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