First, let's consider how much American doctors are paid. The answer is: a lot, by international standards. Here's one look, via an old Ezra Klein post:
As of 1996, the annual average income of American physicians was twice
Canada's, thrice France, and almost four times the UK. And, as nobody
needs to be reminded, the Canadians and French and Brits all live
longer than Americans.But how exactly do you change the "warped incentives" in a way that doctors find acceptable? Changing incentives is something of an expertise -- or at least, fixation -- of the Obama administration. His style isn't to mandate changes from on high but to tweak and nudge incentives to make individual actors find selfish reasons to choose to follow his agenda. Here was my Jennifer Aniston Theory of Obamaism:
Obama's agenda lays out it goals clearly, but it also gives us space, because it wants us to choose its agenda. It wants private investors to choose to buy the toxic assets. It wants private insurers to choose prevenative care. Obama doesn't want to do the dishes. He wants us to want to do the dishes.How do you get doctors to want to want to make less money? Confession: I have no idea. As Ezra suggests, Obama could propose to subsidize medical education in exchange for lowered pay to keep doctors from sinking into debt after graduation (seems a bit heavy handed), or he could allow more nurse practitioners. We could offer a public option that paid doctors by patients, closer to what they do in the UK, instead of by procedure to discourage over-treatment and then find a way to shelter them from law suits to encourage docs to take the pay cut. That latter part could be a bit dangerous. Or we could work incrementally away from overprescription by emulating the Mayo Clinic, which pays doctors a fixed salary to encourage doctors not to maximize their patient load or overprescribe. I could try to go on, but I won't, because other people certainly have better ideas for limiting doctor pay and because limiting doctor pay is going to be like pulling teeth from a jungle cat.
Ultimately, like so many other aspects of our health care crisis, high doctor salaries is just another impacted tooth: easy to put your finger on, awfully sensitive, and damn near impossible to extract without a lot of yelling.
A couple of observations. First, in Ezra Klein's graph, are physicians' salaries controlled for each coutnry's median income? Incomes tend to be lower in other countries, so US physicians' salaries may be a similar multiple of the median. Second, medical school debt is an important consideration. I graduated from medical school with $100K in student loans, and I enjoyed scholarship support. It's like having a mortgage before you even have a job. Even public med schools are expensive. Third, our wages during training are much lower than our peers in similar professions. Compare what an intern makes (about $50K) to what first year law associates make ($160K at big firms last year) or to financial workers (though I shudder to call them my "peers"). Finally, European physicians tend to work fewer hours and see fewer patients than US phsycians. I have worked in hospitals in Spain and Italy, and it's common for them to finish a shift at about 3pm. Many go to work in private offices afterwards, earning additional income, which may not be represented in the graph.
Some specialists may be overpaid for the work they do (based on number of hours worked and amount of work done.) Ultimately, we will have to decide what we want to pay for: a doctor to attend to us, hospitals where they can work (and which pay other care givers like nurses and physical therapists, etc), or devices and medicines. Perhaps everyone will have to get a haircut. But I think we will also have to look very closely at the newest brand name drugs that offer little benefit compared to cheaper generics, and whether some drugs that are taken chronically, generating huge pharma company profits, are worth the money spent on them.
"Compare what an intern makes (about $50K) to what first year law associates make ($160K at big firms last year)"
The only lawyers making $160k out of the gate are alumni of the top 10 or 15 law schools. A lot of law school grads are unemployed making $0, whereas unemployment for med school grads from any accredited American school, I imagine, is negligible. Unlike with hospitals and med schools, there is no feedback system to limit the number of law school grads to openings in the industry. I'd venture that whatever the average intern makes, it's higher than what the average new law school grad makes, if you factor in all the law students who are unemployed or not working in law.
I seem to recall that GP salaries are higher in Canada than they are in the US. Nobody can compete with the US on specialist salaries, but pediatricians and family practice types don't seem overpaid.
Oh, and Radiologists are ridiculously overpaid. Every doctor will tell you that.
People should bare in mind too that 1) tuition for medical school is going to be more expensive in the US than Canada and 2) Canada has a GP shortage.
If you pay by the patient, complicated patients will be shunned, since they don't yield any more income and are a lot more trouble.
As a disabled person, I already can't get any time with my primary care doctor. All he wants is to refer me to a specialist and get me out of his office.
Finally, the whole idea of a market is about compensating people based on things like risk and performance. We get into these problems because we are so adverse to treating medical care like other services. Just let the market operate and you'll see prices come down for many people. If the poor are having trouble paying for health care, give them money, and let them spend it on health care or whatever they like. Stop trying to run it all, as if central planning could accomplish anything.
I think there are many reasons why a free-market approach to health care is unlikely to succeed. First, there is marked information asymmetry (the provider has access to knowledge and information that is unique), and almost all economists will tell you that information asymmetry will wreck a free market. Many times, it's not even the patient who is making the decision. What will we do about people who are unconscious or otherwise unable to make rational decisions for themselves? By using a free market model, all kinds of conflicts of interest arise when others are making economic decisions for them.
Second, in a free market plan, with high cash payments out of patients' pockets, most advanced health care would be frankly unaffordable. It is difficult to imagine that most people might afford to pay cash for surgery or intensive care.
Third, there is basically no example of this kind of approach working. In the world today, the only countries that use a cash approach to medicine are countries with underdeveloped economies (see this recent article: http://www.slate.com/id/2220534/) I am pretty sure we don't want to emulate this model.
Instead of ideology ("we must follow free market principles") we should concern ourselves with what works. What kind of system will allow us to achieve good public health and reasonable patient and provider satisfaction without bankrupting the nation. I think the pertinent existing examples of this are Europe, Australia, and Canada. Not all models involve a government-run health insurance plan, but all have forsaken profit as a motive for insurance companies and hospitals and providers.
Let me say at the outset, that I am not a physician. I have to say that, at least under the present societal conditions, I am not disturbed by a physician, say a GP, making $200,000 a year. Considering how difficult it is to get into medical school, the years of education/training, the responsibilities attendant to the job, not to mention the debt incurred, I don't find it excessive. I do find it ridiculous to expect everyone who enters the field to be Albert Schweitzer, particularly when there are careers, ie, finance or law that can pay nearly that right out of college or lawschool and don't involve life and death decisions.
DavidK is right about the educational debt of US graduates being a major issue. Six-figure debt is quite common. Residency deferments were pretty much the norm for most loans when I was in training. I don't think that's the case now, which means residents today continue to accumulate debt for the 3-7 (and occasionally more) years they are making salaries that preclude any meaningful debt repayment.
One way of of trying to create incentives for primary care and away from "lifestyle specialties" such as dermatology would be loan repayment programs. One of my friends participated in one for indigent primary care and I was fortunate enough to be a part of one for HIV/AIDS care and research. We both still work in those fields, in part because of these programs.
Another issue: the impending physician shortage. This could interact with salary cuts in unpredictable ways. Physician work force capacity historically benefited from long work weeks and careers. If doctors still work those same long hours over decades, despite lower salaries, there could potentially be more of them for the same amount of money (or the same number would cost less). The more likely scenario, I suspect, is that American doctors would scale back hours and the number of patients seen, which could worsen things in understaffed specialties and underserved parts of the country.
After we normalize doctors with the rest of the world, can we get a similar chart for lawyers and legislatures and start normalizing their salaries as well?
"His style isn't to mandate changes from on high but to tweak and nudge incentives to make individual actors find selfish reasons to choose to follow his agenda."
Or he could just demonize them into submission. Worked for AIG.
Maybe use an anonymous strawman:
"Their are some who say Doctors should make obscene amounts of money to tend to the sick..."
Bingo.
Instead of trying to manipulate salaries, cost structure, etc, we should take the simplest approach. Incentivize more people to become doctors (without sacraficing quality, of course).
In addition, the fact that today you have to see your doctor for even the most basic/minor health issues is ridiculous. A lung capacity test, i.e. blowing into a machine, that takes 2 minutes set me back over $100! WTF?!?!
We could increase supply by training more doctors; that might help. And raise taxes on the rich, so that there's somewhat less incentive to boost salaries, not only in medecine, but across the board. In this country's fastest-growing years the marginal tax rate was confiscatory; I say let's bring back the ninety percent bracket...
"We get into these problems because we are so adverse to treating medical care like other services. Just let the market operate and you'll see prices come down for many people."
I don't know; it strikes me that there are important differences between medical care and other services. If my mechanic says I ought to get a pricey diagnostic test to pin down the cause of the rattle in my car, I might well raise an eyebrow, a decided to wait and see another mechanic or do some research and tinker around in there myself if I've a bit of skill. If my doctor says he thinks I ought to have an MRI to check out that chest pain I've been experiencing, I'm much less likely to say no.
We're pretty far from the days when 99% of patients would just nod and say, "Whatever you think's best, you're the doctor." Patients have become much fiercer advocates for themselves, and much less deferential. But when it comes down to it, for the serious stuff that costs the big bucks, the vast majority of people aren't going to stand there and haggle over the cost of a test or a procedure, not if they think it could possibly help save a loved one's life or stop their suffering. And patients are rarely in a position often to say beforehand, "no, that test is definitely unnecessary, please don't do it."
On the other hand, I can easily see people deciding to shop around on some of the smaller costs --- the price of an annual check up, for instance. Maybe even an X-ray for a minor injury. Medical care is something that lends itself to being penny-wise and pound foolish --- cheaping out on the small costs of routine preventative care, and then as a consequence having untreated conditions becomes serious ailments. Deciding to ride out the cold rather than spend a couple hundred bucks on antibiotics, and ending up with a case of double pneumonia that requires hospitalization. That kind of thing.
Why does everybody act as though there were no health care in this country until insurance companies and the government came along? Interestingly, the era of the family doctor's home visit, whose passing is so much decried, was the era when people paid for the care they could afford on their own or relied on charity.
This new ideology that make "rights" out of what once where "privileges" to be paid for out of our own pockets, cannot help but break the country. No one has the "right" to a Harvard education, and they don't have the "right" to a John Hopkins liver transplant. Alternately, we can hope for a time when human beings will have no concern with their own financial well being, and instead take on difficult and taxing professions requiring long years of tough education, merely for the "intangible rewards". That's the day these professions will be filled with mediocrity -- notwithstanding the occasional Mother Teresa.
Interestingly, I have contacts in Canada and England who tell me there's a movement there to allow some privatized medical services, because the national services are so inefficient (long waits for routine services and procedures) and overwhelmed (less and less young people are pursuing medical careers). I guess Canada and England just don't have enough of our high minded Leftist will to work of mere "intangible rewards".
Ever since health care developed technology to prolong life significantly (after World War II), government and health insurance have been involved.In the days of the family doctor who accepted cash, there were few products and services to offer, except for sympathy and bedside manner.
Technology costs money. We need to pool resources to be able to afford it. The risk insurance model is a bad one for health care: all of us will need some kind of health care, eventually. For-profit insurance companies will always have an incentive to deny care.
Not everyone has a "right" to a liver transplant, but I don't think a society in which only people who can pay for health care are those who receive it would be very attractive. It would look a lot like the third world, or the 19th century.
Technological advances in computing have yielded cheaper, faster machines. In health care, most technological improvements have increased costs. It may be that part of the solution is figuring out if sustainability, if you will, should be built into medical research.
Technology can lower costs, but there are legal/regulatory obstacles involved. For example, surgeons in the U.S. already use human-controlled robots for some procedures, to reduce the size of incisions needed (a robot "hand" can be a lot smaller than a human hand). Related to this, the U.S. military has been working on remote controlled surgical robots, so surgeons out of harm's way can operate on soldiers on battlefields. Put those two technologies together, and, if the legal/regulatory obstacles were surmounted, you could have moonlighting Indian surgeons operating on Americans from India. You'd probably want an American physician on site in case something went wrong but maybe you could have one or two American physicians on standby for a half-dozen robot operations. Since our night is India's day, these robot operations could be held at night, increasing our domestic operating room capacity for non-emergency surgeries.
Why not open doctors up to competition? Certainly 90% of doctors visits could be handled by nurse practitioners. But they have to work for doctors, let them be independent. A whole host of other regulations make consumer demand for their services a lot higher.
Price controls always fail.
You're comparision of salaries to Europe is way off. I'm a surgical intern in Ireland. I am paid 35,000 euros for 39 hours of work. I work about 70-80 hours per week and therefore will earn around 70,000 euros for the year (or roughly 100,000 USD). An intern in the US will earn half that amount. In addition medical education is free, so interns here make twice as much as interns in the US do without any debt to pay back. Also, an Irish consultant (attending) receives a base salary of 220,000 euros regardless of speciality. They then receive extra income when treating patients with private insurance. Doctors are paid higher in Ireland without educational debt and without a shortage of primary care doctors.
According to the chart US docs make about 200K while docs in Germany and Canada make about 100K. Other countries make less.
In my neck of the woods every school superintendent (districts with about 4000 kids) makes at least 250K. Unionized school principals make about 130K. Union teachers top out at 100K (for 183 six and a half hours days per year by contract). Unionized cops make 120K (45 33 hour weeks per year). Unionized building inspectors make about 125K.
So virtually all of the unionized public employees mentioned make more than a doc in other countries. Throw in the ludicrous benefits packages and the compensation difference grows immeasurably.
I have not heard Obama complaining about the unionized public employee salaries and, for some reason, don't expect to hear about it.
Your neck of the woods, Ed, is not typical, and I would bet that the doctors in your area make much, much more than the unionized public servants.
I am a unionized teacher, and while I certainly appreciate my union for many reasons, my pay is the least of those reasons, and I make much less money than virtually all of my college classmates. In the rich town I work in, the highest paid cops do make 150K, but they work 80 hour weeks. The doctors and lawyers there, on the other hand, make several times that, and the most highly paid make over a million dollars a year.
Also, the chart is 13 years out of date (that must be a really old Ezra Klein post).
It's not just the education for the doctors themselves that would need to be cheaper if doctors are to work for lower salaries. It's also education for the doctors' children. Educated professionals don't typically pass down businesses, land, or enormous stock portfolios to their offspring. They pass down the opportunity to become educated professionals in turn.
First-generation professionals in particular, the ones who had to take out loans to get their educations, often have strong opinions about subsidizing education for their own children in order to smooth their path. If they do not earn enough to do so, it will be harder to attract people into those fields. Unless education for everyone gets cheaper.
The other major expense that is disproportionate to most salaries, namely real estate, seems to be taking care of itself. But education and medical care remain the two big ones, and they are related.
The salary survey is 13 years old. U.S. doctors make much more now. U.S. doctors often make $300,000 to 600,000 after just 4-5 years of experience--yes, it depends on location, but these are nationwide averages. Surgeons make even more. Many doctors are choosing high-paying specialties rather than becoming family doctors--there is a shortage of the latter (GP's). Let's be honest, doctors are businessmen first, for the most part, seeking maximum profit. (Yes, there are exceptions, but regrettably, these are "exceptions" to the rule.)
The main reason that U.S. healthcare costs are so high, relative to other developed countries, is because doctors' compensations are not tied to performance (patient outcome), but to over-prescription of medicines and services, for which doctor receive kickbacks/extra payments. And, of course, the AMA controls the supply of medical student graduates. Restricting supply while demand increases = higher doctor compensation. The lame excuse used by the AMA is to "maintain quality".
Yes, medical school costs are high, but aspiring doctors know the ROI (return on investment) is very high and employment is almost guaranteed. If recent grads focus on student loan repayment, they can easily pay of those loans in 5 years--which is better than most college graduates can do. However, if they assume more debt (mortgage, cars, etc.) or a more expensive lifestyle, it will take longer.
Most Americans have don't know how much doctors make (see above--those numbers are after all expenses/costs) and assume that there is little money left for doctors after their expenses are paid. Doctors love to blame medical malpractice insurance costs, which many might assume devour every penny a doctor makes. Typical medical malpractice insurance costs are about $40,000 to $60,000. See these articles on the real cost of malpractice insurance:
http://www.cortlandstandard.net/articles/02152008n.html
http://www.mdjobexchange.com/SocioeconomicIssuesDetail.aspx?Mode=19
I am not defending medical malpractice insurance, but the costs that doctors criticize are exaggerated--doctors are almost never specific about numbers regarding their compensation and malpractice insurance costs.
Doctors have successfully vilified health insurance companies--of which I'm no fan--and in doing so, have evaded blame for their expensive (and sometimes unnecessary) services and even billing fraud. Health insurance companies help reduce over-charging by doctors.
Much more can be said, but in the end, I support a government healthcare plan which focuses on treatment outcome, cost effectiveness, and stimulating competition in the healthcare industry (price-performance).
"The salary survey is 13 years old. U.S. doctors make much more now. U.S. doctors often make $300,000 to 600,000 after just 4-5 years of experience"
Wow, where do you get your data? Reimbursement has been declining for years now.....not even keeping up with inflation. THAT'S why it's important to realize that the data is over a decade old. http://www.facs.org/ahp/pubs/whatsurg1006.pdf
I will finish my training this year at the age of 35. I've spent 12 years after college accumulating interest on my $300,000 in educational loans. My starting salary at age 35 will be $200,000. This is after giving up the best decade of my life working 100 hour weeks for below minimum wage (yes, you read correctly). Now I have to purchase a practice, which will further increase my debt and bring my total loan repayments of ~$60,000 per year. This is without even adding in a home mortgage and the same stuff everyone else has. So my $200,000 doesn't look so hot after Obama takes half, the banks take $60G, leaving me with $40,000 per year. After all the personal sacrifice for over a decade (both with family and financially), why would anyone do this and assume the risks with peoples' lives while buzzard-lawyers are circling over head. Be careful what you with for, because you will get what you pay for....and your asking to pay the same salary as a plumber.
1: In the rest of the world (except the US and Canada) medicine is an undergraduate degree that lasts about the same as an engineering degree. This, I believe is one of the reasons why debt is out of control, and physicians need to make so much. Forcing people to undergo four useless years of undergraduate when most of them already know they are going into medicine is idiotic. An example of bad American exceptionalism.
2: Open the borders. The reason engineers make less then physicians and lawyers is because their work is more easily ousourced.
Indian, Mexican doctors are just as good as their American counterparts by international comparisson. We can either let them in, where their work can be supervised or people are going to start flocking to those countries to have their standarized procedures done and insurance companies are going to love it. The world is getting flatter by the minute and your are just not going to get away making much more than a comparable doctor abroad for much longer.
Simply put the united states can't afford to keep on spending so much more on healthcare with such poor results. We pay too much for doctors and too much for medicines. I don't think its a question of either or both groups are going to have to sacrifice.
Doctors charge too much. Probably someone is making too much but it isn't me. I am a general internist.If you wonder what people are making check the want ads in the NEJM or the Kaiser website.
Patients see our charges, which are set , not by us but by the system we work for . My husband had a visit for influnenza--bill $110 for my partner, $100 CXR, around 40 or 50 for the radiologist . My partner got .98 RVUs or about $20 before taxes . I get a max of about $100 before taxes for a hospital admission which takes about 1-2 hours , most are lower . Hospital admits are by their nature at inconvenient times . A lot f the hospital time is uncompensated --answering nurses queries, looking at Xrays , (can't cahrge if you go the extra mile and do it in radiology), looking at old labs, reading the offfice charts, typing prescriptions, and so on. Critical care is pretty well paid, I honestly don't remember, but most of those patients are old and sick (DUH)and on Medicare so we have a limit of about 2 hours we can bill for --and I guarantee that I have spent 5 and 6 hours with a single patient many times . I routinely work more than 24 consecutive hours when I am on call, and I am lucky when I sleep 4 hours in a 32 hour shift . I chose this over my prior career as a software engineer, and I would not un-choose it, but financially I would have been better off staying in software.
In the office a have a patient appointment about every 15 minutes, some are longer, none are shorter . Visits take about 18-23minutes , based on historical data and then I spend another 15 minutes with the darn EMR coding it. for this 1/2 hour of work I get about $20.
I don;t make $300,00, no one i know in my field makes $300,00. I live in the Pacific NW with low salaries, but I work 80 -110 hour weeks , 44 weeks a year at minimum. I couldn't send my kids to their first choice colleges (see above about passing on education) . I have been numerous state comittees for the health dept, for the state medical association ,chair multipe hospital and hospital system comittees , graduated top 10% of my class--which just means I am a respectable, responsible, politically liberal, full time practionier as opposed to a hobby doc. If I was a darn genius I would not have gone into primary care internal med
As general internists we are highly regulated, monitored, graded, weighed and measured by people with less training, higher salaries and shorter work weeks than we have . Not that I am bitter . Second, almost any other private sector employee with 7 years minimum post -college training makes at least as much per hour as I do.
I am all for reducing costs, I am physically unable to work more hours. As far as costs, I have to type an answer to each the 20-40 phone calls that come in daily and store it in the chart . THAT increases costs. We don;t charge enough to pay someone to type that note , but we absolutely need to pay for accountants and lawyers and billers to keep us out of regulatory trouble.
Is it cost effective to offer chronic dialysis to patients over 85? Is it cost effective to do an MRI on the knee of a 16 year old who has been hurting for 2 weeks but has district playoffs ? Is it cost effective to see patients who read that (insert name) prescription drug would cure their migraines? It takes 15 minutes to talk to them, and examine , and review their meds and 10-15 more to document the visit, Used to be about 5 minutes before EMR, that's another story. I may be willing to work for less if I had less stress, but my assistant (we don;t charge enough to afford RN's) my billing clerk, my office manager, my receptionist shoudn't work for less.
AMA has been able to maintain the doctor shortage by restricting the number of residencies to about 22K per year. Please see http://www.medfriends.org/match_statistics/2007%20NRMP%20Match%20Advanced%20Data%20Tables.pdf.
Even if a person could get educated overseas and pass USMLE 1,2 and 3 examinations, he/she will need to complete one year of residency in the US in order to get a medical license. We probably need about 50K new doctors annually to take care of the 50M uninsured. Until the residency barrier is removed, allow foreign medical graduates aka FMGs (with a minimum of 5 years experience), who have passed USMLE 1,2&3 to work in the US on guest worker visas. Passing these tests should not be a problem as several FMGs currently entering US residencies (about 3K as per table referenced above) are scoring very high marks in these tests even now. Page 2 of the table shows that 7430 qualified applicants were unmatched in 2007.
These FMGs may be restricted to treating the Medicare/Medicaid/uninsured patients that our doctors don't want to treat. This will bring down the physician salaries to earthly levels. If doctors earn less, they will be unable to pay heavy malpractice awards. This will motivate the lawyers to move to other industries such as cigarettes or gun manufacturers.
Malpractice costs can be avoided by working for HMOs. Pay scales at HMOs are also high and they provide fantastic retirement benefits.
Education cost is a different topic altogether. Other fields such as MBA/JD/Ph.D cost as much and there is no certainty of payback in those fields. If necessary, the doctor can obtain the license after one year of residency, work in VA or Indian reservation or student/community clinics and earn about 150K. Moonlighting in Urgent care clinics pays over $100 per hour. There is general agreement that Residents are grossly underpaid now. The federal government should supplement their pay right away.
As a current medical student, I feel that I need to clear up some of your beliefs. I'll explain point by point:
1. The number of residencies is restricted to 22k per year. Why? Where the hell are you going to train all the additional residents? Lets say you have 5 neurology residents at one hospital. Are you just going to train 10 instead? How are you going to have enough patients with neurological problems with enough variety to give each of these residents a quality education? Are you going to have each resident examine a patient ten times? How are you going to have the attending staff to be able to teach all of them? There are a whole number of obstacles to this and you should understand now why we can't just say "hey guys lets double enrollment to meet demand." It won't work and it'll produce shitty results.
2. You say that FMG's are perfectly capable of filling in. Again, you have not been informed properly in this situation. There are two groups of FMG's. There's those that are usually US citizens - similar to their peers that go to US medical schools that go abroad because they could not get into a medical school in the US then strive to get high marks in the USMLE to return to practice in the US. Then there are doctors of foreign countries, many of whom do not speak English well and do not get high USMLE scores and FAIL to match.
The "7430 qualified applicants - unmatched in 2007" are NOT QUALIFIED. To get rejected from the most basic of family medicine residency programs is really a feat. Some residency programs WILL go without residents one year simply because these applicants are of a VERY VERY poor calibre and hiring them would be detrimental to their program and would NOT produce good doctors.
3. Flooding the market with poor calibre FMG's would probably succeed in lowering average doctor pay. Then what happens after that is interesting. I guarantee that the calibre of doctors produced would decrease. Instead of spending 16 hour intense study days in the library preparing 2 months for exams to get high marks on the USMLE to be able to choose which specialty you enjoy most people will slack off. Your specialty that you like may also be high paying which means it is more competitive which means that you have to study much much harder to beat other bright students into getting a spot. If all specialties are paid the same and poorly, there won't be this competition to learn the material better etc. Also, bright future applicants will go elsewhere. I have seen some medical students in other countries who do not have as much of these incentives, and there is a significant quantity of them that are just GARBAGE. They go from exam to exam barely passing failing some which they remediate later then barely pass again. If you had seen this, you wouldn't want these people to be your future doctors.
4. As far as the moonlighting goes, MOST residency programs will NOT let the resident work on the side. Also you have to be a THIRD year resident in your field of choice to be able to work in the field you are being trained in. As far as the JD/MBA/PhD cost, I had read an article somewhere that compared applicants from medical schools to law schools. It found out that most (nearly all) successful applicants to medical schools would have been accepted to a top 50 law school had they applied.
ERROR in my previous post in case you want some facts with that whine
We can take up t 6 weeks (including the day here day there stuff) yearly . None of this is paid, nor are sick days .
52-6=46 not 44. Life lesson: Don't type during a call shift.
Response to JohnP:
1. Our population has been growing and we are spending more money treating patients, using new medical and surgical procedures, etc. This workload will increase as we add another 50M uninsured to universal medical coverage. More patient load translates to increased demand for more physicians and residents. So, I don’t understand why more residencies cannot be created with the increase in patient load, at a minimum in family medicine. If the US is incapable of creating residencies, let us rely on foreign countries to train first year residents. We are already validating foreign medical school education using USMLE 1 &2. In the same spirit, allow the first year residency in approved foreign institutions to be validated using USMLE 3. This will alleviate the shortage in family medicine. Over course of time, validate foreign residencies in other specialties by permitting such graduates to take up Board examinations. It is pure hubris to assume that only US doctors are qualified and patients in other countries are dying like flies. We have had very good experience with foreign engineers and, in fact, over 40% of Ph.D. degrees in engineering and sciences are currently awarded by US universities to foreign students. We can realize the same experience with FMGs also.
Some years back, limits were set for residents’ working hours. If hospitals needed to maintain the same number of resident hours, they should have increased the number of residents. This did not happen due to the monopoly power of AMA and state medical licensing boards dominated by doctors. If the federal government will be pouring a trillion dollars into the medical industry, they should demand an increase in the number of residency positions, here or overseas.
There is another advantage to recognition of foreign residencies and allowing foreigners to take up USMLE 3 and board exams. Some functions such as pathology, radiology scans are digitized and their interpretation can be done elsewhere. With a pool of US-certified professionals in other countries, these scans can be interpreted 24x7 at a much reduced cost.
2. I am well aware of FMGs of US origin, foreign origin as well as D.O.’s. I have seen all these categories as heads of departments at several HMOs and have had good experiences with them. If the number of residencies is increased, we can get a lot more US residents educated abroad. Stronger FMG candidates with lots of years’ experience will be motivated to apply for residencies even with guest worker visa status (as in the UK) as they cannot get such high salaries anywhere else in the world. English is spoken in a number of third world countries and is not a big challenge for several FMGs. In fact, with a sizable Hispanic population in this country, a case can be made for importing Spanish speaking medical residents to serve in the southern states. Some FMGs score higher than the average in USMLE exams as they finish their foreign MD first and then have lots of time to prepare for USMLE tests, as compared to the US medical students.
3. Don’t assume that the brightest students go to medicine. In high school, very few students have problems with Biology or Physiology, or even Chemistry. Several struggle with Math and Physics. The ones entering pre-med are after money or weak in Math and Physics. I have reviewed some MCAT practice exams for Math, Physics and Chemistry and these are basically first year college level at best. Once in pre-med, students take easy courses in liberal arts, education, etc., to maintain 3.5 GPA. The MCAT and medical school selection process with in-state bias, unpublished quotas based on geography, race and gender do not select the best qualified students into the medical profession.
I am, in fact, against FMGs since Biology is not a hard subject for our students unlike Math, Physics or Engineering. We should be increasing medical schools in this country. It is a shame that we are ceding several 200K+ jobs to foreigners and these foreigners have had to pay a pittance for their education.
4. I am aware of a resident in Southern California moonlighting for $75 per hour some years back, outside of his residency hospital. With other professions such as JD or MBA, the only moonlighting option is to flip burgers.
Getting into top 50 law schools is not all that scholarly. Instead, consider how many MDs would have finished Ph.Ds. in engineering if you want to compare the rigors of education. It is a shame that several Ph.D’s cannot get steady decent jobs while X-ray, mammograpy technicians with 2 year associate degrees can earn $40 per hour.
There is another difference between MDs and JDs. Even for graduates from top 10 law schools, 150K salary is not assured and the job may not be all that steady. On the other hand, MDs graduating at the bottom of the class can still obtain 200K+ salary lifetime, thanks to the medical monopoly.