What more can we do?

[westsidestoryz]

As a DO student, reading the recent changes about the merge, new DO schools opening, residency shortage, and other political issues with COCA, what can we do as a student?

Besides the conventional wisdom of study hard, make connections, do well on boards, and don't be an ass, what can we, as the future's leader in healthcare do to better the status quo? Sure, my number one concern is school and patient care but I can't ignore the impact these issues have on students from MS1 to 15-year vets. And you might say, "Oh you didn't even graduate yet so you have no experience or power to do much", but isn't it better for our profession if we younger students tackle these issues or at least be keen to it?

I did not get into medicine to go into debates about policies but it looks like its part of our everyday lives. I'm not saying I alone can make the system better but I just feel like our entire profession is reliant on a few select groups in government and the board. And it's pretty disheartening to hear about the same complaints and the hate DOs get on SDN.

Although there were issues in healthcare since the dawn of time, I sense it will only get worse. What happened to our profession and what can the younger generation do about it?

---

Members don't see this ad.

 

[Rekt]

Nothing.

Really. Any argument you put up will be met with, "Oh, you're against fixing the doctor shortage?" regardless of the fact it doesn't really even exist. Having medical students getting pumped out benefits the people who matter. The schools/admins make guaranteed free money off tuition since seats will always fill. COCA benefits by staying relevant and I'm sure they get kickbacks too. Most of the residencies opening now are from national groups/corporations, not even funded by CMS anymore. This benefits them because it drastically increases supply, which will eventually drive salaries down. You can 100% forget about any argument that has anything to do with salary and physicians because we're all "too rich already". You can try and avoid national group/CMG residencies, but the bottom of the barrel students will take anything. This doesn't even touch on the massive proliferation of online non-physician practitioners going into "medicine". You can try and not teach them or hire them, but eventually some docs will take the bait if there's some cash offered. Why would any of these agencies let you in if your goal is to make them less money?

Get in, develop a plan to earn as much passive income as you can, leave this dumpster fire.

 

[Goro]

As a DO student, reading the recent changes about the merge, new DO schools opening, residency shortage, and other political issues with COCA, what can we do as a student?

Besides the conventional wisdom of study hard, make connections, do well on boards, and don't be an ass, what can we, as the future's leader in healthcare do to better the status quo? Sure, my number one concern is school and patient care but I can't ignore the impact these issues have on students from MS1 to 15-year vets. And you might say, "Oh you didn't even graduate yet so you have no experience or power to do much", but isn't it better for our profession if we younger students tackle these issues or at least be keen to it?

I did not get into medicine to go into debates about policies but it looks like its part of our everyday lives. I'm not saying I alone can make the system better but I just feel like our entire profession is reliant on a few select groups in government and the board. And it's pretty disheartening to hear about the same complaints and the hate DOs get on SDN.

Although there were issues in healthcare since the dawn of time, I sense it will only get worse. What happened to our profession and what can the younger generation do about it?

Long term: join the AOA and COCA, get inside their power structure and make changes from within.

Short term: lobby your DO faculty to do the above. If they're True Believers, avoid them, they won't help you. Just as an side, both our Chair of OMM/OMT and our Dean are against this mindless expansion.

Lobby your local Congressperson and Senator and state politicians to support the creation of new residency slots.

What can YOU do: be the best student you can. It's the weakest students, with red flags, that will most likely not match. And if any AOA people come visit your school, politely roast them about the rate of numbers of grads vs much slower rate of residency slot additions.

But keep in mind that the number of residency slots now STILL outnumber the amount of bodies graduating each year, even with the expansions. But you may simply have to get used to doing a residency at a community hospital in small town America.

 

[BorntobeDO?]

Nothing.

Really. Any argument you put up will be met with, "Oh, you're against fixing the doctor shortage?" regardless of the fact it doesn't really even exist. Having medical students getting pumped out benefits the people who matter. The schools/admins make guaranteed free money off tuition since seats will always fill. COCA benefits by staying relevant and I'm sure they get kickbacks too. Most of the residencies opening now are from national groups/corporations, not even funded by CMS anymore. This benefits them because it drastically increases supply, which will eventually drive salaries down. You can 100% forget about any argument that has anything to do with salary and physicians because we're all "too rich already". You can try and avoid national group/CMG residencies, but the bottom of the barrel students will take anything. This doesn't even touch on the massive proliferation of online non-physician practitioners going into "medicine". You can try and not teach them or hire them, but eventually some docs will take the bait if there's some cash offered. Why would any of these agencies let you in if your goal is to make them less money?

Get in, develop a plan to earn as much passive income as you can, leave this dumpster fire.

This type of thinking (the red) is how we got here. I liked the post upto the last line. We have to be better stewarts than the boomers who are going to bleed medicine dry out of pure greed. There were physicians 40+ years ago who made this a great profession and stopped reckless school expansion.

I agree with Goro that the only way we can do that is to get into leadership. And likely the situation will be dire before any of us can do that.

 

[DNC127]

Long term: join the AOA and COCA, get inside their power structure and make changes from within.

Short term: lobby your DO faculty to do the above. If they're True Believers, avoid them, they won't help you. Just as an side, both our Chair of OMM/OMT and our Dean are against this mindless expansion.

Lobby your local Congressperson and Senator and state politicians to support the creation of new residency slots.

What can YOU do: be the best student you can. It's the weakest students, with red flags, that will most likely not match. And if any AOA people come visit your school, politely roast them about the rate of numbers of grads vs much slower rate of residency slot additions.

But keep in mind that the number of residency slots now STILL outnumber the amount of bodies graduating each year, even with the expansions. But you may simply have to get used to doing a residency at a community hospital in small town America.

Disagree with the bolded above. I think the lack of new residency slots is the only thing that will 1. Fix this mess after schools get reprimanded for having low placement rates in a few year, and 2. will keep salaries high (I know I know I am selfish) despite the proliferation of midlevels.

Unfortunately, the DO classes in coming years will take the brunt of this, but it will level out after a few classes get hammered by the match.

Still agree with 99% of what you say tho Goro. Carry on.

 

[libertyyne]

Disagree with the bolded above. I think the lack of new residency slots is the only thing that will 1. Fix this mess after schools get reprimanded for having low placement rates in a few year, and 2. will keep salaries high (I know I know I am selfish) despite the proliferation of midlevels.

Unfortunately, the DO classes in coming years will take the brunt of this, but it will level out after a few classes get hammered by the match.

Still agree with 99% of what you say tho Goro. Carry on.

schools will just push to expand residencies.
Residencies will expand.
physician salaries will decrease after the glut of new residencies accommodates everyone.
And then being a physican will be just like being a lawyer. Or being a physican before the 60's but with less respect.

 

[Sardonix]

This type of thinking (the red) is how we got here. I liked the post upto the last line. We have to be better stewarts than the boomers who are going to bleed medicine dry out of pure greed. There were physicians 40+ years ago who made this a great profession and stopped reckless school expansion.

I agree with Goro that the only way we can do that is to get into leadership. And likely the situation will be dire before any of us can do that.

Agreed. I've bumped into people who don't stop talking about leaving once they've invested in some high rises or something and good lord I feel sorry for their patients or anyone who has to work with them. I get that money is important but I hate when some boomer doctor who already has a well establish practice, (tiny by comparison) loans already paid off, is basically just unhappy with life and tells everyone who will listen that medicine is the worst thing ever.

It's so cringey and shows a complete lack of perspective for the million other jobs out there that are way worse and pay way, way less.

 

[Neopolymath]

Go back in time and push 90% of Boomers off a cliff. It would fix a hell of a lot more than medicine. I'll leave it at that.

 

[zero0]

Go back in time and push 90% of Boomers off a cliff. It would fix a hell of a lot more than medicine. I'll leave it at that.

To be fair, who ever thought that an entire generation buying houses and things they couldn't afford on credit would have serious long-term economic consequences /s

 

[Angus Avagadro]

Go back in time and push 90% of Boomers off a cliff. It would fix a hell of a lot more than medicine. I'll leave it at that.

If Boomers were all pushed off of a cliff, who would millenials blame for their bad choices?

 

[Angus Avagadro]

Agreed. I've bumped into people who don't stop talking about leaving once they've invested in some high rises or something and good lord I feel sorry for their patients or anyone who has to work with them. I get that money is important but I hate when some boomer doctor who already has a well establish practice, (tiny by comparison) loans already paid off, is basically just unhappy with life and tells everyone who will listen that medicine is the worst thing ever.

It's so cringey and shows a complete lack of perspective for the million other jobs out there that are way worse and pay way, way less.

Agreed. I've bumped into people who don't stop talking about leaving once they've invested in some high rises or something and good lord I feel sorry for their patients or anyone who has to work with them. I get that money is important but I hate when some boomer doctor who already has a well establish practice, (tiny by comparison) loans already paid off, is basically just unhappy with life and tells everyone who will listen that medicine is the worst thing ever.

It's so cringey and shows a complete lack of perspective for the million other jobs out there that are way worse and pay way, way less.

Us Boomers paid HEAL loans at 17%. Twice the rate that the Govt loans set by O bama administration when they took over student loans. We paid them back with interest. It all worked out. Our currency had been devalued over the last 10 yrs with quantitative easing and increased deficits. Who was in charge these past 10 years? Be honest and give the people responsible credit.

 

[Neopolymath]

If Boomers were all pushed off of a cliff, who would millenials blame for their bad choices?

I'm sure we will figure it. We have great examples to follow on how to blame everyone else for problems we created, luckily.

 

[Angus Avagadro]

I'm sure we will figure it. We have great examples to follow on how to blame everyone else for problems we created, luckily.

I'm not so sure millenials will figure it out. Unless they can figure out a way to complain their patients into good health

 

[Wjldenver]

Go back in time and push 90% of Boomers off a cliff. It would fix a hell of a lot more than medicine. I'll leave it at that.

What? Were you abused as a child?

 

[BorntobeDO?]

Us Boomers paid HEAL loans at 17%. Twice the rate that the Govt loans set by O bama administration when they took over student loans. We paid them back with interest. It all worked out. Our currency had been devalued over the last 10 yrs with quantitative easing and increased deficits. Who was in charge these past 10 years? Be honest and give the people responsible credit.

You mean your less than 50k loans (1992 - 1) when starting pay was still over 100k (1988-2) even for family practice? The ones where the majority had no interest accrued while you were in training/school? Something tells me that today's median of 200k debt with 7% interest accruing the whole time in school and training, while starting pay is 200k is a worse deal by quite a bit. (4)

And talking about variable rate HEAL loans (which ironically is basically set up the same as all grad loans now) is disingenuous when you know they didn't happen until after Subsidized and Unsubsidized graduate loans (which was 7.5k and 4k a year till 1994 ref 3), when the median expendature was 12.5k a year. That's less than 1k per a year of these loans that are similar to basically all of our loans.

1. 17 statistics about medical school student debt
2. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.11.1.181
3. FinAid | Loans | Historical Loan Limits
4. https://store.aamc.org/downloadable/download/sample/sample_id/240/

 

[Neopolymath]

You mean your less than 50k loans when starting pay was still 100k? The ones that no interest accrued while you were in training/school? Something tells me that todays 300k+ debt with 7% interest accruing the whole time in school and training, while starting pay is 200k is a worse deal by quite a bit.

Hey, snowflake, they had it hard. The greatest generation gave them a golden egg and they had to work hard to turn it into a turd. They did that with their bare hands without complaining (that part came later)

 

[Angus Avagadro]

You mean your less than 50k loans when starting pay was still 100k? The ones that no interest accrued while you were in training/school? Something tells me that todays 300k+ debt with 7% interest accruing the whole time in school and training, while starting pay is 200k is a worse deal by quite a bit.

First, you have no idea what wife and I owed for school. 50 k? LOL. Figure twice that. Our 100k into days dollars would be more like 400k. HEAL loans would defer interest, but you would not want to. You could either pay interest yearly or defer. If deferred, 40k borrowed would turn into 160 k in payback after residency, so deferring was not a great option. Still, today, 350k debt to make 250k a year for 30 yrs,( 7.5 million ) is still not a bad return on investment. It's up to the student to do the math and determine if medicine is the best financial choice. If they didnt do the math, shame on them and their parents for not bringing it up

Also, the nearly 10 yrs prior to Dec 2018, the stock market was essentially flat, so IRAs and pensions were flat for nearly a decade , meaning Boomer retirement will be delayed. Job market will loosen in a few years as we retire.

 

[BorntobeDO?]

First, you have no idea what wife and I owed for school. 50 k? LOL. Figure twice that. Our 100k into days dollars would be more like 400k. HEAL loans would defer interest, but you would not want to. You could either pay interest yearly or defer. If deferred, 40k borrowed would turn into 160 k in payback after residency, so deferring was not a great option. Still, today, 350k debt to make 250k a year for 30 yrs,( 7.5 million ) is still not a bad return on investment. It's up to the student to do the math and determine if medicine is the best financial choice. If they didnt do the math, shame on them and their parents for not bringing it up

Also, the nearly 10 yrs prior to Dec 2018, the stock market was essentially flat, so IRAs and pensions were flat for nearly a decade , meaning Boomer retirement will be delayed. Job market will loosen in a few years as we retire.

References added, and quote adjusted for increased accuracy. While I can't say that medicine was specifically a great deal for you and your wife, I can say that Medicine was a much better deal in the 80's and 90's especially when looking at medians. Note that 50k each is exactly what I posted as being the median debt. So the two of you having 100k total would line up exactly. And since you each would earn 100k, even in family, the ratio is still 0.5, plus the fact that a majority of your loans where probably not HEAL loans, and the situation is even more favorable to the past. See the edited post above for references and to see how I get there.

 

[Osminog]

Anybody who denies that there's a physician shortage in America (and that it will drastically worsen in the next few decades, as the population ages and as entitlement policies expand) may as well also be arguing for the legitimacy of flat earth theory or intelligent design. It's a completely absurd perspective that not only has no basis in reality, but also is directly contradicted by all of the data and evidence that we currently have.

Sure, when you destroy a monopoly, you hurt the beneficiaries of the monopoly. When a medical student takes out $300K in loans in order to get a high salary that solely exists because of artificially limited supply, drastically expanding the supply will financially cripple that medical student after he graduates. Every change in policy creates winners and losers, and the introduction of more physicians into the market will benefit patients and hurt physicians; patients will no longer find themselves in a seller's market, while physicians will make less money and have less geographic flexibility.

I understand why aspiring physicians taking on massive debt would oppose policies that would seriously hurt their financial futures. That's a bias that I find throughout SDN, and I don't think it's a completely unreasonable one to have. However, let's be intellectually honest and not deny that there's a major physician shortage in the US.

 

[Sardonix]

Go back in time and push 90% of Boomers off a cliff. It would fix a hell of a lot more than medicine. I'll leave it at that.

Whoa man, I'm all for fighting the power, but that's a bit much...

 

[Sardonix]

Us Boomers paid HEAL loans at 17%. Twice the rate that the Govt loans set by O bama administration when they took over student loans. We paid them back with interest. It all worked out. Our currency had been devalued over the last 10 yrs with quantitative easing and increased deficits. Who was in charge these past 10 years? Be honest and give the people responsible credit.

Look I apologize for the jab about medical school loans, but I still think it's incredibly disingenuous for a well established professional who has achieved all necessary professional milestones to then turn around and tell the next generation not to go into medicine. It's one thing to share the lessons and experience one has learned over the years, it's a whole other to influence another person's career on very anecdotal information.

For example, a surgeon last week told me to go into finance or tech instead of medicine because of the money situation. The guy has done exactly zero research to back up that claim--as it's VERY hard to just walk into a cushy job in either of those careers. On top of that, he had no idea what my story or situation was--he just knew he was frustrated with his own lot in life.

 

[asnontraditionalasitgets]

For example, a surgeon last week told me to go into finance or tech instead of medicine because of the money situation. The guy has done exactly zero research to back up that claim--as it's VERY hard to just walk into a cushy job in either of those careers. On top of that, he had no idea what my story or situation was--he just knew he was frustrated with his own lot in life.

Exactly. I have heard this from many doctors. I understand they sacrificed a great deal of time and money to get to where they are, but that also provides barrier for entry. Finance and tech take less time but do not usually provide the same career and earning longevity as medicine.

I have also heard physicians say that if they took the effort they put into school and residency into a different field then they could have reached the upper levels of that field, which is probably not accurate for most physicians.

 

[BorntobeDO?]

Exactly. I have heard this from many doctors. I understand they sacrificed a great deal of time and money to get to where they are, but that also provides barrier for entry. Finance and tech take less time but do not usually provide the same career and earning longevity as medicine.

I have also heard physicians say that if they took the effort they put into school and residency into a different field then they could have reached the upper levels of that field, which is probably not accurate for most physicians.

I don't know, the amount of effort it takes our best students to propel themselves to the top would almost certainly work in any field if applied with the same intesity.

 

[sylvanthus]

Nothing.

Really. Any argument you put up will be met with, "Oh, you're against fixing the doctor shortage?" regardless of the fact it doesn't really even exist. Having medical students getting pumped out benefits the people who matter. The schools/admins make guaranteed free money off tuition since seats will always fill. COCA benefits by staying relevant and I'm sure they get kickbacks too. Most of the residencies opening now are from national groups/corporations, not even funded by CMS anymore. This benefits them because it drastically increases supply, which will eventually drive salaries down. You can 100% forget about any argument that has anything to do with salary and physicians because we're all "too rich already". You can try and avoid national group/CMG residencies, but the bottom of the barrel students will take anything. This doesn't even touch on the massive proliferation of online non-physician practitioners going into "medicine". You can try and not teach them or hire them, but eventually some docs will take the bait if there's some cash offered. Why would any of these agencies let you in if your goal is to make them less money?

Get in, develop a plan to earn as much passive income as you can, leave this dumpster fire.

Completely agree.

 

[sylvanthus]

There are alot of things wrong with medicine that will only get worse before getting better and sadly I am not seeing the AMA, AOA, COCA, state medical societies, etc etc doing anything to actually fix the major problems. Instead they seem to focus on social justice warrior nonsense or whatever is PC for the day. Ill give you a few examples of how things are going to **** fast.

1) Everything is about customer service now, not patient care. Press ganey, HCAHPS, WTFBBQ, are pretty much dictating what we do. You want that unnecessary CT, antibiotics, that pain med that starts with a "D?" You got it, anything to appease the customer. Im currently taking care of a sickle cell disease patient on the medicine floors right now. The hospital has a policy that we do not give IV push benadryl as patients abuse it just to get high. Well this patient has complained so much and gotten administration on board, that now we made her an "exception." She now gets her IV benadryl. Does she need it from a medical standpoint? Hell no, she can take PO, PO benadryl works fine for her "itching." But, what do we do? We cave and do what the customer wants and this cycle continues.

2) Charting requirements continue to get worse and the EMRs are for billing not patient care. This continues to get worse. I can't count how many times an extra form has been added that "just takes a couple minutes." The problem is, those forms never go away, we keep adding to them, and those couple minutes become 30min, become hours of BS documentation.

3) Everyone wants to be a doctor. Because there is a "doctor shortage" everyone and their mom is jumping on the bandwagon. Medical schools are expanding, PA programs are expanding and now there is a Doctorate level, online course (yup!) for PAs to get a doctorate, NP schools are going the DNP route to be "doctor nurses" ("skills of a nurse, knowledge of a physician!"), etc etc. Eventually, salaries are gonna tank, medical school tuition is going to continue to rise, and being a physician will just not be worth it financially.

4) Our profession is being destroyed. See above about everyone wanting to be a doctor, just wanted to add that we are now commonly referred to as "providers" Lumped in with NPs, DNPs, PA, etc etc. Some may consider this just words, but it runs much deeper than that. Add to this the fact that things are becoming more and more about protocol and policy and being a physician is no longer an art, this makes us no more than a cog in the wheel.

5) Physicians are burning out - I hate this term because it implies it is our fault, WE burned out, when the real reason is multifactorial and a system issue. Hospitals pay lip service to this by encouraging things like meditations, exercise, etc etc etc. This does absolutely nothing to actually FIX the issues causing burnout, just places blame on the physician and makes it the physicians job to basically just turn the other cheek.

What you guys are discussing I fear is just the tip of the iceberg, when you have experienced the above, likely you will see the problems in medicine run far deeper than what we are told as students and residents. Had I known what being a physician really entailed, there is no chance I would have done this. Those that can think of no other job but doing this lack imagination., just my 2 cents.

 

[puahate]

The death of medicine is approaching

 

[calvinhobbes]

For match, apply broadly, have back-up specialities, interview everywhere, and rank every interview; that’s the best you can do. An example (which echos others schools that that lower match rates this year): for 2019 for the first time in many years, NYCOM did not have a 99-100% match or placement rate. Many students who didn’t match, couldn’t be placed (lack of safety AOA TRI spots available, as they disappeared b/c of the merger). The school won’t even publish an official match/placement rate because it is low. (Sure the match list looks good this year, but it’s not the entire graduating class). So my advice? Don’t be picky or choosy when you apply for residencies. Good luck!

 

[sylvanthus]

So then what can we do? What is your own plan? As a fourth year I see too many of my own colleagues buy into the "provider", were all "equal", "a part of the team", and "protocol" bull****. Not coincidentally it is also the SJW who fit this type. Regardless, what can we do?

Not sure what we can do, there are too many forces working against us. Our specialty societies generally bow down to large corporations, who obviously, want salaries lower and more "providers." But, one of the biggest problems is us......

Most people who enter medicine just want to get through. Med students try to keep their head down, appease everyone around them for grades, honors, etc etc. These people become residents who are in major debt and just want to get through residency. Residents are unlikely to rock the boat, are dishonest on their ACGME surveys ( who wants their program on probation or shut down?), see the problems inherent in the system, but don't say anything because if we lose our residency spot were screwed. We then become attendings who are very reluctant to rock the boat. Not sure what can be done besides a large group of us joining an organization capable of getting **** done.

My own plan is to try and stay somewhat involved with advocacy, that way, I am actually doing something, and not just standing on the sidelines bitching. But, as I am pessimistic any of this is going to get fixed, I plan on saving as much money as I can in the 4 years I have left of PSLF as an attending. If PSLF is around, great I have a bunch of money in the bank. If PSLF is destroyed, I take that savings and pay my loans off. Then when my loans are gone, I save aggressively so that if and when medicine salaries drop, I can choose to go part time, choose another field, etc. etc. As I will be triple boarded, I can jump on whatever ship is sinking the slowest.

 

[863168]

@Osminog I've never seen so much intellectual dishonesty in a single SDN post, but here we are these are the times when medical students shame themselves for their privileged upbringing while the number of independent practice states continue to grow in number. These are the times when you have someone actually think that compromising physician salaries through oversupply is going to actually go back to the patient and is completely NOT going to be absorbed in the black hole comprised of fiends administrators, HMOs, and policy regulators. Not to mention that said actors are the primary culprits for upcharging patients and compromising physicians by hiring midlevels to replace them due to cost efficiency. Not to mention that someone with a gold SDN account (likely spent from their first minimum wage paycheck I'm sure) references student debt as a metaphorical shackle that prevents physicians from developing a true empathic connection with their lower privileged patients. The times we live in.

 

[westsidestoryz]

The issues were specifically for the DO profession but it seems like there is a bigger problem, a problem that will affect future students and physicians, both MDs and DOs. So there really isnt much for me, as a student, to do except to push on and do the best we can with what we got.

As @Goro mentioned, infiltrate the system and obtain leadership position down the road. But I fear the current direction we are trending towards will have more dire consequences for DO students.

Its just sad how much medicine has changed since the days of the golden age of the 20th century. Now its just to turn a profit and see as many patients as possible with little regards for physician's health.