if IOM's recommendations are acted upon...

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would you rather:

  • do primary care residency in an underserved area funded by Medicare

    Votes: 2 25.0%

  • do the residency of your choice paying 40k/year

    Votes: 6 75.0%
  • Total voters
    8
Sikkunt said:
so you can live a considerably better lifestyle as an attending
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Or you can pay nothing and get paid to work and live a considerably better lifestyle as an attending. Working for free is bad enough, why would you pay to work? People starting now in private schools will probably end up paying half a mil back already. 4 more years of tuition and insane interest rates? 7 figure debt easily.
 
Yeah this is an insane proposition.
 
Absolutely not, no way. There are probably few people in this world that would have the drive to work, while paying, after completing medical school, so they can make money as an attending. It's just an unrealistic plan. Even with a $300K salary, having to pay off $750k to $1m in debt would require you to spend at least $100k annually (post taxes obv) to pay your debt off in 10-15 years.


In fact, the only people who would feasibly be able to afford this would be those who have parents completely paying their tuition so they don't owe loans for medical school. This plan would actually promote even less diversification among physicians and cherry pick only the wealthy.

Even with the individuals who had the money from their parents to make this work, even they would probably have a hard time paying to work whatever it is, 80-100 hrs/wk
 
Plus, as it stands there is debt forgiveness after 20(? 25?) years... the number of doctors reaching that currently is not high. But making ppl pay for residency would mean the government would have to offer a lot more loans and that would increase the number of people reaching that, as well as the number of people who default on their loans, I'm sure.
 
Are you people familiar with dental residency? That's how it works. Those orthodontists and periodontists pay tuition for their residency, often coming out with insane loan burdens.
 
maxxor said:
Are you people familiar with dental residency? That's how it works. Those orthodontists and periodontists pay tuition for their residency, often coming out with insane loan burdens.
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How much does it cost? And how does it compare to our residency?
 
maxxor said:
Are you people familiar with dental residency? That's how it works. Those orthodontists and periodontists pay tuition for their residency, often coming out with insane loan burdens.
Click to expand...

Are you familiar with dental residencies? They come out of dental school ready to practice and have the option of doing a residency if they choose to if they want to specialize but do not have to. Those are two fields that can afford to charge for residency because people knew that they can maximize their income potential. Other specialties like pediatric dentistry dont charge. I'm not sure of the job market for dentists though. But doctors have to do a residency. You can be sitting doing 80 hour weeks for a minimum of 3 years and longer if you do a fellowship while the longest dental residencies are three years long to my knowledge.
 
maxxor said:
Are you people familiar with dental residency? That's how it works. Those orthodontists and periodontists pay tuition for their residency, often coming out with insane loan burdens.
Click to expand...
Yeah, and dental residency is ALSO an option. A graduated dentist is licensed to practice independently on Day 1.
 
DermViser said:
Yeah, and dental residency is ALSO an option. A graduated dentist is licensed to practice independently on Day 1.
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If residency was optional, would you pay to do derm?
 
tdram said:
If residency was optional, would you pay to do derm?
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That would be impossible bc you only get zilch Derm education in med school, maybe 1-2 weeks tops. They should bring back the GP thing, like they did before to where every medical school graduate has the chance to practice upon graduation. But to answer your question, yes.
 
DermViser said:
That would be impossible bc you only get zilch Derm education in med school, maybe 1-2 weeks tops. They should bring back the GP thing, like they did before to where every medical school graduate has the chance to practice upon graduation. But to answer your question, yes.
Click to expand...
What I meant was would you still choose derm if you had to pay for residency as opposed to something govt subsidized like FM. I agree that they should allow MDs to practice as a GP upon graduation. That makes plenty of sense if NPs are qualified to do that right out of school.
 
tdram said:
What I meant was would you still choose derm if you had to pay for residency as opposed to something govt subsidized like FM. I agree that they should allow MDs to practice as a GP upon graduation. That makes plenty of sense if NPs are qualified to do that right out of school.
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Yes, I would, bc the level of bureaucratic nonsense and documentation, preauths, and 15 min visits for >5 medical problems, would be absolutely miserable.
 
DermViser said:
http://www.iom.edu/Reports/2014/Graduate-Medical-Education-That-Meets-the-Nations-Health-Needs.aspx

Recommendations: http://www.iom.edu/~/media/Files/Report Files/2014/GME/GME-REC.pdf
Click to expand...

While it sounds like OP's scenario is exactly what this organization would like to happen, has there been any actual mention of not funding specialty residencies? This is the only quote from the recommendations that sounds like what OP is talking about: "and to award new Medicare-funded GME training positions in priority
disciplines and geographic areas."

Will these "priority disciplines" really only include primary care specialties? The report said this plan would ideally be fully implemented in 10 years (just enough time for me to possibly squeeze into a paid specialty residency if all this happens), but man, if this ends up happening.... med students will either be forced to live with a lifetime of debt or be miserable in primary care (unless you're into primary care, then things are about the same).
 
chajjohnson said:
While it sounds like OP's scenario is exactly what this organization would like to happen, has there been any actual mention of not funding specialty residencies? This is the only quote from the recommendations that sounds like what OP is talking about: "and to award new Medicare-funded GME training positions in priority
disciplines and geographic areas."

Will these "priority disciplines" really only include primary care specialties? The report said this plan would ideally be fully implemented in 10 years (just enough time for me to possibly squeeze into a paid specialty residency if all this happens), but man, if this ends up happening.... med students will either be forced to live with a lifetime of debt or be miserable in primary care.
Click to expand...
What they will do most likely is cut down on the number of specialty residency positions offered (which would ironically just drive their attending salaries higher) as well as fellowship positions (which would just create more hospitalists). GME is a publically funded mandate. Hence your services are considered by policy wonks, left-of-center economists and famous doctors like the Atul Gawande's of the world, etc. as a common good and "what you like" as a specialty is secondary to that. The govt. (at least under this administration) feels unequivocally that there are way too many specialists. They tried the carrot method (loan repayment, NHSC obligation, etc.) and that didn't work. This would be the stick method.
 
The way things are going in medicine, I'll probably buy my kids 7/11s to run for their careers (this was my career plan if med school didn't work out).

If they still want the medical school experience, I'll teach them what I learned in med school, and have them get drunk every 2 weeks to approximate the experience of post-exam parties.
 
DermViser said:
They should bring back the GP thing, like they did before to where every medical school graduate has the chance to practice upon graduation. But to answer your question, yes.
Click to expand...

The state of Missouri passed legislation to allow med school graduates to work as assistant physicians and people are having fits, so I highly doubt the GP thing will ever come back.
 
Elisabeth Kate said:
The state of Missouri passed legislation to allow med school graduates to work as assistant physicians and people are having fits, so I highly doubt the GP thing will ever come back.
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The only people having fits are the people who benefit from the system as it is now: ACGME and AMA.
 
Psai said:
Are you familiar with dental residencies? They come out of dental school ready to practice and have the option of doing a residency if they choose to if they want to specialize but do not have to. Those are two fields that can afford to charge for residency because people knew that they can maximize their income potential. Other specialties like pediatric dentistry dont charge. I'm not sure of the job market for dentists though. But doctors have to do a residency. You can be sitting doing 80 hour weeks for a minimum of 3 years and longer if you do a fellowship while the longest dental residencies are three years long to my knowledge.
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Break out of this "doctors have to do residency because we are stupid and unqualified" mindset.

It doesn't have to be this way. In fact, until recently, it wasn't.
 
maxxor said:
Break out of this "doctors have to do residency because we are stupid and unqualified" mindset.

It doesn't have to be this way. In fact, until recently, it wasn't.
Click to expand...
Yeah, this mindset is ridiculous. The same people who think doctors are stupid and unqualified after 4 years of school and multiple Step exams think PAs and NPs are perfectly qualified right out of school after even less training and far less rigorous testing.
 
maxxor said:
Break out of this "doctors have to do residency because we are stupid and unqualified" mindset.

It doesn't have to be this way. In fact, until recently, it wasn't.
Click to expand...

Why are you saying this as if it's a reply to my post? You posted something about dentists and I corrected you. Doctors having to do a residency is a fact, not a mindset
 
Psai said:
Why are you saying this as if it's a reply to my post? You posted something about dentists and I corrected you. Doctors having to do a residency is a fact, not a mindset
Click to expand...

The mindset is that doctors are useless without residency. It hasn't been this way for most of history.
 
Psai said:
Why are you saying this as if it's a reply to my post? You posted something about dentists and I corrected you. Doctors having to do a residency is a fact, not a mindset
Click to expand...
You said dentists aren't required to do residency while we are. I argue that Mds being required to complete a residency (as opposed to just internship) is a mindset that should be broken free from.
 
maxxor said:
You said dentists aren't required to do residency while we are. I argue that Mds being required to complete a residency (as opposed to just internship) is a mindset that should be broken free from.
Click to expand...

100% agree. We should go back to residency being optional as it once was. If NPs can practice independently without any residency, there is no reason we need to have it be mandatory either.
 
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