Medical School - This Little Piggy Stayed Home
Photo: Jim Champion
Now that we live in an uber-regulated world of medicine what has this produced? Nothing particular good for patients. The insurance companies continue to rape the American public and the pharmaceutical companies and other companies assure themselves of profit.
How does a person decide what to do for a career? I think we all have gone through this in any field of endeavor. Here is a partial list of things someone considers when looking for a career:
- Is it interesting to me?
- Will I be good at it?
- Am I helping people?
- Will I actually get a job?
- How much will I make?
- What will my lifestyle be?
This and many other questions arise whether you want to be a nuclear physicist, small business owner, or a doctor.
What is the career that looks like this?
- It is interesting to me
- I know I will be good at it
- I will definitely be helping people
- I may not get a job (at least in the geographic area I want)
- I will not make nearly as much as I could in other fields open to me
- My lifestyle in this field is overworked and over-regulated by politicians and lawyers
The above career is actually medicine for a lot of people. Talented people who have choices put all these things into a hat and a decision is made. For many talented youth, medicine is not coming up on the radar.
There are numerous studies predicting the shortage of physicians that we will be beginning to experience within the next ten years. This has prompted certifying organizations like the Association of American Medical Colleges (AAMC) to recommend increasing medical school spaces significantly. There are many studies and editorials as to whether this can practically be done. Issues related to the massive debt incurred by the cost of medical school with uncertainty of reimbursement in future years decrease the raw numbers of talented applicants. We are also seeing more students who went to off-shore medical schools or foreign-trained non-Americans who perceive the medical environment more favorable in this country than their own.
I am not completely sure whether these changes are good or bad. They may just be the factual state medicine and medical education that we will all need to adapt to. One can certainly argue that people who choose to go into medicine for the money may not be the doctors we want caring for us. Does this go against American nature, though? Money does seem to attract talent in many areas of the marketplace. On the other hand, a dedicated physician who has a reasonable balance of commitment and expectation of reasonable reimbursement would be a good model as well.
We will be running into problems though because there will certainly be many dedicated people who simply can't afford to go to medical school. The cost of medical education is so prohibitive (over $50,000/year) that a $200,000 debt upon leaving school is not possible for anyone except the children of the wealthy.
It seems that in this scenario, the Piggies will stay home. If you are in it for the money then medicine is not for you. If you are in it for the passion and to help mankind you are staying home unless you can afford to go.
I recall having a breakfast meeting with a dean of a major American medical school a short time ago and I asked him about the issue of funding for medical education. He told me that at his medical school (ranked in the top 15 in the nation), that 80% of the revenues came from government research grants, 10% from donations, and 10% medical school tuition. Then came from me the following obvious question- If only 10% of medical school revenue comes from tuition then why do you charge tuition at all? Why can't you make up the 10% in cost savings, more donations, or more grants? I told him to imagine the talent pool he would get by being a free medical school.
Here is the bottom line.
If we are going to force upon doctors regulations on how much they can earn with Universal Health Care and regulations restricting revenue from other sources it is clearly obvious that in exchange, medical education should be free and medical malpractice premiums should be paid by the insurers (government and private) and not the doctors. Then, and only then will we have a pure, dedicated talent pool to assure our health care for many generations and all the Piggies will not stay home from medical school.
~Dr. K.
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14 Comments:
In addition (if medical school was free), admission to medical would be even more competitive. The result of talented individuals who otherwise could not afford medical school, combined with the increase in competition to get in, could only increase the quality of doctors.
In my opinion, the worst thing that can happen to medicine is the Piggies stay home. I really don't understand the disdain people have for the salaries that doctors make. They should be among the highest paid professions. Many of our lives depend on it. The president of my university makes more than my family doctor. Nobody seems to have a problem with that even though his salary is paid for by the state taxpayers and his travel expenses often include playing golf. I've spent years in my profession. I'm very good at it, I like what I do, and I've worked hard to get promotions. Nobody seems to think there's anything wrong with me wanting a promotion so I can get a raise in salary. Everybody I have ever met wants to make more money. Why should doctors be any different?
Personally, I don't want a foreign-trained, foreign-born doctor any more than I want to talk to a tech support specialist in another country. I want a doctor that I can understand and one that understands me. Not that being an American magically makes one a better doctor, I have no doubt that there are talented, compassionate doctors all over the world, but I don't want a doctor that I have to struggle to understand. I want to be confident that they recieved an education at a good medical school with a certain level of standards. Two of my doctors are from countries with socialized medicine. They came here partly because the medical environment is more favorable here than their countries and partly because they can make more money. The fact that they want more money hasn't made them less passionate about their work. I think it's a great loss for their own countries that some of their best talent has come here.
Anybody that looks at list of doctors in any practice nowadays is going to see a lot of foreign names. I don't think it's because our best and brightest have left for other countries. I think it's more likely that they have stayed home, and that's a great loss for our country.
Are you seriously arguing that the insurance companies should pay their own malpractice premiums? You should do some research on how insurance works. That's like saying "patients should get free healthcare, and doctors should pay themselves". Insurance companies pool the money required to hire your malpractice attorneys and pay out settlements by collecting premiums from the physicians, who are the ones who are seeking protection from the liability. You seem to be arguing that the insurance companies should somehow CREATE money out of nowhere, and use that money to protect you in the event of a lawsuit. That's not how insurance works.
http://en.wikipedia.org/wiki/Insurance
I agree with the med school being free thing. If my tuition is only 2% of my school's revanue, why do i have to live a life of ramen noodles and junky cars, just scrapping to get by ? i'm a quarter million dollars in debt - thats rediculous. icouldn't drop out of school now if i wanted to. whats worse, i spend hours each week at tghe hospital doing work for the doctors that are getting paid that are supposed to be teaching me - and i'm paying to do it!! as for insurance companies paying for malpractivce, i don't think that makes much sense. the real problem is that patients can sue for reduiculous amounts of money and we as doctors have to jump through so many hopes, wasete so much of our time asking questions and filling out paper work that has NOTHING to do qwith patient care just to cover our butts so we doen't get sued and lose our credibilidy and careers. if there was a cap on the amount of money patients could sue for, malpractivce insurance costs would be far more reasonable and may actually help prevent errors. great doctors, who pay attention to details and truely care for their patients wouldn't be penalized for the sloppy work of itgh other doctors. it would also get rid of all those anoying lawyer ads on TV - if you took this med call me and we'll sue your doctor for not . it would also prevent things like vioxx - this was a great drug for so many people with arthritis. yes there are some serious side efects but certain people may be more at risk - doctors could be able to identify those opeople. plus, those side effects are rare. even with the possible serious side effects, i bet a lot of patients would still rather take thge risk than have a decreased quality of life.
To Dr. Sina:
You could not be further from the truth. Insurance companies do not pool money to pay for the malpractice and lawyers. Insurance companies pool money to make themselves wealthy. In a pure indemnity insurance world, you would be right but we don't live in that world. We live in a world where what you call insurance companies actually call themselves HMO's. That's Health Maintenance Organizations. They get certain protections under the law for that. Because HMO's interfere with clinical decision making and involve themselves in the daiy care of patients they are adding to the medical liability burden and should be responsible. Many HMO's cause situations that lead to adverse effects. By law, HMO's are protected from being sued.
Since HMO's do precertification and payment based on their own determination of medical necesity, they must share in the medical malpractice premiums.
Dr. K.
I come from a country wih socialized medicine where medical education is free. Gaining admission to a medical school is extremely competetive, only the brightest and dedicated make it.However most of them if asked would like to leave the country and practise elsewhere for better pay and perks.So maybe we have to take into account other factors in deciding eligibility to medical schools.Academic talent alone without an altruistic personality will not gaurantee high quality doctors.
Interesting comments "Anonymous". Check your spelling before posting next time.
To Anonymous with comments of another country:
That was an excellent point. Human nature towards a capitalistic spirit often dominates. Social Darwinism in action.
By determining that we need "altruistic" people going into medicine now adds another piece of the doctor criteria list:
-Diligent
-Skillful
-Intelligent
-Compassionate
-Hard Working
-Altruistic-[unselfishly concerned for or devoted to the welfare of others] from www.dictionary.com
Now ask yourself:
How many people have you met in your entire life that fit those criteria?
What should this unique group get paid?
Why should this group ever answer to insurance company eprsentatives who want to tell them what is medically necessary or not?
Dr. K.
I agree with Dr K. There are very few people with all those criteria. However when we base eligibility to a medical school mostly on academic achievements we almost guarantee leaving out those altruistically inclined piggies. Think about this; how many of those who are focused and only concerned with their personal goals, (academic or otherwise) are willing to sacrifice their time and energy helping others? These two qualities are often incompatible, especially in today’s competitive world. Those who have had little time for others during their student lives are not going to become altruistic medical professionals later on.
So how can we really judge the hearts and minds of those wanting to enter the medical profession? Certainly not by the number of community service hours, or by personal recommendations. The reason for that is self evident. Administer Myers-Briggs personality tests? Perhaps, but that would not work for long either.
The only practical and realistic solution I can think of is to have two systems. Provide free medical education to those piggies who really want to help the sick, and who are not into it for the money or prestige alone, provided they meet reasonable academic criteria. On completion of their education they would be reasonably reimbursed but would have to work in medically under served areas, at community hospitals or in a regulated universal healthcare setting. (Somewhat similar to military doctors who also don’t have to answer to insurance company representatives). Those who cannot make that commitment can pay their way through medical school, but are later free to work where and how they wish. This way those genuinely kind and altruistic piggies who really don’t mind the ramen noodles and junk cars, still have a fair chance at pursuing their dream of helping those people who really need it.
I recall that one South American country has such a system, though I cannot recall which one exactly.
To The Altruistic:
I agree with Anonymous Above. There are many more criteria than academic excellence. Making medical schools free actually allow the medical schools to choose whomever they wish. Currently there is pressure to choose students who will make them look good on tests. With free schools, all levels of students can apply. The cost of medical school has nothing to do with the criteria the school uses to choose. I say choose the best. The best may mean the nicest and sweetest. Whatever the definition of "best" is a school will define its character.
Doctor K
To All:
Just for the record:
I love ramen noodles.
I drive a 2000 Acura CL with the front fender taped with duck tape. Love the car. Great mp3 player and with Stevie Ray playing on max I am prepped for the operating room.
This is my choice.
Doctor K
Dr. K,
Maybe history plays a role in how society feels doctors should be compensated, like in the horse & buggy days where patients would pay doctors with fresh produce, livestock, or savings bonds. Many years ago, it was more important to have a roof over your head, clothing on your back, & food on the table. That, is true wealth. Today, we associate wealth with the SIZE of your house, the TYPE of clothing on your back, & what BRAND of food is on your table. So maybe the term "profit", when associated with noble careers (e.g. healthcare, teaching, law enforcement, etc.), seems almost deviant-which is wrong. I believe any altruistic healthcare provider-foreign or domestic- should be well compensated to be able to live comfortably. Sadly, society pays more attention to stereotypes. As for Dr. Shina, was he confusing malpractice insurance with healthcare insurance?
To All:
We are certainly in a major transition time in medicine. Patients and doctors need to serious reassess their expectations of medical care.
Dr. K.
Dr.k,I was surprised to know the type of music thst prepares you for work.I happen to be a fan of "music motivation" in almost all areas of my life.I couldn't agree more. However, that doesn't necessarily mean I would choose you as a 1st choice based on Stevie Ray,but it may help!Also, the taped bumper is a nice touch,but what "other " vehicles do you own?It would be nice to hear the whole story,considering much of what is "owned" is a matter of public record.Darn good honest attempt anyway.Keep on writing Doc.I'll bite! God Bless all.boss302kirk
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