What specialties can be outsourced or mostly automated requiring less number of doctors in next 15-20-25 years?

[Dr. Trafalgar Law]

Compare the earnings of a primary care doctor under the AOC/far left proposals versus a UPS driver who is aggressively saving in the SP500 or AAPL over the last decade. Then you will have your answer.

I still think with that math a PCP would outpace the UPS driver by retirement age, likely earlier than that with even the most conservative estimates. Furthermore the UPS driver that is aggressively saving (it’s really investing in safer stocks though) is not left with much money to “enjoy“ during their youth, which is the often cited “opportunity cost” of med school.

Comparing post far-left reimbursement cuts with other white collar jobs (CS, engineering, finance) that have significant potential for growth throughout a career makes for a better discussion. They may very well have the advantage all-around in this instance.

---

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[Mad Jack]

No one is really fighting to take my psychotic/bipolar/borderline patients from my cold, dead hands and a robot walking you through not killing yourself probably won't work all that well so I think I'm good

 

[Thesimplelifeofamyloid]

Compare the earnings of a primary care doctor under the AOC/far left proposals versus a UPS driver who is aggressively saving in the SP500 or AAPL over the last decade. Then you will have your answer.

In fairness, I think people like AOC and others respect physicians tremendously, and I don't think they should be viewed as an adversary per say

 

[Mad Jack]

I agree with slowthai the “sacrifice” concept makes no sense. If so, my brother is “sacrificing” his 20’s to get a PhD. My sister sacrificed her 20’s to get teaching credentials and do her internships/apprenticeships/whatever they’re called. Had to bounce between multiple temporary jobs. As a non-read I had a number of jobs prior to med school as well. I had three one one time at one point.

Why is it that we physicians sacrifice our 20’s but no one else does? We’re not the only ones studying our butts off. We’re not the only ones working long hours. Is it a longer path than most? Sort of... 4 years of med school plus 3-5 on average of residency—they’re we’re a fully paid attending immediately. How long do you think an architect has to go to school and then work as an apprentice before they can be the principle of their own firm and be responsible for all the big decisions? Quite a while, unless all they want to do is design garden sheds. Same for so many other professions out there.

If anyone gets to play the sacrifice card, it’s deployed soldiers. They sacrifice. I didn't--I just had to show up to school for another four years, see my friends daily, learn some cool stuff, then do an apprenticeship where others hold my hand most of the time. Most professions don't have a Match process, nor do they have the checks/balances to prevent abuse like we do. New architect apprentice at a big firm? You're not sleeping at all the weeks prior to a big project deadline, and I'd wager most weeks you're well above the 40hrs/week we think everyone who isn't a doctor works. I'm guessing 60-70hrs+/week if you're really trying to get ahead. And then after everything is done, maybe you're looking at a salary of $50-80k as a junior architect.

Coders doing crunch time can spend half of their working careers earning far less than physicians while working more hours than residents. Associates in law, finance, and architecture will put in 60-100 hours a week in their early careers to learn skills and get ahead. A lot of people end up working 60-80 hours a week for their entire lives just to make ends meet.

 

[Mad Jack]

In fairness, I think people like AOC and others respect physicians tremendously, and I don't think they should be viewed as an adversary per say

They respect us, but I doubt they respect our incomes

 

[VA Hopeful Dr]

There is an artificially low number of physicians in this country due to AMA lobbying. It doesn’t do our patients or our lifestyles any favors. Does help the wallet though (questionably).

That is utterly false

 

[FrontierPsychiatry]

No one is really fighting to take my psychotic/bipolar/borderline patients from my cold, dead hands and a robot walking you through not killing yourself probably won't work all that well so I think I'm good

And the beautiful thing is that those cases are always the most fun(ok maybe not bordeline for most, I'm a weirdo).

 

[Mad Jack]

And the beautiful thing is that those cases are always the most fun(ok maybe not bordeline for most, I'm a weirdo).

I'm not a fan of worried well patients, so I absolutely agree

 

[ohmanwaddup]

....you are financially blessed to get a loan at 7-10% interest? What am I reading in this thread.

I mean I'm being given a decent amount of money that has deferred payments and decent payback options as long as I study. I don't have savings and if it was not for that I would not be able to attend med school. 100% could not work a job with out failing out.

With Covid too, I have friends in barely scraping by to support their families and COVId has really messed them up financially. I have not had a single change in financial lifestyle due to the pandemic, and I'm practically guaranteed a 6 figure job as long as I do the work.

 

[aldol16]

I haven't read fully the comments on the first page so don't attack me if this has already been said, but I think radiology will be #1. COVID has shown us that this can be done almost completely virtually. There are laws that govern this when you talk about people in different states reading images but those are just regulatory hurdles that can be surmounted. As our technological capacity grows, I think a lot of diagnostics that are computer-based will be able to be outsourced to other areas.

That's not to say that there won't be a reaction though. Everybody who is affected will come up with new ways to stay relevant and my feeling is that entire fields will evolve.

 

[Tangerine123]

Not gonna lie, I never understood the
"sacrificing our 20s" thing

My sacrifice was my own physical and mental integrity. Years later i'm still taking meds and will soon undergo a second surgery because of the damage that medical school brought upon me.

 

[Tangerine123]

No one is really fighting to take my psychotic/bipolar/borderline patients from my cold, dead hands and a robot walking you through not killing yourself probably won't work all that well so I think I'm good

Also this. Currently doing Psych with the intention to focus on suicide. Human interaction can't really be replaced

Looking at it from the other side, as a patient, I feel that even receiving psychotherapy through Zoom has been detrimental for me. I can't ever see myself being comfortable receiving therapy from a robot that just goes through algorithms.

"How does that make you feel"

If good Then
Print("That is good to hear!")
Else
Print("Tell me more about it")
End If

Naaaaaah. Hard pass.

 

[slowthai]

My sacrifice was my own physical and mental integrity. Years later i'm still taking meds and will soon undergo a second surgery because of the damage that medical school brought upon me.

I am very sorry to hear that.

 

[RangerBob]

I haven't read fully the comments on the first page so don't attack me if this has already been said, but I think radiology will be #1. COVID has shown us that this can be done almost completely virtually. There are laws that govern this when you talk about people in different states reading images but those are just regulatory hurdles that can be surmounted. As our technological capacity grows, I think a lot of diagnostics that are computer-based will be able to be outsourced to other areas.

That's not to say that there won't be a reaction though. Everybody who is affected will come up with new ways to stay relevant and my feeling is that entire fields will evolve.

While diagnostic radiology can be and typically is done virtually, it's never going to be outsourced. The docs in other countries reading nighthawk films are US-trained physicians with a state license. Perhaps they went to med school in the country they lived in, but they're trained and licensed in the US.

Critical decisions are made by physicians based on the radiologist's report. Granted, many surgeons ignore the report, but for mere mortals like myself that don't operate, the radiologist's read can be critical. They will never be outsourced to a non-US trained doc, or a computer. No doc will. At most I think we'll see AI used to "increase productivity" (ie., make us more "efficient/miserable").

Physicians will be replaced by computers when we trust those same computers to run our government and run our military. I don't see Skynet ever taking over the armed forces--what we see is the military using AI/technology in specific situations, under their control.

Frankly, once we get to a point computers can diagnose and treat us (and run the government/military, which may actually be easier for robots than delivering healthcare) our purpose here is moot as the robots could likely fix themselves/build better models. Not trying to be all dystopian here, but what would humans really do in such a world? There'd likely be mass anarchy long before we get replaced as all the stock traders, MBAs, administrators, restaurant servers, hair stylists, miners, construction workers, teachers/professors, engineers, etc see their jobs dissipate due to AI/robots. It'd be magnitudes worse then when US factory jobs got outsourced.

People want people to take care of their health, just as much as they want people to be their leaders and be their military heroes.

 

[MavFab]

I haven't read fully the comments on the first page so don't attack me if this has already been said, but I think radiology will be #1. COVID has shown us that this can be done almost completely virtually. There are laws that govern this when you talk about people in different states reading images but those are just regulatory hurdles that can be surmounted. As our technological capacity grows, I think a lot of diagnostics that are computer-based will be able to be outsourced to other areas.

That's not to say that there won't be a reaction though. Everybody who is affected will come up with new ways to stay relevant and my feeling is that entire fields will evolve.

I actually think rads is one of the safest specialties. With more midlevels working independently the number of images ordered is only going to increase.

 

[YCAGA]

I always laugh when I read medical students saying that radiology will be replaced by AI during our careers. I doubt medical students who say this have ever even read a radiology report for a remotely complex patient. Maybe in 5-10 years we will have an AI that can find pneumothorax's on CXR's better than a radiologist...so what? Doing 10-15 true or false analyses on CXR's is literally multiple order of magnitudes less complex than interpreting a fairly benign CT chest w/ contrast. If we have AI's that can read and report on CT's and MR's as well as a radiologist, we need to start brushing up on our Skynet defense plan and give Arnold a call.

 

[bGMx]

While diagnostic radiology can be and typically is done virtually, it's never going to be outsourced. The docs in other countries reading nighthawk films are US-trained physicians with a state license. Perhaps they went to med school in the country they lived in, but they're trained and licensed in the US.

Critical decisions are made by physicians based on the radiologist's report. Granted, many surgeons ignore the report, but for mere mortals like myself that don't operate, the radiologist's read can be critical. They will never be outsourced to a non-US trained doc, or a computer. No doc will. At most I think we'll see AI used to "increase productivity" (ie., make us more "efficient/miserable").

Physicians will be replaced by computers when we trust those same computers to run our government and run our military. I don't see Skynet ever taking over the armed forces--what we see is the military using AI/technology in specific situations, under their control.

Frankly, once we get to a point computers can diagnose and treat us (and run the government/military, which may actually be easier for robots than delivering healthcare) our purpose here is moot as the robots could likely fix themselves/build better models. Not trying to be all dystopian here, but what would humans really do in such a world? There'd likely be mass anarchy long before we get replaced as all the stock traders, MBAs, administrators, restaurant servers, hair stylists, miners, construction workers, teachers/professors, engineers, etc see their jobs dissipate due to AI/robots. It'd be magnitudes worse then when US factory jobs got outsourced.

People want people to take care of their health, just as much as they want people to be their leaders and be their military heroes.

Couldn't say it any better. I was going to try to, but I realized that people like to imagine things for fun. To solve AI, especially to a degree that would effectively replace people, would be to solve the hard problem of consciousness-- this would render humanity obsolete.

 

[Redpancreas]

A lot has been said about the whole sacrificing our 20s thing. What I meant was that working harder than most other qualified professionals in our field doesn’t guarantee us that money. Having gone through a good deal of medical training, I do think we work harder than a majority of high income fields so I’m not trying to gaslight anyone in that regard. I’m just saying that that doesn’t give us the ability to say, hey pay us more.

 

[jambro]

For anyone who assumes rads is the first to go - if AI can do everything a radiologist can do, you're telling me we won't just have AI + NPs for almost every specialty? Also, when are fully self-driving cars EVER coming? You know, that task that we decide any *****ic 16 year old can do? Then again, flying is essentially completely automated, and I always get in 747s without any pilots.... oh wait....

Compare the earnings of a primary care doctor under the AOC/far left proposals versus a UPS driver who is aggressively saving in the SP500 or AAPL over the last decade. Then you will have your answer.

What policies are you specifically referring to? Have you seen any numbers with regard to RVUs or reimbursement? Btw, most politicians are bought off by insurance companies; what do you think insurance companies ideal reimbursement is for physicians? lol

 

[Obnoxious Dad]

That is utterly false

I'm afraid it's utterly true. All of the health care professions, from dental hygiene to medicine, are regulated by the providers themselves. It's regulatory capture on human growth hormone. These professions have done their best to make training as expensive, exclusive, time consuming and aggravating as possible. Two years of training to clean teeth? Eight years to become a pharmacist? $400,000 in nonresident tuition at Michigan State and Illinois for medical school? According to Robert Grossman, Dean at NYU, medical school tuition is diverted to supporting nonproductive faculty i.e. people who don't teach, don't see patients and don't write grants. Closing down almost all of the hospital based 3 year diploma programs for RNs? It all fits.

 

[VA Hopeful Dr]

I'm afraid it's utterly true. All of the health care professions, from dental hygiene to medicine, are regulated by the providers themselves. It's regulatory capture on human growth hormone. These professions have done their best to make training as expensive, exclusive, time consuming and aggravating as possible. Two years of training to clean teeth? Eight years to become a pharmacist? $400,000 in nonresident tuition at Michigan State and Illinois for medical school? According to Robert Grossman, Dean at NYU, medical school tuition is diverted to supporting nonproductive faculty i.e. people who don't teach, don't see patients and don't write grants. Closing down almost all of the hospital based 3 year diploma programs for RNs? It all fits.

None of that has anything to do with the post I was responding to.

To become a physician, the first step is medical school. Between MD, DO, and Caribbean schools we have PLENTY of spots. Cost is a whole separate issue and but with the easy availability of loans isn't stopping many people from going to med school.

The second step, and really where the bottleneck is, is residency spots. Those are 99% unregulated. You have to get ACGME approval but that is not difficult to do. The issue is funding. Congress historically paid for resident spots but has more or less capped the numbers at the 1990s numbers. Plenty of places have opened new programs/expanded spots and they have to pay the associated costs themselves.

The last step is to actually get licensed. If you graduate residency, this is a gimme and so don't really even count as a hurdle.

Notice how I didn't mentioned the AMA in this? Its because they aren't involved.

 

[Obnoxious Dad]

None of that has anything to do with the post I was responding to.

To become a physician, the first step is medical school. Between MD, DO, and Caribbean schools we have PLENTY of spots. Cost is a whole separate issue and but with the easy availability of loans isn't stopping many people from going to med school.

The second step, and really where the bottleneck is, is residency spots. Those are 99% unregulated. You have to get ACGME approval but that is not difficult to do. The issue is funding. Congress historically paid for resident spots but has more or less capped the numbers at the 1990s numbers. Plenty of places have opened new programs/expanded spots and they have to pay the associated costs themselves.

The last step is to actually get licensed. If you graduate residency, this is a gimme and so don't really even count as a hurdle.

Notice how I didn't mentioned the AMA in this? Its because they aren't involved.

The AMA is involved. The LCME was founded by the AMA and the AAMC.
Origin of the LCME, the AAMC-AMA partnership for accreditati... : Academic Medicine (lww.com)

The LCME establishes accreditation standards for MD granting medical schools in the U.S. Those standards, including the research mandate, make medical education more expensive than it should be. The actual cost of a medical education is the per student cost of medical school when it's efficiently delivered. It is not the per student price of a medical education pork barrel. The first two years of medical school, with the exception of the history and physical class, could be done entirely on line and at a much lower cost than the current structure. I have never seen a professionally conducted study of the actual costs of the third and fourth year of medical school. I would like to see it. Furthermore, admission to MD granting medical schools is denied in many cases to people who chose the harder road i.e. the physical sciences and engineering at rigorous colleges or who were residents of states like California, New Hampshire or Rhode Island. We'll never know how worthy applicants have been turned away or were turned off because they didn't want to go $600,000 in debt to be an MD.

The number of residency slots is not really limited by the 1997 budget deal. At many programs the number of residents has grown because medical residents provide cheap labor. A note by Chandra, Khullar, and Wilensky in the June 19, 2014 edition of The New England Journal of Medicine makes this point. I suspect that the $15 billion or so in annual federal funding for residency training programs could be better spent by simply providing residency programs with the fixed administrative costs of training residents and then allowing hospitals and clinics to charge for services provided by residents. That would be efficient but it's not the way it is.

 

[VA Hopeful Dr]

The AMA is involved. The LCME was founded by the AMA and the AAMC.
Origin of the LCME, the AAMC-AMA partnership for accreditati... : Academic Medicine (lww.com)

The LCME establishes accreditation standards for MD granting medical schools in the U.S. Those standards, including the research mandate, make medical education more expensive than it should be. The actual cost of a medical education is the per student cost of medical school when it's efficiently delivered. It is not the per student price of a medical education pork barrel. The first two years of medical school, with the exception of the history and physical class, could be done entirely on line and at a much lower cost than the current structure. I have never seen a professionally conducted study of the actual costs of the third and fourth year of medical school. I would like to see it. Furthermore, admission to MD granting medical schools is denied in many cases to people who chose the harder road i.e. the physical sciences and engineering at rigorous colleges or who were residents of states like California, New Hampshire or Rhode Island. We'll never know how worthy applicants have been turned away or were turned off because they didn't want to go $600,000 in debt to be an MD.

The number of residency slots is not really limited by the 1997 budget deal. At many programs the number of residents has grown because medical residents provide cheap labor. A note by Chandra, Khullar, and Wilensky in the June 19, 2014 edition of The New England Journal of Medicine makes this point. I suspect that the $15 billion or so in annual federal funding for residency training programs could be better spent by simply providing residency programs with the fixed administrative costs of training residents and then allowing hospitals and clinics to charge for services provided by residents. That would be efficient but it's not the way it is.

Lots to unpack.

First, you think the AMA set up the LCME which set up the current standards just to keep the numbers of graduates low? Utterly ridiculous. Research has always been a big thing for MD schools. It also gives students who want to do research a way to do it. Even I did research in med school.

Second, if all of the "pork" as you call it (research faculty and whatever) is the driving cost of medical education? Then why aren't DO schools, which don't have the same requirements, significantly less expensive?

Third, the main cost of 3rd and 4th years are in the decreased productivity in the academic attendings. I know what I can do in a day, academic attendings can't pull that off anything close to that for a multitude of reasons.

Fourth, no one should be going into 600k debt for medical school. Tufts, which is historically one of the most expensive schools to attend, including room/board/everything estimates around 95k/year this year. If we round that up to an even 100k, that's still 1/3rd less than the 600k you're throwing around.

Fifth, with the rapid expansion of DO school and the Caribbean schools we have way more applicants than we do residency spots. Med school (other than cost) isn't the problem here.

Sixth, yes places are opening brand new programs but they aren't really set up to be educational. Talk to some of the ED folks whose hospitals are opening residency programs. They don't want to teach. That's very unusual for residency programs. You can make money off of residents, but only if you do the bare minimum to get accredited which isn't exactly a good thing.

 

[Obnoxious Dad]

Lots to unpack.

First, you think the AMA set up the LCME which set up the current standards just to keep the numbers of graduates low? Utterly ridiculous. Research has always been a big thing for MD schools. It also gives students who want to do research a way to do it. Even I did research in med school.

Second, if all of the "pork" as you call it (research faculty and whatever) is the driving cost of medical education? Then why aren't DO schools, which don't have the same requirements, significantly less expensive?

Third, the main cost of 3rd and 4th years are in the decreased productivity in the academic attendings. I know what I can do in a day, academic attendings can't pull that off anything close to that for a multitude of reasons.

Fourth, no one should be going into 600k debt for medical school. Tufts, which is historically one of the most expensive schools to attend, including room/board/everything estimates around 95k/year this year. If we round that up to an even 100k, that's still 1/3rd less than the 600k you're throwing around.

Fifth, with the rapid expansion of DO school and the Caribbean schools we have way more applicants than we do residency spots. Med school (other than cost) isn't the problem here.

Sixth, yes places are opening brand new programs but they aren't really set up to be educational. Talk to some of the ED folks whose hospitals are opening residency programs. They don't want to teach. That's very unusual for residency programs. You can make money off of residents, but only if you do the bare minimum to get accredited which isn't exactly a good thing.

Well, now you see that the AMA was behind the LCME. Thanks for coming around. The Flexner Report of 1909 also plays a big part here. This was a put up job by Joseph and Abraham Flexner to close medical schools to drive up physician salaries.

The DO schools have a wide range of prices. LECOM is only about $33,000 per year and they are generating enough margin to keep opening new med school campuses, a pharmacy school and a dental school. The rest of these DO schools like Midwestern are throwing money up to their parent institutions and paying lavish salaries to dart throwers. Ask your accountant to print a copy of their publicly filed Form 990 and you will see the light.

Please show me an independent study of the cost of the third and fourth year of medical school. We've all heard the stories about inefficiencies caused by medical students, without any acknowledgment of the scut work performed by students, but we never see a study. Why?

It's easy to go $600,000 in debt from medical school if you attend Illinois, Michigan State or the University of South Carolina as an out of state student. With tuition at $90,000 to $100,000 per year, plus living expenses, plus the accrual of interest on loans during a four year residency, getting to a debt of $600,000 is easy.

You think a lack of teaching at the new ED programs is a new phenomenon? Look at hundreds of reviews on Scutwork.Com One review after another bemoans lousy didactic programs.

 

[Captain_Falcon]

Well, now you see that the AMA was behind the LCME. Thanks for coming around. The Flexner Report of 1909 also plays a big part here. This was a put up job by Joseph and Abraham Flexner to close medical schools to drive up physician salaries.

The DO schools have a wide range of prices. LECOM is only about $33,000 per year and they are generating enough margin to keep opening new med school campuses, a pharmacy school and a dental school. The rest of these DO schools like Midwestern are throwing money up to their parent institutions and paying lavish salaries to dart throwers. Ask your accountant to print a copy of their publicly filed Form 990 and you will see the light.

Please show me an independent study of the cost of the third and fourth year of medical school. We've all heard the stories about inefficiencies caused by medical students, without any acknowledgment of the scut work performed by students, but we never see a study. Why?

It's easy to go $600,000 in debt from medical school if you attend Illinois, Michigan State or the University of South Carolina as an out of state student. With tuition at $90,000 to $100,000 per year, plus living expenses, plus the accrual of interest on loans during a four year residency, getting to a debt of $600,000 is easy.

You think a lack of teaching at the new ED programs is a new phenomenon? Look at hundreds of reviews on Scutwork.Com One review after another bemoans lousy didactic programs.

How many people attend those schools as OOS students? You're making it seem like the 600k debt is a common occurrence amongst all med students whereas over 20,000 plus students it accounts for what, a few dozen students?

 

[Obnoxious Dad]

How many people attend those schools as OOS students? You're making it seem like the 600k debt is a common occurrence amongst all med students whereas over 20,000 plus students it accounts for what, a few dozen students?

First year MD students in the U.S. equal approximately 22,000. About 50% of MD students in the U.S. either attend a private medical school or attend a state school as a non resident. For those students a tuition bill of $55,000 per year is typical. Throw on $25,000 per year in living expenses, books, fees etc and the total is $80,000. After cooking the interest through med school and a four year residency, the total debt is a mere $460,750. That figure, except for instate students at OK State, MSU, Rowan, Ohio U and TCOM, would be just about spot on for about 7,000 first year DOs as well. To pay that debt off over 30 years at 6.8% the annual payment would approximate $36,000 with no place to deduct that on a tax return,.

For 11,000 +1,000 instate students at state MD + DO schools a typical tuition bill is $30,000 and with living expenses at $25,000 the total is $55,000. After cooking the interest through med school and a four year residency, the total debt is a mere $316,766. To pay that debt off over 30 years at 6.8% the annual payment would approximate $25,800 with no place to deduct that on a tax return.

Gee, I'm sorry if I only picked on the outliers above.

 

[VA Hopeful Dr]

Well, now you see that the AMA was behind the LCME. Thanks for coming around. The Flexner Report of 1909 also plays a big part here. This was a put up job by Joseph and Abraham Flexner to close medical schools to drive up physician salaries.

The DO schools have a wide range of prices. LECOM is only about $33,000 per year and they are generating enough margin to keep opening new med school campuses, a pharmacy school and a dental school. The rest of these DO schools like Midwestern are throwing money up to their parent institutions and paying lavish salaries to dart throwers. Ask your accountant to print a copy of their publicly filed Form 990 and you will see the light.

Please show me an independent study of the cost of the third and fourth year of medical school. We've all heard the stories about inefficiencies caused by medical students, without any acknowledgment of the scut work performed by students, but we never see a study. Why?

It's easy to go $600,000 in debt from medical school if you attend Illinois, Michigan State or the University of South Carolina as an out of state student. With tuition at $90,000 to $100,000 per year, plus living expenses, plus the accrual of interest on loans during a four year residency, getting to a debt of $600,000 is easy.

You think a lack of teaching at the new ED programs is a new phenomenon? Look at hundreds of reviews on Scutwork.Com One review after another bemoans lousy didactic programs.

You're still completely missing the point of my original post. I'll quote the post I initially responded to:

There is an artificially low number of physicians in this country due to AMA lobbying. It doesn’t do our patients or our lifestyles any favors. Does help the wallet though (questionably).

The emphasis is mine. I'll restate my point: the low number of physicians has nothing to do with the AMA. Even if we admit (which I don't) that they helped found the LCME to keep numbers of medical school graduates low, that doesn't matter. The reason we have the number of physicians we have is because of the number of residency spots. Hard stop. That's the rate limiting step, and the AMA has a seat at the ACGME table so do half a dozen other organizations most of whom would support increasing numbers of residency spots (AHA, AAMC, ABMS, AOA, AACOM). Everything else is just noise.

But to address the rest of your points anyway: USC (my alma mater, BTW) out of state tuition comes to 88k/year. Let's say go ahead and round up to an even 100k to cover books, Step fees, whatever. Columbia is a surprisingly inexpensive city to live in. The exact same apartment I lived in 15 years ago is now just under 1k/month so we'll round up there as well. Those two costs across 4 years will run 450k. That gives us 150k over 4 years to "easily" reach 600k. I lived on 1k/month to cover gas, food, entertainment, power/water/cable and had some to spare. So no, 600k isn't easy nor common debt for medical school. Don't get me wrong, I absolutely think tuition is way too high. USC in-state tuition has literally doubled since I graduated in 2010 and I'm pretty sure the education isn't twice as good. But we don't need to be hyperbolic to make that point.

Of course poor teaching isn't a new phenomenon. We've all had poor teachers in every setting. I just bet its more likely at newer programs, especially ones opened specifically to make money on resident labor.

As for a study, I'd actually like to see that too. I suspect that we probably are charging students more than needed for 3-4th years (though probably not by a huge amount) but it would be nice to see actual numbers.

 

[Captain_Falcon]

First year MD students in the U.S. equal approximately 22,000. About 50% of MD students in the U.S. either attend a private medical school or attend a state school as a non resident. For those students a tuition bill of $55,000 per year is typical. Throw on $25,000 per year in living expenses, books, fees etc and the total is $80,000. After cooking the interest through med school and a four year residency, the total debt is a mere $460,750. That figure, except for instate students at OK State, MSU, Rowan, Ohio U and TCOM, would be just about spot on for about 7,000 first year DOs as well. To pay that debt off over 30 years at 6.8% the annual payment would approximate $36,000 with no place to deduct that on a tax return,.

For 11,000 +1,000 instate students at state MD + DO schools a typical tuition bill is $30,000 and with living expenses at $25,000 the total is $55,000. After cooking the interest through med school and a four year residency, the total debt is a mere $316,766. To pay that debt off over 30 years at 6.8% the annual payment would approximate $25,800 with no place to deduct that on a tax return.

Gee, I'm sorry if I only picked on the outliers above.

So you acknowledge that $470k is not the same as $600k?

Half at most end up with 470k if we go with your calculations. That is 130k less than what you said. If someone said they make 600k a year, but then you asked for their taxes and their income was only 470k, you bet your bottom youd say that's not close to 600. That's not a rounding error by any means.

I go to a private MD school. Tuition with fees is about 65k a year. Living costs IF YOU CHOOSE TO TAKE OUT ALL LOANS (which most people do not NEED to do but would be their choice) would be 21k. That is 86k a year, which comes out to 344k. That is not 600k
Not 500k. Heck it isnt even 400k.

 

[jambro]

So you acknowledge that $470k is not the same as $600k?

Half at most end up with 470k if we go with your calculations. That is 130k less than what you said. If someone said they make 600k a year, but then you asked for their taxes and their income was only 470k, you bet your bottom youd say that's not close to 600. That's not a rounding error by any means.

I go to a private MD school. Tuition with fees is about 65k a year. Living costs IF YOU CHOOSE TO TAKE OUT ALL LOANS (which most people do not NEED to do but would be their choice) would be 21k. That is 86k a year, which comes out to 344k. That is not 600k
Not 500k. Heck it isnt even 400k.

How much do you think is reasonable to live on? And where would they be getting that money if not for loans? And interest after residency is done? 350 would turn into tens of thousands more... Still not 600, but not 350 either.

 

[Captain_Falcon]

How much do you think is reasonable to live on? And where would they be getting that money if not for loans? And interest after residency is done? 350 would turn into tens of thousands more... Still not 600, but not 350 either.

That depends on where you're living. San Francisco? Miami? Or Oklahoma City, Western Michigan, Milwaukee, St Louis, etc. etc.
1. Rooming with multiple roommates cuts down on rent
2. Not eating out cuts down on well, expensive foods (the pandemic has made this easier for me personally since i prefer to dine-in than carry out)
3. Some people in school, especially in-state schools, can commute from home (living with parent's)
4. A decent number of people get grants, scholarships, and a larger number of people get help from parents (i.e. parents are doctors)
5. Some people have spouses that work, and thus can pay for COL expenses

Say your tuition cost of 344k in loans is at ~6%. Each year you rack up 5k for each 86k loan. So M1 loans accrue 20k, M2 loans 15k, M3 10k, M4 5k. That accrued interest becomes 50k. So yes, you get up to $394k assuming you took out every dime and nickel of loans.

Now you graduated, you can easily refinance that to <4% interest rate (even close to 3%). Your daily accrued interest at 4% is then $43. Monthly accrued interest is $1,288. Yearly is $15,460. As a resident you make 60k annually (some less, some more), after taxes you have $40,000 - $45,000 give or take. Subtract your interest on your loans that you pay off, you have $25k-$30k to live off of. That's $2,083 - $2,500.


You see how you won't come anywhere near 600k? Even 500k would be really difficult, purposely not paying anything and spending your money as you earn it.

 

[jambro]

You're not wrong, but this also assumes you had 0 undergrad debt which is not a guarantee. Fact is a person without any support could def have 600k of total educational debt from med school and undergrad. And thats insane

 

[Obnoxious Dad]

So you acknowledge that $470k is not the same as $600k?

Half at most end up with 470k if we go with your calculations. That is 130k less than what you said. If someone said they make 600k a year, but then you asked for their taxes and their income was only 470k, you bet your bottom youd say that's not close to 600. That's not a rounding error by any means.

I go to a private MD school. Tuition with fees is about 65k a year. Living costs IF YOU CHOOSE TO TAKE OUT ALL LOANS (which most people do not NEED to do but would be their choice) would be 21k. That is 86k a year, which comes out to 344k. That is not 600k
Not 500k. Heck it isnt even 400k.

You are conveniently overlooking the accrual of interest. At 6.8% and taking out loans of $86,000 per year you will have a debt obligation of $380,705 at graduation. Because your salary during residency will be taxable, because you will have residency related expenses, and because you may not want to live like a monk during residency, interest will keep building on that debt as you train. At the end of a four year residency your debt will be $495,306. If you train as a resident and fellow for six years, your debt will be $564,958.

You may choose to make payments on that debt during residency. If you train in New York City, LA, Boston, DC or (may the Lord have mercy on you) Seattle, happy Ramen off the hot plate.

 

[jambro]

You are conveniently overlooking the accrual of interest. At 6.8% and taking out loans of $86,000 per year you will have a debt obligation of $380,705 at graduation. Because your salary during residency will be taxable, because you will have residency related expenses, and because you may not want to live like a monk during residency, interest will keep building on that debt as you train. At the end of a four year residency your debt will be $495,306. If you train as a resident and fellow for six years, your debt will be $564,958.

You may choose to make payments on that debt during residency. If you train in New York City, LA, Boston, DC or (may the Lord have mercy on you) Seattle, happy Ramen off the hot plate.

You're technically right, but to be fair if you're not on an income based payment scheme like REPAYE you're being horrible with money. Paying 200-300 bucks a month (assuming you're single) would cut the interest accrual in half. And yes everyone can afford to do that.

 

[Taddy Mason]

You are conveniently overlooking the accrual of interest. At 6.8% and taking out loans of $86,000 per year you will have a debt obligation of $380,705 at graduation. Because your salary during residency will be taxable, because you will have residency related expenses, and because you may not want to live like a monk during residency, interest will keep building on that debt as you train. At the end of a four year residency your debt will be $495,306. If you train as a resident and fellow for six years, your debt will be $564,958.

You may choose to make payments on that debt during residency. If you train in New York City, LA, Boston, DC or (may the Lord have mercy on you) Seattle, happy Ramen off the hot plate.

Everything that you've contributed to this thread is just so rich, but I can't anymore. I spent 7 years in undergrad during which I was pretty reckless financially, maxed out my student loans each semester, and didn't qualify for federal aid my last 1.5 years and had to pay for school solely with private loans due the number of credits I had amassed and degrees I completed. During the 2 years between undergrad and med school the loan payments I made barely did anymore than keep interest at bay. In med school I didn't receive any scholarships and finished with a combined undergrad and med school debt load of ~$360K, which was considerably higher than most of my classmates. With REPAYE, income based loan repayment, and refinancing my private loans that don't qualify for REPAYE my total debt load is now ~$300K in my third year of residency ; none of my loans are in deferment. I live in one of the HCOL areas you specifically mentioned above and am able to afford daycare for my child, make a care payment, contribute modestly to retirement, and live relatively comfortably without surviving off of "ramen off a hot plate." Yeah, I have the benefit of my spouse's income, but it's comparable to residency salary, she has her own student loan debt, and has also been paying for adult learning courses at night out of pocket. Pending any exceptional, extreme, and unforeseen circumstances there's absolutely no reason your debt should be increasing while in residency.

 

[Obnoxious Dad]

You're technically right, but to be fair if you're not on an income based payment scheme like REPAYE you're being horrible with money. Paying 200-300 bucks a month (assuming you're single) would cut the interest accrual in half. And yes everyone can afford to do that.

Everyone can afford to do that? Have you seen what it costs to live in Seattle or San Francisco? Sure, if you're training in Grand Rapids or Kalamazoo you can put a dent in it. However, if you look at the geographic distribution of residency programs you'll see that they are definitely skewed to high cost of living areas like Boston, New York and Philadelphia.

 

[Obnoxious Dad]

Everything that you've contributed to this thread is just so rich, but I can't anymore. I spent 7 years in undergrad during which I was pretty reckless financially, maxed out my student loans each semester, and didn't qualify for federal aid my last 1.5 years and had to pay for school solely with private loans due the number of credits I had amassed and degrees I completed. During the 2 years between undergrad and med school the loan payments I made barely did anymore than keep interest at bay. In med school I didn't receive any scholarships and finished with a combined undergrad and med school debt load of ~$360K, which was considerably higher than most of my classmates. With REPAYE, income based loan repayment, and refinancing my private loans that don't qualify for REPAYE my total debt load is now ~$300K in my third year of residency. I live in one of the HCOL areas you specifically mentioned above and am able to afford daycare for my child, make a care payment, and live relatively comfortably without surviving off of "ramen off a hot plate." Yeah, I have the benefit of my spouse's income, but it's comparable to residency salary, she has her own student loan debt, and has also been paying for adult learning courses at night out of pocket. Pending any exceptional, extreme, and unforeseen circumstances there's absolutely no reason your debt should be increasing while in residency.

Let me take a wild guess here. You went to a state medical school as an instate student and You had the benefit of your spouse's income? How much does your spouse earn? I don't think you've disproven my point.

 

[Taddy Mason]

You have the benefit of your spouse's income? How much does your spouse earn?

As mentioned in my post you quoted, its comparable to my income as a resident. She also has her own student loans which she is making payments on, is contributing to retirement, and paying for night classes out of pocket.

 

[Obnoxious Dad]

As mentioned in my post you quoted, its comparable to mine income as a resident. She also has her own student loans which she is making payments on, is contributing to retirement, and paying for night classes out of pocket.

OK, the two of you make approximately $120,000 per year. This is hardly the norm for the vast majority of residents.

 

[jambro]

Everyone can afford to do that? Have you seen what it costs to live in Seattle or San Francisco? Sure, if you're training in Grand Rapids or Kalamazoo you can put a dent in it. However, if you look at the geographic distribution of residency programs you'll see that they are definitely skewed to high cost of living areas like Boston, New York and Philadelphia.

I'm not saying put a dent in it, all I'm saying is pay the REPAYE amount which can be about 300 bucks a month but will importantly get you the interest rate subsidy and save you 50k in interest in your example. I absolutely believe everyone can do that (even in Seattle or SF) because I bet you if their residencies paid 4k less they wouldn't starve on the street, and people who make less make it work for the rest of their lives.

 

[Taddy Mason]

Let me take a wild guess here. You went to a state medical school as an instate student and You had the benefit of your spouse's income? How much does your spouse earn? I don't think you've disproven my point.

Beings you changed your post - yes I went to a state medical school, however I didn't receive any scholarships, I wasn't married until half way through medical school, and my wife and I kept our finances completely separate (i.e., she didn't support me and I didn't take out any less in loans than I would have if I were single and living alone). I had a large undergrad debt load which accumulated a fair amount of interest and put my total debt load when I finished med school higher than the national average of the total debt load of med school graduates. My debt has also decreased, not increased. So, with your extreme claims of what typical med student debt looks like (which isn't supported by available data), and claim that debt will most likely increase in residency, particularly in HCOL areas, yeah, I've disproven that. Yes, I have the benefit of my wife's income, however, our combined income is less than $120K and in one the HCOL areas you keep specifically mentioning. She has her own debt and expenses, we both contribute to retirement, we both have medical bills, we have a car payment, we have a child, and we pay for daycare, yet we've been able to decrease our total debt, still go out, go on vacation, go to concerts etc., and aren't scraping to get by with rising debt. If I weren't married and had the benefit of my wife's income I also wouldn't have to worry about her expenses, her debt, a car payment, her medical expenses, paying for her and my son’s medical insurance, paying for the costs of caring for a child or daycare. I'd probably be living in a smaller place or with roommates, but have no doubt I'd likely still be in the same place in regard to my debt load, it decreasing, and living comfortably. I'd also have much more time for moonlighting and thus a considerably larger income, which I've opted not to do thus far so that I can have more time with my wife and son thus isn't a factor in my income or ability to decrease my debt.

I don't disagree by any means that the cost of medical school (and higher education in general) is exorbitant. But it's no where near as high as you suggest and is also quite manageable.

 

[Captain_Falcon]

That depends on where you're living. San Francisco? Miami? Or Oklahoma City, Western Michigan, Milwaukee, St Louis, etc. etc.
1. Rooming with multiple roommates cuts down on rent
2. Not eating out cuts down on well, expensive foods (the pandemic has made this easier for me personally since i prefer to dine-in than carry out)
3. Some people in school, especially in-state schools, can commute from home (living with parent's)
4. A decent number of people get grants, scholarships, and a larger number of people get help from parents (i.e. parents are doctors)
5. Some people have spouses that work, and thus can pay for COL expenses

Say your tuition cost of 344k in loans is at ~6%. Each year you rack up 5k for each 86k loan. So M1 loans accrue 20k, M2 loans 15k, M3 10k, M4 5k. That accrued interest becomes 50k. So yes, you get up to $394k assuming you took out every dime and nickel of loans.

Now you graduated, you can easily refinance that to <4% interest rate (even close to 3%). Your daily accrued interest at 4% is then $43. Monthly accrued interest is $1,288. Yearly is $15,460. As a resident you make 60k annually (some less, some more), after taxes you have $40,000 - $45,000 give or take. Subtract your interest on your loans that you pay off, you have $25k-$30k to live off of. That's $2,083 - $2,500.


You see how you won't come anywhere near 600k? Even 500k would be really difficult, purposely not paying anything and spending your money as you earn it.

You are conveniently overlooking the accrual of interest. At 6.8% and taking out loans of $86,000 per year you will have a debt obligation of $380,705 at graduation. Because your salary during residency will be taxable, because you will have residency related expenses, and because you may not want to live like a monk during residency, interest will keep building on that debt as you train. At the end of a four year residency your debt will be $495,306. If you train as a resident and fellow for six years, your debt will be $564,958.

You may choose to make payments on that debt during residency. If you train in New York City, LA, Boston, DC or (may the Lord have mercy on you) Seattle, happy Ramen off the hot plate.

Look at my post above, I accounted for a realistic scenario. You keep reverting to (a) highest school tuition (b) worst case scenario handling money (c) longest training (d) training in most expensive cities. You are extrapolating the extreme scenario in all of the above to all medical school graduates and residents, which is simply not the case whatsoever.

 

[VA Hopeful Dr]

Look at my post above, I accounted for a realistic scenario. You keep reverting to (a) highest school tuition (b) worst case scenario handling money (c) longest training (d) training in most expensive cities. You are extrapolating the extreme scenario in all of the above to all medical school graduates and residents, which is simply not the case whatsoever.

Its also worth noting that most people only pay OOS tuition for the first year, after that they become residents of that state and get in-state rates. That's what the non-South Carolinians did when I was there.

 

[Obnoxious Dad]

Look at my post above, I accounted for a realistic scenario. You keep reverting to (a) highest school tuition (b) worst case scenario handling money (c) longest training (d) training in most expensive cities. You are extrapolating the extreme scenario in all of the above to all medical school graduates and residents, which is simply not the case whatsoever.

I accepted your premise of $86,000 per year. When did you accept the notion that interest is accruing during medical school?

Six years of training is hardly out of line. It's surgery, pediatrics or internal medicine with a fellowship. Some people in surgical specialties train for nine or ten years. Look at the number of internal medicine residencies in the New York City Metro area and compare that with the number of residencies in places like Minnesota or Wisconsin. Even after allowing for the population differences you can see that the number of slots per 100,000 people is vastly greater in New York.

 

[Obnoxious Dad]

Its also worth noting that most people only pay OOS tuition for the first year, after that they become residents of that state and get in-state rates. That's what the non-South Carolinians did when I was there.

That's also true in Ohio. However, where else is that true?

 

[VA Hopeful Dr]

That's also true in Ohio. However, where else is that true?

Let me throw that back, what states won't allow you to claim residency there if you live there for 1 year, have an actual address (meaning not a PO box), have a bank account in that state, and spend money there?

 

[Captain_Falcon]

I accepted your premise of $86,000 per year. When did you accept the notion that interest is accruing during medical school?

Six years of training is hardly out of line. It's surgery, pediatrics or internal medicine with a fellowship. Some people in surgical specialties train for nine or ten years. Look at the number of internal medicine residencies in the New York City Metro area and compare that with the number of residencies in places like Minnesota or Wisconsin. Even after allowing for the population differences you can see that the number of slots per 100,000 people is vastly greater in New York.

I made this post in a different thread (thought i made it in here, sorry about that)

That depends on where you're living. San Francisco? Miami? Or Oklahoma City, Western Michigan, Milwaukee, St Louis, etc. etc.
1. Rooming with multiple roommates cuts down on rent
2. Not eating out cuts down on well, expensive foods (the pandemic has made this easier for me personally since i prefer to dine-in than carry out)
3. Some people in school, especially in-state schools, can commute from home (living with parent's)
4. A decent number of people get grants, scholarships, and a larger number of people get help from parents (i.e. parents are doctors)
5. Some people have spouses that work, and thus can pay for COL expenses

Say your tuition cost of 344k in loans is at ~6%. Each year you rack up 5k for each 86k loan. So M1 loans accrue 20k, M2 loans 15k, M3 10k, M4 5k. That accrued interest becomes 50k. So yes, you get up to $394k assuming you took out every dime and nickel of loans.

Now you graduated, you can easily refinance that to <4% interest rate (even close to 3%). Your daily accrued interest at 4% is then $43. Monthly accrued interest is $1,288. Yearly is $15,460. As a resident you make 60k annually (some less, some more), after taxes you have $40,000 - $45,000 give or take. Subtract your interest on your loans that you pay off, you have $25k-$30k to live off of. That's $2,083 - $2,500.


You see how you won't come anywhere near 600k? Even 500k would be really difficult, purposely not paying anything and spending your money as you earn it.

 

[Taddy Mason]

Its also worth noting that most people only pay OOS tuition for the first year, after that they become residents of that state and get in-state rates. That's what the non-South Carolinians did when I was there.

A number of schools also offer reciprocity, so OOS students may be eligible for in-state tuition, eligible for OOS tuition after 1 semester, or pay less than the advertised OOS tuition until they've establish in-state status.

 

[Obnoxious Dad]

A number of schools also offer reciprocity, so OOS students may be eligible for in-state tuition, eligible for OOS tuition after 1 semester, or pay less than the advertised OOS tuition until they've establish in-state status.

Name them, please.

 

[Obnoxious Dad]

Let me throw that back, what states won't allow you to claim residency there if you live there for 1 year, have an actual address (meaning not a PO box), have a bank account in that state, and spend money there?

You've got the burden of proof on this one. The only states I know that grant in state status after a being there for a year AS A STUDENT are Ohio and (thanks to you) South Carolina.

 

[Taddy Mason]

Name them, please.

Off the top of my head without looking at other programs:
University of WA
University of MN
University of ND
University of SD

Can also confirm that in 3 of those states students can easily claim residency after 1 year and be eligible for in-state tuition. In talking with colleagues I believe this is the case for MA, NY, FL, and TX as well. If anything, it's more the rule than the exception.

Edit: And just because of the ridiculous numbers you've been throwing around for med school debt alone - https://store.aamc.org/downloadable/download/sample/sample_id/374/

I love the irony of making baseless claims with no objective data to back them up, then demanding specific evidence when those claims are countered, especially when all it takes is a quick Google search.