<p>Somemom- absolutely not confined to rural areas. We know physicians who have served in large urban hospitals in major metro areas. This is a particularly attractive option if you are part of a dual career couple since the job opportunities in a large city can make it easier for the trailing spouse.</p>
<p>I am just curious. Would the US health service corps be extremely attractive to specialists because specialists are most highly paid in rural areas?</p>
<p>The high pay is suppose to compensate for the general unattractiveness of the location and the lack of doctors in the area.</p>
<p>boy jason once you get an idea you hold on to it 
no they arent. for the same level of service doctors are paid the same… a visit is a visit is a visit… the only differential comes in between the level of service (admittedly sometimes a specialist may have a higher level of visit… but the spread between levels from lowest to highest is about 38-95 in this state…a 95 visit takes alot more time than a 38…so its a wash). There is a thing called a hpsa bonus (medicare only) for some designated rural areas (but we live in a small town about 10K people…not qualified as rural enough) . a specialist needs a referral base and a catchment area that would support a practice so perhaps a rural program may not work on that basis though…
eta you are correct that different areas of the country have different fee schedules… however the more rural a place, usually the lower the fee schedule as cost of practice is calculated into the reimbursement rates… the assumption is that your cost of doing business is less in some states than others…ie california and florida have higher fee schedules</p>
<p>The US will have to decide what to do. In Europe school is government funded and residency/specialty spots are severely regulated. As the cost of school rises and reimbursements decrease something has to give. Johnson wanted more primary care docs, and he got them. After a few years they went back for additional training and took up specialty jobs. The market responds to incentives. School costs are one issue. If we don’t want to support/subsidize the cost of med school, as a society we will have to pay docs. In some speialities, the real reimbursment have gone down 30- 70 % since the 1970’s. </p>
<p>Another is malpractice. If malpractice is $100,000 that is a cost that is passed on to the consumer and insurance company. One would have to collect $100,000 and bill about 270,000 to pay that bill. Add that to rent, secretary, and health insurance, and the cost for a small group thets say 3 docs is $350,000 a year in collections. Actual charges? $1,000,000. That is before taking a penny home. Add into it uncertainty - four times this year a 21% CUT in Medicaid was delayed (yup not fixed) by congress. Twice it went into effect and was beaten back retro actively (weeks of delay). Think about if you were at you job, and four times since January they said maybe we’ll cut you, maybe we won’t. It makes it difficult to plan. One does not buy that new piece of equipment. One does not hire the new associate. One can’t pay on going bills.</p>
<p>Again Medicine is a great and fulfilling field. Doc’s don’t have to donate to causes to save their souls because they really do give at the office every day. Don’t discourage the next generation from going into medicine, cause who is going to take care of me? 
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<p>Watch the dollars, take out the MINIMUM of loans, pay back at least the interest while in training, go to state schools, when you finish training continue to live like a resident until the debt is behind you. Be realistic. If you have no money, already have a bucket of debt, and want a lower paying field, really cruch the numbers and see if you can afford it. Unfortunately for some, because of present debt and current obligations (family etc), Med school may not be an option.</p>
<p>well said greyhaired!!!</p>
<p>I agree that doctors are paid the same for the same procedures but most doctors are (correct me if i am wrong) salaried employees at hospitals. Hospitals decide their pay and pocket the Revenue - Wage. With a shortage of a specialist, the hospital is willing to pay higher wages in lieu of higher profits.</p>
<p>not exactly… i am unsure of the percentage of hospital vs office based. it used to be that hospitals could offer incentives to doctors but YEARS ago, laws like the stark bills etc, have made that more difficult. there are many scenarios , its not just as cut and dry as your post above. also remember a rural hospital isnt going to recruit as many specialists, they just wont have the patient base to support him/her.</p>
<p>there is the definite advantage of a hospital based practice though as you are correct, the revenue you generate or salary is yours…no office costs</p>
<p>I do not undestand how those usurous terms are or were even legal. If they are legal and allowable, there should be some reasonable speed limits built into this.</p>
<p>What is going to happen when all of these student default on these loans or need indefinite deferrals so that very little is being repaid/ Some of the kids I know have so much debt that there is no way they could be paying it back on the pittance they make. They may not even be making ANYTHING! So what is happening to those loans they tooK and are not repaying?</p>
<p>saw suzie orman on today show today… she says that 20% of all student loans are currently in default. her recommendations for student loan maximums was not to borrow more that your first years salary after graduation ie if your chosen field would give you a starting salary of 40K that should be your max amount of loans. (i guess that matches the figures i have seen about payment being 10% of income over 10 year term) that is going to get harder and harder to do as college COA is over that in alot of cases for one year. also no guarantee there will be a job on graduation</p>
<p>My guide lines as well, parent56. But as you said, as the costs go up, and the salaries are not rising along with them, along with fewer job opportunities, it is going to be even more difficult. What happens when these kids cannot possibly,mathematically pay their loans because they have a) no job or b) such a low paying job that the payment can barely be paid?</p>
<p>My one friend has had a heart to heart with her daughter who has about $40K in loans and landed a very nice job at about $30K a year. The girl is going to be living at home after 4 years away, sharing transportation with parents, and work on getting a big piece of the loan paid. The danged loan is growing at $2000 a year of incurred interest alone, and that is a car insurance payment or even a car payment for the girl. That isn’t even repayment of principal. Even with this job, which is truly a prize, by the time the health insurance, taxes, dental ins, soc sec is taken out, she is not netting all of that much. Her parents are going to match her loan payments dollar for dollar this year, and hopefully get about half of the loan paid so that she can then afford to move out on her own, get a car, spend some money. But she is one of the lucky ones.</p>
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<p>Which is sound advice, though there are certainly thousands of people who graduated this year and last who took out loans based on salary estimates that seemed entirely reasonable when they entered college and wound up looking wildly optimistic.</p>
<p>I predict the whole thing is going to implode. The combination of ~runaway tuition increases, which are made possible in large part and then create these unjustifiable loan amounts (which if they were not guaranteed by the government and the lender himself would have to eat the default, no lender in his right mind would make - sound familiar to any recent crises we can think of? Lender beware is how it ought to be) and ~a job market which is simply not going to provide these kids the opportunity to make enough to pay these loans off - is going to, I predict (and hope) cause a major and profound change in the way the student loan industry does business.</p>
<p>And I disagree rather vehemently with the change in the 80’s that prevented any discharge in bankruptcy. Look, people do have financial disasters and the whole furor over all these supposed doctors who took out loans and deliberately defaulted, we later discovered, were hugely exaggerated. And, anyway, even if there were a handful of people who did that at one time, why should some one not guilty of such a thing be punished? It would be entirely possible to create rules which allowed bankruptcy when it was justified and fair and did not permit bankruptcy when it was caused by willful financial misconduct. </p>
<p>The baby was thrown out with the bathwater.</p>
<p>People can commit a murder and still get out of prison eventually…people can still run up their credit cards with trips to Bermuda and discharge THAT in bankruptcy…(which is wrong) people can get sick and even if they have insurance sometimes end up with hundreds and thousands of dollars worth of debt that they will never be able to pay back. Those people can still discharge that debt. (until they figure out a way to do away with that too…we are going to be a nation of debtor serfs if that trend does not reverse)</p>
<p>It’s bad business and pointless to try to collect debts which are simply impossible for an individual to ever have hope of repaying, which is why we have (and have always had, going back to Old Testament law) a provision for release of debt.</p>
<p>Why on earth that a student loan should be the one and only exception to this, does not make sense to me. </p>
<p>If the lenders didn’t know for a fact they had ZERO risk they might have a little more vested interest in not loaning these incredulous amounts of money out. Boy what a sweet deal! I sure would like to open up a business in which I knew that I could make such irresponsible decisions such as to loan 150,000 dollars to someone so they could get a BA in anthropology, which is frankly a really stupid thing to lend someone money for ordinarily, but that the government would promise to pick up the tab - and excelerated at that, SWEET!</p>
<p>The schools would have to figure out how to make their product sell for a price more in keeping with the actual cost that the market would bear. Currently there is a disconnect between the actual amount people can afford to pay and what they are paying anyway. It’s a bad idea and will eventually implode. Just think, what if something like, say, mortgages were given out for more than people could afford to pay back because the originator of the loan knew he was at no risk if the borrower defaulted? ~ Oh, wait…</p>
<p>:-)</p>
<p>I know this is probably not a popular opinion, and there seems to be a tendency to be almost judgemental about the student taking out the loan, but frankly, I know a lot of 18 and 19 year olds who really are not fully baked yet so to speak and even if they are legally of age, they have no business making these decisions, and they have been, if the truth is to be told, exploited. Lending institutions have not the excuse of being an 18 year old who hasn’t yet finished his education and they should know, if the kid doesn’t, that certain degrees will not provide the income it will take to pay off that loan. And as pointed out - even highly paying professions may not be able to afford the cost of starting business and paying off the loan.</p>
<p>“what is an education WORTH though?” the schools say on their websites, implicating that if you won’t just do whatever it takes to pony up the price no matter how high it goes, that you don’t value education. Sure the dream college is WORTH the money, and a mansion is WORTH several million dollars, and the dream car is worth 85,000 (well, maybe) but if you can’t afford a dream house or a dream car or a dream school you should not buy it.</p>
<p>That is NOT the pervasive message the kids are getting. I personally do not see how it can be reasonably expected of someone who is 22 or younger, if they didn’t happen to have parents who drilled it into their heads that graduating debt free or with very low debt was to be highly weighed against a “dream” school they could not afford, could figure it out on their own when the entire higher education industry has a vested interest and a very successful plan in place to get them to borrow as much as possible.</p>
<p>That sounds cynical of me but I do not see how any other conclusion can be reached.</p>
<p>That’s how I see it. Your views may vary. But I feel really sorry for these kids who probably think they are doing the wise thing by “investing” in their education (because that is what everyone is telling them over and over again) and end up with such a crushing debt load that financially they might end up far behind schoolmates who got a two year vocational certificate from community college and started making money right away, with low or no debt. No, they won’t have a liberal arts education. But another thing we as a society need to stop doing is talking out of both sides of our mouths about the purpose of college. Is it to be “educated” or is it to get a job? They tell the kids “you need a degree to make money!” then if you point out that the debt will offset earnings they say “oh but it’s not about a job it’s about being EDUCATED!” </p>
<p>Which is it? And in either case, if the only way many students can buy the education is with insane amounts of debt, then the price of college is too high and universities might have to figure out how to run their businesses more efficiently.</p>
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<p>Kids don’t know, but their parents should know unless the parents are the very ones who took out a huge mortgage on a house that they couldn’t afford.</p>
<p>Are you saying lending institutions should screen kids who are applying for school loans just like mortgage loans? Should the types of major be one qualification ? Engineering, accounting majors would get the loan but philosophy and women’s studies majors won’t?</p>
<p>Well, that sounds like a horrible thing to do, I agree, and I happen to be a liberal arts type person myself and feel that fields other than engineering should be valued in society.</p>
<p>(and there are a lot of parents who do that…so yeah, we are now in our second, maybe third generation who are mislead and unwise about debt? we need to somehow break that cycle)</p>
<p>But a loan is a business decision and the problem here is we are making cold hard dollar and cents business decisions on how much money a “education” is worth. An eduction is an intangible thing, really. How do you put a dollar value on it? You can’t really put a value on it’s worth.</p>
<p>You can put an estimate as to what the earnings potential of a degree might be, but it would be hugely flawed in many cases, vary widely, and have so many unpredictable and varying factors that it would be pretty much worthless.</p>
<p>Frankly I just think that for the most part, loans are becoming an untenable way to fund higher education. edit to add: and again I make the point that loans which the lender has no risk and there fore will give out in unlimited quantities, unrelated to the “value” of the education however one figures it, are contributing to a disconnect between what the college will cost and what the market will bear. If it were not for that particular peculiarity, there would be far fewer students able to pay as much, and the colleges would have to either face dropping sales - I mean, enrollment, or find an alternative way for students to pay for their education. As of now they have really no incentive to do so. Neither loaners nor schools have any incentive to do anything about the high loans and default rates because the only person shouldering that risk is the student…and clearly not nearly enough of them are getting clear headed, sound financial advice on how much loans they should take out. Clearly.</p>
<p>Wish I knew exactly what the alternative was, but in previous posts mentions were made of the European model: I think we need a sea change in the way we do higher education funding in this country. We get all emotional and dreamy about the value of an education and they sell the sizzle: but when it comes down to paying back the loan, in an economy that simply doesn’t provide the opportunity, suddenly all the philosophical waxings about the value of an education don’t seem to be enough to pay the debt off.</p>
<p>It sounds as if I don’t think an education is valuable. Quite the opposite. I think it is, and I think that if it costs more to get one than one can afford to pay back in a lifetime, we will end up with only the elite classes being able to do it, and that would be a huge loss for society.</p>
<p>Snapdragonfly…I like your posts.</p>
<p>Thank you! Are there any scholarships for kids with moms who occasionally write likable posts on college message boards?</p>
<p>I believe you are stuck with the federal loans till death do you part. They’ll get you through tax returns, somehow if you don’t pay them; that has been the way. However, we are talking about people who may not be making enough to even make the payments. How much do you have to make to pay off $80K which is still accruing interest during the deferral years. It’s frightening to me. What do colleges do when the lend the money to the kids as part of the financial aid package and the kids can’t pay? Are the private loans discharged at bankruptcy?</p>
<p>“Thank you! Are there any scholarships for kids with moms who occasionally write likable posts on college message boards?”</p>
<p>Lol</p>
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I disagree rather vehemently with the idea of discharging any loans through bankruptcy. If the person acquired a loan, spent the money on himself and received the benefit, he should pay it back.</p>