Med school faculty

[TwoHighways]

Given the trend of how little students actually attend lecture and instead utilize outside resources along with tuition rates that have far outpaced the rate of inflation, how do schools justify having as many dedicated faculty and administrators as they currently do? Will we see a trend of schools cutting positions and subsequently tuition rates in order to attract students that may place a greater important of graduating in the best economic position possible? If there’s anything that I’ve learned about medical school, to be successful requires initiative from the student more than faculty efforts.

---

Members don't see this ad.

 

[GoSpursGo]

Given the trend of how little students actually attend lecture and instead utilize outside resources along with tuition rates that have far outpaced the rate of inflation, how do schools justify having as many dedicated faculty and administrators as they currently do? Will we see a trend of schools cutting positions and subsequently tuition rates in order to attract students that may place a greater important of graduating in the best economic position possible? If there’s anything that I’ve learned about medical school, to be successful requires initiative from the student more than faculty efforts.

This argument has been made many times. I think you overestimate the number of people who are funded 100% by teaching. The vast majority also attend on clinical service, do research, or both, and are required to do some teaching on the side.

Your tuition doesn't go to funding their salary. It's been discussed in a bunch of other threads, but it mostly goes to the cost of your clinical rotations, malpractice coverage, etc. And of course, the almighty "because you'll pay whatever we tell you to pay."

You're not going to get an argument from me that tuition is out of control, but whether or not students show up to lecture in the first 2 years will have zero impact on that.

 

[slowthai]

In your dreams. In mine too. They will literally invent nonsense just to justify their worthless positions.

 

[TwoHighways]

This argument has been made many times. I think you overestimate the number of people who are funded 100% by teaching. The vast majority also attend on clinical service, do research, or both, and are required to do some teaching on the side.

Your tuition doesn't go to funding their salary. It's been discussed in a bunch of other threads, but it mostly goes to the cost of your clinical rotations, malpractice coverage, etc. And of course, the almighty "because you'll pay whatever we tell you to pay."

You're not going to get an argument from me that tuition is out of control, but whether or not students show up to lecture in the first 2 years will have zero impact on that.

What M3/M4 is doing something without a resident or attending overlooking that could have such a profound impact as to constitute such hefty costs of malpractice coverage?

Regarding the “you’ll pay whatever we tell you to pay” aspect, if it’s just to cover the cost of clinical costs/rotations, where is the rest of the money going, if not towards the salaries of bureaucrats?

For all the wokeness that seems to be prevalent in today’s med Ed, there seems to be a stunning disconnect between COA and how that may influence the decisions of potentially great future doctors that don’t come from a well off family and balk at the staggering amount of debt they’ll graduate with, on top of whatever debt they accumulated during undergrad (because God forbid you completed some prereqs at a community college to save money and did well on the MCAT relative to kids that did their prereqs at a four year)

 

[slowthai]

Your tuition doesn't go to funding their salary. It's been discussed in a bunch of other threads, but it mostly goes to the cost of your clinical rotations, malpractice coverage, etc. And of course, the almighty "because you'll pay whatever we tell you to pay."

The problem is, there is zero transparency and accountability here. I remember someone interviewed the dean of a top school asking where all the money is going to and he basically shrugged his shoulders and said "Uhhhh I don't know." Like he couldn't account for it. That's totally ridiculous.

 

[slowthai]

What M3/M4 is doing something without a resident or attending overlooking that could have such a profound impact as to constitute such hefty costs of malpractice coverage?

What's ironic is that M3s/4s can do so much less than they used to be able to do, yet tuition is like 10x higher than it used to be.

 

[TwoHighways]

Full disclosure, I have no reason to complain on a comparative basis. I attend a Texas school and pay in state tuition. The point I’m making is that if we really need more physicians, we ought to make barriers to entry into the profession less difficult/costly. Like, if it’s a matter of passing boards, I could do that independently of any med school curriculum. If I was paying for my own malpractice and rotation costs, I’m sure I could shop that cost and find what works best for me and my professional goals.

 

[GoSpursGo]

What M3/M4 is doing something without a resident or attending overlooking that could have such a profound impact as to constitute such hefty costs of malpractice coverage?

Regarding the “you’ll pay whatever we tell you to pay” aspect, if it’s just to cover the cost of clinical costs/rotations, where is the rest of the money going, if not towards the salaries of bureaucrats?

For all the wokeness that seems to be prevalent in today’s med Ed, there seems to be a stunning disconnect between COA and how that may influence the decisions of potentially great future doctors that don’t come from a well off family and balk at the staggering amount of debt they’ll graduate with, on top of whatever debt they accumulated during undergrad (because God forbid you completed some prereqs at a community college to save money and did well on the MCAT relative to kids that did their prereqs at a four year)

The problem is, there is zero transparency and accountability here. I remember someone interviewed the dean of a top school asking where all the money is going to and he basically shrugged his shoulders and said "Uhhhh I don't know." Like he couldn't account for it. That's totally ridiculous.

Man, I don't know what to tell you RE where the money is going. I'm just saying it ain't the people giving you lectures in M1-M2, which was the hypothesis posited in the OP.

 

[slowthai]

Man, I don't know what to tell you RE where the money is going. I'm just saying it ain't the people giving you lectures in M1-M2, which was the hypothesis posited in the OP.

I agree with everything you've said; I'm just frustrated by the fact that our money goes into some black hole. One thing I have wondered for a while is when will it get to the point where one can no longer justify going to med school? It looks like dentistry is beginning to experience that. It's even more expensive than med school.

 

[libertyyne]

This is a complicated question since not all schools are alike. Some schools are independent of UG where as some schools will have a general fund where the tuition goes towards the entirity of the university. Some schools have massive sources of revenue like grants and endowments, whereas others are barebones.
Here is what harvard looks like

and here is what a osteopathic school in WV looks like.

http://www.wvhepc.edu/wp-content/uploads/2018/11/2018-Audit-WV-School-of-Osteopathic-Medicine-Financial-Statements.pdf

Schools are obligated to provide an education according to the rules that accrediting bodies put out. If they say you need to have a biochem professor, anatomy lab, etc you have to pony up to pay for those even if students are not getting value out of them. Some students probably still use the instructor material and information.

Schools can set prices as high as they are because loans are backed by the government and essentially they can find students willing to pay those prices.

You would need reform on the accreditation side, reform of the way schools are paid to actually reduce costs medical education.
Just like healthcare in general there is a lot of fat in terms of waste and administration without any real incentive to make it better.

 

[Lawpy]

This argument has been made many times. I think you overestimate the number of people who are funded 100% by teaching. The vast majority also attend on clinical service, do research, or both, and are required to do some teaching on the side.

Your tuition doesn't go to funding their salary. It's been discussed in a bunch of other threads, but it mostly goes to the cost of your clinical rotations, malpractice coverage, etc. And of course, the almighty "because you'll pay whatever we tell you to pay."

You're not going to get an argument from me that tuition is out of control, but whether or not students show up to lecture in the first 2 years will have zero impact on that.

So this means reducing preclinical to 1 yr is a bad thing because more time for rotations/electives = more expensive? Or am i misunderstanding this?

 

[GoSpursGo]

So this means reducing preclinical to 1 yr is a bad thing because more time for rotations/electives = more expensive? Or am i misunderstanding this?

That would be a reasonable hypothesis based on my limited understanding, but honestly

 

[libertyyne]

That would be a reasonable hypothesis based on my limited understanding, but honestly

I honestly do not think third and fourth year as as expensive as people would like to believe. We as students pay for our own malpractice insurance besides the general malpractice insurance. The coordinators are employeed by the GME offices at the rotating hospitals. The sites do not get paid any money from the school, the residents and attendings do not get pain any money.

 

[GoSpursGo]

I honestly do not think third and fourth year as as expensive as people would like to believe. We as students pay for our own malpractice insurance besides the general malpractice insurance. The coordinators are employeed by the GME offices at the rotating hospitals. The sites do not get paid any money from the school, the residents and attendings do not get pain any money.

To be clear, I'm saying that the cost of M3-4>M1-2, not that the cost justifies the tuition.

 

[QuizzicalApe]

What M3/M4 is doing something without a resident or attending overlooking that could have such a profound impact as to constitute such hefty costs of malpractice coverage?

i mean, the main cost is that they exist.

ignoring any potential liability issues, having students saps productivity. the difference in time to take care of daily work is truly unreal when you compare having students to not having students

 

[Obnoxious Dad]

The problem is, there is zero transparency and accountability here. I remember someone interviewed the dean of a top school asking where all the money is going to and he basically shrugged his shoulders and said "Uhhhh I don't know." Like he couldn't account for it. That's totally ridiculous.

You're thinking of the interview with Robert Grossman, the Dean of NYU's Med School. According to Dr. Grossman tuition is used to support unproductive faculty, i.e., people who don't teach, don't write grants and don't see patients.

Why Doctors Are Drowning in Medical School Debt

A resident physician investigates the causes of skyrocketing tuition

blogs.scientificamerican.com

 

[CliveStaples]

Predicting that the cost of medical school will go down is like rolling an apple off a table and predicting it'll hit your ceiling.

 

[Goro]

In your dreams. In mine too. They will literally invent nonsense just to justify their worthless positions.

Yeah, like indirects from R01s.

MD schools lose money on student tuition only. A decent academic dep't can generate more funding in indirects from extramural grants than from an entire class worth of tuition.

As DO schools run leaner ships because they don't have those pesky LCME requirements like research, they can run solely on tuition. But it is immoral for a school like CCOM to charge some $73K in tuition.

 

[NITRAS]

Full disclosure, I have no reason to complain on a comparative basis. I attend a Texas school and pay in state tuition. The point I’m making is that if we really need more physicians, we ought to make barriers to entry into the profession less difficult/costly. Like, if it’s a matter of passing boards, I could do that independently of any med school curriculum. If I was paying for my own malpractice and rotation costs, I’m sure I could shop that cost and find what works best for me and my professional goals.

We don’t actually need to need more physicians. We need more of them to work in less desirable places. You should ask the pharmacists how producing too many did for them.

It also needs to be drilled into your head how you can differentiate yourself from mid levels, because they are here to stay. You will compete with them. At the end of the day, no one gives a rats hind end that you spent the extra years in training and more in student loans. How are you better? Why should they pay you more? These are better questions.

 

[InFreudWeTrust]

In your dreams. In mine too. They will literally invent nonsense just to justify their worthless positions.

It sounds like you need to attend some more wellness lectures during your free time that is meant to be spent away from school focusing on your, well, wellness...

Which reminds me, have you downloaded the latest mindfulness app? I know you don’t spend enough time looking at screens, so I thought it could be helpful. There will be a mandatory lecture on it next week. See you there!

 

[Real McCoy]

Given the trend of how little students actually attend lecture and instead utilize outside resources along with tuition rates that have far outpaced the rate of inflation, how do schools justify having as many dedicated faculty and administrators as they currently do? Will we see a trend of schools cutting positions and subsequently tuition rates in order to attract students that may place a greater important of graduating in the best economic position possible? If there’s anything that I’ve learned about medical school, to be successful requires initiative from the student more than faculty efforts.

Cost of higher education (housing and automobiles also) is indeed absurd relative to average wages in America, but faculty salaries do not make up the bulk of tuition costs. It's always interesting to learn how students, faculty, and administrators view their individual roles and each other's roles in the medical education enterprise. It really is unfortunate to have faculty who don't contribute much to the students or the institution. They definitely exist, but there are greater numbers of faculty who make meaningful contributions to varying degrees. We can make the same arguments for/against students and administration as well, but each group absolutely needs the other (although they are loathe to admit it). The extent of those needs is always up for debate and efficiency could always be higher.

 

[Ho0v-man]

Our schools literally pays the hospitals/preceptors nothing/next to nothing. I can’t imagine our malpractice insurance is really all that much. The highest average malpractice cost I can find for an internist is still well below my tuition and I rarely even have the EMR access necessary to contribute to care.

There’s construction projects at my school that don’t actually do anything. But they’re constantly happening. I imagine there’s just some very generous rounding that goes in to those construction costs that “justify” hiking tuition every year.

Couple that with multiple departments at my school that just push around paper, forward emails with a zoom link to a guest speaker at another medical school, or just dumb stuff like put on a virtual dog show, then I’m just not convinced it needs to be anywhere near this high.

Yeah I’m obviously jaded. And I say this with no evidence to back it up. But I feel very confident that malpractice costs for the month are probably covered by less than a week of tuition.

Edit: and they didn’t even show their own dogs.

 

[Dr. Doctor MD]

Our schools literally pays the hospitals/preceptors nothing/next to nothing. I can’t imagine our malpractice insurance is really all that much. The highest average malpractice cost I can find for an internist is still well below my tuition and I rarely even have the EMR access necessary to contribute to care.

There’s construction projects at my school that don’t actually do anything. But they’re constantly happening. I imagine there’s just some very generous rounding that goes in to those construction costs that “justify” hiking tuition every year.

Couple that with multiple departments at my school that just push around paper, forward emails with a zoom link to a guest speaker at another medical school, or just dumb stuff like put on a virtual dog show, then I’m just not convinced it needs to be anywhere near this high.

Yeah I’m obviously jaded. And I say this with no evidence to back it up. But I feel very confident that malpractice costs for the month are probably covered by less than a week of tuition.

Edit: and they didn’t even show their own dogs.

Malpractice for students costs next to nothing. I had to purchase it for away rotations and if I recall correctly was like somewhere between $25-75 for a 4 week rotation. I think I paid about $50.

So malpractice probably doesn't even account for even 2% of your clinical years tuition

 

[Ho0v-man]

Malpractice for students costs next to nothing. I had to purchase it for away rotations and if I recall correctly was like somewhere between $25-75 for a 4 week rotation. I think I paid about $50.

So malpractice probably doesn't even account for even 2% of your clinical years tuition

Yeah I think the highest I saw for an away was like $200. But I don’t know if there’s some more expensive baseline package the school pays as well.

 

[Neopolymath]

I honestly do not think third and fourth year as as expensive as people would like to believe. We as students pay for our own malpractice insurance besides the general malpractice insurance. The coordinators are employeed by the GME offices at the rotating hospitals. The sites do not get paid any money from the school, the residents and attendings do not get pain any money.

These are the same people telling you that having a residency costs the hospital a lot of money. Just straight up lying. Of course they lie about the costs while laughing in the 60 random extra admin offices and deans of bull****.

Go talk to real business people about this stuff and they don't lie like the academic faculty and admin.

 

[Goro]

These are the same people telling you that having a residency costs the hospital a lot of money. Just straight up lying. Of course they lie about the costs while laughing in the 60 random extra admin offices and deans of bull****.

Go talk to real business people about this stuff and they don't lie like the academic faculty and admin.

One of the things left unspoken is that med school funds to go into a general pool for the parent university. So you tuition might very well be going to the School of Fine Arts or the UG campus.

 

[Neopolymath]

One of the things left unspoken is that med school funds to go into a general pool for the parent university. So you tuition might very well be going to the School of Fine Arts or the UG campus.

Valid detail to share but I would say accounting and budgetary silos don't change what libertyyne said. I don't know about anyone else here but I got As in my accounting, finance, econ etc. classes in undergrad and did some successful real life business as well. If a med school's argument to me as a student is that the big bad undergrad needs a new library, I would say "excellent. Let me know when you lay off a dean of bull**** to pay for it. Good luck picking." I don't think pretending the expenses are different than reality actually argues the point.

 

[Goro]

Valid detail to share but I would say accounting and budgetary silos don't change what libertyyne said. I don't know about anyone else here but I got As in my accounting, finance, econ etc. classes in undergrad and did some successful real life business as well. If a med school's argument is that the big bad undergrad needs a new library, I would say "excellent. Let me know when you lay off a dean of bull**** to pay for it. Good luck picking." I don't think pretending the expenses are different than reality actually argues the point.

Wise @Med Ed...comments?

 

[Neopolymath]

Wise @Med Ed...comments?

No matter how wise this poster is (and he is quite wise), nothing they can say will counter the argument. The argument isn't denying that money gets funneled away. It clearly does. It definitely does at my school.

Libertyyne says medical school tuition cost does not match the expenses. Saying that the money is going somewhere else can be both true and not really change the point IMO. We can label half the money organic banana expense fund for all I care. It still doesn't change the exponential growth in tuition for no change in product that is indefensible.

 

[Med Ed]

Wise @Med Ed...comments?

I tend to avoid the Alexander Pope forum, but at your behest I will chime in.

The simple fact is that domestic allopathic medical schools do not make money. They haven't since the Flexner report. The notion that medical school revenue is getting funneled to other entities is laughable. For the last century medical schools have existed as financial barnacles plastered on the hulls of their respective parent universities/hospitals, their budgets a series of rounding errors on the larger balance sheet. Recent history is littered with new medical schools striving to break even.

Increases in medical school tuition over the years have been driven by three main factors, two of which are shared with higher ed in general:
1. Administrative bloat
2. Diminished public funding
3. Decreased subsidization from clinical revenue

As a fourth I would tack on technology costs. When I started teaching we had notebooks and chalkboards. Now we have tablets and interactive whiteboards. and a legion of people to keep them running. As a fifth I would consider the physical space. Again, we used to have a couple of lecture halls and some labs. Now we have adaptable teaching spaces with laser projectors and microphones.... and a legion of people to keep them running. We spend two years giving students expensive NBME exams so they'll be ready for USMLE. The first USMLE-style exam I took was... USMLE. Accreditation also drives a fair amount of cost, but it would be difficult to decide which parts are worthy of elimination.

Ultimately medical school remains a good financial deal for the vast majority. I know there is great mystery in how the sausage is made, and many assumptions that it could be made better. To those who are so inclined I invite them to cross over and join the administrative side some day. You may find the situation more conflicting than you realize, and yourself making the same decisions that you currently scorn.

 

[sliceofbread136]

I tend to avoid this here Alexander Pope forum, but at your behest I will chime in.

The simple fact is that domestic allopathic medical schools do not make money. They haven't since the Flexner report. The notion that medical school revenue is getting funneled to other entities is laughable. For the last century medical schools have existed as financial barnacles plastered on the hulls of their respective parent universities/hospitals, their budgets a series of rounding errors on the larger balance sheet. Recent history is littered with new medical schools striving to break even.

Increases in medical school tuition over the years have been driven by three main factors, two of which are shared with higher ed in general:
1. Administrative bloat
2. Diminished public funding
3. Decreased subsidization from clinical revenue

As a fourth I would tack on technology costs. When I started teaching we had notebooks and chalkboards. Now we have tablets and interactive whiteboards. and a legion of people to keep them running. As a fifth I would consider the physical space. Again, we used to have a couple of lecture halls and some labs. Now we have adaptable teaching spaces with laser projectors and microphones.... and a legion of people to keep them running. We spend two years giving students expensive NBME exams so they'll be ready for USMLE. The first USMLE-style exam I took was... USMLE. Accreditation also drives a fair amount of cost, but it would be difficult to decide which parts are worthy of elimination.

Ultimately medical school remains a good financial deal for the vast majority. I know there is great mystery in how the sausage is made, and many assumptions that it could be made better. To those who are so inclined I invite them to cross over and join the administrative side some day. You may find the situation more conflicting than you realize, and yourself making the same decisions that you currently revile.

source please. I just have a hard time believing that a product with such a high demand and customers that have near infinite leverage is not being price gouged like crazy

 

[Med Ed]

source please.

Years of direct observation. If you don't like my opinion then find someone in the business who has a different one.

I just have a hard time believing that a product with such a high demand and customers that have near infinite leverage is not being price gouged like crazy

Public schools typically have their tuition set, or at least approved, by some sort of governing body. Doesn't prevent growth that outstrips inflation, but it does provide some drag. Private schools compete with each other, which is why most of their tuition costs tend to hover in the same range. Go too high and you start losing out on the students who buffer the selectivity component of your USN&WR ranking. The wild card is OOS tuition for public schools, which approaches 100K at some places. If there were truly no brakes on tuition increases I think 100K/year would be the going rate for private schools, and maybe 80K for public ones.

 

[TwoHighways]

Getting rid of the government guarantees of student loans and making the loans absolvable through bankruptcy would undoubtedly put some deflationary pressure on tuition rates. One has to question the value of all the techy stuff and physical space as well, given the amount of self directed learning going on and the lack of value a significant portion of students feel they are getting out of a traditional classroom/lecture environment.