why must we forego money to become doctors?

[Tommyguns89]

This is slightly off-topic, but I wonder how far tuition will rise before we top out? It can't just keep going up forever, right? At some point the whole system will break or apps will go through the floor.

With IBR it will become monopoly money before getting to that point. Worst case is you pay 10% of your income for 25 years(or 10 if your job is considered to be public interest) and it is forgiven. There is some speculation about a tax bomb for those on the 25 year path but it is all speculation until it gets to that point or Congress addresses it specifically.

Obviously it probably wont come to that for most physicians. Thats the worst case scenario. Although that seems to be the default path for a lot of students with large loan balances in fields that arent doing well(law)

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[slz1900]

I don't think doctors earning 200k to investment bankers is really an apt comparison. It would make more sense to compare doctors who are equally as obsessive about $$ to business types with similar motivations. If you are wanting to go into medical school just so that you can make a lot of money, you are probably not going to go into a lower paying specialty, and if you end up in one even though you didn't want to, then you probably weren't cut out to be a ceo billionaire anyway.

 

[Eiot]

.

.

 

[TheWeeIceMan]

With IBR it will become monopoly money before getting to that point. Worst case is you pay 10% of your income for 25 years(or 10 if your job is considered to be public interest) and it is forgiven. There is some speculation about a tax bomb for those on the 25 year path but it is all speculation until it gets to that point or Congress addresses it specifically.

Obviously it probably wont come to that for most physicians. Thats the worst case scenario. Although that seems to be the default path for a lot of students with large loan balances in fields that arent doing well(law)

Yeah, I keep forgetting that IBR hasn't even been used to completion yet. Will be interesting to see what happens.

 

[circulus vitios]

With IBR it will become monopoly money before getting to that point. Worst case is you pay 10% of your income for 25 years(or 10 if your job is considered to be public interest) and it is forgiven. There is some speculation about a tax bomb for those on the 25 year path but it is all speculation until it gets to that point or Congress addresses it specifically.

Obviously it probably wont come to that for most physicians. Thats the worst case scenario. Although that seems to be the default path for a lot of students with large loan balances in fields that arent doing well(law)

The speculation is the other way around: as it stands, the debt forgiven under IBR will be treated as taxable income. http://www.ibrinfo.org/faq.vp.html#_Will_forgiven_loan

 

[rangoon1984]

Nontrad here...

Money really shouldn't be your number one priority when choosing a job. If you choose a job purely for the money, but hate what you are doing 8-16 hours a day, what's the point?

That said, when you're entering significant debt (ie, medical school), it's good to know what you are getting into.

But never do a job just for the money. There's something to be said for liking what you do, and if you hate what you are doing for the majority of your day, it doesn't matter how much money you have in the bank. You will be miserable.

 

[yehhhboiii]

Nah, they mostly just had the right upbringing and moderately wealthy parents.

Med school more and more is becoming only accessible to people from wealthy families. The obscene cost of med school makes it virtually unobtainable to people from poorer backgrounds, who may have children, parents, or other family members to provide for, and who didn't have the luxury of having paid-for premium schooling since they were 6 so they could focus on their studies without any other distractions and obtain the flawless record needed to gain admission. Even if a poorer kid can find financing for med school, usually his grades will keep him out because he hasn't had the privileged lifestyle most med students have had.

I can't think of a single person in my 200 person class who had any sort of significant adversity in their past. The vast majority spent christmas break either on a cruise or in an exotic overseas destination (new zealand, australia, europe, etc.).

A very large percentage of med students have at least one parent who is a doctor. And just deal with it, almost everyone chooses to do this because of the earning potential and/or social status. And we wonder why we have a doctor shortage in rural areas? Nearly everyone in my class wants to practice in a high cost of living area and wants to train in a surgical subspeciality or other highly profitable speciality. Granted I go to a top school, and the higher ranked the school, the more you're going to see these kind of people. I would guess there would be far fewer silver spoon kids at community based schools.

It's a profession of the wealthy and elite. For those without the proper pedigree and funding, few have the flexibility in life to assume such massive financial risks pursuing an MD requires. Smarts and work ethic have little to do with it. I think most people with an average IQ could do this given the right upbringing.

This entire post is bollocks.

 

[WompyWomperton]

This entire post is bollocks.

There is some truth to it, though.

 

[WompyWomperton]

This entire post is bollocks.

Whoops, double post.

There is some truth to it, though. I know an MD/PhD who was raised in a "less fortunate family" who said that medical school was just (quote) "rich kids getting richer."

It really surprised me when he said some students drive high end vehicles (BMW, Lexus, etc.) and their parents buy them a home a few blocks down the street. Some even foot the entire medical school tuition bill for their children.

 

[Barcu]

Whoops, double post.

There is some truth to it, though. I know an MD/PhD who was raised in a "less fortunate family" who said that medical school was just (quote) "rich kids getting richer."

It really surprised me when he said some students drive high end vehicles (BMW, Lexus, etc.) and their parents buy them a home a few blocks down the street. Some even foot the entire medical school tuition bill for their children.

I agree there is a ring of truth to it. But I also would say it's bollocks because it assumes that medicine is like that and other fields are not. Business is the same way. Unfortunate thing about America today (unless you are rich of course).

 

[thefritz]

I agree there is a ring of truth to it. But I also would say it's bollocks because it assumes that medicine is like that and other fields are not. Business is the same way. Unfortunate thing about America today (unless you are rich of course).

First point: Business is not a "field." All fields involve business. A field is something like healthcare, telecommunications, mining, shipping, retail, etc. Opportunities exist for great profit in any field as long as you are an owner and not an employee. Healthcare is one of the few fields where employees can earn high incomes because their labor is sold by their employers for extremely high prices (to insurers and the government). Owners in other fields are generally more limited in how much they can pay their employees because of much tighter profit margins, increased competition, and a far greater pool of available labor to choose from.

Second point: As far as the post being "bollocks," it is simply an observation of fact. I'm not even in a big city. Doctoring is and always has been a profession of the wealthy and the elite. That does not mean that poorer people sometimes don't break into the field, but they eventually become wealthy themselves and their children go to medical school and the cycle continues. Very few medical students come from poor families or grew up on welfare, or have any sort of troubled past with criminal records or illegitimate children, etc. The reason being that the admissions process effectively precludes these individuals from gaining admission because of the huge financial hurdles and because of the fact that GPA and test score considerations are unforgiving - everything has to be reported and you can't re-do the MCAT or hide a semester of Fs. It takes a very, very nurturing environment to produce a 4.0 GPA and a 38 MCAT at age 21. The only way really around this is to play the race card, and even that only goes a very small way in admissions. Yes, there will always be a few exceptions, but the vast majority come from stable families whose parents are at a minimum college educated and paid for some, if not all, of college. It's a really tight nit club with little diversity. Do you seriously contend this?

As far as I know, DO schools are more forgiving in terms of overwriting past screw-ups due to difficult circumstances growing up and there are more rounded and experienced people in these programs.

 

[yehhhboiii]

Maybe it's just me but I know several people that came from lower class backgrounds. I don't argue that people go into medicine to have a stable well paying career. But being a medical student doesn't mean that you were born with a silver spoon in your mouth. Some people had the work ethic and intelligence that brought them from the bottom to the top. Having a criminal record or children means you made poor choices. Being poor sucks. But that doesn't stop someone frim displaying scholastic aptitude.

 

[circulus vitios]

Maybe it's just me but I know several people that came from lower class backgrounds. I don't argue that people go into medicine to have a stable well paying career. But being a medical student doesn't mean that you were born with a silver spoon in your mouth. Some people had the work ethic and intelligence that brought them from the bottom to the top. Having a criminal record or children means you made poor choices. Being poor sucks. But that doesn't stop someone frim displaying scholastic aptitude.

Yes it does.

52% of fathers of medical students hold a doctorate, 35% of mothers. Compare this to 12% and 10%, respectively, for the entire US population. https://www.aamc.org/download/142770/data/aibvol9_no10.pdf

$100k/year median family income in 2006. I remember reading a $110k/year figure from more recent stats. https://www.aamc.org/download/102338/data/aibvol8no1.pdf

 

[LizzyM]

But being a medical student doesn't mean that you were born with a silver spoon in your mouth.

Yes it does.

52% of fathers of medical students hold a doctorate, 35% of mothers. Compare this to 12% and 10%, respectively, for the entire US population. https://www.aamc.org/download/142770...bvol9_no10.pdf

$100k/year median family income in 2006. I remember reading a $110k/year figure from more recent stats. https://www.aamc.org/download/102338...aibvol8no1.pdf

It is unusual for a medical student to come from a family of limited resources but it is not impossible. I would estimate that at least 5% of every class consists of people who came from very modest circumstances but got where they are through hard work, mentoring and the kindness of strangers (in the form of scholarships and other assistance).

 

[Barcu]

First point: Business is not a "field." All fields involve business. A field is something like healthcare, telecommunications, mining, shipping, retail, etc. Opportunities exist for great profit in any field as long as you are an owner and not an employee. Healthcare is one of the few fields where employees can earn high incomes because their labor is sold by their employers for extremely high prices (to insurers and the government). Owners in other fields are generally more limited in how much they can pay their employees because of much tighter profit margins, increased competition, and a far greater pool of available labor to choose from.

Second point: As far as the post being "bollocks," it is simply an observation of fact. I'm not even in a big city. Doctoring is and always has been a profession of the wealthy and the elite. That does not mean that poorer people sometimes don't break into the field, but they eventually become wealthy themselves and their children go to medical school and the cycle continues. Very few medical students come from poor families or grew up on welfare, or have any sort of troubled past with criminal records or illegitimate children, etc. The reason being that the admissions process effectively precludes these individuals from gaining admission because of the huge financial hurdles and because of the fact that GPA and test score considerations are unforgiving - everything has to be reported and you can't re-do the MCAT or hide a semester of Fs. It takes a very, very nurturing environment to produce a 4.0 GPA and a 38 MCAT at age 21. The only way really around this is to play the race card, and even that only goes a very small way in admissions. Yes, there will always be a few exceptions, but the vast majority come from stable families whose parents are at a minimum college educated and paid for some, if not all, of college. It's a really tight nit club with little diversity. Do you seriously contend this?

As far as I know, DO schools are more forgiving in terms of overwriting past screw-ups due to difficult circumstances growing up and there are more rounded and experienced people in these programs.

I agree with you. I meant business as it was being discussed in this thread: high-paying opportunities like I-banking. To make a lot of money, you tend to come from money. It's very true in medicine and it's true in EVERY field. That is the point I was trying to make. The biggest predictor of income in the United States today is your parents income, regardless of the field you choose to pursue.

 

[Tommyguns89]

First point: Business is not a "field." All fields involve business. A field is something like healthcare, telecommunications, mining, shipping, retail, etc. Opportunities exist for great profit in any field as long as you are an owner and not an employee. Healthcare is one of the few fields where employees can earn high incomes because their labor is sold by their employers for extremely high prices (to insurers and the government). Owners in other fields are generally more limited in how much they can pay their employees because of much tighter profit margins, increased competition, and a far greater pool of available labor to choose from.

Second point: As far as the post being "bollocks," it is simply an observation of fact. I'm not even in a big city. Doctoring is and always has been a profession of the wealthy and the elite. That does not mean that poorer people sometimes don't break into the field, but they eventually become wealthy themselves and their children go to medical school and the cycle continues. Very few medical students come from poor families or grew up on welfare, or have any sort of troubled past with criminal records or illegitimate children, etc. The reason being that the admissions process effectively precludes these individuals from gaining admission because of the huge financial hurdles and because of the fact that GPA and test score considerations are unforgiving - everything has to be reported and you can't re-do the MCAT or hide a semester of Fs. It takes a very, very nurturing environment to produce a 4.0 GPA and a 38 MCAT at age 21. The only way really around this is to play the race card, and even that only goes a very small way in admissions. Yes, there will always be a few exceptions, but the vast majority come from stable families whose parents are at a minimum college educated and paid for some, if not all, of college. It's a really tight nit club with little diversity. Do you seriously contend this?

As far as I know, DO schools are more forgiving in terms of overwriting past screw-ups due to difficult circumstances growing up and there are more rounded and experienced people in these programs.

I guess it depends on what you consider "wealthy". My dad makes good money(high 5 figures) working in a trade for the city. He never completed college and neither did my mom. That being said we live in a middle class suburb where most people dont have a college degree and many people make a similar living. While we arent the type of kids likely to get into Hopkins or Harvard(who is though?) we all have a decent shot of getting into A medical school if we are willing to put the work in.

My point being that you are correct in that it will be tough for somebody who is truly poor, but I dont see med school being for just rich kids(using the actual definition of rich). I am sure there are plenty of kids from middle class and working class families.

 

[Tommyguns89]

Yes it does.

52% of fathers of medical students hold a doctorate, 35% of mothers. Compare this to 12% and 10%, respectively, for the entire US population. https://www.aamc.org/download/142770/data/aibvol9_no10.pdf

$100k/year median family income in 2006. I remember reading a $110k/year figure from more recent stats. https://www.aamc.org/download/102338/data/aibvol8no1.pdf

lol, I guess I'm screwed then. My parents didnt even finish community college.

 

[mokhoras]

.

 

[circulus vitios]

lol, I guess I'm screwed then. My parents didnt even finish community college.

My dad dropped out of high school and my mom has a high school diploma.

 

[thefritz]

I am sure there are plenty of kids from middle class and working class families.

Depends on what you mean by "plenty" and how you define middle class.

Food for thought: my parents earn around 200 grand a year and I personally made about half that before starting med school. And I received the maximum financial aid grant based on "need" that my school gives (in other words, I received the same tuition discount someone whose parents had zero income would have received). I'm wealthy compared to normal society, but compared to my classmates, I'm poor.

Interestingly enough, these tuition grants/discounts are most prevalent at top-end schools, where the endowment is huge and most students are wealthy. A significant portion of the class does not receive any discount at all because their parents make too much money.

Bottom line: Most medical students come from wealthy families, whether or not they are borrowing the full COA, have any disposable income, assets, or trust funds. The more prestigious the medical school, the greater the percentage of these students, the greater percentage of private college grads, the fewer military scholarship students, the higher the grades and test scores, and the greater percentage pursuing the highest paying specialties (ortho, radiology, ENT, rad-onc). Don't let the fact that your classmates moan about their loans and aren't sporting overt signs of wealth fool you.

 

[thefritz]

double post

 

[KnuxNole]

I must be in the minority, because my family doesn't have six figure salaries or holds doctorate degrees, we just lived in a normal house in the suburbs.

 

[Tommyguns89]

Depends on what you mean by "plenty" and how you define middle class.

Food for thought: my parents earn around 200 grand a year and I personally made about half that before starting med school. And I received the maximum financial aid grant based on "need" that my school gives (in other words, I received the same tuition discount someone whose parents had zero income would have received). I'm wealthy compared to normal society, but compared to my classmates, I'm poor.

Interestingly enough, these tuition grants/discounts are most prevalent at top-end schools, where the endowment is huge and most students are wealthy. A significant portion of the class does not receive any discount at all because their parents make too much money.

Bottom line: Most medical students come from wealthy families, whether or not they are borrowing the full COA, have any disposable income, assets, or trust funds. The more prestigious the medical school, the greater the percentage of these students, the greater percentage of private college grads, the fewer military scholarship students, the higher the grades and test scores, and the greater percentage pursuing the highest paying specialties (ortho, radiology, ENT, rad-onc). Don't let the fact that your classmates moan about their loans and aren't sporting overt signs of wealth fool you.

Well that is depressing. But like you said, that tends to be at the higher end of Med Schools. Its like that for undergrad too for the most part. I was speaking more of the schools that I am personally shooting for.(SUNY for the most part).

 

[BamaSlamma]

I came from an upper class family, but then enlisted in the Navy. After 5 years in the military, my outlook has been drastically recalibrated, and just wanted to point out that "living in a normal house in the suburbs" does not make you disadvantaged in the least. On SDN, and in your med school classes, you may be near the bottom of the barrel, but you're not. Take a drive through the worst part of the nearest major city or the most rural of farming communities and reassess your position in life.

This thread wreaks of people who have distorted perceptions of where they truly fall in the socioeconomic pecking order. Just because you're used to looking up the ladder doesn't mean that the vast majority of americans aren't on rungs below your own.

 

[thefritz]

This thread wreaks of people who have distorted perceptions of where they truly fall in the socioeconomic pecking order. Just because you're used to looking up the ladder doesn't mean that the vast majority of americans aren't on rungs below your own.

Exactly. The loss of perspective in medical school is remarkable.

 

[BestDoctorEver]

"Medicine is probably the only sure way one can become a millionaire in the US if you are not stupid with your money." Dr Acevedo (Infectious Disease doc)... I really dont know how true is that.

 

[Tommyguns89]

I came from an upper class family, but then enlisted in the Navy. After 5 years in the military, my outlook has been drastically recalibrated, and just wanted to point out that "living in a normal house in the suburbs" does not make you disadvantaged in the least. On SDN, and in your med school classes, you may be near the bottom of the barrel, but you're not. Take a drive through the worst part of the nearest major city or the most rural of farming communities and reassess your position in life.

This thread wreaks of people who have distorted perceptions of where they truly fall in the socioeconomic pecking order. Just because you're used to looking up the ladder doesn't mean that the vast majority of americans aren't on rungs below your own.

I dont recall anybody making that claim. People were just posting statistics and imo speaking more to the lack of social mobility in general in this country. I dont believe anybody in this thread said they were disadvantaged in a serious tone. The point relates exactly to the people you refer to below everybody economically in this thread. How many of them have a realistic shot at getting into any US medical school, let alone a top school?

 

[NickNaylor]

Exactly. The loss of perspective in medical school is remarkable.

Just wanted to say that I absolutely 200% agree with your characterization of med students. I had an idea this was the case as I was applying and interviewing (especially at the "top schools"), but it has become even more plain to me after reading many applications and doing interviews for my schools. It's no joke that it is very rare to see a student that doesn't have parents with post-secondary training. Most have masters or a terminal degree. Keep in mind this is at a school that prides itself on diversity and, in my view, genuinely does its absolute best to recruit people from backgrounds that are disadvantaged and where opportunities are sparse.

Just look at the admissions process from a cost perspective. Even if you're poor and get a fee waiver, that does absolutely zero for you in terms of attending interviews - which is really where the real costs come in. What average family can afford to spend a few hundred bucks on a flight for their kid to go to an interview? Multiply that by five or six - which most people would probably say is less than ideal with respect to getting an acceptance - and already you're at a couple grand without even including any other expenses beyond travel. If I didn't have the grace of my parents to loan me money for my application expenses, there's absolutely no way that I would've even had the chance to be as successful at the admissions process. Now look at the costs throughout the entire process: applying to college, college costs, the cost (real or opportunity) of doing ECs, the MCAT and MCAT prep, etc.. It requires substantial resources to even apply to medical school, much less do well.

No one is saying that disadvantaged applicants can't get in. What people are saying is that the admissions process itself has an ingrained bias that, intentional or not, gives advantages to the wealthy and limits opportunity for the poor. Through sheer hard work and an absolute grind you can certainly do well without any support and beat the odds. However there's a reason why those stories are so exceptional and why those applicants are so strongly sought out.

(sent from my phone)

 

[Dusn]

Just a couple things that I think pre-meds may not realize:

The job security in medicine is not what it used to be. Some of the traditionally competitive fields, like radiology, ophtho, cardiology, etc are at market saturation on the east and west coast and you will have a difficult time finding a job. Many will not find a job unless they are willing to move their family and work wherever in the country a job opens up. If you work for anyone else, they will expect to make money off you and this will lower your starting salary to far below the salaries you see on those surveys.

Trying to start your own practice can cost several hundred thousand dollars at a point in your life when you're already in debt. You will probably lose money your first year, or first few years in practice. You'll be closer to 40 when you actually start making money. The business skills that you need to run your own practice are significant and you will deal with all the stresses of business and the stresses of medicine.

The overhead for most practices is 50-60%. That means a 5% reduction in reimbursements = more than 10% decrease in your income. Reimbursements have gotten cut every single year and will continue to do so.

In 10-15 years, when you actually start practicing, the market and salary for physicians will be completely different and the reimbursement will definitely be far lower than it is today. You are also not guaranteed a job or location of your choice, especially if you want to live near a big city or on the east or west coasts.

Getting into medical school is far easier than everything that comes after it. As a pre-med, you probably can't appreciate how much you and your family will have to sacrifice due to your lack-of-time and having to relocate at every stage of your education. There are truly many other fields that are much easier than medicine, have the same job stability, and pay well. The people in those fields also don't have to deal with the stress and personal guilt involved in medicine (because, like every physician, you will inevitably end up hurting someone -- or a number of people -- with your treatment or lack of treatment, missed diagnosis, or bad surgical outcome). You will relive those medical decisions (and you career choice) over and over again, wondering if you should have done something differently. Sometimes you may have to relive those decisions in court or in front of a medical or hospital board, with your privilege to practice medicine on the line.

In short: you truly only should do medicine if you really think you will love medicine and you hate everything else in life.

--just some advice from someone who has recently finished fellowship and recently finished the job search.

 

[thefritz]

The job security in medicine is not what it used to be. Some of the traditionally competitive fields, like radiology, ophtho, cardiology, etc are at market saturation on the east and west coast and you will have a difficult time finding a job.

Absolutely. Logically follows everything I've been talking about. Kids from wealthy families have the nuturing required for perfect grades and are pushed by the nature of their upbringing to pursue these specialities and to practice them in the most desireable parts of the coutnry.

I wouldn't move to NYC if they gave me the whole goddamn town, but it's part of the package deal most people in med school want. Rural america is begging for these specialties and can't get anybody to fill them. Job offerings for neurosurgeons in rural areas for 7 figures go unfilled. And it's the medical education system's fault. It's harder to get into med school from state schools in rural areas due to the lack of grade inflation and prestige, and the few kids from these areas who make it are usually trying to move up in society and never go back to their home town. And it doesn't stop with admissions. The USMLE exams and match process rewards these same type of people and puts up roadblocks to people who haven't been coached their entire lives for this and the tracks greased the whole way. Result - no specialists in rural america.

So what do we get? A huge influx of foreign medical grads practicing in these areas. Or even worse, nobody at all.

Screwed up aint it?

 

[thefritz]

The overhead for most practices is 50-60%. That means a 5% reduction in reimbursements = more than 10% decrease in your income. Reimbursements have gotten cut every single year and will continue to do so.

Granted I'm few years behind you, but I think primary care is one of the greatest secrets in this medicine. You can pretty much write your own ticket and work as much or little as you like.If money is your thing, there's opportunities for that. If lifestyle is your thing, there's opportunities for that. Additionally there are plenty of ways to get your loans written off in primary care. Plus reimbursements are going up for primary care. This is assuming you don't want to live in a big city in a nice area, where nobody cares about primary care docs and goes straight to specialists.

Yet everybody ****s on it. http://pritzker.uchicago.edu/about/news/2012_Match_Results.shtml

4% of their class went into family med last year, which is about typical of higher end schools.

 

[Planes2Doc]

Granted I'm few years behind you, but I think primary care is one of the greatest secrets in this medicine. You can pretty much write your own ticket and work as much or little as you like.If money is your thing, there's opportunities for that. If lifestyle is your thing, there's opportunities for that. Additionally there are plenty of ways to get your loans written off in primary care. Plus reimbursements are going up for primary care. This is assuming you don't want to live in a big city in a nice area, where nobody cares about primary care docs and goes straight to specialists.

Yet everybody ****s on it. http://pritzker.uchicago.edu/about/news/2012_Match_Results.shtml

4% of their class went into family med last year, which is about typical of higher end schools.

Well said. I have heard the same thing from a few people. A few of the family medicine physicians in my hometown do extremely well with their private practice. I also used to see a family medicine physician in one of Chicago's most affluent suburbs. He doesn't take insurance, and let's say he does better than most specialists.

 

[45408]

Just look at the admissions process from a cost perspective. Even if you're poor and get a fee waiver, that does absolutely zero for you in terms of attending interviews - which is really where the real costs come in. What average family can afford to spend a few hundred bucks on a flight for their kid to go to an interview? Multiply that by five or six - which most people would probably say is less than ideal with respect to getting an acceptance - and already you're at a couple grand without even including any other expenses beyond travel. If I didn't have the grace of my parents to loan me money for my application expenses, there's absolutely no way that I would've even had the chance to be as successful at the admissions process.

Perhaps its the generous dose of California applicants that throws this off for a lot of people, but I didn't fly to a single med school or residency interview.

I didn't have 5-6 med school interviews to get an acceptance. I had 3 interviews, and I got 2 acceptances and a waitlist. I stayed with a college friend for one out-of-town interview, my brother for an OOS interview, and I stayed at home for my in-city school interview.

For residency interviews, I drove to all 13 of them (with the car I paid for with my summer job in college/med school). Most people can go to med school/residency within 300-400 miles of where they live. If you want to fly all over, then go ahead, but for large portions of the country, there are tons of regional options.

Exactly. The loss of perspective in medical school is remarkable.

If anything, being in medicine keeps you exposed to average and below average people. Read the Twitter feed from Goldman-Sachs "overheard in the elevator" if you really want to see what it's like when someone loses perspective.

 

[thefritz]

If anything, being in medicine keeps you exposed to average and below average people. Read the Twitter feed from Goldman-Sachs "overheard in the elevator" if you really want to see what it's like when someone loses perspective.

Seeing is not the same as understanding.

Granted your point about GS is probably accurate. But doctors actually work with regular joes as well as the lowest creatures of society. GS employees don't.

Doctors in America earn significantly more than those in any other country in the world, except maybe Canada. Everywhere else, it's a respectable and stable upper middle class profession. What makes us so special that we get to bill 2-3 times as much for the same labor? Is our quality that much better?

 

[45408]

Doctors in America earn significantly more than those in any other country in the world, except maybe Canada. Everywhere else, it's a respectable and stable upper middle class profession. What makes us so special that we get to bill 2-3 times as much for the same labor? Is our quality that much better?

Why does it have to be because we're "special"? That's not how billing rates are determined...

Regardless, we have longer training at much greater expense than most/all of the comparable countries, often with much longer work hours (the UK residency is capped at 56 hours/week). We are well-paid, obviously, but we have fewer years to recoup the difference, and we have huge student loans. The principle on my loans was around $150K, but it'll probably be over $250K by the time I've paid it all back.

There also isn't as large of a discrepancy as you're describing, if you're looking at comparable countries - http://www.practicelink.com/magazine/vital-stats/physician-compensation-worldwide/ - http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/ - http://www.motherjones.com/kevin-drum/2013/02/charts-day-doctor-pay-america-and-other-countries - http://www.slate.com/articles/news_and_politics/prescriptions/2009/09/lets_pay_doctor.html . Plus, Americans work more hours in all professions - http://www.pbs.org/now/politics/workhours.html

 

[calvnandhobbs68]

Perhaps its the generous dose of California applicants that throws this off for a lot of people, but I didn't fly to a single med school or residency interview.

I didn't have 5-6 med school interviews to get an acceptance. I had 3 interviews, and I got 2 acceptances and a waitlist. I stayed with a college friend for one out-of-town interview, my brother for an OOS interview, and I stayed at home for my in-city school interview.

For residency interviews, I drove to all 13 of them (with the car I paid for with my summer job in college/med school). Most people can go to med school/residency within 300-400 miles of where they live. If you want to fly all over, then go ahead, but for large portions of the country, there are tons of regional options.


If anything, being in medicine keeps you exposed to average and below average people. Read the Twitter feed from Goldman-Sachs "overheard in the elevator" if you really want to see what it's like when someone loses perspective.

Okay that's cool but most people have to schedule all their interviews before they get an acceptance. That's awesome that it worked out for you but most people aren't gonna take the chance of blowing their whole application cycle by applying to 3 schools. Not everyone has a college friend/brother in the city they interview in either and not every medical school has a student hosting program.

You're also forgetting that that money saved in anticipation of interviews or that you saved up to buy that car (especially in college) was still disposable income. That is, you're setting that money aside for something that is not necessary and you are ABLE to save the money you made during your summers. What about the kids who work during the year but give the few thousand bucks they make back to help out their family? (assuming their Pell Grant and Stafford loan cover their tuition/fees and room/board which is a big assumption to make even for state schools).

I have to agree that the application cycle is very rough if you don't have disposable income handy. You can easily blow through 2K-3K by the time you've bought a suit and gone to interviews even if you do have FAP.

 

[45408]

Okay that's cool but most people have to schedule all their interviews before they get an acceptance. That's awesome that it worked out for you but most people aren't gonna take the chance of blowing their whole application cycle by applying to 3 schools. Not everyone has a college friend/brother in the city they interview in either and not every medical school has a student hosting program.

You're also forgetting that that money saved in anticipation of interviews or that you saved up to buy that car (especially in college) was still disposable income. That is, you're setting that money aside for something that is not necessary and you are ABLE to save the money you made during your summers. What about the kids who work during the year but give the few thousand bucks they make back to help out their family? (assuming their Pell Grant and Stafford loan cover their tuition/fees and room/board which is a big assumption to make even for state schools).

I have to agree that the application cycle is very rough if you don't have disposable income handy. You can easily blow through 2K-3K by the time you've bought a suit and gone to interviews even if you do have FAP.

I didn't say it was free. I was just saying that certainly don't need your wealthy parents to be lending you money just to go to med school interviews, and you didn't need to attend a silver-spoon preparatory pre-school in order to have a chance at med school. Of course people who grew up in poverty and have no parental support are at a disadvantage. Is anyone arguing otherwise?

 

[Dusn]

Yes, I agree with you re: primary care. I'm not sure if reimbursements for primary care are going up so much as reimbursements for everything else are going down. But I do think that primary care has some definite benefits (such as job market).

And by primary care I mean internal medicine and family. The reimbursement for general peds really is ridiculously low.

 

[thefritz]

Why does it have to be because we're "special"? That's not how billing rates are determined...

Regardless, we have longer training at much greater expense than most/all of the comparable countries, often with much longer work hours (the UK residency is capped at 56 hours/week). We are well-paid, obviously, but we have fewer years to recoup the difference, and we have huge student loans. The principle on my loans was around $150K, but it'll probably be over $250K by the time I've paid it all back.

There also isn't as large of a discrepancy as you're describing, if you're looking at comparable countries - http://www.practicelink.com/magazine/vital-stats/physician-compensation-worldwide/ - http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/ - http://www.motherjones.com/kevin-drum/2013/02/charts-day-doctor-pay-america-and-other-countries - http://www.slate.com/articles/news_and_politics/prescriptions/2009/09/lets_pay_doctor.html . Plus, Americans work more hours in all professions - http://www.pbs.org/now/politics/workhours.html

Well, med school is 6 years in most other countries, typically following military or community service, but not necessarily college, and residency is about the same time, although with lower work hours as you mentioned. The difference is made up by the fact that new residency graduates usually have to practice under someone else's supervision for a number of years (at reduced pay) before they are granted full practice rights.

Additionally, the training we go through and tuition we incur does not affect the forces that determine how much third parties pay us. We might think it is fair that we should earn more. But there are all sorts of schools that cost equal amounts of money.

To earn a commerical pilot's license with the requisite total turbine and multi time to get hired on by an airline takes many years and at least as much as medical school costs. And they start at $20k/year or less, and are looking at maxing out in the 50-100k range in their career. Do they deserve to earn more? Absolutely. But life's not fair and what's fair or not has nothing to do with what their labor is deemed worth.

 

[thefritz]

The reimbursement for general peds really is ridiculously low.

Peds is a ridiculously popular specialty here. But no one wants to do general peds. Maybe that's why. I just don't like kids so never thought much about it.

 

[yehhhboiii]

Yeah the way it's set up is that real money comes from doing stuff, not from thinking. Peds is pretty poorly compensated.