http://www.amazon.com/Doctored-Disillusionment-Physician-Sandeep-Jauhar/dp/0374141398
Book is by a physician who is rather disillusioned by the economic pressures placed on physicians, which pressure physicians into doing some of the things that run up costs in a wasteful manner in US medical care.
A new MD graduate with $300,000 in medical school debt may find it hard to avoid such economic pressures.
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A new MD graduate with $300,000 in medical school debt may find it hard to avoid such economic pressures.
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And it is sad that some many premed/med students think that kind of debt (and more) is no big deal. When you add undergrad and med school debt, some kids will graduate with way too much debt.
Did this author go through 6 years of post-med-school training, in addition to securing a PhD? And is it supposedly expensive if he has received so much education and training?
If his debt at the graduation of med school was, say, $180K-$200K, how much additional interest would be accrued after 6 additional years of residency & fellowship training?
Hmmm…I just notice this. He seems to have been in a MD-PhD program, or he could have completed his PhD before he started his MD program. (Likely the former, considering the fact that his father seems to be so unpleased or even disdained about a research career in academics.) So it “explains” why he completed his cardiology fellowship at the ripe age of 36?
Alternatively, I heard there was a med school in Texas where the med school could allow their “family practice/primary care focused” med school students to finish the med school in 3 years instead of 4 years. So these students save 1 year for the med school part. To become a family practice doctor, it requires totally 3 years in residency. So, since these doctors save one year, they essentially spend two additional years only. As long as we make the pay to the specialist like the author and these accelerated family practice doctors more “equalized”, it may encourage more doctors to choose the “cheap” way. Fewer specialists mean fewer expensive equipment and procedures. It will not necessarily cause more patients to die. (And we could afford to have a slightly fewer old folks even if the lack of specialists could cause some older patients to die - as long as the phrase “death panel” is prohibited to be used from now on. Didn’t Obama claim that his beloved grandma really should not “deserve” the expensive hip replacement procedure at such an old age?)
But the author will likely never take this “cheap” route, considering the background of his up-bringing. Isn’t it true that the family practice doctors (maybe ER doctors as well??) are in the “lowest” rank in our health care system – way below the cardiologist rank the author of the book belongs to.
Sometimes I feel that if we could somehow encourage more of those from a truly well off family to pursue medicine, it may be “better”. It is more likely that those from a truly well off family may not have much motivation to make money. They may more likely resist the pressure to prescribe unnecessary procedures. This is because they do not have any financial pressure in their whole life.
Right now, maybe only <20% of med school students are full pay and graduate debt-free. Try to make this percentage as large as 90%, and it could “cure” a lot of these problems. But it could mean that med schools had to tell the prospective applicants that those not from a truly well off family need not apply.
BTW, many med school students who graduate debt-free right now may not belong to the “truly well off” economic class. Many of them had to pay the money back to their parents in the form of “parent tax” because the money within their family could just temporarily be shuffled from their parents to them (not even the early inheritance!) and eventually it had to be paid back (via “parent tax”.) The strategy mentioned in the previous paragraph would work only if the bar is raised higher; that is, only those from a truly well off family (thus having almost zero motivation in making money by themselves in their life time) may need to apply to med school.
I guess my imagination runs away today!
Undergraduate studies - 4 years
Med School - 4 years
PhD - 4 years (if you’re lucky)
Cardiology residency 4-5 years
Fellowship - 2-3 years
No, it wouldn’t be uncommon to finish a cardiology fellowship at age 36.
"A new MD graduate with $300,000 in medical school debt may find it hard to avoid such economic pressures. "
-I do not know about this book, did not read it.
However, I know that there are ways to graduate from Med. School without debt. About 25% of Medical Students are graduating without debt (I did not research, I jsut saw this number somewhere on CC). My own D. will graduate from expensive private Med. School in May of this year without debt. She knows personllay several kids (mostly her private HS friends, primairly with physician parents) who will graduate wihtout debt. How they did it? As a top caliber students (and if one chooses medical career, be assured that we are dealing with the top caliber student), these kids are eligible for full tuition and full rides Merit awards at many places (personal experience as well as D’s friends experience). Many of them are very much brain washed by GC’s and general environment at most HSs to pursue acceptances to Ivy’s / Elite colleges. If they have strong personalities and know how to withstand the pressure from GC (who is personally very interested to send as many as he/she could to the very top UGs), they will choose non-Ivy’s that offer great Merits and free family resources to finance their Med. School.
Money aside, as far as I am aware, the reason for “doing some of the things that run up costs in a wasteful manner in US medical care” is NOT the personal gains, but rather tons of regulations and the fear of liability. Phicisians have to “cover, protect”, not only themselves personally, but in many cases the place of their employment, hospitals, clinics. They order many more tests than required to protect themselves from the law suits. Nobody is perfect, phycisian is a human being whose mistake, error in judgement and extreme push in time may result in some cases in unfortunate consequences and even loss of life.
On the other hand, for those who are saying that American system is not working and wasteful, I can tell you, that you do not know what you are talking about. One of my Canadian friends who was woring in the USA for few years, mentioned, that Canadian system is perfect for a healthy person. It does not work for the sick, you cannot get help as soon as you need it. My persoanl unfortuante experience tells me that Canadian system is NOT the worse one out there, by far. People suffer, loose their lives prematurely in many palces in advanced countries. Here, wasteful situation may be improved by getting government and lawyers out, but it is not possible. So, we may as well forget it and stick to what we have.
As far as type of people who decided on Medical career and who actually survive on this brutal path, I can only bow down to them as my heroes. do not know any other field that requires such a degree of torture in all aspects, mental, emotional, physical. And I can only talk about experience at Med. School. I heard that many residency experiences are much more brutal.
The debt is staggering. But what is the option? We will help our kid as much as we can if she goes to medical school…but she will be taking loans…as do many, many future doctors.
Right now the pressure is an INCREDIBLE increase in Obamacare-driven paperwork, none of which does anything to improve patient care. (Looks like it’s oriented toward finding ways to cut costs/ration care for patients down the road)
Things are changing quickly. Reimbursement is down. Productivity is down thanks to electronic medical records (which, paradoxically, makes order entry even more tedious). Physicians are having to do their own coding. Paperwork seems to have trebeled in the last 5 years despite (or because of) electronic systems. Minute clinics run by giant corporations are eating into profits (at least for primary care). Nurse practitioners scope of care erodes into services previously done by physicians. Hospitalists are doing inpatient care (usually strangers who do shift work) so the old model of the doctor that did office and hospital practice is dying. Malpractice fears are still pervasive. The industry has become more about “placating the patient” and avoiding liability than being firm with non compliant patients. I could go on and on…
All the more reason I told one of my kids interested in premed to consider engineering or dental school instead.
Exactly. And, the worse thing is that the physician is rapidly being squeezed out of decision making, which is what they did best. Used to be that half or more of the new physicians were really good quality docs. Now, we don’t see but maybe 1 in 10 like that.
Many of my close friends are physicians and surgeons. Twenty-five years ago, 8 or 9 out of 10 of their kids would have been headed for medicine. Do you know how many it is now? None. Zero.
For many, there are no other options. Yes, the kids of the very affluent can graduate debt free, but most kids will have debt by the time they’re out of med school.
I don’t know what’s in store for the private SOMs that aren’t tippy top. I realize that they will still get students to enroll who don’t have other acceptances, but when given a choice between $75k COA per year at a mid/low-tier private SOM and $45k COA at an instate SOM, then the instate one will likely win out. It sure did with my son. It was easy to decline $75k COA when his alternative state SOMs have COAs below $50k.
I wouldn’t be too sure about that. Nearly ALL of my friends have the same rule…“We’ll pay for 4 years, but after that, it’s on you, so better figure it out carefully.”
The paperwork requirements are a function of the insurance companies and have nothing to do with the healthcare laws.
I want to know why independent practicing physicians are more cost-effective, have the same or better outcomes, and have happier patients, yet are paid less by insurance. Our independents are almost all gone, replaced by conglomerate-owned clinics with expensive testing and facility fees.
^^ Thank you. It has very little to do with ObamaCare, although @Trisherella was spot on with everything else she said.
About the indebtness of med school graduates:
https://www.aamc.org/download/152968/data/debtfactcard.pdf
It is telling that a higher percentage of students attending a private med school (18%) are graduating without debt than that of the students attending a cheaper public med school (14%).
@MiamiDAP, The first line in the table of this debt fact card from AAMC shows that the pct. of graduates without debt is 84%. So only 16% are graduating without debt. This is the “bank of mom and dad” effect. (The case in your family is one of the “bank of mom and dad” cases. LOL. Don’t you think your D could be graduating from med school without debt without the contribution from the bank of mom and dad even if she is full ride at a college? Not a chance. So, by and large, the sole reason why a non-MD/PhD med school graduate is debt free is because her family is rich enough to pay it outright.)
Also, for students from a poor family background, several truly generous need-based top private colleges (e.g., HYPS) are not expensive. The expenses for attending a med school are usually much higher than attending any “good (in its FA policy)” college for such a student. This is because, relatively speaking, almost all med schools do not do “social engineering” (i.e., they do not do this: charging the rich much more than the poor) and and they do not need to “buy” their students like some colleges do at the undergraduate level.
@JustOneDad
That may be so amongst the upper middle/low-upper class (the $125k-250k set), but not really for the really affluent. At most med schools, about half the kids are children of doctors…and many of those parents are paying.
At my son’s White Coat Ceremony, the school asked for all the parents who are doctors in the audience to stand up. It blew me away.
Re: https://www.aamc.org/download/152968/data/debtfactcard.pdf
The last page of the above should be required reading for pre-meds. The “typical” first scenario means 10 years of $2,700 per month debt service payments after completion of residency. Some other scenarios have even longer terms of debt service payments.
I did not go to the White Coat Ceremony so I do not know. But I guess the percentage is likely high. I heard that in DS’s class, both the parent and the grandparent of a particular student attended the same med school as this student. Also, I heard that a lab all med school students would use was named after the family of a student in his class. His parent is a physician. Also, the parents of a particular student (whose parents are physicians) generously gave every student in the class a stratoscope (sp?)
For one thing, it is easier for physician’s kid to fulfill his/her clinical related EC requirement as a premed.
Running the numbers on the “typical” debt scenario with $180,000 in debt…
A $170,000 per year earning primary care physician probably takes home about $122,000 per year after federal income and payroll taxes (of course, there could also be state income and payroll taxes). The $2,700 per month debt payment would be another $32,400 per year, leaving $89,600 left. If we assume $12,600 per year of malpractice insurance costs, that leaves $77,000 left.
$77,000 after taxes and malpractice insurance can certainly lead to a comfortable life. But it is probably not the kind of life that their physician parents enjoyed and brought them up in. Of course, that assumes working as an employee; a physician who wants his/her own private practice needs to find the money for the start up costs, or buy an existing one from a physician retiring or otherwise departing the business.
Of course, if the physician had $300,000 in debt (e.g. if s/he were only admitted to private medical schools with $75,000 per year total costs – most pre-meds would be lucky to have even one admission to choose from, so they probably will not be able to choose a lower cost medical school), then the debt service would be $4,500 instead of $2,700 per month. So that would leave $55,400 after taxes and malpractice insurance.
My child does not have a physician parent. So he should be relatively “low maintenance.” Not sure about what his “future” SO will bring into their life style though.
My wife started to have a “talk” with him about the need for him to save money for his future child’s education expenses when it will be many years before he will make any money. It is funny to me she would even bring up this topic. (I guess it is likely because she is aware that we will not be able to give him any inheritance. She is not a stingy parent. She starts to talk about distributing the money in her meager IRA account to pay down his student loans after she is over 59.5 years old; I am trying to persuade her not to do it. But the wedding cost in the future is more in my mind than in her mind and I thought it would likely cost $40k and she thought it would be $20k. So we all have our own individual “weakness”.)
^^^ moving from the topic of discussion Mcat, but why would you have to pay for your son’s wedding? Traditionally, in this country, the bride’s family foots the bill. Although nowadays there are lots of different arrangements and sometimes the cost is shared by the bride/groom and both of their families.