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(Washington Post)   The latest degree that is quickly becoming a bad value: MD   (washingtonpost.com ) divider line
    More: Interesting, Health Affairs, Aaron Schock, Balanced Budget Amendment, Medicine study  
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11913 clicks; posted to Main » on 15 Feb 2013 at 2:24 PM (3 years ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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Archived thread
2013-02-15 02:22:40 PM  
5 votes:
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 02:52:50 PM  
3 votes:

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 05:12:48 PM  
2 votes:

Akuinnen: Tommy Moo: BigLuca:
Just looking at the money: the average primary care doctor makes (minus education costs) roughly the same as a plumber over the course of their career.

You can easily pay off $250k in debt in three years by living below your $300k salary

Primary care doctors don't make $300k, so I'm not sure why you are quoting and replying to BigLuca with that number.


Yes, he has some serious misconceptions of the field. Doctors that make $300,000+ a year have specialized, which requires 14 total years of school.
2013-02-15 04:12:10 PM  
2 votes:
Occam's Disposable Razor:

"Artifical" limiting of med school spots is not necessarily an evil, profit driven thing. Nearly every resident I've spoken with agrees that the bottom 5-10% of their graduating class (the ones who failed courses and had to retake them or made it through by one lucky answer) are not physicians they would visit if they were sick. Most go so far as to say the school pushed these students through, and question whether they should be practicing at all. Then there are the students who can't get into a US school and go to the Carribean (where residency match rates can be truly scary).

Meh, went to a Caribbean medical school. matched into an incredibly competitive field, and am now chief resident.  Classes are the same, books are the same, USMLE is the same (and my school has higher average Step1 scores than US students), so your argument is highly unconvincing . . .
2013-02-15 03:40:05 PM  
2 votes:

LockeOak: GUTSU: potterydove: 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.

Everyday I'm thankful that I went to a technical school instead of a collage. Having a welding certification is worth a thousand liberal arts degrees.

10/10


I'm going to tell you a little secret, No one cares if you have a degree in political science, communications, photography, or sociology. Learning how to be a plumber, welder, electrician, or mechanic will probably land you a job, and actually has real world applications.
2013-02-15 02:51:28 PM  
2 votes:

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 02:33:13 PM  
2 votes:
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 02:31:58 PM  
2 votes:
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 02:29:44 PM  
2 votes:
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.
2013-02-16 11:06:20 AM  
1 vote:
CWeinerWV:
I like what you're about.  Consider yourself favorited.

Thanks man.  Ditto.  Nice to see some who doesn't need "We are the Champions" played whenever they walk in a room.
drp
2013-02-16 04:00:49 AM  
1 vote:
All you guys who think the cost-containing solution is fewer doctors and more midlevels (NPs, PAs, CRNAs, and so on) ...

When the day comes that your medical condition is evaluated by a NP and referred to a specialist PA who gets a CT read by a Radiology Technologist Assistant, who then sends you to a cost-effective Surgical Technician with his online "doctorate" to operate with the help of an independent unsupervised CRNA ...


You can indulge in some satisfaction that even more money will be saved when your autopsy is conducted by the Certified Registered Licensed Nurse Pathology Practictioner Helper Assistant.


In the end, you may get what you ask for.

/ and you'll deserve it
2013-02-15 11:54:17 PM  
1 vote:

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 Early divorce and replacement by at least a decade younger trophy spouse, here I come.


I'm sorry but someone had to say it...
2013-02-15 05:07:57 PM  
1 vote:

Tommy Moo: BigLuca:
Just looking at the money: the average primary care doctor makes (minus education costs) roughly the same as a plumber over the course of their career.

You can easily pay off $250k in debt in three years by living below your $300k salary


Primary care doctors don't make $300k, so I'm not sure why you are quoting and replying to BigLuca with that number.
2013-02-15 04:52:53 PM  
1 vote:

BigLuca: Tommy Moo:
All of that is also true in other countries. What makes the US special? Doctors here make three times the salary of comparable doctors in the number two country. More than half of your hospital bill goes to pay the doctor's $300,000 salary. There are many jobs that require 8-10 years of schooling in the country that pay a very respectable $70-$100k salary.

[www.mnhospitals.org image 562x406]

In other countries doctors work less hours (in the case of surgical specialties about 1/2 the hours), get way more sick leave/maternity leave/vacation time, earlier retirement with better retirement benefits, and nearly free education. The tuition paid by the average med student adds up to about 250k, and you can't begin to pay that off until after residency, so add interest on that. Also, European countries import a greater percentage of their doctors so you are much more likely to get a recent grad from New Delhi U. who started learning English 6 months ago.

Just looking at the money: the average primary care doctor makes (minus education costs) roughly the same as a plumber over the course of their career.


You can easily pay off $250k in debt in three years by living below your $300k salary, or you can pay it off over twenty years without feeling it. A $2000 monthly education bill isn't exactly bringing you hardship when you bring home $15,000 a month after taxes. Education repayment takes your $300k salary and reduces it to a $270k salary. Big whoop. They still make three times as much as PhDs.

And that's not even getting into the fact that the loans are easily forgiven by doing a few years of work in underprivileged areas. Plus I'm pretty sure loan interest is deferred when you're in residency.

If med school wasn't a sweet ass deal, there wouldn't be a million undergrads banging at the door every year.
2013-02-15 04:13:50 PM  
1 vote:

JohnAnnArbor: 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?


All of that is also true in other countries. What makes the US special? Doctors here make three times the salary of comparable doctors in the number two country. More than half of your hospital bill goes to pay the doctor's $300,000 salary. There are many jobs that require 8-10 years of schooling in the country that pay a very respectable $70-$100k salary.

www.mnhospitals.org
2013-02-15 04:12:41 PM  
1 vote:
Been a shiatty value for a while, actually, compared to others.

As part of a programming class, I made a program where you could put in your major, years of school, and average starting salary, and it would spit out numbers telling you how 'worth it' your degree was.  Some of the highest returns over a lifetime were trade schools and engineering, some of the lowest (but still positive) were doctors and lawyers.  This is assuming you're the standard run of the mill student who doesn't get full rides or big scholarships, just the standard 'here you are sign on the dotted line' grants/loans.  Basically, I found out that the average MD doesn't make nearly enough to make up for all the requirements, cost, opportunity costs, etc that must be fulfilled.

Imagine if you had to put down a year of your own money to get an intensive degree, work a bunch of free hours, be under a lot of stress, etc, all to start a job at $10/hr.  When you would have made much much more money just working your way up from minimum wage, or going to trade school, etc.

The art and humanities type students got the worst deal:  They were significantly behind people that worked their way up from minimum wage.  Like, way way behind.  Like, they would have had better job prospects if they took the cost of college and spent it all on hookers and blow and forwarded them to the correct addresses.
2013-02-15 03:58:05 PM  
1 vote:
no it is a great value, if you can find a residency position.

congress in the 1997 balanced budget act, AFTER BEING LOBBIED TO DO SO BY THE AMA, capped the number of residency slots that medicare paid for (the vast majority of funding for residency) tat 1997 levels to ensure a shortage of doctors and the attendant massive increase of salary for what was already by far the most lucrative profession in the history of the world.

greed, that's what drives our nations medical regulation.
2013-02-15 02:48:23 PM  
1 vote:

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 02:48:10 PM  
1 vote:

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 02:46:42 PM  
1 vote:

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 02:44:38 PM  
1 vote:
Because who the fark needs DOCTORS when nobody can afford one, right?
Bwah-HAHAHAHAHAHAHA.

/Idiots.
2013-02-15 02:43:43 PM  
1 vote:

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 02:42:24 PM  
1 vote:
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 02:39:59 PM  
1 vote:
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 02:39:17 PM  
1 vote:
* 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 02:35:44 PM  
1 vote:

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 02:34:44 PM  
1 vote:

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 02:34:29 PM  
1 vote:

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 02:33:56 PM  
1 vote:
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 02:31:40 PM  
1 vote:
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 02:28:02 PM  
1 vote:
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?
 
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