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(Washington Post)   The latest degree that is quickly becoming a bad value: MD   (washingtonpost.com) divider line 123
    More: Interesting, Health Affairs, Aaron Schock, Balanced Budget Amendment, Medicine study  
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11893 clicks; posted to Main » on 15 Feb 2013 at 2:24 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-02-15 02:22:40 PM
What a horseshiat article.  According to this  http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8  there were 17,300 US medical school graduates in 2011.  The chart in TFA clearly shows nearly 25,000 PGY-1 spots.  The increasing number of applicants is due to an influx of applications from foreign trained MDs.

Relatively few foreign MDs get spots compared to their US trained peers.  The ones that do are usually very good (though I've seen some bad ones, and often language barriers are tough). They are also usually filling in spots that went unfilled.  I knew absolutely 0 people from my US medical school class that didn't get a residency position.

The real issue isn't residency spots, it's medical school slots in the US.  Medical schools are very expensive to build / create.  Our current system is simply too small for our population.  With the boomer population at Medicare age, a much smaller Gen X and Millennial pool to pick from, and increasing sub specialization, there most definitely will be a shortage of US trained primary MDs.  Expect to see more foreign trained physicians and allied professionals (NP, PAs) in the primary care roles in the years to come.  Not necessarily a bad thing, but it is the way things are moving.
 
2013-02-15 02:28:02 PM
FTFA: Who else, after all, can show up at dinner and claim to have spent her day saving lives?

Police, Fire, EMS, Nurses...

/ Dragonslayers?
/ Nanobots?
/ Guinness brewers?
 
2013-02-15 02:29:10 PM
How long before we can replace doctors and lawyers with robots?

We can keep cute nurses, though.
 
2013-02-15 02:29:44 PM
So they're in the same boat as most other professions.  We have too many people with degrees and not enough skilled trades(wo)men.
 
2013-02-15 02:30:02 PM
Interesting reading about physician training, geography, and an aging medical work force...

http://www.aamc.org/download/263512/data/statedata2011.pdf
 
2013-02-15 02:30:33 PM
YEREVAN
FTFA: Who else, after all, can show up at dinner and claim to have spent her day saving lives?

Police, Fire, EMS, Nurses...

/ Dragonslayers?
/ Nanobots?
/ Guinness brewers?


/Heroin pushers
/Bomb Squad
/Animal Control
/4 Chan "no fap" threads.
 
2013-02-15 02:31:40 PM
As someone who is married to a doctor who will complete residency this year I can confirm that this article is full of shiat. Early retirment here I come.
 
2013-02-15 02:31:58 PM
And once you are a doctor, its going to take much longer to pay off the mountains of student debt you amassed getting your MD.  Medicare/Medicaid reimbursements are below cost these days.. you actually lose money taking on people who are under those programs.  And if congress stops delaying the additional cuts that were scheduled quite a few years ago, its going to be much worse.  (I think its another 45% cut in reimbursement that is hanging over doctors heads).

Which is why you see larger institutions gobbling up smaller ones since they can more easily absorb the losses and are generally more efficient through larger volumes.
 
2013-02-15 02:32:51 PM

pho75: As someone who is married to a doctor who will complete residency this year I can confirm that this article is full of shiat. Early retirment here I come.


Living in Baltimore doesn't make you an MD.
 
2013-02-15 02:33:13 PM
Why yes, I'd love to spend the next ten years of my life living in a bachelor apartment with a steady diet of ramen and red bull and go six figures into debt in order to someday have a good job.

Just kidding. I did seriously consider the medical school route but I grew up poor and want a higher standard of living *now*, so I got a 3-year advanced diploma in medical lab science and work in Canada as a technologist for decent pay.

I did wish to be a doctor, but for those of us who are footing the education bills ourselves with our families unable to help at all? It's daunting.

Anyways: I console myself this way. In the lab, body fluids arrive in test tubes and jars. Anywhere else in healthcare, and those same fluids are liable to be flying out of a patient and splattering the wall/floor/shoes, etc. So, at least things are a little more tidy and predictable in my department.

And I already have a nice place and will be debt-free in ten years, so there's that. :)
 
2013-02-15 02:33:56 PM
Pfft... they should have thought about that before going after a useless degree.

Pepper spray them, beat them and lock them up with the rest of the OWS neo-hippie scum.
 
2013-02-15 02:34:05 PM

alywa: Medical schools are very expensive to build / create.


Michigan's expanding their options: Oakland U, Western Michigan U, and Central Michigan U all are adding/recently added medical schools.  WMU's is from a $100-million anonymous grant.  (Those awful rich people.)
 
2013-02-15 02:34:29 PM

TheOther: pho75: As someone who is married to a doctor who will complete residency this year I can confirm that this article is full of shiat. Early retirment here I come.

Living in Baltimore doesn't make you an MD.


But living in Tulsa makes you OK.
 
2013-02-15 02:34:44 PM

alywa: there most definitely will be a shortage of US trained primary MDs


All a GP does any more is ask "where does it hurt?", and order tests then refer a specialist.  I would imagine that in coming years, that function could be supplanted by a pinprick at a LabCorp or Quest kiosk.

Even now, some plans (like mine) don't require a referral. If one has a known pre existing condition or is websavvy at all they can refer themselves most of the time.
 
2013-02-15 02:35:24 PM

Kejlina: Why yes, I'd love to spend the next ten years of my life living in a bachelor apartment with a steady diet of ramen and red bull and go six figures into debt in order to someday have a good job.

Just kidding. I did seriously consider the medical school route but I grew up poor and want a higher standard of living *now*, so I got a 3-year advanced diploma in medical lab science and work in Canada as a technologist for decent pay.

I did wish to be a doctor, but for those of us who are footing the education bills ourselves with our families unable to help at all? It's daunting.

Anyways: I console myself this way. In the lab, body fluids arrive in test tubes and jars. Anywhere else in healthcare, and those same fluids are liable to be flying out of a patient and splattering the wall/floor/shoes, etc. So, at least things are a little more tidy and predictable in my department.

And I already have a nice place and will be debt-free in ten years, so there's that. :)


So you aimed low. It's okay, that way you won't fail.
 
2013-02-15 02:35:44 PM

alywa: What a horseshiat article.  According to this  http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8  there were 17,300 US medical school graduates in 2011.


So there are two bottlenecks, not just one. Doesn't make the article horseshiat. I agree, though, that we need more med schools. The AMA has done a damn good job constraining the supply of docs (and thus inflating the prices of schools and doctors) by refusing to accredit new schools.

What went unstated in the article - the number of residencies is limited because hospitals themselves refuse to pay residents and demand taxpayers foot the bill. That's a huge pile of horseshiat. Hospitals make money hand over fist but the public has to subsidize their profits?
 
2013-02-15 02:37:09 PM

JohnAnnArbor: alywa: Medical schools are very expensive to build / create.

Michigan's expanding their options: Oakland U, Western Michigan U, and Central Michigan U all are adding/recently added medical schools.  WMU's is from a $100-million anonymous grant.  (Those awful rich people.)


That seems to be a rarity, but good for MI.  Surprising given the state's shrinking population that they were able to get that going.
 
2013-02-15 02:37:18 PM
Worthless MDs?  Well thank heavens I just got my MBA.  Who's the loser now, DOCTA?
 
2013-02-15 02:37:25 PM

alywa: What a horseshiat article.  According to this  http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8  there were 17,300 US medical school graduates in 2011.  The chart in TFA clearly shows nearly 25,000 PGY-1 spots.  The increasing number of applicants is due to an influx of applications from foreign trained MDs.

Relatively few foreign MDs get spots compared to their US trained peers.  The ones that do are usually very good (though I've seen some bad ones, and often language barriers are tough). They are also usually filling in spots that went unfilled.  I knew absolutely 0 people from my US medical school class that didn't get a residency position.

The real issue isn't residency spots, it's medical school slots in the US.  Medical schools are very expensive to build / create.  Our current system is simply too small for our population.  With the boomer population at Medicare age, a much smaller Gen X and Millennial pool to pick from, and increasing sub specialization, there most definitely will be a shortage of US trained primary MDs.  Expect to see more foreign trained physicians and allied professionals (NP, PAs) in the primary care roles in the years to come.  Not necessarily a bad thing, but it is the way things are moving.


So more docs who went for medical school in greneda?
 
2013-02-15 02:37:30 PM

Master Sphincter: Kejlina: Why yes, I'd love to spend the next ten years of my life living in a bachelor apartment with a steady diet of ramen and red bull and go six figures into debt in order to someday have a good job.

Just kidding. I did seriously consider the medical school route but I grew up poor and want a higher standard of living *now*, so I got a 3-year advanced diploma in medical lab science and work in Canada as a technologist for decent pay.

I did wish to be a doctor, but for those of us who are footing the education bills ourselves with our families unable to help at all? It's daunting.

Anyways: I console myself this way. In the lab, body fluids arrive in test tubes and jars. Anywhere else in healthcare, and those same fluids are liable to be flying out of a patient and splattering the wall/floor/shoes, etc. So, at least things are a little more tidy and predictable in my department.

And I already have a nice place and will be debt-free in ten years, so there's that. :)

So you aimed low. It's okay, that way you won't fail.


The world needs white-blood-cell counters too, son.
 
2013-02-15 02:39:17 PM
* The best and brightest people are the ones who become physicians.
* We require rigorous, self-financed training that requires years of self financing follwed by years of indentured servitude with the prospect of perpetually longer than average workweeks.
* America must continue to strive to pay as little for our healthcare as possible.

Pick two.
 
2013-02-15 02:39:42 PM
Obvious question (unanswered by the article) - are residencies funded solely by the Fed?
 
2013-02-15 02:39:53 PM
FTFA: Who is to blame for the gap between medical school graduates and residency slots? As with many things these days, it's largely Congress.

i72.photobucket.com
 
2013-02-15 02:39:59 PM
Bad for med students, good for us. This is hitting literally every field. Why shouldn't they share in the suffering? The single largest reason health care costs so much in this country is because of the outlandish salaries of doctors. Let's dump a glut of competent doctors on the market until the invisible hand finally does its job and lowers salaries down to the point where people will actually have to weight the costs vs. benefits of entering the field of medicine. Currently it's a no brainer: if you can get into med school, you go, because you are 100% guaranteed a life of Corvettes and naked underwear models.
 
2013-02-15 02:41:22 PM

pho75: As someone who is married to a doctor who will complete residency this year I can confirm that this article is full of shiat. Early retirment here I come.


Yes, on the personal level the only unemployment rates are zero and  100 per cent.  Congratulations.
 
2013-02-15 02:41:56 PM

alywa: JohnAnnArbor: alywa: Medical schools are very expensive to build / create.

Michigan's expanding their options: Oakland U, Western Michigan U, and Central Michigan U all are adding/recently added medical schools.  WMU's is from a $100-million anonymous grant.  (Those awful rich people.)

That seems to be a rarity, but good for MI.  Surprising given the state's shrinking population that they were able to get that going.


Michigan State has both medical and osteopathic medical schools, too.
 
2013-02-15 02:42:24 PM
Second attempt at speaking English.

* The best and brightest are the ones who become physicians.

* Self-financed training involving years of indentured servitude is required.

* We want to pay as little as possible for healthcare services.

Pick two.
 
2013-02-15 02:43:43 PM

Tommy Moo: Bad for med students, good for us. This is hitting literally every field. Why shouldn't they share in the suffering? The single largest reason health care costs so much in this country is because of the outlandish salaries of doctors. Let's dump a glut of competent doctors on the market until the invisible hand finally does its job and lowers salaries down to the point where people will actually have to weight the costs vs. benefits of entering the field of medicine.


That's why people have been arguing for expanding the things a nurse is allowed to do.
 
2013-02-15 02:44:00 PM

TofuTheAlmighty: What went unstated in the article - the number of residencies is limited because hospitals themselves refuse to pay residents and demand taxpayers foot the bill. That's a huge pile of horseshiat. Hospitals make money hand over fist but the public has to subsidize their profits?


Teaching / public / rural hospitals don't make money hand over fist.  I agree that they do profit from the work of residents, but a lot of hospitals are closing... A very good one in the city I trained closed a few years ago and had to shut down its residency program along with it.  Poor long-term strategy, competition from a state U hospital, bad part of town, etc... it is a tough business, and being a poor hospital makes it harder with medicaid cuts.

TofuTheAlmighty: So there are two bottlenecks, not just one. Doesn't make the article horseshiat.


No, it is bullshiat because their stated problem doesn't exist for US trained medical graduates.  I don't think we have a duty to train the entire world's physicians to come work here.  Just because people apply from elsewhere doesn't necessarily mean their has to be a spot for them.  If it becomes an issue that US trained applicants can't get spots in the US, well that's different.
 
2013-02-15 02:44:04 PM

UseUrHeadFred: * The best and brightest people are the ones who become physicians.


Our best and brightest go into finance.  Has been that way for 30 years.
 
2013-02-15 02:44:38 PM
Because who the fark needs DOCTORS when nobody can afford one, right?
Bwah-HAHAHAHAHAHAHA.

/Idiots.
 
2013-02-15 02:45:10 PM

pho75: As someone who is married to a doctor who will complete residency this year I can confirm that this article is full of shiat. Early retirment here I come.


My wife will finish her Residency this year as well. However, she's going to extend it to a Chief year (somehow this doesn't change her graduation date) then she's going to do a fellowship. I'm wondering if she'll ever start her career.
 
2013-02-15 02:46:22 PM

Johnsnownw: she's going to extend it to a Chief year


www4.images.coolspotters.com
 
2013-02-15 02:46:42 PM

Tommy Moo: Bad for med students, good for us. This is hitting literally every field. Why shouldn't they share in the suffering? The single largest reason health care costs so much in this country is because of the outlandish salaries of doctors. Let's dump a glut of competent doctors on the market until the invisible hand finally does its job and lowers salaries down to the point where people will actually have to weight the costs vs. benefits of entering the field of medicine. Currently it's a no brainer: if you can get into med school, you go, because you are 100% guaranteed a life of Corvettes and naked underwear models.


0-media-cdn.foolz.us
 
2013-02-15 02:48:10 PM

tricycleracer: UseUrHeadFred: * The best and brightest people are the ones who become physicians.

Our best and brightest go into finance.  Has been that way for 30 years.


Yes, and just look at the results.
 
2013-02-15 02:48:23 PM

Tommy Moo: The single largest reason health care costs so much in this country is because of the outlandish salaries of doctors.


Not really, but nice try.  Think about the enormous amount of paperwork required by three levels of regulation: the hospital (document everything to avoid getting sued), the insurance companies (document everything and you MIGHT get paid, some day), and government (document everything because we said so and/or so that you MIGHT get paid half the cost of the procedure, some day).

Add on top of that hospital systems that feel the need to build absolute palaces instead of what's actually needed (expensive entraceways, giant atria, etc.) and things are stupidly expensive.  I don't think every hospital should look like a bad 1970s Soviet hospital, but we can do without the expensive "architectural statement" every time a new building goes up, can't we?
 
2013-02-15 02:48:27 PM

alywa: That seems to be a rarity, but good for MI.  Surprising given the state's shrinking population that they were able to get that going.


It really hasn't been shrinking, some cities have but the state population hasn't abnormally shrank.
 
2013-02-15 02:48:42 PM
WooHoo
Obama Care to the rescue... what what MD's have to pay huge student loans and Obamacare only pays them like a school teacher?  Screw that, should have become a plumber.

Historically as soon as a country nationalizes a sector the shock waves are felt for years.  I expect to see
1: glut of some kind of Doctors (specialist)
2: shortage of general practice Dr.
3: Collapse of private/corporate funded research.
4: Government funded drugs and research will use politics to get passed FDA approval for drugs that are less safe.
 
2013-02-15 02:51:06 PM

probesport: alywa: That seems to be a rarity, but good for MI.  Surprising given the state's shrinking population that they were able to get that going.

It really hasn't been shrinking, some cities have but the state population hasn't abnormally shrank.


We're losing people (dying and moving out) at about the same rate as the birth rate.  I think we're the lowest-growth state.
 
2013-02-15 02:51:28 PM

TofuTheAlmighty: alywa: What a horseshiat article.  According to this  http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8  there were 17,300 US medical school graduates in 2011.

So there are two bottlenecks, not just one. Doesn't make the article horseshiat. I agree, though, that we need more med schools. The AMA has done a damn good job constraining the supply of docs (and thus inflating the prices of schools and doctors) by refusing to accredit new schools.

What went unstated in the article - the number of residencies is limited because hospitals themselves refuse to pay residents and demand taxpayers foot the bill. That's a huge pile of horseshiat. Hospitals make money hand over fist but the public has to subsidize their profits?


Hospitals do not make money hand over fist.  The average profit margin in a hospital is around 7%.  A good portion of hospitals have operating losses, but make up for it slightly in investment income.  When the 2012 data is out, I suspect that 7% will be down, as more people are avoiding hospitals, and commercial insurers are cracking down on hospital stays.

The best money in US healthcare these days is medical device suppliers.
 
2013-02-15 02:51:29 PM

MonoChango: WooHoo
Obama Care to the rescue... what what MD's have to pay huge student loans and Obamacare only pays them like a school teacher? Screw that, should have become a plumber.


Wow... that statement was absolutely dripping with facts and citations.

I feel a whole lot smarter now.

THANKS!
 
2013-02-15 02:52:16 PM

HotIgneous Intruder: tricycleracer: UseUrHeadFred: * The best and brightest people are the ones who become physicians.

Our best and brightest go into finance.  Has been that way for 30 years.

Yes, and just look at the results.


Nanosecond stock trades and make-believe derivatives.  It's a glorious time to be alive.
 
2013-02-15 02:52:50 PM

Tommy Moo: The single largest reason health care costs so much in this country is because of the outlandish salaries of doctors.


Physicians do make a lot of money in the US.  However, there is much blame to go around for our ridiculous healthcare costs.  Multi-layer insurance structures with corresponding multiple overheads.  Litigious sentiments creating a "defensive medicine" atmosphere.  Poor preventative healthcare coverage.  Fat, unhealthy population.  Poor IT / data sharing leading to duplication of testing / services.  Reimbursement based on testing / volume instead of results (which is a difficult metric to measure, btw).  Huge numbers of uninsured patients who abuse the system and never pay bills, leading to higher charges for services for those who do.  Lobbying by pharma / device manufacturers to cover and pay dearly for meds / implants / devices / scans / etc.  Increasing availability of ever-more expensive and sophisticated diagnostic / treatment modalities.  Longer average life expectancies.  A society which doesn't accept death very well and consequently wants "everything done".  Breakdown of extended family structure leading to more people in long-term care facilities.  The list goes on...

Take your pick... they are all part of the problem
 
2013-02-15 02:55:47 PM

Tommy Moo: Bad for med students, good for us. This is hitting literally every field. Why shouldn't they share in the suffering? The single largest reason health care costs so much in this country is because of the outlandish salaries of doctors. Let's dump a glut of competent doctors on the market until the invisible hand finally does its job and lowers salaries down to the point where people will actually have to weight the costs vs. benefits of entering the field of medicine. Currently it's a no brainer: if you can get into med school, you go, because you are 100% guaranteed a life of Corvettes and naked underwear models.


Ding ding ding!  Yes - this!  Finally we are seeing some alternative mechanisms for healthcare happening (surgical centers, NPT's) and competition and benefit reform (MOAR PLEASE) are beating some sense into "the way it's always been done".

I talked to my anesthesiologist neighbor about internships and residency, how they work 12 hour shifts and isn't that a terrible and dangerous idea, given how it's been shown that performance drops and errors rise after about 5 hours of being on a shift.  His response was "It's not a problem because they're used to it."  Basically 1) That's how we always have done it, 2) Those studies don't apply because we are supermen
 
2013-02-15 03:06:07 PM
Well Starbucks can alway use more baristas.


I would actually expect that as Obamacare kicks into full gear over the next few years, Doctors will become more in demand.
 
2013-02-15 03:06:11 PM
Yeah, me and my MFA are laughing all the way to the bank...eventually...
 
2013-02-15 03:08:03 PM

Abe Vigoda's Ghost: I would actually expect that as Obamacare kicks into full gear over the next few years, Doctors will become more in demand.


as the money offered for a given procedure drops, as it will under a federal payment system, the supply of doctors will dry up.  Or so I'm told.
 
2013-02-15 03:08:32 PM

TheOther: Living in Baltimore doesn't make you an MD.


That's a bit creepy, or a very lucky guess.
 
2013-02-15 03:12:27 PM

pho75: TheOther: Living in Baltimore doesn't make you an MD.

That's a bit creepy, or a very lucky guess.


He may have seen it in your profile, but Occam's razor suggests he is a stalker.
 
2013-02-15 03:12:55 PM

YEREVAN: FTFA: Who else, after all, can show up at dinner and claim to have spent her day saving lives?

Police, Fire, EMS, Nurses...

/ Dragonslayers?
/ Nanobots?
/ Guinness brewers?



Thank you.
 
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