On The Question of: Shall the Debt Be Repayed?

[YCAGA]

This is an interesting thread, but difficult to follow since multiple ideas are being discussed: Removing debt for those that are unmatched, Removing debt for everyone, Lowering tuition, and lowering interest rates on student loans. The situation is complicated and "fixing" it involves fixing lots of moving pieces at once -- tuition increases are at least partially due to the infinite availability of loan dollars, and the (apparent) infinite willingness of students to pay tuition.

But I do wonder whether loan forgiveness for the chronically unmatched could be addressed somewhat independent of all of those other issues. People who complete medical school but ultimately can't get a residency spot, for whatever reason, have great difficulty ever paying back their loans. Yes, they can stay in IBR for 25 years and have their debt discharged -- but that seems like a poor option, is it really necessary for them to carry this debt for that period of time if they have no chance of paying it off?

Yet, simply forgiving the debt seems wrong too -- students did make a commitment to repay, and they also (often) have the degree which might be of some benefit. My idea, posted on another thread, was to "share the pain". The student keeps 10% of the debt that they are responsible for -- this should be a more reasonable amount of debt that they actually have a chance of paying off. The school they graduated from is on the hook for 30-45% of the cost [Not sure what the right amount is, would need economic modeling]. Schools need some skin in the game, and schools that chronically do not match students need to be impacted more. The Gov't is on the hook for the rest. If you'd like to add a slice of the pie for the lender, I'm fine with that also although that's likely going to lead to lenders shying away from higher risk students / schools which might be problematic.

There clearly would need to be additional details. Someone who graduates medical school with an MD/MBA and is off to Wall Street shouldn't be able to use this pathway -- probably some income sensitivity is needed. Plus, anyone who uses this pathway loses all CMS funding eligibility -- that should stop people from trying to claim that they "failed to match and need their debt erased" and then try to match to something else. Plus this should only be available 5 years after graduation -- people can use IBR until then.

They already have to pay a certain percentage with IBR (unless their income is near the poverty line) and then pay a huge tax bill in year 25. If you have $600k forgiven in 2045, you pay income taxes on that $600k…and if you made $100k that year from employment, that $600k forgiven is taxed in the higher tax brackets because in the eyes of the government, you made $700k in income that year 🤡

Also why would the schools be on the hook? If anything your idea could create a system where schools have a financial incentive to give residencies to people that have giant red flags to the point of being unsafe.

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[dpmd]

What a weird argument. There is a large difference between a personal loan for a different car and literally having no choice (unless you come from an affluent family) but to take the money to acquire an education. (Which is pretty much a necessity in our society)

This is why K-12 is paid by property taxes and why you don't need to whip out a checkbook to pay for a child to go to school. This mindset is the same one that should be applied to college and graduate school. (Many modern nations worldwide have either FAR lower costs, easier payment plans, or tax-paid college in general, especially when speaking about Medical schools). Education is basically required to make any income in this nation to be able to survive, have healthcare (you know, not to die or go bankrupt if you get violently sick), and buy a home (to start building wealth). Yes, yes, I know there are exceptions, but again high school degrees only, on average, have FAR lower income compared to other individuals. Stats below:

HigherEdInfo.org: Difference in Median Earnings Between a High School Diploma and a Bachelors Degree

www.higheredinfo.org

The difference in Median Earnings Estimate, High School Diploma, and Bachelors Degree:
In my state of CA: 32,995, which is massive.
Or
Median usual weekly earnings of full-time wage
Q3: Bachelors: 1281(1.7x higher) or high school 749

Median weekly earnings $606 for high school dropouts, $1,559 for advanced degree holders : The Economics Daily: U.S. Bureau of Labor Statistics

In the third quarter of 2019, full-time workers age 25 and older had median weekly earnings of $975. Those without a high school diploma had median weekly earnings of $606, compared with $749 for high school graduates (no college), and $874 for workers with some college or an associate degree.

www.bls.gov

To have a middle-class job, you basically require a degree, especially since this nation lacks so many social safety nets that every other modern nation has.

I don't get why people keep talking about liberal art degrees. Suppose you go to undergraduate and get a bachelors to be a teacher, which is one of the world's most important jobs. You can easily end up in debt 80-100k if you need to pull out all loans. Then you have a teacher whose purpose is to help young minds develop be held down by loan payments that can cripple them for their entire lives. The United States does a horrible job incentivizing many of these positions that are so important since individuals need to think about the crippling debt that would occur.

Not to mention, the cost of undergraduate along is extremely cheap for a tax cost.

Tuition-Free College Could Cost Less Than You Think (Published 2019)

Making a tuition-free college education available to everyone who wants one is an immensely worthwhile — and realistic — goal, a Harvard economist says.

www.nytimes.com

Revenues of public degree-granting postsecondary institutions, by source of revenue and level of institution: Selected years, 2007-08 through 2016-17

The primary purpose of the Digest of Education Statistics is to provide a compilation of statistical information covering the broad field of American education from prekindergarten through graduate school. The Digest includes a selection of data from many sources, both government and private...

nces.ed.gov

"Eliminating tuition at all public colleges and universities would cost at least $79 billion a year, according to the most recent Department of Education data, and taxpayers would need to foot the bill.'
To put that in perspective, that would have been less than the US's military increase in 1 year alone. Doing something like this sounds like a no-brainer to me since it would benefit society, candidates, and future generations.

Anyways, education should not be compared to most items that can be bought by a persona loan. This isn't a new truck you want because you want the fastest horsepower. Education has always been different and always will be. (Similar to healthcare). It's time people stop treating a personal loan for a truck or car even close to the ability to rise out of poverty through education.

Edit: Note that I used a car for the example of a personal loan. A personal loan can be used for several different things. I was just giving an example of where a personal loan can be used. I am merely pointing out the point that education is not just some other thing you can buy on the market and should never be treated as such.

A car loan is a secured loan and is not the same thing as a personal unsecured loan. The necessity of a car to a person who has to commute to work versus the necessity of a bachelor's degree in just about anything except maybe for certain things that make you occupationally ready with the degree alone is very different (especially with the availability of numerous trade schools and apprenticeships that may be available with little to no cost). To use your healthcare example it is sort of like comparing coverage for acute injuries versus coverage for cosmetic surgery. The latter may lead to good things but isn't a necessity the way the former may be.

 

[YCAGA]

A car loan is a secured loan and is not the same thing as a personal unsecured loan. The necessity of a car to a person who has to commute to work versus the necessity of a bachelor's degree in just about anything except maybe for certain things that make you occupationally ready with the degree alone is very different (especially with the availability of numerous trade schools and apprenticeships that may be available with little to no cost). To use your healthcare example it is sort of like comparing coverage for acute injuries versus coverage for cosmetic surgery. The latter may lead to good things but isn't a necessity the way the former may be.

Just to clarify, are you saying that a bachelor’s degree is not de facto mandatory in today’s economy?

 

[dpmd]

Just to clarify, are you saying that a bachelor’s degree is not de facto mandatory in today’s economy?

It is not. Our economy requires plumbers, electricians, construction workers, vocational nurses, daycare workers, medical assistants, military members, dental hygienists, and any number of other workers who do not need bachelor degrees to do their jobs.

 

[NotAProgDirector]

They already have to pay a certain percentage with IBR (unless their income is near the poverty line) and then pay a huge tax bill in year 25. If you have $600k forgiven in 2045, you pay income taxes on that $600k…and if you made $100k that year from employment, that $600k forgiven is taxed in the higher tax brackets because in the eyes of the government, you made $700k in income that year 🤡

Also why would the schools be on the hook? If anything your idea could create a system where schools have a financial incentive to give residencies to people that have giant red flags to the point of being unsafe.

Not mentioned in my post, I'd make the loan forgiveness tax free. That way the student is left with a (hopefully) manageable debt and still is responsible for something.

I'd make the schools responsible because of the prliferation of offshore schools with marginal graduation rates. They should be held accountable for this.

Schools are separate from residency programs. My affiliated school has some unmatched students and wants us to create spots for them. The hospital has refused.

If schools actually "make a spot" for someone, or if this makes schools contract with programs for at least an internship, then those students would actually have some physician career moving forward. I don't see that as a bug, but rather a feature.

 

[tony101]

People are probably talking about Liberal Arts degrees because they make up an overwhelming majority of junk degrees. Teachers, sure I agree with you there. I think teacher pay should be boosted if they are spending their lives to educate the young. That probably is a calling more then any other profession I can think of and totally should be supported through taxpayer funding. However, there's also people, probably more so, that get degrees in fashion design and Greek philosophy and cooking. The taxpayers shouldn't be on the hook for that at all. Want to learn about Greek philosophy? Awesome. Go to your local library and check out a book.

As far as choice, I kinda agree, except you have the choice to be thoughtful and pick an education that is affordable to you and will have a good ROI for your future. The challenge is that most of education, the costs are inflated in proportion to what skills you actually gain and that the people seeking to gain skills are too young or naive to realize that. That's the real problem.

No, I think people are talking about liberal arts degrees because it seems like a common talking point I constantly hear about millennials. First, Liberal arts degrees are an expansive list of fields and are beat out or tied by other fields.

Fast Facts: Most popular majors (37)

The NCES Fast Facts Tool provides quick answers to many education questions (National Center for Education Statistics). Get answers on Early Childhood Education, Elementary and Secondary Education and Higher Education here.

nces.ed.gov

"Of the 1,956,000 bachelor’s degrees conferred in 2016–17, the greatest numbers of degrees were conferred in the fields of business (381,000), health professions and related programs (238,000), social sciences and history (159,000), psychology (117,000), biological and biomedical sciences (117,000)."
or more up to date

The 10 Most Popular College Majors | BestColleges

Some college majors are more popular than others due to their high earning potential and strong job prospects. Learn what the top 10 majors are in this guide.

www.bestcolleges.com

Furthermore, even breaking down liberal arts degrees, a huge percentage go into teaching (You know, the group you just spoke about).

Liberal Arts & Humanities | Data USA

In 2021, the locations with the highest concentration of Liberal Arts & Humanities degree recipients are Miami, FL, Los Angeles, CA, and Orlando, FL. The most common degree awarded to students studying Liberal Arts & Humanities is a associates degree.

datausa.io

Huge percentages making up elementary school teachers, middle school teachers, and educators in general.

Even the argument for philosophy is shocking to read. I guess I might be involved more with it since I am also doing bioethics, but they can be extremely useful. An example would be medical guidelines and ethics taught to physicians around the nation created by ethicists. A lot of these individuals gained their Ph.D. in philosophy since it allowed them to understand arguments and arrive at solutions through logical steps. Something many physicians lack which is why it's taught nationwide and is being more and more tested on USMLE. How is it "Junk"? Or do you mean the amount of money they make compared to the cost? Again how is it Junk? Do you really think you can learn as much as a Ph.D. just by reading the web without any insight or help along the way?

 

[Matthew9Thirtyfive]

It is not. Our economy requires plumbers, electricians, construction workers, vocational nurses, daycare workers, medical assistants, military members, dental hygienists, and any number of other workers who do not need bachelor degrees to do their jobs.

I’ve been saying for years that the idea that everyone needs to go to college for a bachelors is a scam.

 

[Goro]

This is an interesting thread, but difficult to follow since multiple ideas are being discussed: Removing debt for those that are unmatched, Removing debt for everyone, Lowering tuition, and lowering interest rates on student loans. The situation is complicated and "fixing" it involves fixing lots of moving pieces at once -- tuition increases are at least partially due to the infinite availability of loan dollars, and the (apparent) infinite willingness of students to pay tuition.

But I do wonder whether loan forgiveness for the chronically unmatched could be addressed somewhat independent of all of those other issues. People who complete medical school but ultimately can't get a residency spot, for whatever reason, have great difficulty ever paying back their loans. Yes, they can stay in IBR for 25 years and have their debt discharged -- but that seems like a poor option, is it really necessary for them to carry this debt for that period of time if they have no chance of paying it off?

Yet, simply forgiving the debt seems wrong too -- students did make a commitment to repay, and they also (often) have the degree which might be of some benefit. My idea, posted on another thread, was to "share the pain". The student keeps 10% of the debt that they are responsible for -- this should be a more reasonable amount of debt that they actually have a chance of paying off. The school they graduated from is on the hook for 30-45% of the cost [Not sure what the right amount is, would need economic modeling]. Schools need some skin in the game, and schools that chronically do not match students need to be impacted more. The Gov't is on the hook for the rest. If you'd like to add a slice of the pie for the lender, I'm fine with that also although that's likely going to lead to lenders shying away from higher risk students / schools which might be problematic.

There clearly would need to be additional details. Someone who graduates medical school with an MD/MBA and is off to Wall Street shouldn't be able to use this pathway -- probably some income sensitivity is needed. Plus, anyone who uses this pathway loses all CMS funding eligibility -- that should stop people from trying to claim that they "failed to match and need their debt erased" and then try to match to something else. Plus this should only be available 5 years after graduation -- people can use IBR until then.

I could see schools trying to weasel out of this type of arrangement by simply dismissing students who are at risk of not matching

 

[tony101]

It is not. Our economy requires plumbers, electricians, construction workers, vocational nurses, daycare workers, medical assistants, military members, dental hygienists, and any number of other workers who do not need bachelor degrees to do their jobs.

A bachelor's degree is required for a variety of professions. You are speaking about certification or specification in one small field of training, which is usually a short-term fix. However, this is again incorrect based on statistics where bachelors are far higher than their counterparts who may have some college or no college without training. Measuring the value of education : Career Outlook: U.S. Bureau of Labor Statistics
Again the statistics do not agree with you in terms of income on average and in a nation. Especially in a nation where income may dictate every aspect of your life due to limited social safety net programs, you need to make as much as possible.
Of course, the trade-off is here you are in debt so heavily that it can cripple you for your entire life, which is a massive issue.

Even then, the point still stands. If an individual wants to go for certification who can again become a large benefit to society, the cost would be less to help them thus should be done. The system should not be: if you are poor go to certification unless your career pays massive amounts of money (Even if the career is massively helpful to the nation). If affluent and mom and dad can pay, go to college.

 

[dpmd]

A bachelor's degree is required for a variety of professions. You are speaking about certification or specification in one small field of training, which is usually a short-term fix. However, this is again incorrect based on statistics where bachelors are far higher than their counterparts who may have some college or no college without training. Measuring the value of education : Career Outlook: U.S. Bureau of Labor Statistics
Again the statistics do not agree with you in terms of income on average and in a nation. Especially in a nation where income may dictate every aspect of your life due to limited social safety net programs, you need to make as much as possible.
Of course, the trade-off is here you are in debt so heavily that it can cripple you for your entire life, which is a massive issue.

Even then, the point still stands. If an individual wants to go for certification who can again become a large benefit to society, the cost would be less to help them thus should be done. The system should not be: if you are poor go to certification unless your career pays massive amounts of money (Even if the career is massively helpful to the nation). If affluent and mom and dad can pay, go to college.

The point is that the decision to get more education to earn more money is just that, a decision. Not a requirement like some are claiming here. It is a decision that people need to make taking into account the debt they will go into to get the increase in salary. Are you seriously trying to say that because doctors important that everyone else should pay for our education while allowing us to keep our six figure salaries? Because that is what it means to make higher education taxpayer funded.

Oh and that huge increase you are talking about in median pay for high school grad versus bachelor's degree is about 20k a year. So you are saying people have to get a bachelor degree (at the cost of what, like 30k a year) so they can take 6 yrs to even make up for the cost of tuition, let alone what they lost out on by taking longer to earn money? Meanwhile if a high school kid plans appropriately they can participate in a regional occupational center program and get training for entry level jobs in a variety of field for absolutely free and might get college credit for some of them meaning they can then start their career and work while furthering their education to advance in their career with less debt (this is part of what I did).

 

[Goro]

Hmmmm....I note that the OP got a Banhammer smack. Not gloating, just sending kudos to the Mods.

 

[YCAGA]

Are you seriously trying to say that because doctors important that everyone else should pay for our education while allowing us to keep our six figure salaries? Because that is what it means to make higher education taxpayer funded.

The audacity to suggest a system that every peer country to the US already has for all of higher education, not just doctors 😧

(And their doctors still make 6 figures)

 

[SurfingDoctor]

No, I think people are talking about liberal arts degrees because it seems like a common talking point I constantly hear about millennials. First, Liberal arts degrees are an expansive list of fields and are beat out or tied by other fields.

Fast Facts: Most popular majors (37)

The NCES Fast Facts Tool provides quick answers to many education questions (National Center for Education Statistics). Get answers on Early Childhood Education, Elementary and Secondary Education and Higher Education here.

nces.ed.gov

"Of the 1,956,000 bachelor’s degrees conferred in 2016–17, the greatest numbers of degrees were conferred in the fields of business (381,000), health professions and related programs (238,000), social sciences and history (159,000), psychology (117,000), biological and biomedical sciences (117,000)."
or more up to date

The 10 Most Popular College Majors | BestColleges

Some college majors are more popular than others due to their high earning potential and strong job prospects. Learn what the top 10 majors are in this guide.

www.bestcolleges.com

Furthermore, even breaking down liberal arts degrees, a huge percentage go into teaching (You know, the group you just spoke about).

Liberal Arts & Humanities | Data USA

In 2021, the locations with the highest concentration of Liberal Arts & Humanities degree recipients are Miami, FL, Los Angeles, CA, and Orlando, FL. The most common degree awarded to students studying Liberal Arts & Humanities is a associates degree.

datausa.io

Huge percentages making up elementary school teachers, middle school teachers, and educators in general.

Even the argument for philosophy is shocking to read. I guess I might be involved more with it since I am also doing bioethics, but they can be extremely useful. An example would be medical guidelines and ethics taught to physicians around the nation created by ethicists. A lot of these individuals gained their Ph.D. in philosophy since it allowed them to understand arguments and arrive at solutions through logical steps. Something many physicians lack which is why it's taught nationwide and is being more and more tested on USMLE. How is it "Junk"? Or do you mean the amount of money they make compared to the cost? Again how is it Junk? Do you really think you can learn as much as a Ph.D. just by reading the web without any insight or help along the way?

I interact with a lot of Bioethicists in my line of work (dying or near death kids often envolks that). I'm not here to throw shade and they are all nice folk... but I've never found ethics very helpful. Ethics is a societal feeling but even more so, can be very personal... not something one learns in a classroom. Personally, I'd much rather had a lawyer backing my medical decisions than an ethicist. But I digress.

 

[YCAGA]

I interact with a lot of Bioethicists in my line of work (dying or near dying kids often envolks that). I'm not here to throw shade and they are all nice folk... but I've never found ethics very helpful. Ethics is a collective feeling... not something one learns in a classroom. But I digress.

Iirc philosophy majors have the highest average LSAT scores, but I might just be making that memory up because philosophers and lawyers are both tricky with fancy words. Either way, philosophy degrees aren’t totally useless.

 

[SurfingDoctor]

Iirc philosophy majors have the highest average LSAT scores, but I might just be making that memory up because philosophers and lawyers are both tricky with fancy words. Either way, philosophy degrees aren’t totally useless.

Yeah? When was the last time you paid a philosopher?

 

[YCAGA]

Yeah? When was the last time you paid a philosopher?

Never. My lawyer works for free

 

[YCAGA]

Average LSAT Scores by Major

Are some majors better prepared for the LSAT than others? While law schools don’t require students to have any particular major, Derek T. Muller,

magoosh.com

Classics, the ultimate “useless liberal arts degree”, has the second highest average LSAT…so this argument doesn’t make sense that certain liberal arts degrees are automatically worthless. It’s also barely relevant to the 17 different discussions happening in this post, and definitely not the original post.

 

[Lawpy]

Average LSAT Scores by Major

Are some majors better prepared for the LSAT than others? While law schools don’t require students to have any particular major, Derek T. Muller,

magoosh.com

Classics, the ultimate “useless liberal arts degree”, has the second highest average LSAT…so this argument doesn’t make sense that certain liberal arts degrees are automatically worthless. It’s also barely relevant to the 17 different discussions happening in this post, and definitely not the original post.

isnt the lsat based on reading ability? So reading heavy majors doing well on a reading test is no surprise

 

[beattheprocess]

isnt the lsat based on reading ability? So reading heavy majors doing well on a reading test is no surprise

It's strictly a deductive reasoning test. Every question is either "must be true" or "must not be true." I wish the MCAT was this easy.

sample: https://www.lsac.org/sites/default/files/legacy/docs/default-source/jd-docs/sampleptjune.pdf

 

[Lawpy]

It's strictly a deductive reasoning test. Every question is either "must be true" or "must not be true." I wish the MCAT was this easy.

sample: https://www.lsac.org/sites/default/files/legacy/docs/default-source/jd-docs/sampleptjune.pdf

Section 4 of that pdf looks like a reading analysis section. Philosophy majors will obviously destroy the LSAT because that is cakewalk for all the dense readings they have to do. I think classics and literature majors can fare well too.

 

[Chemist0157]

The audacity to suggest a system that every peer country to the US already has for all of higher education, not just doctors 😧

(And their doctors still make 6 figures)

US physicians make quite a bit more, QUITE a bit more, than the rest of the world.

Medscape: Medscape Access

www.medscape.com

That is not the best angle to critique the current system IMO. I would rather be here and pay off some loans and still come out well ahead in the US than anywhere else.

I don't think this has much to do with the OP though.

 

[YCAGA]

US physicians make quite a bit more, QUITE a bit more, than the rest of the world.

Medscape: Medscape Access

www.medscape.com

That is not the best angle to critique the current system IMO. I would rather be here and pay off some loans and still come out well ahead in the US than anywhere else.

I don't think this has much to do with the OP though.

That survey is horrible and leaves out the countries that pay close to the US: the Netherlands, Australia, Canada, and Switzerland. It also leaves out the countries (Norway, Finland, Denmark, New Zealand, Belgium, Ireland) that still pay very well, especially in private practice and considering their 40-50 hour/week residencies with 6 weeks of vacation and free medical school. Surgical residents in some of those countries are working 45 hours/week with Q7-Q14 call, with 6-12 months of paid family leave and the possibility of doing residency at 0.8 FTE so you work a 4 day week plus monthly call. Tell me that isn’t worth making “only” $200k with excellent benefits and still being in the top 1% of income of their respective country. All of these countries (normally) pay residents overtime which results in much better pay during residency. That survey includes Germany but the number for Germany is low for private practice, which is where you want to be if money is your goal. $240k/yr in primary care private practice isn’t unheard of in Germany, and Germany isn’t even near the top of that list of the countries in terms of salary.

I can cite source but most of them will be in German/Dutch/Nordic languages. And further details about each countries systems comes from discussions with medical students/residents/attendings in those countries.

US doctors have it great in terms of attending salary and lifetime earnings, but that Medscape survey which people love to link is depressingly misleading. I almost wish I could scrub that thing from the internet.

Oh, and the US spends 50-150% more on healthcare per capita than all of these countries, and their physician salaries are definitely not proportionately deflated.

 

[YCAGA]

I need to make a bot that auto replies the above comment every time someone links that Medscape surgery and tries to argue that American physicians are overwhelmingly ahead of our peer countries in terms of salary. That is the Kool-aid they make us drink while we work 80hrs/week for $55k/yr with 2 weeks vacation, no family leave, no overtime. Then as attendings we still don’t have much vacation, pay is definitely higher, but we don’t have amazing tort reform and many patients don’t have insurance or are quite under-insured. Suing a doctor in those countries is not common or easy, and every patient you see is insured. Also in many of those countries, you bill one insurance company…the government. Your overhead in private practice is half or a third of what it is in the US. And, although conservative in the US will die trying to convince you otherwise, the governments in these countries are normally less pissy about denying claims than US insurance companies. Their governments just want to protect against fraud, not generate huge profits like in the US.

 

[WhittyPsyche]

Okay it’s driving me nuts. Can we stop saying “repayed”???

 

[beattheprocess]

Tell me that isn’t worth making “only” $200k with excellent benefits and still being in the top 1% of income of their respective country.

Ok.

It's not worth it.

 

[YCAGA]

Ok.

It's not worth it.

Witty. Fortunately for those countries, medicine is still by far the most competitive degree to be admitted to, so they have no trouble finding highly qualified people that think what I described is a pretty awesome deal.

 

[mrbreakfast]

Classics, the ultimate “useless liberal arts degree”, has the second highest average LSAT…so this argument doesn’t make sense that certain liberal arts degrees are automatically worthless.

Classics major here. Strongly believe that my degree has helped me more in medicine (and life) than a biochemistry degree or whatever the "correct" degree for premed is. Would imagine the same is true for most of my graduating classmates in my major, many of whom went on to law or medical practice.

To argue against myself, however, I (and I think most humanities majors) chose this major not because we expected to get a job in the field - the chance of getting tenure as a classics PhD is probably around the same as a randomly-selected college freshman premed ending up matching ortho - but because we liked it and knew we'd probably end up doing something else.

Ultimately, I think our country is shifting (or already has shifted) toward viewing education as a direct means to a career, and not as personal enrichment on the pathway toward a career. If it's the former, it's difficult to envision compensation for people who "failed" their training. If it's the latter, you could argue for free undergraduate training, but it's tough to state that there are intrinsic benefits to medical school education.

 

[beattheprocess]

Ok.

It's not worth it.

I think you're missing the part of the survey where they ask if they feel they are being compensated fairly, and all the other countries fall under 50%.

 

[YCAGA]

I think you're missing the part of the survey where they ask if they feel they are being compensated fairly, and all the other countries fall under 50%.

I think you’re missing the part of the survey where the sample size was 500-1000 in countries with tens of thousands or hundreds of thousands of physicians. Not to mentioned the survey included one of the 8 or so countries I mentioned.

Plus the crazy response bias that comes with any survey. And in this case, who do you think is more likely to respond to a salary survey? Someone who thinks they are underpaid or someone who thinks their job is great? Just like SDN, people are much less likely to get involved with surveys and discussions when they are already happy.

And the country that approaches the US (Germany) really was embrassed by their mid 40s salary satisfaction when the US came in and smacked them with a whopping mid 50s percent satisfaction.

 

[beattheprocess]

I think you’re missing the part of the survey where the sample size was 500-1000 in countries with tens of thousands or hundreds of thousands of physicians. Not to mentioned the survey included one of the 8 or so countries I mentioned.

Plus the crazy response bias that comes with any survey. And in this case, who do you think is more likely to respond to a salary survey? Someone who thinks they are underpaid or someone who thinks their job is great? Just like SDN, people are much less likely to get involved with surveys and discussions when they are already happy.

And the country that approaches the US (Germany) really was embrassed by their mid 40s salary satisfaction when the US came in and smacked them with a whopping mid 50s percent satisfaction.

The same response bias would also apply to US physicians. And I would say the difference in pay more than offsets the price and hours.

 

[Chemist0157]

That survey is horrible and leaves out the countries that pay close to the US: the Netherlands, Australia, Canada, and Switzerland. It also leaves out the countries (Norway, Finland, Denmark, New Zealand, Belgium, Ireland) that still pay very well, especially in private practice and considering their 40-50 hour/week residencies with 6 weeks of vacation and free medical school. Surgical residents in some of those countries are working 45 hours/week with Q7-Q14 call, with 6-12 months of paid family leave and the possibility of doing residency at 0.8 FTE so you work a 4 day week plus monthly call. Tell me that isn’t worth making “only” $200k with excellent benefits and still being in the top 1% of income of their respective country. All of these countries (normally) pay residents overtime which results in much better pay during residency. That survey includes Germany but the number for Germany is low for private practice, which is where you want to be if money is your goal. $240k/yr in primary care private practice isn’t unheard of in Germany, and Germany isn’t even near the top of that list of the countries in terms of salary.

I can cite source but most of them will be in German/Dutch/Nordic languages. And further details about each countries systems comes from discussions with medical students/residents/attendings in those countries.

US doctors have it great in terms of attending salary and lifetime earnings, but that Medscape survey which people love to link is depressingly misleading. I almost wish I could scrub that thing from the internet.

Oh, and the US spends 50-150% more on healthcare per capita than all of these countries, and their physician salaries are definitely not proportionately deflated.

I know I would make less in Canada. That is true for several of the other countries you listed. Comparable countries were Luxembourg, Netherlands, and Australia in some ways.

 

[VA Hopeful Dr]

I know I would make less in Canada. That is true for several of the other countries you listed. Comparable countries were Luxembourg, Netherlands, and Australia in some ways.

Australia is not comparable. One US dollar is worth currently 1.3 Australian dollars, so while the salaries in dollars may be roughly equivalent that means that we're actually making 30% more than they are. Plus, that assumes equal cost of living which for the vast majority of the US it is not. Let's also not forget their significantly higher income tax rate especially at higher income levels.

You can go ahead and throw out Luxembourg because that is a blindingly small, quite wealthy country. Same with Switzerland.

 

[Matthew9Thirtyfive]

I think you’re missing the part of the survey where the sample size was 500-1000 in countries with tens of thousands or hundreds of thousands of physicians. Not to mentioned the survey included one of the 8 or so countries I mentioned.

Plus the crazy response bias that comes with any survey. And in this case, who do you think is more likely to respond to a salary survey? Someone who thinks they are underpaid or someone who thinks their job is great? Just like SDN, people are much less likely to get involved with surveys and discussions when they are already happy.

And the country that approaches the US (Germany) really was embrassed by their mid 40s salary satisfaction when the US came in and smacked them with a whopping mid 50s percent satisfaction.

So the small sample size is a problem for his conclusions but not for yours?

 

[NotAProgDirector]

I could see schools trying to weasel out of this type of arrangement by simply dismissing students who are at risk of not matching

I'd treat dismissed students the same way as those that don't match. Perhaps some sort of exception for professionalism issues (although that could be abused by schools also)

 

[Dr.SPAC3MAN]

No
If the Everybody Wins Everybody win, If the Student Loses, Everybody else Has to Lose too. Sound Fair To Me?

Life's not fair. Wow, I used that on you before I used it on my son.

 

[Dr.SPAC3MAN]

Just Like @SurfingDoctor said.

If I am a very good gambler, and you give me a quarter million to go gamble (to preseumably make more money) and I lose all the money, how are you gonna ask me for the money back? I tried in good faith to win money. I didn't and the money is gone. We both Lose. Periodt.
If I turned the 250K into 400K, would you complain then? My guess is no?

lenders are not buying lottery tickets. They are making money of the interest you pay them back. They don't expect any more or any less than the agreed upon terms in the loan contract.

 

[YCAGA]

So the small sample size is a problem for his conclusions but not for yours?

Where did I use a small sample size?

 

[YCAGA]

I know I would make less in Canada. That is true for several of the other countries you listed. Comparable countries were Luxembourg, Netherlands, and Australia in some ways.

I never said you would make the same in Canada or any of these countries. Just that they are close to US compensation, especially when you adjust for other factors. I guess if you don’t place a monetary value on a better lifestyle and working conditions then the difference in pay seems larger.

Also my original reply to bring up other countries was that their doctors still make 6 figures since someone implied they didn’t, and then disagreeing when someone said that American doctors might “quite a bit, QUITE a bit” more than our peer countries. You guys are losing the context, which is fine, this thread has like 4 different topics going on at once. I have even said that American doctors on average win in terms of salary. My point is that they don’t win by as much as that Medscape survey makes it seem, due to a ton of reasons.

 

[YCAGA]

The same response bias would also apply to US physicians. And I would say the difference in pay more than offsets the price and hours.

Exactly, which is why that survey is crap. I was being sarcastic that we should care about the US numbers in comparison to the German ones. I didn’t use any of the Medscape salary numbers in my argument.

 

[beattheprocess]

Wait why did OP’s account get put on hold?

 

[calivianya]

This is an interesting thread, but difficult to follow since multiple ideas are being discussed: Removing debt for those that are unmatched, Removing debt for everyone, Lowering tuition, and lowering interest rates on student loans. The situation is complicated and "fixing" it involves fixing lots of moving pieces at once -- tuition increases are at least partially due to the infinite availability of loan dollars, and the (apparent) infinite willingness of students to pay tuition.

But I do wonder whether loan forgiveness for the chronically unmatched could be addressed somewhat independent of all of those other issues. People who complete medical school but ultimately can't get a residency spot, for whatever reason, have great difficulty ever paying back their loans. Yes, they can stay in IBR for 25 years and have their debt discharged -- but that seems like a poor option, is it really necessary for them to carry this debt for that period of time if they have no chance of paying it off?

Yet, simply forgiving the debt seems wrong too -- students did make a commitment to repay, and they also (often) have the degree which might be of some benefit. My idea, posted on another thread, was to "share the pain". The student keeps 10% of the debt that they are responsible for -- this should be a more reasonable amount of debt that they actually have a chance of paying off. The school they graduated from is on the hook for 30-45% of the cost [Not sure what the right amount is, would need economic modeling]. Schools need some skin in the game, and schools that chronically do not match students need to be impacted more. The Gov't is on the hook for the rest. If you'd like to add a slice of the pie for the lender, I'm fine with that also although that's likely going to lead to lenders shying away from higher risk students / schools which might be problematic.

There clearly would need to be additional details. Someone who graduates medical school with an MD/MBA and is off to Wall Street shouldn't be able to use this pathway -- probably some income sensitivity is needed. Plus, anyone who uses this pathway loses all CMS funding eligibility -- that should stop people from trying to claim that they "failed to match and need their debt erased" and then try to match to something else. Plus this should only be available 5 years after graduation -- people can use IBR until then.

I think the school being on the hook for some of the debt is one of the best ideas I’ve ever heard - it would force schools to be a little more careful in the selection process, and would likely make schools (especially DO schools) think twice about opening up weak programs with poor clinical experiences in the middle of nowhere. Outside of medicine, it would also curb a lot of expensive degrees that don’t lead to jobs, which would be great for literally everyone except the schools themselves. Heaven forbid they don’t get to trick students who didn’t do enough research beforehand into tens or hundreds of thousands of dollars in debt.

Just to clarify, are you saying that a bachelor’s degree is not de facto mandatory in today’s economy?

Other people have covered it, but not even close. My SO doesn’t even have a high school diploma (dropped out in 10th grade and never got his GED) and he makes far more than I did when I was working as a RN with a bachelor’s. He’ll continue to make more than me while I’m a resident... the tides are only going to shift once I’m a practicing physician. There are plenty of jobs that pay decently without a bachelor’s. The problem is that a lot of people look at some jobs as “less” just because they require physical labor and/or getting dirty.

Even the argument for philosophy is shocking to read. I guess I might be involved more with it since I am also doing bioethics, but they can be extremely useful. An example would be medical guidelines and ethics taught to physicians around the nation created by ethicists. A lot of these individuals gained their Ph.D. in philosophy since it allowed them to understand arguments and arrive at solutions through logical steps. Something many physicians lack which is why it's taught nationwide and is being more and more tested on USMLE. How is it "Junk"? Or do you mean the amount of money they make compared to the cost? Again how is it Junk? Do you really think you can learn as much as a Ph.D. just by reading the web without any insight or help along the way?

Useful personally and useful financially, are two totally different things. My first degree was in psych. I learned a ton and I have found the knowledge useful, but it was a completely useless degree in that I could not find a different tier of job when I was done. I actually got lower offers while I was job searching after my degree than what I was currently making at the job I worked during school, so I just ended up staying put.

Knowledge is wonderful, but not if you’re going to pay $20k, $50k, or even more for it for no return. I could have easily learned everything in my psych degree off of YouTube and have been better off.

I do think a motivated person can learn absolutely anything off the internet - more complicated concepts might take watching several different videos, hearing it several different ways, and discussing it on forums, but it can still be done. I would bet most of us here are living proof of that, considering there are a large fraction of us who have taught ourselves medicine with sketchy, pathoma, UWorld, and Anki while never stepping foot in a classroom if we could help it.

 

[YCAGA]

The problem is that a lot of people look at some jobs as “less” just because they require physical labor and/or getting dirty.

Uh…there is a huge practical side to this that you are complete ignoring. Physical labor is very difficult to do into your 50s, let alone your 60s. And you need to work that long to save for retirement if you are making mid to high 5-figures, which is how much those jobs make normally. Yes I know everyone’s second cousin on SDN and Reddit is a plumber who makes $300k at age 35 but, on average, physical trades are making $50-70k after completing training. You can make that much with a “useless” major bachelor’s degree in your first job at 22 years old.

Also for every person like your SO that dropped out in 10th grade and never got a GED, there are at least a dozen people with that same story that will never make more than an RN and have a fraction of the job security. These anecdotes for trade jobs are so silly. I can give an anecdote about an art history major who started their own business and makes $500k/yr, and people would rightfully say that example is hardly representative. But for some reason people think anecdotes are acceptable when pushing trades jobs and averages are acceptable when talking about “useless majors.” Makes no sense.

 

[VA Hopeful Dr]

Uh…there is a huge practical side to this that you are complete ignoring. Physical labor is very difficult to do into your 50s, let alone your 60s. And you need to work that long to save for retirement if you are making mid to high 5-figures, which is how much those jobs make normally. Yes I know everyone’s second cousin on SDN and Reddit is a plumber who makes $300k at age 35 but, on average, physical trades are making $50-70k after completing training. You can make that much with a “useless” major bachelor’s degree in your first job at 22 years old.

Also for every person like your SO that dropped out in 10th grade and never got a GED, there are at least a dozen people with that same story that will never make more than an RN and have a fraction of the job security. These anecdotes for trade jobs are so silly. I can give an anecdote about an art history major who started their own business and makes $500k/yr, and people would rightfully say that example is hardly representative. But for some reason people think anecdotes are acceptable when pushing trades jobs and averages are acceptable when talking about “useless majors.” Makes no sense.

Most of us aren't even talking about the 1 in a million people who did exceptionally well. But lots of good jobs don't require a bachelor's degree. Associates degrees get you lots of jobs that will pay well and you can get started at age 20 with minimal/no debt. If your high school has a good vocational school, you can start at 18. And sure, those jobs likely get you in the 50-75k range. But starting that early without a huge debt load can be a huge thing. I mean, teachers start at 22 making 30-40k. This is more than that starting earlier.

 

[Matthew9Thirtyfive]

Wait why did OP’s account get put on hold?

Repeated inflammatory posts despite warnings. He’s on a temporary time out.

 

[dpmd]

The audacity to suggest a system that every peer country to the US already has for all of higher education, not just doctors 😧

(And their doctors still make 6 figures)

There are six figures and then there are six figures

I have no interest in government funded school in exchange for a permanent decrease in earnings (well, aside from the government funding i got in exchange for my military service prior to becoming a doctor)

 

[GoSpursGo]

I'd make the schools responsible because of the prliferation of offshore schools with marginal graduation rates. They should be held accountable for this.

So, I wholeheartedly agree with you, but how can the US government hold a foreign school responsible for a US citizen taking out a bad loan? Like, if Uncle Sam comes asking AUA for his money back and AUA says "no," what then?

 

[SurfingDoctor]

So, I wholeheartedly agree with you, but how can the US government hold a foreign school responsible for a US citizen taking out a bad loan? Like, if Uncle Sam comes asking AUA for his money back and AUA says "no," what then?

 

[YCAGA]

There are six figures and then there are six figures

View attachment 333431
I have no interest in government funded school in exchange for a permanent decrease in earnings (well, aside from the government funding i got in exchange for my military service prior to becoming a doctor)

It is a fallacy to assume that government funding for school equals a permanent decrease in earnings. That data is 17 years old (damn we are all old since 2004 doesn’t seem that long ago) and from what I know for 2020-2021 numbers, some of those numbers are too low even adjusted for PPP and inflation (Germany, Switzerland, Norway, and Finland all are much lower than more recent numbers). Regardless, two countries (Netherlands and Australia) beat the US in specialist earnings and they have extremely cheap medical school, basically free compared to what we pay in the states. So it’s not impossible to have better working conditions, free/cheap school, and equal or near equal pay. It’s already been done…

 

[YCAGA]

Australia is not comparable. One US dollar is worth currently 1.3 Australian dollars, so while the salaries in dollars may be roughly equivalent that means that we're actually making 30% more than they are. Plus, that assumes equal cost of living which for the vast majority of the US it is not. Let's also not forget their significantly higher income tax rate especially at higher income levels.

You can go ahead and throw out Luxembourg because that is a blindingly small, quite wealthy country. Same with Switzerland.

Australia is comparable even when adjusting for currency conversion and PPP. Hopefully anyone that got into medical school knows that currency conversions exist lol. So probably not needed to say that an equal number in Kangaroo bucks doesn’t equal the same amount in USD, but I guess people always surprise me

Luxembourg is hilariously small and very rich so I agree it is not a useful data point. Switzerland is within 10% of the US in terms of GDP/capita (PPP) so they aren’t so rich that we can just throw their system out because it doesn’t fit a certain narrative. They also have a almost completely private insurance system which is heavily regulated by the government to protect citizens from being exploited. Specialists in Switzerland are making US level numbers in private practice (500k in ortho, 450k in anesthesia, 700k in neurosurgery, 500k in GI, etc). They also have tax rates similar to the US, a little higher but not Sweden level high

Also let’s not pretend like the US government isn’t already spending a stupid amount on healthcare…medicare and Medicaid make up 25% of the federal budget. Our super-power military and foreign “assistance” only costs us 16% of the federal budget. Salaries aren’t even that much higher than countries that 2/3 to 1/3 as much as on healthcare on a per capita basis.

Finally, these countries all do have higher taxes. But, it’s not as if you pay a 25% effective tax rate in the US and a 45% effective tax rate in another country that your 20% of extra taxes aren’t helping you at all and they are just turning into handouts for poor people. You don’t have to save for your kids college since it will be essentially free, don’t have to spend as much on disability or malpractice insurance, your salary pays for you and/or your spouse to take off months of family leave with each kid you have and still get paid (albeit a reduced amount of your usual salary), all of these salaries include at least 6 weeks vacation compared to probably an average of 3-4 in the US, you and your family’s healthcare normally is included in that 45% tax rate whereas in the US it is not. Probably forgot a few, but my point is that yes you will get taxed more in these countries with free/cheap medical school, but your disposable income isn’t that much lower in these countries. The US is still king when it comes to building wealth as an average physician, but the gap isn’t nearly as wide as most Americans think.

Most of us aren't even talking about the 1 in a million people who did exceptionally well. But lots of good jobs don't require a bachelor's degree. Associates degrees get you lots of jobs that will pay well and you can get started at age 20 with minimal/no debt. If your high school has a good vocational school, you can start at 18. And sure, those jobs likely get you in the 50-75k range. But starting that early without a huge debt load can be a huge thing. I mean, teachers start at 22 making 30-40k. This is more than that starting earlier.

That’s all fair. I agree getting an expensive bachelor’s and then going into a field that pays comparatively little is a bad decision and should be discouraged. But it’s not as simple as trades = good and non-STEM bachelors = bad which is how this argument usually goes. I understand you personally have a more nuanced view which I mostly agree with.

 

[dpmd]

It is a fallacy to assume that government funding for school equals a permanent decrease in earnings. That data is 17 years old (damn we are all old since 2004 doesn’t seem that long ago) and from what I know for 2020-2021 numbers, some of those numbers are too low even adjusted for PPP and inflation (Germany, Switzerland, Norway, and Finland all are much lower than more recent numbers). Regardless, two countries (Netherlands and Australia) beat the US in specialist earnings and they have extremely cheap medical school, basically free compared to what we pay in the states. So it’s not impossible to have better working conditions, free/cheap school, and equal or near equal pay. It’s already been done…

More recent data disagrees with you (aside from Luxembourg).
Luxembourg 352/278
US 350/242
Belgium 331/138
Germany 222/214
Canada 249/158
Switzerland 228/172
Netherlands 200/137
Australia 210/104