Wednesday, March 15, 2006

$ and Medical School

Here's a little bit of hard truth for those aspiring medical students out there. You will pay about $10,000 a year to attend a state supported medical school. You will pay up to $40,000 a year to attend a private medical school. These figures are conservative.

After medical school you might choose to become a general internist or pediatrician. That's going to pay you about $37,000 a year during your residency training (if you are lucky). During that time you will be very sleep deprived and work about 80 hours a week. At the end of your residency your medical school debt will be about $50,000 to over $200,000. If you happen to owe money from your undergraduate education you might find yourself $300,000 in debt.

What does a general internist or pediatrician make after passing the national boards and becoming ''board certitfied"? Anywhere from $70,000 to $200,000 a year if you work full time. You do the math. How long to get out of debt? Can you afford a house?

Assuming you go straight through from undergraduate school to medical school you will be about 28 years old. Maybe by the time you are 35, if you are very good with money, you can pay off the loans you took out to become a physician.

Let's assume you want to do the other extreme... neurosurgery for example. Well, how does eight to ten years of training after medical school sound? How does 110 hours a week sound? How does severe sleep deprivation sound? Divorce? How does being 35 with a few hundred thousand of debt sound? What will you make? Well, a lot really, perhaps a million dollars a year give or take a few hundred thousand. Assuming you make it through your residency without a crack-up and get boarded you might be out of debt rather quickly. Was it worth the 14 years you gave at the prime of your life? For many the answer is no.

It is no secret that many doctors do not want their kids to go into medicine.

What about business school or law school? Well, B school is two years. You will work hard. Graduates of Harvard or Kellog or an equally highly regarded school may start work with six figure salaries and then the sky is the limit. What about lawyers? Well, three years of hard work and pass the bar and if you did well and went to a good school you might start at $150,000 and on a partnership track, well, you will do much better than that. All of this without severe sleep deprivation, all of this without the not insignificant burden of having your clients die in spite of your efforts or even because of them. Your debt burden will also be significantly less and you can start your adult life a lot sooner. Does medical school still sound like a good idea?

One more thing. In business and law you operate, for the most part, in a fee for service environment. If your customers don't pay then they cease to be your customers. Also, except in rare instances, they do not sue you. How about this, as an Emergency Physician I am required to treat all comers regardless of their ability to pay. Our particular group collects about 30% of what we bill. However, even non-paying customers can sue me for damages without limit. Imagine that!

Do I have an answer? No, but I do know that when you make something free the demand increases. People routinely tell me that they can not afford to get a primary care physician so they use the ED as their primary care. Why? Because it's ''free''.

The good news? Most doctors did not go into medicine to become rich. Most decided on medicine for the challenge of a dynamic field, and the reward of making a real difference for their patients. Most of us do find rewards greater than money. It's a noble profession, but a sober look will often turn the most capable and dedicated students away from medicine for the reasons stated above.

We will get what we pay for. If you want cheaper medical care you will have it. You may not speak the same language as your physician, he or she may have trained outside of this country, they may not have the skills or knowledge that a graduate of any US medical program will have, but they will be called ''doctor''.

Tort reform needs to happen. Many states have already enacted monetary caps on damages at $250,000. We'll see how that works. The government run facilites such as the Veteran's Administration, Military Facilities, and City hospitals have always had this cap. Their malpractice insurance coverage is therefore affordable.

Cost shifting is killing us. The worst place to be is to be a gainfully employed citizen who can't afford or is not provided with medical insurance. They get the full bill. Unemployed? Free. The rest of us pay. There is a simple solution to part of this problem... a copay for all visits to the ED. A bit of responsibility placed on every patient. Not a popular idea with the left, they have the idea that if the government could just get a hold of the whole thing that they could fix it. I have worked in both military facilities and the VA. If you want your doctor's visits to mimick a visit to the DMV then go ahead.

Grist for the mill.


  1. If I had it to do over again I would be one of those guys in San Fran or another big city that spray paints himself to look like a robot and stands on a milk carton. That looks like a lot of fun.

  2. well the training involved is taxing my friend. the money is probably better though... hmmm, yes.