Wednesday, January 29, 2014

For Medical Students, It Seems Nothing's Changed

It was a very brief 15 minutes but I had arrived early.  There they were, sitting in our conference room, waiting to be interviewed for a residency position at our institution.  They had come from far and wide: California, New York, Michigan, for instance - all dressed in their nicest suits or business attire - a 50-50 split of bright women and men.  I was to give a lecture as part of my monthly series on EKG interpretation that fell at this time of year.  So these applicants could see how faculty interact with residents firsthand, I was asked to give my lecture to a crowded room of residents and the applicants together as part of their visit.

Since I had a few minutes, I introduced myself to the applicants and asked them how things were going.  They were very complimentary (of course) and seemed eager to want to talk about something besides why they wanted to come to our institution for residency training.  So being a bit subversive (of course) I asked what seemed like a little question: "How much does medical school cost these days?"

Heaven to Betsy, every one responded and shook their head.  "It's cost me $75,000 in loans so far this year!" one female residency applicant exclaimed in an embarrassed tone.  Most agreed that many of them were astonished at the costs, quoting some with debts of $300,000 to $400,000 for some of their classmates."  "How did you do it?" they asked.  And I mentioned by 26 years in the Navy and how I couldn't believe my roommate in medical school left with $65,000 debt at the time.  They all laughed that I thought that was a lot of money, realizing how much more most of them owed in the present day.  "I guess none of you are going into primary care, right?" I said.  They laughed nervously, yet didn't really answer.

Medical school costs and the costs of educating America's physicians is in its bubble stage, about to pop.  Our finest medical students are accruing huge debts and no one cares.  After all, these young doctors were the lucky ones, right?  Smart, social, good interpersonal skills, hard-working, driven, and most of all, disciplined.  Look how lucky they are!

But when these young doctors look at their first salaries, reality will hit hard.  They will realize the next mountain they will have to climb (as if medical school wasn't enough).  Tough choices will have to be made.  Needless to say, the picture for lower-paid specialties in medicine is particularly grim, yet the reality of fewer residency slots also exists.  Depression, already a problem, is likely to increase.

In the past five years, the world of medicine has forever changed for everyone, except medical schools it seems.  Their costs and expectations for revenue continues to exceed inflation by a large margin.  When will it stop?  For our newest trained doctors increasingly saddled with nearly insurmountable debt, the lure of medicine is waning. For those already in the pipeline,  the reality of what's coming when the loan bills come due is inevitably going to be turning our best new hope for medicine's future away unless the cost problem is fixed soon.

I am not proposing we make medical school free - that would make things worse in my view.  Different, more disruptive ideas that reign in costs will be needed - removing tenured professorial positions and limiting medical school building projects would be a good first step, but admittedly difficult with our entrenched old-school teaching model.  Unless we really work to change the cost of educating our next generation physicians I fear that medicine's best hope for the future will quickly dwindle away.

-Wes

13 comments:

Anonymous said...

third year student, already over 300K in debt, will hit lifetime Stafford amount next year which means most of 4th year will be grad plus loans at higher rates. nothing is subsidized for grad students anymore so the debt grows exponentially. My spouse is also in medicine, and while in a little better shape than I, in a year and a half we will begin life making a combined ~100K with ~500K in debt before we've bought a house, had a kid, put a dime towards retirement, or traded in our POS cars. My family and friends already assume we're rich, and if they have anything at all to say about finances and medicine, it's that doctors make too much money.

Treated like scum for years of training, put life on hold for 10 years, and at the end of it spend half your day documenting complete garbage and being told how you will and will not practice by people who have no idea what they're talking about. The sad but true reality for me is if I could go back and do it again, I wouldn't go into medicine. I still love the patients and the puzzles, but on the whole it's becoming a tough sell. Hopefully it seems worth it when all is said and done, but hard to see the light at the end of the tunnel right now.

And you are correct, nobody at all cares.

Anonymous said...

Dear Dr. Wes,

I have followed your blog for quite some time and wanted to ask you a simple question: how would you counsel a loved one (family friend, son/daughter, etc) about the merits of pursuing an MD right now?

My context: I was recently admitted to my state medical school, but after a lot of conversations with residents, fellows and physicians plus reading your blog I am wondering if this is all a huge mistake. I am particularly troubled by the loss of professional autonomy, a recurring theme in your posts.

Anonymous said...

With MOOCs(online), the new way to teach and learn there is no reason why med schools should cost sooo much!
Agreed there is clinical teaching but the debts seems to be so off the charts with each year, something needs to change soon.

Anonymous said...

Dear potential student,
Medicine is a calling. Don't worry about the debt. Show up for work everyday, every night, weekends, call, holidays. We will worry about the economics and take care of you.

Signed,
Hospital administrator

Anonymous said...

Dear Potential Student,

Don't listen to that person behind the curtain! (Hospital Administrators, or any other administrator).

Do keep conversing with residents, fellows and physicians, to give you insight.

By the way, "A Calling" is most often just a poor excuse to shun all personal responsibility, forever. Remember that.

Also and importantly, if someone tries to guilt you into "A Calling" it always means you will be signing your life away to be the property of that person/entity.

-SCRN

Dan Munro said...

I do care. I did my best.

Med Student Gives Sober Assessment Of Future With $500K In Student Debt

onforb.es/1iRHdCr via @Forbes

Bernie Goulet said...

Assuming a student does not come from a family of unlimited financial resources perhaps now is the time they should vote with there feet and pursue Med school in locations that are not gouging the students. If the market demand for US Med School education drops substantially, US Med schools will be forced to respond by decreasing costs. Belize is an English Speaking country here is a link to the Medical schools tuition. http://www.cahsu.edu/tutionfees.html

Bernie Goulet said...

Its all about market demand. Assuming students do not have access to unlimited family cash, they should consider out of country alternatives. If enough choose to do this market demand for US schools will diminish forcing those schools to correct there pricing. There are many fine international schools, some even in English speaking countries, here is the tuition page from one. http://www.cahsu.edu/tutionfees.html

DrWes said...

Bernie -
Sadly, medical students who go to schools in other countries are not looked upon as favorably by admissions committees, so the challenges are even greater. Imagine, spending all those bucks to go to Belize only to find there's no one that will take your education. The ACGME makes it difficult for certain foreign med students to be admitted to US residency programs. Just sayin'.

Bernie Goulet said...

True! But I think I would rather be a GP in a County Hospital with little debt than a specialist choking on it. Gives you more options. It just a damn shame that people that want to follow an honorable profession are put in this conundrum in the first damn place by greedy corporate hacks.

pricelez said...

Interesting thread so far. Brings to mind my neighbor, who joined the Navy. Our gov. is paying 100% for his education and overhead at a brand new international Medical School in Florida. It was luck that brought me to writing about healthcare. Two dear friends just had surgeries. Both, at the top teaching hospitals in the country. What a disaster. One has been in hospital since Nov 1. his 6th surgery on the same knee is scheduled for March 7th. Tthrough trial and error, I became somewhat of an expert about healthcare in Thailand and Malaysia. I figure Cuba is a lot closer to home. The largest immigrant population in the U.S. today speaks Spanish. Cuba's ELAM - Latin American School of Medicine (ELAM)- is operated by the Cuban government and described as the largest medical school in the world. The more than 10,000 enrolled are international students come from all over the world -including the U.S. Student’s tuition,as well as room and board are FREE. In return, you pay back two years of your life by perhaps saving lives in that part of the world. Michael Moore's film, "Sicko" inspired me. Miraculously, pieces and people fell into place. www.CME-Abroad.com is my new website, dedicated to Continuing Medical Education. (Fingers crossed, accredited in the near future.) Cuba has just approved my very unique Medical Education Tour for May 11th. I'm not pitching, although you are invited. I'm really interested in feedback from the medical community. Believe me I empathize with your situation. The hours that surgeons work are ridiculous, and unhealthy. I'll stop here, although I've plenty to go on about... Appreciate your insight about www.CME-Abroad.com

Anonymous said...

Dan Munro, thanks for quoting me, I do appreciate it!!

Elizabeth said...

Dr. Wes - Elizabeth from SoFi here, thanks for sharing these important stories about crippling medical debt. We agree it's out of control and there aren't enough options out there to help doctors lower and/or manage their debt. There are a handful of private companies like SoFi that will refinance debt of doctor's post-residency - helping them lower their monthly payments or lifetime cost of debt (and often both). We wrote this post for individuals considering whether to refinance their loans: bit.ly/WhyReFi