulate $8.2M. A doctor who takes 3 gap years as a research assistant and does an MPH before taking the same job but has no loans at all would only accumulate $6.8M under the same circumstances. So these fluff years that are so common in medical training (at the behest of medical school faculty and admins, some of whom are rolling their eyes at my previous post) just cost you $1.4M while the loans only cost you $0.5M. If you use PAYE from PSLF, it will be even less (~$0.25M). Also, as you alluded, you are much more susceptible to adverse life events when income is low. I'd much rather have a baby with an income of $255K and a loan balance of $270K than with an income of $50K and a loan balance of $0.

So yeah, I don't really think loans are the problem. I also don't think med school preferences are the problem. It's training bloat that hurts our bottom line most, and it benefits only the academic system, which needs a steady supply of research assistants and masters students pulled from a crowd of desperate pre-meds.

Yeah I wouldn't say the debt is a HUGE problem. As long as you can make it through and match (which the majority of MD/DO students do), you will be able to pay off your debt.

But that doesn't mean it still isn't daylight robbery at the end of the day.

 

[dantt]

So let's get back to the OP. Yeah, it's that annoying wokeism that everybody in the peanut gallery has to be included or God forbid, someone is left out, but I'm also seeing people actually triggered by meaningless drivel. "Honor this" doesn't mean that shamanism is going to be in U MN-SOM curriculum, kids.

Thank you!

I am truly interested in the thought process behind the politicizing of medical education. I believe it only serves to undermine our legitimacy as doctors and I can't imagine being the only one who thinks this. Can we do anything to stop this without being cancelled? Return the postcards soliciting alumni donations with a demand to stop this drivel?

 

[operaman]

Thank you!

I am truly interested in the thought process behind the politicizing of medical education. I believe it only serves to undermine our legitimacy as doctors and I can't imagine being the only one who thinks this. Can we do anything to stop this without being cancelled? Return the postcards soliciting alumni donations with a demand to stop this drivel?

I think in this case it has more to do with what type of student volunteers to help write the oath in the first place.

Then add to that the inherent difficulty in resisting the wokism if one student in the bunch is pushing for it. Like if one Uber-SJW in the bunch says let’s start out with a land acknowledgment because that’s what they always did at their small liberal arts college, is anyone going to push back on that and say they don’t think squatters rights trump all else? No, they just nod and move on. And what faculty member wants to risk their job over something like that?

My money is on 2 SJW students trying to out virtue signal each other such that they totally missed the whole point of the oath itself.

Personally I see the white coat ceremony as an induction into the profession and as such, things like oaths should come from those already in said profession. Otherwise it’s like listening to 19 year olds talk about how they want to bring about world peace when they haven’t even gotten their own apartment.

 

[hamstergang]

I am truly interested in the thought process behind the politicizing of medical education. I believe it only serves to undermine our legitimacy as doctors and I can't imagine being the only one who thinks this. Can we do anything to stop this without being cancelled?

This is just the pointless oath semi-muttered at a ceremony. I don't see how this really impacts their actual education.

 

[Mad Jack]

The average salary of a family medicine doctor is 255k. After taxes, that comes to about 168k depending on the state, but asssuming average state income tax. If you were paying 40k a year on loans youd drop your net salary to another 128k. The cost of living in many areas is quite high, in my area you cant even find a decent house for less than 400k and the housing market here has stood firm. Couple that with mortgage rates that are absurd right now, and that 128k gets slowly eaten away. Lets also remember, by the time you're an attend you are early 30s. How is that retirement account working out for you? Probably at zero if youre just starting out as an attending.

Debt does matter, because taking 40k out for loans every year when it could be used for investing in growth stocks or index funds etc adds up a lot more than you realize. You miss out on an average annualized return of 9% that compounds each year with subsequent investments

you can be effectual in your community by being any doctor besides maybe something like i dunno a plastic surgeon? Psychiatrists are high in demand as well. ER doctors. Etc. Dermatologists are needed as well in the area I live.

To say that it isnt a factor depends on how you view financial security. You can not predict the future. Life events happen. Babies happen. College funds are needed. Natural disasters happen. Bear markets happen. Etc.

Debt makes a big difference for financial security of almost any physician but it has nothing to do with the number of people going into primary care. If US graduates don't fill those residencies IMGs will. It's six of one and a half dozen of the other. Either way we get the same number of PCPs, it just changes where they were originally trained.

 

[Karlington]

Honor all evidence-based methods of healing regardless of originating culture. Honor no ways of healing without evidence regardless of originating culture. I think that's the only reasonable way.

 

[operaman]

With respect to the honoring indigenous ways of healing, I think their Wokism kept them from getting at a much deeper truth and something worth a place in such an oath: sometimes in medicine you’re a physician, and sometimes you’re a healer, and once in awhile you’re both. And much of the art of medicine lies in knowing which one the patient in front of you needs right now.

Sadly that’s a more universal truth so you can’t use it to virtue signal about an oppressed group which is probably why it didn’t make the final cut.

 

[sloop]

"Honor all approaches to healing" and leaving the "western medicine" bit out would be a better line imo that would get the point across and be even more inclusive.

What about homeopathy?

My opinion is that the Hippocratic Oath is supposed to be about the core values of doctoring, not some public affirmation of woke politics. There are parts of the Hippocratic Oath that are anachronistic, but by and large it focuses on values that are important and uncontroversially part of being a doctor: you’re supposed to act in the best interest of your patient, not act to harm them, not participate in killing people, and treat everybody with dignity and compassion even if they’re a prisoner (or a slave, in the time of Hippocrates). I don’t understand why people feel the need to make the Hippocratic Oath about things it’s not.

 

[aldol16]

Honor all evidence-based methods of healing regardless of originating culture. Honor no ways of healing without evidence regardless of originating culture. I think that's the only reasonable way.

A popular misconception of evidence-based medicine is that if there is no published evidence for the treatment, then the treatment is not worth pursuing. This is naive. A lot of what we do in medicine does not have a solid evidence base. We scrub our hands from fingers to elbows in surgery and then we wash it off with non-sterile water. Does this actually improve infection rates? We use a variety of dressings in surgical wounds, all to the preference of the attending surgeon. Do they actually change infection rates?

The point is, it is important to notice that just because there is no evidence for something does not mean that it does not work. It just means that a study has not yet been done on it, or that a study cannot be done on it for some political or ethical reason. This is different from something for which evidence shows that it does not work. If there is affirmative evidence that something does not work, then it should obviously not be used.