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...or middle class parents who immigrated to the US, made many sacrifices, established themselves, and dedicated every drop of their success to their offspring's education.
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Why Does the U.S. Make It So Hard to Be a Doctor?
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I remember reading basically this exact same article with different wording from the Atlantic years ago before I was even in medical school. Personally I don't see how it's a good thing to lower the intelligence standards to become a doctor just to create an artificial surplus. Most of those newly-minted doctors will just end up going to the most desireable areas that are already saturated with physicians anyway. But the way medical school expansion is going right now, it seems the author will get their wish.
You had PLENTY of information to help guide your decision. You are at the age where EVERYONE was talking about the dynamics in medical education. Perhaps those who graduated c ollege in the 90s can use the excuse that didnt know. But as it stands now, all the information about how unfavorable medical education is, is out there.
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Yes they are fake doctors. I assume you are referring to nurse doctors who do not even have the most basic requirements fulfilled.
The entire system lacks direction and is chaotic and getting worse because the leadership is piss-poor across the board in every aspect of healthcare and medical education. The least of which is the Affordable care act which did not do medical education any justice. The goals are not coordiated and the incentives are back asswards.
Here's the deal. It's hard to be a doctor in the U.S. because the medical establishment has erected entry barriers to keep the salaries of physicians higher than they'd be in a rational market. This all goes back to the AMA and the Flexner Report in 1909. The Flexner Report inspired the closing of numerous medical schools including some, such as Fordham's, that were run by legitimate universities. The whole purpose of that exercise was to create artificial shortages of physicians.
Today the ACGME and the LCME require that residency programs and medical schools sponsor research. This adds to the cost of medical education and decreases the use of residents in hospitals. Medical schools and training programs in most other countries are simply devoted to cranking out competent clinicians. Not true on the good old USA.
Robert Grossman, the Dean of NYU's medical school, clearly stated in an interview that the tuition paid by medical students was funneled to support unproductive faculty i.e., people who didn't teach, didn't get grants and didn't see patients.
blogs.scientificamerican.com
One of the excuses for the ridiculously high tuition in American medical schools is that students divert the time and attention of attending physicians away from money making opportunities. On the other hand, where does the credit go for the scut work performed by medical students, the lower salaries paid to physicians who WANT to work in the academic setting and the greater revenues generated by medical school hospitals as a consequence of the prestige associated with academic medicine?
The same anticompetitive forces worked in the nursing profession which saw the dismantling of 1,250 hospital sponsored RN programs since 1960. The people who ran university-based nursing programs were hell bent to close those programs and they got their way. We now have a severe nursing shortage.
Today the ACGME and the LCME require that residency programs and medical schools sponsor research. This adds to the cost of medical education and decreases the use of residents in hospitals. Medical schools and training programs in most other countries are simply devoted to cranking out competent clinicians. Not true on the good old USA.
Robert Grossman, the Dean of NYU's medical school, clearly stated in an interview that the tuition paid by medical students was funneled to support unproductive faculty i.e., people who didn't teach, didn't get grants and didn't see patients.
Why Doctors Are Drowning in Medical School Debt
A resident physician investigates the causes of skyrocketing tuition
One of the excuses for the ridiculously high tuition in American medical schools is that students divert the time and attention of attending physicians away from money making opportunities. On the other hand, where does the credit go for the scut work performed by medical students, the lower salaries paid to physicians who WANT to work in the academic setting and the greater revenues generated by medical school hospitals as a consequence of the prestige associated with academic medicine?
The same anticompetitive forces worked in the nursing profession which saw the dismantling of 1,250 hospital sponsored RN programs since 1960. The people who ran university-based nursing programs were hell bent to close those programs and they got their way. We now have a severe nursing shortage.
The problem with this is that for a lot of people, there isn't an amount of "more" that would get them to move to these rural areas.
When desirable area pay is high enough that you can have a comfortable life, there is no price point that will incentivize many people to go somewhere with limited resources. I currently live in a town of 15k people and after living and doing rotations here for nearly two years, there is no price point that could get me to come here as an attending. Just the fact that the nearest decent airport is an hour an a half away, so it's a big ask to get someone to drive me to the airport and I have to pay ridiculous money to put my car in airport parking anytime I go anywhere, is enough to make me want to live somewhere else. Let alone the things that are day to day QOL issues for me... target, starbucks, more than one chain grocery store, something other than walmart to buy non-grocery things at, a fed ex/UPS location to ship things from, etc. Doing absolutely anything here is harder than doing it somewhere larger. I don't even have a decent inexpensive place to get a haircut in town so I've been getting haircuts while on away rotations.
Add in the fact that many specialties have *one* physician here - so you know you're going to be on call 24/7, 365 for your specialty... we have one gastroenterologist, one nephrologist, one neurologist, and one urologist on staff at my hospital. If those people go on vacation, even basic procedures get shipped out, and if you're not out of town, you're on call. If I was looking at coming here as a new hire and I knew that I'd be taking call literally half the year because there was only one other physician of my specialty in town, I'd laugh and look elsewhere no matter what they were offering.
It's just not possible to increase the salary differentials enough to get people to move to these rural areas unless you're talking about city salaries dropping sub-150k IMO.
Exactly. That’s why you’re only ever going to successfully recruit people to these places who were from them to begin with. However, it seems like there’s like 10-15 ish cities where >90% of all med students are from and they’d all happily take a pay cut to be near family and civilization.
Thus also doesn’t account for how hard it is to practice in these places. Even if you are okay with being the few/only people in your whole county covering a specialty, good luck doing any of the stuff you need to do your job. Hospitals need to have neurosurgery at the ready if you’re going to have an NIR department for example. Say that one neurosurgeon, quits/retires/dies, well now that department is up the creek until the hospital finds someone or you deal with locus (if the hospital will pay for them). Even if you have that coverage, you’ll always have staffing shortages and constant ancillary staff turnover because they don’t want to be there either.
I’m from a rural area and don’t like cities. But I’m hesitant to go rural for the reasons above.
TLDR; it’s not just the undesirable location. It’s a harder job wrought with potential logistical nightmares.
I disagree with most of what you wrote honestly. Physicians are paid rationally since they have to be one of the top students in their classes in undergrad and give up at least 11 years to train counting undergrad, medical school, and residency. For that they're paid enough to be comfortable and provide for their family but most aren't living in mansions and driving new ferarris. To be among the best and compete for so long one should deserve a comfortable life.Here's the deal. It's hard to be a doctor in the U.S. because the medical establishment has erected entry barriers to keep the salaries of physicians higher than they'd be in a rational market. This all goes back to the AMA and the Flexner Report in 1909. The Flexner Report inspired the closing of numerous medical schools including some, such as Fordham's, that were run by legitimate universities. The whole purpose of that exercise was to create artificial shortages of physicians.
Today the ACGME and the LCME require that residency programs and medical schools sponsor research. This adds to the cost of medical education and decreases the use of residents in hospitals. Medical schools and training programs in most other countries are simply devoted to cranking out competent clinicians. Not true on the good old USA.
Robert Grossman, the Dean of NYU's medical school, clearly stated in an interview that the tuition paid by medical students was funneled to support unproductive faculty i.e., people who didn't teach, didn't get grants and didn't see patients.
Why Doctors Are Drowning in Medical School Debt
A resident physician investigates the causes of skyrocketing tuition
One of the excuses for the ridiculously high tuition in American medical schools is that students divert the time and attention of attending physicians away from money making opportunities. On the other hand, where does the credit go for the scut work performed by medical students, the lower salaries paid to physicians who WANT to work in the academic setting and the greater revenues generated by medical school hospitals as a consequence of the prestige associated with academic medicine?
The same anticompetitive forces worked in the nursing profession which saw the dismantling of 1,250 hospital sponsored RN programs since 1960. The people who ran university-based nursing programs were hell bent to close those programs and they got their way. We now have a severe nursing shortage.
I don't think there is a shortage of doctors compared to other countries when factoring a few variables into those studies. If you don't live in a major city it's pretty much a requirement to own a car. Having fewer doctors isn't as much of an issue then because while it would suck to have to drive an hour to see a doctor that doesn't make it impossible.
The other factor is that it's up to people to look at where the closest doctor is when moving to an area. We shouldn't flood the market and drop everyones salaries because Pam wanted to move to the boonies and complain that the nearest doctor is an hour away. If you live in areas with doctors you can get appointments for most stuff fairly quickly.
Doesn’t the United States also have the best hospitals in the world (not necessarily health outcomes or healthcare). I think I saw a global hospital list and US had most representation of any other country
Physicians are often some of the top students in their classes in undergrad, but it's definitely not a requirement. Of the 11 years you include (many of which include learning and relearning abstract concepts), many of them (my opinion) do not contribute to the quality of the physician.
I do think physicians are paid near where they should for what they train to and do now, but it would be nice for our profession to trim the fat proactively (unnecessary years, etc. and earlier integration and improved clinical education) instead of waiting for market forces to dictate what becomes the bidding price for healthcare which in today's world is diagnosing acute conditions after an onslaught of tests. I have no proof, but I suspect NP/PAs spend a lot of money doing unnecessary tests. They may also relay incorrect assessments which may or may not lead to incorrect plans which has the potential to cause harm, but I don't think there's a way to tease that out as PAs/NPs often work in conjunction with not only their physicians, but likely other physicians in separate departments so they're not being leaned on to make any life changing decision.
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From my recollection from unnecessary undergraduate classes, the US spends somewhere between 20-25% of it's federal budget on healthcare and our GDP is the world's largest. If we spend that much, we will meet the "best hospital" criteria by some metrics probably in areas of the quality of technology and the depth of services we have to offer. America has and always will have a lot of things going for it, but it'd be better if we make reforms to our systems (in this case healthcare training and education) proactively instead of waiting for a crisis like we are already seeing in Emergency Medicine.
Right now things are good, physicians are paid well, they ultimately are trained well by the time they're practicing, and there's no reason for leadership to look under the hood, but over time the system needs to adapt to today's parameters or else things will get bad in the future and we will then sit down and wonder where this all started.
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Sorry for the confusion I meant that for undergrad. Another thing people don't think about when screaming doctors make too much is that there's far fewer safety nets in this country. If you want a good education for your children and good healthcare you are going to pay through the nose for it which justifies that salary as well.
No need to say sorry. Just making my points. I think if you broke down Introductory Organic Chemistry grades across universities across the nation by career aspirations/major, actual pre-medicine students would probably have a higher overall performance than those planning on pursuing organic chemistry research and chemical engineering. It's laudable that we know how covalent bonds work, but the problem is that doesn't improve our ability to be physicians as much as perhaps early clinical integration. I think something even as simple as a paid scribing job in the ED contributes way more to a physician's eventual experience and training. I just think US medical/premedical education system needs to rethink the entire structure. I do think there's some value in a broad education with emphasis on history, math, communication, and now information technology (especially early on_ and don't think we should be teaching medicine to elementary school students, but I just think the middle school-medical school process has a lot of redundancy in it and as a result, opportunities to teach clinical skills necessary for physicians gets pushed back into one's mid/late 20s...Some of that has to do with poor standards in middle school/high school that is more related to general US education, but then the undergrad/medical school portion also carries a lot of redundancy.
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This is why I'll not only never work in a rural area, I'd never live in one either even if I loved it tbh.
There's an easy solution to the neurosurgeon/NIR problem - don't have either. That's how my hospital does it, so anyone that's outside the window for TPA is just up crap creek without a paddle. Congrats on your new paralysis. I don't want to be the patient more than an hour and a half away from NIR/neurosurgery if I have a stroke in the middle of the night and nobody knows what time I was last normal beyond "oh, she was okay before she went to bed last night," because I also never saw us transfer somebody like that when I was in the ED either.
Take an economics course. The salaries of physicians are not at all rational because they aren't set in a rational market. Access to medical training in this country, or any other country for that matter, should be open to anyone who is willing to pay the price for an efficiently delivered medical education. Residency slots should be plentiful because in most cases residents are a more efficient alternative to NPs or PAs.
Your attitude concerning the accessibility of medical care in rural areas and small towns is absolutely stunning. Do you think farmers and miners are subhuman? Would you repeat this nonsense in a medical school interview?
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Never did I say I regretted my decision.
I'm just pointing out that it's ass compensation in comparison to other choices I could have made.
Wow you are putting words in my mouth and jumping to extreme conclusions to try to character assassinate me. This is a rational market because physicians are trying to control it to maintain a pay that makes sense for the profession. If left unchecked a similar situation that happened to law and pharmacy would happen to medicine. If you hold no power the corporations and educational institutions will grind you into the ground exploit you for cheap labor, and prevent you from being able to protect yourself.
I never said people in rural areas don't deserve or aren't worthy of care. I said that if you move to the middle of nowhere expect to drive far to get to places. This seems like common sense to me but I guess it isn't since you don't seem to get it. Let's open a full blown hospital next to every farmhouse but we need money care to donate?
Yeah let's allow anyone with the money and a pulse go to medical school like you said. That would totally not decrease the quality of care the public would recieve. Honestly man it's ironic that you said you're a dad in your username but you have the arguing skills of a child. "He has a different opinion than me he's a horrible person!".
The tuition is high across all colleges and grad school. Govt got more involved in loans and it increased alot.
Yes esp when teachers, librarians etc get pensions
True, but it's not like it's much. My mother was a teacher for 30 years. Her district had 4 pay scales based on education, she had the 2nd highest level.
Her monthly pension check is roughly the same as her monthly social security check.
Pensions for teachers are a big recruitment tool which given their fairly low pay (I made as much as an intern as she did that same year after 28 years teaching) is pretty important.
The residency programs that can be easily expanded are doing so at a pretty fast pace. But not all of th can be.
Why is that? This isn't true for any other field that I'm aware of.
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Want to get an MBA or a law degree? Go for it. Want to get an IT degree? It's yours for the taking. There are a few fields in the trades in strong union towns that are tough to break into but for the most part if you have the talent and inclination to do anything BUT medicine, you can do exactly that in this country.
The market shouldn't be controlled to prop up physicians' salaries artificially. Do you want the prices you pay for food, energy, water etc. to be controlled or do you want to pay prices that are set in a competitive market?
Yes but it's forever until death.. that's a big thing. And becoming a teacher is much faster.
The type of unregulated capitalism that you're suggesting leads to the exact opposite outcome that you're saying. If you take physicians power to control supply then medical schools will pop up everywhere and flood the market. Doctors will then make less money and have less freedom to find jobs. Corporations will get dirt cheap labor from them and any physicians that try to find a way around their control would get stomped out. This has already happened to other aspects of our economy we don't need a repeat of that in the medical field.
Unregulated capitalism is like a snake devouring itself. Big companies flourish and stomp out the competition. They then corner the market and charge whatever they want. Limiting competition to keep rates high is the antithesis of capitalism. You want that in healthcare too? Doctors make crap but patients pay even more for their care?
Everything concerning doctors is pretty stable where it's at. Physicians get paid what most people consider they are worth and wait times are not as bad if you live in a populated area. If you want to help patients and make their lives better go after administration, pharmaceutical companies, and health insurance companies. That's where most of their money goes to limiting their freedom to recieve health care.
There has to be a balance in power between employer and employee because otherwise the customer pays the same or more and the money just goes to the top and stays there.
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What are you talking about? There are limits to the number of available spots for law school and MBA School. They are not unlimited, so no not everyone who has the talent and inclination is guaranteed a spot in either.
Interestingly, there are more residency positions per year than there are law school graduates per year.
Have you not heard of the lsat or gre? There’s barriers to entry to all these fields and not sufficient resources to train an unlimited amount of people in any of them.
Slightly different situation. This wasn't a financial decision nearly as much as it was a plea to legitimize the academic/science-based nature of nursing. It's what allowed the field to begin to evolve into a huge monster like it is today.
I'm not saying that the situation is good, but the motives were much, much different.
All that aside, I work with some of those old-guard diploma RNs and I typically prefer them, although the sample is skewed towards extremely experienced RNs being the majority who still practice with that background.
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Well, you are wrong about the numbers. About 38,000 people march off to law ABA accredited law schools every year according to the ABA. See the ABA 509 reports. That's about 4,000 more than the number of people who enter ACGME accredited residency slots leading to board certification.
Standard509Disclosure
You prefer the diploma grads because they actually know how to take care of sick people. My better half was an ICU head nurse with a BSN at a top 20 hospital in the 1970s and 1980s. She and her fellow head nurses all agreed that the diploma grads actually knew what they were doing on the floor while the new BSNs were helpless.
I'm not talking law school matriculants, I'm talking graduates as I specifically say in my post: 2020 law school grads having harder time finding jobs, data shows.Well, you are wrong about the numbers. About 38,000 people march off to law ABA accredited law schools every year according to the ABA. See the ABA 509 reports. That's about 4,000 more than the number of people who enter ACGME accredited residency slots leading to board certification.
Standard509Disclosure
www.abarequireddisclosures.org
Now maybe you're looking at 2021 numbers as I can't easily find those but that would be a pretty big change in 1 year.
I've taken both of them. Thanks. There are more law school seats than there are people who are able to graduate and actually practice law. This is the reason that a number of law schools like Indiana Tech and Valparaiso have closed. Furthermore, there are plenty of cheap places to attend law school as an instate student if you do a little research
Sure. The number of law school grads has exceeded the number of jobs for decades. That's because the legal establishment hasn't erected barriers to the study of law.
Cool, so I'll let you go back and edit your previous post then.
As I said early in this thread, the barriers that medicine put in place in the 90s aren't holding at all these days. We just haven't caught up yet for multiple reasons, and for some specialties we might not ever quite given that some residency/fellowship programs require a large hospital system often with an academic bent of which there are a finite number.
I have no need to edit anything. You are the one who wasn't clear. First, you wrote about the number of spots in law school and that was the point to which I was responding. Then you addressed the number of people who actually graduated.
Not even close. Let's review:
In paragraph one I did bring up law school spots at first. That point is still accurate as there are not infinite spots in law schools. Based on what a quick Google search reveals, even the least selective law school only accepts 80-ish percent of applicants which means there are still people who don't get accepted to law school which follows with my point about not everyone being guaranteed a spot: 2020 Law School Rankings - Acceptance Rate (High to Low)
In the second paragraph my point about residency positions and law school graduates was separate but still very clear given that its a single sentence and not exactly a lengthy one either. You were responding to a point I didn't make comparing residency spots to law school matriculants instead of the one I did make that used law school graduates.
I'm honestly not sure I could have made it any more clear.
I think it’s more a function of whoever has the most experience. Diploma nurses are learning on the job whereas it takes an ASN/BSN nurse more time to catch up to the clinical hours, but I see your point
The only people who can't get into law school in the U.S. are people who have absolutely no business going to law school. They are people who couldn't beat a traffic ticket for the Pope in Vatican City. Look in the ABA 509 reports at the average LSAT scores of accepted students at places like Cooley or California Western. Yikes!
On the other hand, MD schools turn away thousands of people every year who are perfectly capable of succeeding in medical school. You know that. Don't even try to jive me about this. The medical school admissions process is not some utterly rational, empirically validated contest played out on some level playing field. People who go to tough schools, major in engineering or the physical sciences and come from states like California, New Hampshire, Rhode Island and others with few or no state-owned medical school seats, get turned away in droves. Their options are offshore diploma mills or some DO school with terrible clinical rotations and obscene tuition.
I believe we've had this same discussion before. I'm writing because I respect your position.
I agree with you that keeping the number of physicians limited simply to prop up salaries is abhorrent. I get why those in the profession would desire it. I don't want to make less in salary than I do today.
And I think you've already mentioned this, but this is not a medical school problem. We already have more residency spots than med school graduates. If we increased the number of medical school spots all alone all that would happen is IMG physicians would be displaced. Whether that's a good or bad idea is debatable, but it won't increase the supply of physicians and hence won't address your primary issue.
So the "solution" is increasing the number of residency spots. But that isn't so easy, and won't necessarily fix the cost problem.
It's often said that residents are cheaper than NP/PA's. The latest example is some NS program closing and replacing all of their residents with midlevels. A more accurate statement would be that midlevels are cheaper in programs that overwork their residents. So, no surprise, true in almost any NS program. But in many IM programs, residents get lots of electives and outpatient blocks. One NP/PA could cover the work of several residents -- less financially efficient. This will be very dependent on local work patterns, and how much "grunt" work vs "elective" work is in the resident schedule.
Adding a new resident to our program isn't easy. Sure, I have plenty of general IM teams that my Hosp Med program would love to have residents on -- some teams have residents, and at least half do not. But an IM resident doesn't do all Gen Med rotations. They need ICU, and Neurology, and Geriatrics. And a continuity clinic. And research mentors. And specialty experiences. And if I add more day teams, then I might need more night residents (so more night rotations). And bigger conference rooms / work space. That's the magic of hiring an NP/PA - they do inpatient Hospital Medicine with every shift, all the time. It's much more efficient and simple (and much less turnover).
And then there's the issue of Medicare funding for GME. You and I agree (from other threads) that this is a boondoggle. It's the grift that pays my salary, and I know that. I'm still against it. If we're increasing resident slots, then there's more GME funding to flow. Unless we're fixing that too.
Ignoring all that, then the question is: would more physicians lower health care costs? Sadly, I think the answer is no. Healthcare doesn't seem to follow standard economic principles, because lots of things distort the marketplace. Including:
- Patients don't pay for healthcare directly. Many have insurance which just pays the bill. Some have no insurance and end up never paying the bill. Some people get squeezed in the middle. But market forces don't tend to work well when consumers don't pay the bill
- Fixed payments for services. Most insurances have a fixed payment for a service. It doesn't matter how much experience I have, or (somewhat) what part of the country I'm in. I get whatever the insurer has decided is the "maximum allowable amount". And since insurers publish that, it's unlikely anyone would charge less (and, even if I did, it wouldn't save the patient anything)
- Many studies / analyses have determined that healthcare tends to be "supply sensitive". If I'm a new Cardiologist in town and I just paid for a new shiny Cath Lab and the schedule is empty, I'm much more likely to recommend a Cath than medical management. If I'm a new PCP in town and my schedule is wide open, I'm much more likely to see you back for a blood pressure check in 1 month rather than 3-6. Both physician want their schedule to be full (as would someone who owns a restaurant). Patients tend to be very happy -- they get their test, or visit, or attention from their physician. But this just drives up costs.
- There is information asymmetry between buyers and sellers. When buying a new washing machine, I can do all sorts of research on what type of machine I want, price comparison, shop various stores, and pick what I want (although, in my house, after all of that if we go to the store my wife looks down the line, points to one and says "I like that one, it's what we're going to get", and all of my research is wasted). In healthcare, it doesn't work this way. You come and see me for abdominal pain and I tell you that you need a CT scan. Costs $2000. What are you going to do -- go ask someone else for another opinion? And what happens when they tell you that you don't need a CT scan, whom are you going to believe? Even for elective procedures, shopping around is very difficult. Most patients won't be able to manage this. I'm sure you can -- you're here talking about it. But most cannot.
And in the end, every healthcare dollar wasted is someone's income, somewhere. So cutting healthcare costs = cutting people's salaries (or having less people do the same amount of work). This is no different than any other commodity -- offshoring production to cut costs, technology replacing workers in factories, tracking workers to maximize productivity, etc -- all done to drive down prices. Which is great if you're the consumer, and less good if you're the person whose job is being replaced.
Bottom line is that there's no easy answer. And anyone trying to sell an easy answer, whether it's NP/PA's, Universal Healthcare, Malpractice reform, or whatever is a pipe dream. Sadly, I expect we'll need to wait until the system truly fails to change anything, and it will be incremental tweaks that put off the problem a few years at a time.
Yes. But there is only like a ~40-45% acceptance rate nationally. So there is barrier to entry. So no, not just anyone can do it.
You make a point that only people that have no business applying to law school don’t get in but med schools routinely turn away good applicants. But the reality is that every training program turns away qualified applicants for another qualified applicant that is deemed “better” in some way. This again proves the point that not just anyone gets to do anything. More applicants than spots.
Ignoring most of my post, but OK I'll play along. Between 2011 and 2020 we've increased the number of med school spots in the US by about 50%. Yet the acceptance rate in 2011 was around 55% while in 2020 it was down to 42%. This isn't a shock as the number of applicants went up by a large amount in that time. Why not, medicine is a pretty good job.
We would need to literally double the number of med school spots to accept everyone that wants to be a doctor and that's neither feasible (since we'd have to increase residency spots by around 75%) no desirable since not everyone who applies is going to be qualified. I'm not saying that everyone who is rejected is unqualified by any means, just that some are. Given that we are, fairly rapidly, increasing both med school spots and residency spots I see no need to make any changes at the moment.
Pensions are a bad deal for the consumer, generally. If joe teacher dies at age 62 after being retired for 2.5 years. . . .
The rate of return is around 6.5% and there is nothing for the estate to pass on. The main beneficiaries are people who can’t manage money.
Pensions have gone away for a reason. They are expensive to run, have a tendency to be poorly run, have poor rates of return, and leave little or nothing to be given to the next generation.
What it really boils down to is that this is standard practice in basically every developed country- medicine is a field where you have to train within that country to work there. Any other field, it would be obvious why we limit work to mostly American and American-trained citizens, as part of the work of a country is to provide a stable economic situation for its citizens. People also desire good quality control with regard to life and death, so countries often want to have the certifying bodies within their borders determining what adequate training is.
Why America Has So Few Doctors
As a matter of basic economics, fewer doctors means less care and more expensive services.www.theatlantic.com
It's a good question without a satisfactory answer...
(I can also appreciate any article that takes a slash at the AMA)
But this article only kinda deals with the elephant in the room... the cost and time of education in this country that has very little pay off.
Personally, I think we should have more reciprocity agreements with foreign accrediting bodies, but they generally don't want them because that opens their borders to us just as much as it opens ours to them, which looks bad to their medical graduates and citizens.
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Plus midlevels have exploded and will fill many roles formerly carried by physicians, so we would just be training people that would go unemployed or underemployed.
Depends on the pension. Mine is spectacular. 9% withheld (to a max of 22k/year) for 27 years, I get 55-ish% of my highest 3 consecutive years pay. At retirement I can also choose to take a lower monthly rate and then when I die my kids get to split that pension for the rest of their lives.
I actually did the math and saving 22k/year in pre-tax accounts assuming I live for 18 years after retirement (assuming age 62 which is when I can retire with the pension) and the pension resulted in like 40% more monthly income.
Most of those calculations that favor pensions are on extremely conservative rates of return for equity based portfolio. Past rates of return are >10%.
$1830/month for 27 years with a 10% rate of return gets you about $4M. 12% is closer to $5M.
I’d rather have the lump sum.
Using the 4% rule, the pension monthly income compared to 10% growth for pre-tax accounts wins by a couple hundred dollars if my average earnings are 300k. If I earn 350k (I've broken 400k the last 2 years for context) and go with the 12% rate of return, they're about the same. If I continue with 400k then the pension wins by like 4-5k/month.
I also like the idea of a lump sum so I'm doing both the pension and maxing out the 401k. Plus the hospital just started a 401(a) for 10k/year.
Physician pay scale is merit based, as it should be, so I agree with the sentiment of the statement, but there is this prevailing sentiment among some physicians and trainees that there is this element of 'giving up' something that somehow entitles them to special consideration. If anyone is giving anything up, those are the mentors that guide and instruct in the clinical area to form an actual doctor. It takes years off our lives that would not otherwise be taken in private practice. You give up nothing. You are being given more than you've ever been given and if you are smart about your finances in the first 5-10 years of your practice, you'll end up having done very well.
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