New England Journal Med: Are We in a Medical Education Bubble Market?

[Espadaleader]

This article brings up some pretty important points. Look at the debt/income ratio over the past 10 years. Its not sustainable.

http://www.nejm.org/doi/full/10.1056/NEJMp1310778

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[thegypsyqueen]

"Although it seems unlikely that we're in a bubble market for medical education, we may already be in one for veterinary medicine." From the article, last paragraph. I think it highly unlikely.

 

[NYCNative]

"Although it seems unlikely that we're in a bubble market for medical education, we may already be in one for veterinary medicine." From the article, last paragraph. I think it highly unlikely.

Awesome article.

Why would you say that? Starting salary for vets is $45,575, and average indebtedness is $150,000+, with large numbers of student breaking even $300,000 now.

http://www.nytimes.com/2013/02/24/business/high-debt-and-falling-demand-trap-new-veterinarians.html

 

[CarlosDanger]

Read this article recently, and I thought it was really interesting too. I've been out of college for a few years, but when I started college (not that long ago) the tuition at my state med schools was less than $25K, now its already $35K - and nowadays it seems like every non-state school is $50K or more, its getting seriously ridiculous. This article made me feel bad for vets, pharmacists, etc, although I don't know how much their tuition usually is. I think we will eventually be in a bubble, because I just can't see the med schools LOWERING tuition in the near future...but I can definitely see doctor's fees going down.

 

[Espadaleader]

There is no way we can insure more people and truly provide more care if physicians aren't paid more OR medical school is less expensive. Ask any physician today if the can run a private practice on ONLY medicaid patients. That is impossible. Its just impossible. You cannot come out of medical school + training with a quarter of a million of debt and take a loss. Healthcare in the US is doomed and the ACA is doomed because the poor people that have all of the health problems are not going to be covered under the medicaid expansion. When these people go to the ER and receive mandated care the hospitals will take HEAVY losses.

I don't think doctors want to make money just to make money. Most doctors are just trying to survive. You make 300,000k. Malpractice is 50k, you are 200,000k in debt, and you still have wife/husband/partner + children + house + life. I don't think the bubble will burst though because of the prestige. Physicians are the most respected profession. Physicians can do what no other profession can and that will keep the bubble from popping for a while. I think the education AS A WHOLE will burst first.

BU undergrad COA is 60k! That's insane.

 

[thegypsyqueen]

Awesome article.

Why would you say that? Starting salary for vets is $45,575, and average indebtedness is $150,000+, with large numbers of student breaking even $300,000 now.

http://www.nytimes.com/2013/02/24/business/high-debt-and-falling-demand-trap-new-veterinarians.html

Sorry, the "I think it unlikely" referred to medicine, not the other fields. Vets do seem to be nearing a burst.

 

[darkjedi]

BU undergrad COA is 60k! That's insane.

ugh I know, BU was poop

 

[LizzyM]

This article made a lot of sense to me. Reimbursements will go down with a consolodation of the insurance market and/or single payer (I think we are headed there in the next 5-8 years). Many services currently provided by physicians could be provided by mid-levels with no decrease in quality. Higher level care will be provided by physicians but again, reimbursement will go down. All the borrowing that is predicated on massive reimbursement for services will be a millstone around the necks of those who still owe when the bubble pops and physicians are unable to service their debt.
Can we loser costs by 25% by making med school 3 years rather than 4? Can we change the pre-med requirements so some of the material taught in med school is shunted to undergrad? Can we solve the problem before the pop?

 

[woltej1]

I'm not too worried really. Yea the system is screwed up, but the pre-med to physician education route with wage is far from being on the leading edge of a bubble. There will be a different career education bubble to pop first and once that happens all the other ones will be recognized and at least have an attempt to be fixed. Let's be honest, the cost of education and the burden it puts on people compared to the positives is on the forefront of legislation and not even close to being ignored.

 

[CarlosDanger]

This article made a lot of sense to me. Reimbursements will go down with a consolodation of the insurance market and/or single payer (I think we are headed there in the next 5-8 years). Many services currently provided by physicians could be provided by mid-levels with no decrease in quality. Higher level care will be provided by physicians but again, reimbursement will go down. All the borrowing that is predicated on massive reimbursement for services will be a millstone around the necks of those who still owe when the bubble pops and physicians are unable to service their debt.
Can we loser costs by 25% by making med school 3 years rather than 4? Can we change the pre-med requirements so some of the material taught in med school is shunted to undergrad? Can we solve the problem before the pop?

Yeah, makes sense. I also think that there may be more and more consolidation on the provider end which could raise prices for services, but we might see higher quality as a result which would be a good thing. I'm also curious about the 3 year MD. A few schools are experimenting with this - albeit very differently - but the idea seems to have met a lot of skepticism so far, I'm kind of skeptical myself. I think we could shunt some course work to undergrad though, PAs do it right?

I'm personally very cynical about politics and don't think anything is on the forefront of legislation...we can barely pass a clean CR. I'm not sure schools will have an incentive to lower tuition as state payments are lessening and of course less federal research money means less grant money going to med schools...I think the bubble will have to pop to force changes to the system - unless it happens to vet/optometry/pharmacy students first and we wise up.

 

[TheWeeIceMan]

I'm not too worried really. Yea the system is screwed up, but the pre-med to physician education route with wage is far from being on the leading edge of a bubble. There will be a different career education bubble to pop first and once that happens all the other ones will be recognized and at least have an attempt to be fixed. Let's be honest, the cost of education and the burden it puts on people compared to the positives is on the forefront of legislation and not even close to being ignored.

I hope you are right, but I don't think it's going to happen. I think you could argue that the law school bubble has already popped and it sure doesn't look like anything is changing. Let's be honest, most politicians don't care as much about us (students) as they do about the middle aged and elderly. We just don't have the voting/political power that the older generations do. Not to mention that the government is benefiting from all of the interest on student loans. The education bubble will be popped long before meaningful reform imo.

 

[OCDOCDOCD]

I don't see the bubble popping anytime soon. Higher education has proven to be disturbingly resilient to economic pressures. Undergrad tuition still increases higher than the rate of inflation every year, people know by now that most BA/BS degrees are worthless, and yet families still clamor to send their kids to a no-name private school that costs $50k/year over a no-name state school that costs $5k/year simply because the private school is ranked slightly higher in USNWR, and the humanities still remain extremely popular majors. Most law schools are now essentially scams and yet still fill their classes every year. Vet schools leverage the same debt on their students as med schools despite the fact that a vet will never be able to pay off that kind of debt, and yet vet schools still fill their classes every year. PhD programs continue to grow in competitiveness despite the prospects for academics becoming ever more bleak.

Consider that medicine still offers excellent job security, the highest "guaranteed" salary of any profession (there are professions that pay more, but most people who go into them never make it to the lucrative salaries), is still among the most prestigious careers, and is revered as an almost divine career by some ethnic groups and social classes. Now consider the state of careers/schools that I described above. Put everything together and it should be pretty obvious that we have a very, very long way to go until the med school bubble bursts.

 

[TheWeeIceMan]

It will also be harder for the med school bubble to totally burst because income of physicians is so varied. The peds guy making 125k is going to be screwed a lot faster than the spine guy making 750k.

 

[Espadaleader]

Thanks for the great commentary. I think healthcare will collapse in the next ten years. Healthcare costs are rising because no one knows the value of the services being provided - not even the physicians. The lack on Medicaid expansion will doom the ACA. 68% of poor uninsured blacks and 60% of poor uninsured whites will not have ANY coverage. Who or what will absorb their healthcare costs? Medical student enrollment is increasing dramatically but their is a residency freeze. In 2016 their will be more MD/DO students that residency spots. Big issue. Debt/income ratio is increasing as payment reform is moving toward capitulation and bundled care - lower physician payment. Sequestration is crushing healthcare. It's decreasing funding to Medicare by 25%. Cutting residency programs. Honestly, medicine will crash hardcore. Over the past year, I grew up and I see medicine for what it is. I am even more passionate now because if you're not you will be eliminated.

 

[13132]

The article implies that if the bubble begins to pop then the different specialties will pop separately and at different times with the highest salaried specialties being last. Considering FM would be the first to experience the pop and the nation is already pressed for FM physicians (that conversation is on the forefront of people's minds), wouldn't this incremental pop which knocks out FM first and leaves specialties be protracted enough for policy makers to realize the issue and course correct?

They would have reason to act because at that point the dearth/projected shortage of FM practitioners would be a disastrous national health/policy issue.

 

[TheWeeIceMan]

The article implies that if the bubble begins to pop then the different specialties will pop separately and at different times with the highest salaried specialties being last. Considering FM would be the first to experience the pop and the nation is already pressed for FM physicians (that conversation is on the forefront of people's minds), wouldn't this incremental pop which knocks out FM first and leaves specialties be protracted enough for policy makers to realize the issue and course correct?

They would have reason to act because at that point the dearth/projected shortage of FM practitioners would be a disastrous national health/policy issue.

You would think they would be smart enough to correct, but what they'll probably do is just keep pushing for PAs and NPs to take over FM.

 

[Lucca]

Thanks for the great commentary. I think healthcare will collapse in the next ten years. Healthcare costs are rising because no one knows the value of the services being provided - not even the physicians. The lack on Medicaid expansion will doom the ACA. 68% of poor uninsured blacks and 60% of poor uninsured whites will not have ANY coverage. Who or what will absorb their healthcare costs? Medical student enrollment is increasing dramatically but their is a residency freeze. In 2016 their will be more MD/DO students that residency spots. Big issue. Debt/income ratio is increasing as payment reform is moving toward capitulation and bundled care - lower physician payment. Sequestration is crushing healthcare. It's decreasing funding to Medicare by 25%. Cutting residency programs. Honestly, medicine will crash hardcore. Over the past year, I grew up and I see medicine for what it is. I am even more passionate now because if you're not you will be eliminated.

My gut wants to say this outlook is a bit pessimistic, if not fatalistic but I can't help but agree. Rhetoric in Washington and in most publications (Economist, WSJ, Forbes) suggests physician reimbursement will take a blow in response to unsustainable healthcare costs. I find this difficult to stomach considering how much other fat could be trimmed instead of exacerbating a reimbursement wound that will only decrease the influx of new physicians in the long run. The solution seems rather simple to me. Switch to a single player health care system, legislate and regulate the pharmaceutical industry to keep prescription costs down, and heavily subsidize medical education to absorb the incoming blows to physician reimbursement. The question again becomes who or what will pay for that? The reality is this country cannot or won't pay for anything that doesn't pump oil out of the ground or kill something based on our history and available data. I don't think we should approach this possible bubble with a "fight or flight" attitude but should instead seek to educate future healthcare providers in the political process; if physicians don't lobby for their rights, no one will, and current undergraduate/high school education is not conductive to producing an active member of civic society.

 

[rain4venus]

There is no way we can insure more people and truly provide more care if physicians aren't paid more OR medical school is less expensive.

This*1,000,000

 

[jeffblue]

Let's be honest, the cost of education and the burden it puts on people compared to the positives is on the forefront of legislation and not even close to being ignored.

You have watched the financial debacle of the past five years and you can make a statement like that? The preamble to the financial meltdown was IGNORED. Government is dysfunctional. It does not exist to do good anymore. It exists just to exist.

 

[Dbate]

This article made a lot of sense to me. Reimbursements will go down with a consolodation of the insurance market and/or single payer (I think we are headed there in the next 5-8 years). Many services currently provided by physicians could be provided by mid-levels with no decrease in quality. Higher level care will be provided by physicians but again, reimbursement will go down. All the borrowing that is predicated on massive reimbursement for services will be a millstone around the necks of those who still owe when the bubble pops and physicians are unable to service their debt.
Can we loser costs by 25% by making med school 3 years rather than 4? Can we change the pre-med requirements so some of the material taught in med school is shunted to undergrad? Can we solve the problem before the pop?

The real issue isn't the debt-to-income ratio for physicians. But the relative debt-to-income ratio in the field of medicine compared to other fields.

Prospective students have to choose amongst the options available to them. They have to decide if they will be: accountants, lawyers, PhDs, or physicians (to provide a few examples)

Law=massive debt and no job
PhD (in bio)=years slaving away as a post-doc making 40k with no hope of tenure
Accountants=actually probably a decent financial career (see the MBA figures in the paper), but super boring
Physicians=high debt, high pay, and high job security

As long as physicians are financially better off compared to other fields, then students will still flock to medical school.

Judging from the second graph in the article, it will be a long time before people are dissuaded from being a physician for financial reasons.


P.S. And for students in Texas, it will be even longer. (note: Every time i read an article about student debt, i thank god I was born in Texas. )

 

[QuantumQuark]

The real issue isn't the debt-to-income ratio for physicians. But the relative debt-to-income ratio in the field of medicine compared to other fields.

Prospective students have to chose amongst the options available to them. They have to decide if they will be: accountants, lawyers, PhDs, or physicians (to provide a few examples)

Law=massive debt and no job
PhD (in bio)=years slaving away as a post-doc making 40k with no hope of tenure
Accountants=actually probably a decent financial career (see the MBA figures in the paper), but super boring
Physicians=high debt, high pay, and high job security

As long as physicians are financially better off compared to other fields, then students will still flock to medical school.

Judging from the second graph in the article, it will be a long time before people are dissuaded from being a physician for financial reasons.


P.S. And for students in Texas, it will be even longer. (note: Every time i read an article about student debt, i thank god I was born in Texas. )

Great post. Basically the author's premise and yours is the same. A lot of other bubbles would have to burst before medicine's does and it probably will self regulate before it ever will.

 

[LizzyM]

Physicians=high debt, high pay, and high job security

But the argument in NEJM is that high pay is going to go away. One might argue that high job security may go as well as mid-levels replace physicians in primary care and are used more often as extenders by specialists. Then the debt to income ratio will be out of whack and make medicine look very unattractive compared with other fields.

 

[Dbate]

But the argument in NEJM is that high pay is going to go away. One might argue that high job security may go as well as mid-levels replace physicians in primary care and are used more often as extenders by specialists. Then the debt to income ratio will be out of whack and make medicine look very unattractive compared with other fields.

That begs the question: what is high pay?

Everyone knows that physician's salaries are going to decline relative to today's wages. But decline down to what?

I wonder if people have taken a look at the salaries in countries with national health systems. Here's a link: http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/?_r=0.

General Practitioners in the UK and Canada still make: 107K and 118K respectively
Specialists in the UK and Canada make: 150K and 161K respectively.

By any standards, those are extremely high salaries and much higher (and securer) than the options in other fields. It doesn't matter how bad it gets for physicians objectively. It only matters that medicine is a better financial career relative to other fields.

 

[LizzyM]

That begs the question: what is high pay?

Everyone knows that physician's salaries are going to decline relative to today's wages. But decline down to what?

I wonder if people have taken a look at the salaries in countries with national health systems. Here's a link: http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/?_r=0.

General Practitioners in the UK and Canada still make: 107K and 118K respectively
Specialists in the UK and Canada make: 150K and 161K respectively.

By any standards, those are extremely high salaries and much higher (and securer) than the options in other fields. It doesn't matter how bad it gets for physicians objectively. It only matters that medicine is a better financial career relative to other fields.

You don't get it. It doesn't matter if the pay is "relatively high" if the debt required to acquire the credentials to earn that pay are out of whack with the pay. It's what you have left after the loan payment that is what will cause the bubble to burst.

 

[alpinism]

That begs the question: what is high pay?

Everyone knows that physician's salaries are going to decline relative to today's wages. But decline down to what?

I wonder if people have taken a look at the salaries in countries with national health systems. Here's a link: http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/?_r=0.

General Practitioners in the UK and Canada still make: 107K and 118K respectively
Specialists in the UK and Canada make: 150K and 161K respectively.

By any standards, those are extremely high salaries and much higher (and securer) than the options in other fields. It doesn't matter how bad it gets for physicians objectively. It only matters that medicine is a better financial career relative to other fields.

The main issue is that students in UK/Canada aren't graduating residency being 200K to 400K in debt. The average cost of U.S. private medical schools is now over $278,000 not including costs associated with undergrad or any post bacc courses.

http://www.bloomberg.com/news/2013-...000-means-even-bernanke-son-carries-debt.html

 

[yehhhboiii]

That begs the question: what is high pay?

Everyone knows that physician's salaries are going to decline relative to today's wages. But decline down to what?

I wonder if people have taken a look at the salaries in countries with national health systems. Here's a link: http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/?_r=0.

General Practitioners in the UK and Canada still make: 107K and 118K respectively
Specialists in the UK and Canada make: 150K and 161K respectively.

By any standards, those are extremely high salaries and much higher (and securer) than the options in other fields. It doesn't matter how bad it gets for physicians objectively. It only matters that medicine is a better financial career relative to other fields.

that's not what begging the question means
it doesn't matter how other fields are doing or how much people make in other countries
if someone makes 50k in the us and 50k in the uk but goods and services costs twice as much in the uk, obviously those salaries aren't equivalent
what matters is how valuable your education and skills are, the number of hours you work, the quality of your work, your efficiency and how much money you generates for your workplace.
people are always quick to say hey let's cut doctors salaries! think of the patients! then for some reason, patients aren't seeing any savings and salaries for administrators keep going up. hmmm...

 

[Dbate]

You don't get it. It doesn't matter if the pay is "relatively high" if the debt required to acquire the credentials to earn that pay are out of whack with the pay. It's what you have left after the loan payment that is what will cause the bubble to burst.

I think you may be looking at it through a myopic lens.

All fields require debt to enter into professional endeavors.

Like i said in my previous post, it only matters if the debt-to-income ratio in medicine exceeds other comparable fields.
I don't see value in debating this topic, when we can easily just do a quick numbers crunch similar to that done in the article. A key metric was the debt to starting salary figure.

Even at pay rates seen in the UK, physician's ratio would be:

175K/118k=1.48
175k/150k=1.16


That is still superior to alternative fields.

Note: Median med student debt from: https://www.aamc.org/download/152968/data
Note: UK salary from: http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/

For example, the average law grad has 100K debt from private school, with a starting average salary of 60K (in 2011).
For a ratio of:

100K/60k=1.92 (private law school)=1.67

Note: Average debt from: http://taxprof.typepad.com/taxprof_blog/2012/03/law-schools-rankings.html
Note: Median salary found here: http://www.nalp.org/classof2011_salpressrel
(it is important to use median figures as opposed to the average because the average is impacted moreso by extreme outliers)

I previously did a full blown projected economic analysis (with very conservative figures for physician salary) here: http://forums.studentdoctor.net/index.php?threads/go-into-medicine-for-money.1009560/
(this document takes into account the years of lost salary and the net present value of earnings, so it allows for a direct comparison of the economic value of alternative careers.)

From an economic perspective, it is unequivocally true that Medicine is the most lucrative and best field to enter. Even if you consider that salaries are declining.


It is important to articulate this with actual data and economic analysis--as opposed to hysterical hearsay--because some prospective med students may be dissuaded from entering this awesome profession on the basis of such erroneous claims.

 

[CarlosDanger]

Dbate, You're arguing a moot point, we all know that medicine is a lucrative field - and in better shape than other professions like law and vet, did you even read the article?

That doesn't mean that we can't talk about the fact that tuition rates are rising and doctors' fees may be falling...this is a problem. This could create a bubble at some point in the future if we don't address it. Is it as bad as vet? No, but its still a problem that should be addressed. I think its pretty idiotic to call NEJM "hysterical hearsay." They obviously did their homework and make very valid points.

Lots of data shows that prospective med students are not being dissuaded from applying to med school, last cycle there was a record number of applications, up over 6% from the year before - it was the biggest year-to-year increase since the mid '90s.

If you get a 60 on a test, would you consider that a success just because the class average was a 50? No. This is a problem that needs to be addressed.

 

[Euxox]

175K/118k=1.48
175k/150k=1.16

That is still superior to alternative fields.

It isn't that clear cut. The average starting salary of a physician (as in the average salary of a resident) is only about 55k. Sure, most physicians will get a virtually automatic bump to 175k three or four years down the line, but by this time the average MBA or JD will have gotten significant pay raises and a head start on paying off their debt. Also keep in mind that MBAs and JDs do not have to worry about increasing competition from doctors of accounting, paralegal practitioners, or lawyer assistants.

People will still go into medicine for the prestige and the moral satisfaction. The issue is that unless these debt/salary issues are addressed, future physicians will be very stressed and unhappy, and unhappy physicians are not going to be able to give 100% when treating their patients.

 

[Dbate]

Dbate, You're arguing a moot point, we all know that medicine is a lucrative field - and in better shape than other professions like law and vet, did you even read the article?

That doesn't mean that we can't talk about the fact that tuition rates are rising and doctors' fees may be falling...this is a problem. This could create a bubble at some point in the future if we don't address it. Is it as bad as vet? No, but its still a problem that should be addressed. I think its pretty idiotic to call NEJM "hysterical hearsay." They obviously did their homework and make very valid points.

Lots of data shows that prospective med students are not being dissuaded from applying to med school, last cycle there was a record number of applications, up over 6% from the year before - it was the biggest year-to-year increase since the mid '90s.

If you get a 60 on a test, would you consider that a success just because the class average was a 50? No. This is a problem that needs to be addressed.

This entire post makes me question your reading comprehension.

 

[Dbate]

It isn't that clear cut. The average starting salary of a physician (as in the average salary of a resident) is only about 55k. Sure, most physicians will get a virtually automatic bump to 175k Also, MBAs and JDs do not have to worry about increasing competition from doctors of accountanting, paralegal practitioners, or laywer assistants.

People will still go into medicine for the prestige and the moral satisfaction. The issue is that unless these debt/salary issues are addressed, future physicians will be very stressed and unhappy, and unhappy physicians are not going to be able to give 100% when treating their patients.

I definitely agree that people will still go into medicine for the moral satisfaction. I will never be able to economically justify leaving my current job/career for medical school (as starting compensation in my field is about 75K and rises to 150K within 5-6 years).

But I want to be a doctor because I truly love interacting with people and want to know that my work is making a positive contribution to people's lives, and not just to a company's profits.

I think this dimension of the profession is what complicates more rational/traditional economic evaluation of the "med school bubble".

People don't choose medicine just for the money.

 

[RogueUnicorn]

Thanks for the great commentary. I think healthcare will collapse in the next ten years. Healthcare costs are rising because no one knows the value of the services being provided - not even the physicians. The lack on Medicaid expansion will doom the ACA. 68% of poor uninsured blacks and 60% of poor uninsured whites will not have ANY coverage. Who or what will absorb their healthcare costs? Medical student enrollment is increasing dramatically but their is a residency freeze. In 2016 their will be more MD/DO students that residency spots. Big issue. Debt/income ratio is increasing as payment reform is moving toward capitulation and bundled care - lower physician payment. Sequestration is crushing healthcare. It's decreasing funding to Medicare by 25%. Cutting residency programs. Honestly, medicine will crash hardcore. Over the past year, I grew up and I see medicine for what it is. I am even more passionate now because if you're not you will be eliminated.

lots of uncited prognostics/statistics in your posts in general. also, who do you think is absorbing these costs right now?

 

[sinombre]

and the ACA is doomed because the poor people that have all of the health problems are not going to be covered under the medicaid expansion. When these people go to the ER and receive mandated care the hospitals will take HEAVY losses.

lol... uninsured people have always received care in the ER. And who do you think pays for it? Everyone else. The costs just get passed on to people who actually pay (people with insurance).

Which is less expensive: treating a problem in an outpatient setting, or treating that same problem in an ER? How about treating diabetes in a primary care setting, or treating a patient in DKA in the ER?

I'm not making an argument for or against the ACA, but this is the most commonly overlooked issue around healthcare reform, and it's seriously frustrating.

 

[Alexf]

P.S. And for students in Texas, it will be even longer. (note: Every time i read an article about student debt, i thank god I was born in Texas. )

What makes it different for Texas? Should I start establishing residency?

 

[13132]

What makes it different for Texas? Should I start establishing residency?

I think in state tuition is just super cheap there.

EDIT: I just check the MSAR and it is ~16k for Texas schools.

 

[sinombre]

also, who do you think is absorbing these costs right now?

Exactly.

 

[Alexf]

Exactly.

Sinombre, this may be slightly off topic, but the direction of the conversation is heading this way: what is a solution to serving the uninsured while being able to maintain the current pay rates that Doctors enjoy? Because I know that abuse of the ER isn't helping. I guess it may be a loaded question, but I am honestly just interested in hearing an answer.

 

[sinombre]

Sinombre, this may be slightly off topic, but the direction of the conversation is heading this way: what is a solution to serving the uninsured while being able to maintain the current pay rates that Doctors enjoy? Because I know that abuse of the ER isn't helping. I guess it may be a loaded question, but I am honestly just interested in hearing an answer.

I guess my point is that these people are already treated medically in emergency rooms, and we're already absorbing the cost. The same medical issue is more expensive to treat in an ER than an outpatient clinic, and preventative treatment in most cases is much cheaper than waiting until it becomes emergent and requires hospitalization (e.g. the diabetes vs DKA example). So a surge of newly insured people might have a fair number of drawbacks, but it's not as if we'll suddenly be paying for millions of people that we weren't already paying for.

 

[slz1900]

You don't get it. It doesn't matter if the pay is "relatively high" if the debt required to acquire the credentials to earn that pay are out of whack with the pay. It's what you have left after the loan payment that is what will cause the bubble to burst.

But the debt isn't out of whack with the income. That there probably isn't a bubble is the conclusion of the article.

 

[LizzyM]

But the debt isn't out of whack with the income. That there probably isn't a bubble is the conclusion of the article.

"Although it seems unlikely that we're in a bubble market for medical education, we may already be in one for veterinary medicine. That bubble will burst when potential students recognize that the costs of training aren't matched by later returns. Then the optometry bubble may burst, followed by the pharmacy and dentistry bubbles. At the extreme, we will march down the debt-to-income-ratio ladder, through psychiatrists to cardiologists to orthopedists . . . until no one is left but the MBAs."

We aren't there yet but it is possible that it may happen. Can we prevent it from happening? Keep in mind that this is a timely article given that the Deans and medical school administrators are meeting this week in Philly.

 

[slz1900]

"Although it seems unlikely that we're in a bubble market for medical education, we may already be in one for veterinary medicine. That bubble will burst when potential students recognize that the costs of training aren't matched by later returns. Then the optometry bubble may burst, followed by the pharmacy and dentistry bubbles. At the extreme, we will march down the debt-to-income-ratio ladder, through psychiatrists to cardiologists to orthopedists . . . until no one is left but the MBAs."

We aren't there yet but it is possible that it may happen. Can we prevent it from happening? Keep in mind that this is a timely article given that the Deans and medical school administrators are meeting this week in Philly.

Vet, optometry, pharmacy and law have had income/debt ratios that are far more out of whack than PCPs for 20 years, and no bubble has burst. Even if medicine is heading in that direction, we have proof of the resiliency of far less lucrative forms of education, and there is no reason to believe that medical school will be any less appealing in the future, even if debt continues to climb. If law school can have a model of terrible return for decades and still be appealing to new college grads, medical school can too (and I'm talking about in a couple decades when income might be out of whack with debt). It's possible that it may happen, but even the authors of the piece acknowledge that it would happen after higher ed completely falls apart. Averting problems that as of now are totally shapeless and that would appear in a totally different healthcare climate in the face of the collapse of our entire educational system seems like a tall order.

 

[KnuxNole]

This is also why it is a GOOD thing to go to cheap schools! Or, if you are offered scholarships, to jump on it!

 

[deleted407021]

It's something we definitely need to be cautious of. We have all the data we need from what amounts to an ongoing longitudinal study. From what I see, however, most people feel very secure in taking on debt in exchange for a career as physicians, so the faith is still there.

 

[yehhhboiii]

Vet, optometry, pharmacy and law have had income/debt ratios that are far more out of whack than PCPs for 20 years, and no bubble has burst. Even if medicine is heading in that direction, we have proof of the resiliency of far less lucrative forms of education, and there is no reason to believe that medical school will be any less appealing in the future, even if debt continues to climb. If law school can have a model of terrible return for decades and still be appealing to new college grads, medical school can too (and I'm talking about in a couple decades when income might be out of whack with debt). It's possible that it may happen, but even the authors of the piece acknowledge that it would happen after higher ed completely falls apart. Averting problems that as of now are totally shapeless and that would appear in a totally different healthcare climate in the face of the collapse of our entire educational system seems like a tall order.

thats because bubbles take time to burst. you can already see for law school that people are choosing other fields because the good jobs simply aren't there. why get a law degree when you can't get a decent job as a lawyer

 

[solitarius]

thats because bubbles take time to burst. you can already see for law school that people are choosing other fields because the good jobs simply aren't there. why get a law degree when you can't get a decent job as a lawyer

I think it's because there are no more cool lawyer shows on TV anymore.

 

[KnuxNole]

I think it's because there are no more cool lawyer shows on TV anymore.

I guess it's time for the renewal of Single Female Lawyer!

 

[CarlosDanger]

I guess it's time for the renewal of Single Female Lawyer!

Ally McBeal remake? God help us.

 

[KnuxNole]

Ally McBeal remake? God help us.

That would be lame. However, the show Bender made would make people flock to law school in drones!

 

[twelvetigers]

"Although it seems unlikely that we're in a bubble market for medical education, we may already be in one for veterinary medicine. That bubble will burst when potential students recognize that the costs of training aren't matched by later returns. Then the optometry bubble may burst, followed by the pharmacy and dentistry bubbles. At the extreme, we will march down the debt-to-income-ratio ladder, through psychiatrists to cardiologists to orthopedists . . . until no one is left but the MBAs."

We aren't there yet but it is possible that it may happen. Can we prevent it from happening? Keep in mind that this is a timely article given that the Deans and medical school administrators are meeting this week in Philly.

I'm late to the game in this thread - just kinda staggered in here randomly. I don't spend much time in pre-allo.

There are too many veterinarians graduating and not enough jobs to reliably employ them all. The AVERAGE debt is $150k... average. And the average starting income for a typical small animal sort of vet is about $60k/yr. This has become WAY WAY MORE of an issue in the last ten years than it ever was before. Maybe it was a bit of a problem before, but loans have skyrocketed in the last ten years or so.

A lot more vets these days are pursuing internships and/or residencies. (Vets can graduate and go directly into practice if they want, or they can pursue a specialty similar to what y'all do - some require an internship first and some don't.) Any vet doing an internship/residency is going to likely be putting their loans in forbearance, so that makes the debt even higher (the pay during either would be like $23k, though I'm sure there is variation). But they are pursuing these more than they were previously because sometimes it's easier to get an internship than it is to get a job...

Here's the thing about pre-vet students, though. Your article points out that the vet med 'bubble' is close to bursting as students realize that the returns aren't worth it and pursue other fields. Well... yeah, sure. Some will hear how much debt they will have compared to the income and they will decide it's not worth it. But (and I don't know if this is any different from what pre-meds are like).. but pre-vets are just... they want to be veterinarians. They decided when they were five and they just... they won't yield. Nothing you could say about it would scare them off, and they will probably even get mad at you for being pessimistic about it.

Obviously, it's not like you could generalize completely. I'm basing this on the forums, on people I knew personally... and on myself. I decided I was gonna be a vet when I was in kindergarten, and damnit, I fought tooth and nail to get here. It took me a while. Now I'm 28, about a year and a half away, and I have to admit I'm a bit jaded. But boy was I stubborn.

Anyway... I feel like as long as there are open seats, there will be students to fill them. That's part of the problem. They keep adding 'schools' and they recently accredited two of our three 'island' schools, so it's just... I wonder sometimes if the AVMA even realizes what a big deal this is, what it's doing to the profession, and that it's not just a 'phase' based on some glitch in the economy.

TL;DR vets are having rough times, and I don't see a good solution any time soon. I wouldn't be too quick to brush this off. It really sucks not feeling sure that I will be able to reliably find employment somewhere I want to live after I graduate, especially if I want to avoid corporate clinics.

Sorry if that was all a bit random - I just wanted to chime in.

 

[GiantMed]

I think there is a misunderstanding of the systems of Canada and the UK. The reason that the UK can get away paying physicians $100k to $160k is because it is almost free to go to school when compared to the USA. Also the UK has socialized medicine where physicians are employed by the state. Canada on the other hand has nationalized health insurance, where the state pays medical bills and people also have the option to buy private insurance. The income levels cited for Canada are wrong from what I have seen around, Internists in Canada are bringing in $200k a year and specialist are making well into the $300k to $400 range. Yes, physicians in Canada aren't bringing in Millions as much as they are in the USA but they aren't simply living off of $100k.
If America does head down the road towards a single payer system it would be more in line with Canada than Europe as it would be hard to explain to most students why they should take on $200k in debt and be okay being paid $100k. Think about it, you go through a long residency such as Neurosurgery or cardiothoracic and are told that you are a federal employee that is going to be paid $100k a year on top of your large loans. That isn't going to go over well at all, I wish the media would stop saying that we are heading towards a European model because we aren't. Unless there is some new plan to make MD a bachelors degree and make it damn near free. Also another point is that the salary figures from the UK are for people working for the government run hospitals. There are physicians in private practice making USA figures, such as there was a story of a neurosurgeon in the UK who was pulling down $600k a year in private practice.