Correct, but I don't know a single doctor in the US who actually paid it upfront instead of taking out all those loans and then easily paying them back with their newfound doctor salary later.
Yeah, the only people that I know who don't have >400000 in loans with a >5% interest rate coming out of residency have wealthy parents who paid for everything, did the military's HPSP program [1], or did a free 7-year MD/PhD program. It's an interesting process.
Can you explain your logical reasoning for why you believe most folks with medical school debt come from well off middle class families?
I'm confused because need based financial aid for medical schools is still mostly loans. My partner who comes from a relatively poor family (they used to be on welfare) had most of their need based financial aid in the form of loans. Out of her residency class the highest % of folks taking out loans were from low to middle income families not well off families. So I'm curious where you got that stat from?
Anecdotally, I know some people who did not come from well off families who got need-based financial aid that covered the entirety of their medical school tuition. There was still some loans for living expenses but that’s about it.
It's interesting because you know we are weeding out talent that comes from low socio economic backgrounds and who need cash flow to support their families. At end of the day, we shouldn't be weeding out our doctors to only be folks who don't need to support their families for the next 10 years.
There is a limit put in place on supply (seats at medical schools) already. Weeding out is part of that system already. The question is should cost be part of that.. we decided somewhat yes which is fair if you decide to limit supply in the first place.
To limit supply is mostly to control price, like how OPEC controls oil. Current doctors have a vested interest in remaining a scarce commodity and lobby accordingly on the boards it matters.
The actual limit is residency slots. Every year there are many students who graduate from medical school but are unable to practice medicine because they can't get matched to a residency program.
Yep, that's the true barrier to entry. The main issue is there is that Congress has capped the Medicare funded residency roles to the same number since 1997 (Balanced Budget Act of 1997). In that time period, the US population has grown 21%.
Many people fail to become doctors and or lose their license for various reasons. So, it’s a huge gamble in the US that can easily cause massive financial issues.
What's interesting is that student pilots face those same issues now.
To go from ab initio to an airline pilot role, the cost is in the area of $200,000 - $250,000 now and there's a lot of ways to end up not getting picked for an airline job.
Entry salary is up from $18,000 to $40,000 or so now, but that's not much improvment considering the cost of training.
Part of the issue is the 1,500 hour experience rule, which is government-imposed. (There's an option for 1,200 hours, but then your major has to be airline-focused., preventing them from wisely diversifying their career options.)
US airlines are in a bind because their policy is to not subsidize initial training, but cannot fly without pilots.
And students are getting sticker-shock, and thinking about other careers with better ROI and certainty.
Yea, but that’s only half the story. Military pilots get training for free, which is vastly more and has massively suppressed airline pilot salaries. There are a few other approaches that can similarly reduce costs, but sticker shock is huge.
A friend of mine flies island-hopping cargo/shipping in the Puerto Rico area which is a common route to make money, live well, and get enough flight time to land a commercial pilot job in the future.
It would cost even more trying to do it midlife. You have the cost of feeding/housing your family and other responsibilities.
It's not an easy decision for anyone but the lucky wealthy.
The admission process is also very geared towards undergrads coming straight out of premed programs. I thought about going to medical school after finishing a biomedical PhD, where I had picked some relevant skills (large animal physiology) and worked on some translational stuff. We even had a semester of neuroanatomy classes with the med students.
However, when I talked to admissions staff, this counted for essentially nothing. My prerequisites were out of date—-I’d have to go take biology and physics (with lab!), even though I’d spent the last 6 years measuring the electrical activity of living brains in living animals. I’d need to volunteer in a hospital for....whatever reason. None of this would have been insurmountable but it would have added another year or two to the process, while making less than a grad student and pushing a real job even further into the future.
This is especially maddening since the NIH is particularly keen on training physician-scientists, but everything seems designed for physician->scientist and not the other way around even though we have a glut of biomedical researchers and not enough doctors!
Ouch. Worse than I thought. I suppose it's correlated to eventual revenue— doctors aren't nearly as rich in Europe, although they are clearly among the top earners. (what filoleg suggests in the other reply)
There's an underlying premise, I think, that countries like France or Germany seek to minimize the cost of healthcare in general, because the bill is collectively paid— the bottom line is a direct cost on GDP, that's what mutualizing bills means i.e. "social security", beyond that the whole socialistic apparel of redistribution of (some % of) wealth.
Artificially inflating any of these mutual bills simply means that some (people, corporations, the medical field entirely including drugs and supplies) would take more than they should from all others, financially. Starting with having to buy their way in the field (exactly the kind of artificial gating that modern democracies sought to remove, historically; long-term it's no better than saying "voting costs $100k per person").
It's a form of inner competition at a national level, because the enrichment of some hampers the velocity of the whole towards the core mission. It's a huge distraction, at best.
In layman terms: because I'm gonna charge 200 instead of 100, the country can only buy N/2 worth of what I do. If "I" is the entire field of medicine drugs/supplies/infra, we only cure half what we could, but I personally get 2x profits. It's wrong on every level when we're talking about mutual bills.
But in the USA, the bills are not (yet) mutualized, not enough of them... so there is no incentive to keep costs low and treat as much as we could, because microeconomically, it makes more sense for the field of medicine to increase its relative profit. Unless you add the macroeconomic coupling, that bills are mutualized and everybody pays them at the end of the day, it just can't / won't change imho.
It costs a lot more than that to become a doctor in the US. Typical student loan debt for doctors is well into 6 digits.
https://www.bestmedicaldegrees.com/is-medical-school-worth-i...