Tweet
Okay, that's a given, but do you have any realistic suggestions, given that the MD training process is highly unlikely to change any time soon?
-
<Reverend> IRC is just multiplayer notepad.
I like your SNOOPY POSTER! - While you Wait quote. -
By way of illustration, my friend S spent about... 4 years undergrad, 4 years medical school, 1 year internship, 2 years internal medicine residency, 3 years cardiology residency, 1 year invasive cardiology fellowship, 1 year electrocardiology fellowship. By the time he was done with those 16 years of training at 80+ hours a week of work, he was able to insert pacemakers under his own name.
Hmmm... My timeline is off somewhere. I think he was only in 15 years.Last edited by DanS; February 14, 2008, 19:21.I came upon a barroom full of bad Salon pictures in which men with hats on the backs of their heads were wolfing food from a counter. It was the institution of the "free lunch" I had struck. You paid for a drink and got as much as you wanted to eat. For something less than a rupee a day a man can feed himself sumptuously in San Francisco, even though he be a bankrupt. Remember this if ever you are stranded in these parts. ~ Rudyard Kipling, 1891Comment
-
I know that you didn't mean it, but the dismissiveness of this comment is pretty insulting.Originally posted by snoopy369
Okay, that's a given, but do you have any realistic suggestions, given that the MD training process is highly unlikely to change any time soon?
If you aren't going to fix this, then no manner of combinations of solutions will do any good.I came upon a barroom full of bad Salon pictures in which men with hats on the backs of their heads were wolfing food from a counter. It was the institution of the "free lunch" I had struck. You paid for a drink and got as much as you wanted to eat. For something less than a rupee a day a man can feed himself sumptuously in San Francisco, even though he be a bankrupt. Remember this if ever you are stranded in these parts. ~ Rudyard Kipling, 1891Comment
-
I'm not going to argue substantially on behalf of our medical training practices, which are total ****, but residency != school; you do get paid for it after all. Sure, less than a doctor by a large amount, but I got paid less when I started my first job than I did a few years later also... and the upside is tremendously high on that pay scale
Either way, it's not going to change any time soon. Doctors have way too much power over this, and they have no interest in decreasing their wages. Unless someone sues the AMA for being a monopoly, which somehow seems like it would fail (ABA does have an interest in this after all...), it's not going to change... There's a lot wrong about it, but you need to be realistic about what you could realistically change in the short (or medium) run, or you're just shooting the breeze...<Reverend> IRC is just multiplayer notepad.
I like your SNOOPY POSTER! - While you Wait quote.Comment
-
If that's your attitude, then we might as well throw up our hands and fork over however much money is demanded of us. This is the crux of the supply bottleneck. This training regime is by far the most laborious of any profession. Getting a Ph.D. is much easier (and yes, TAs do get paid). There's no law of nature that requires this process.
There are market mechanisms that you can insert into the process that could circumvent this. Flooding the market with physician's assistants could be a start.
In any event, I think you were paid more in your starting job per hour. Residents get paid about minimum wage and the working conditions are harsh.Last edited by DanS; February 14, 2008, 19:54.I came upon a barroom full of bad Salon pictures in which men with hats on the backs of their heads were wolfing food from a counter. It was the institution of the "free lunch" I had struck. You paid for a drink and got as much as you wanted to eat. For something less than a rupee a day a man can feed himself sumptuously in San Francisco, even though he be a bankrupt. Remember this if ever you are stranded in these parts. ~ Rudyard Kipling, 1891Comment
-
Indeed they do. But it's interesting to note that there is no shortage of people trained in the law and it takes at most 9 years for training for the law, if you want an LLM in taxation. Training for the law is by no means harsh in comparison to training for medicine.Originally posted by snoopy369
ABA does have an interest in this after all...
You know, GP always rails against the airline pilots and their sweet deals for being glorified bus drivers. I wish he were here so he could say what he thinks about the doctors.Last edited by DanS; February 14, 2008, 19:43.I came upon a barroom full of bad Salon pictures in which men with hats on the backs of their heads were wolfing food from a counter. It was the institution of the "free lunch" I had struck. You paid for a drink and got as much as you wanted to eat. For something less than a rupee a day a man can feed himself sumptuously in San Francisco, even though he be a bankrupt. Remember this if ever you are stranded in these parts. ~ Rudyard Kipling, 1891Comment
-
So that people can get more botox? One problem is that there's all kinds of medical treatment to get now that rich people can afford to get. Supply and demand isn't working again.Originally posted by DanS
Overall, you have to allow supply to meet demand.I drank beer. I like beer. I still like beer. ... Do you like beer Senator?
- Justice Brett KavanaughComment
-
Oh, and a lot of the doctors we already have are crappy. We don't need more crappy doctors.I drank beer. I like beer. I still like beer. ... Do you like beer Senator?
- Justice Brett KavanaughComment
-
1. Mean resident salary for a 3 year residency is $46,000/yr for a 3 year resident, and higher for a more experienced resident (see this table) with cost-of-living adjustments in some areas. Even at 80 hours a week - now the legal limit for residents - this is well over minimum wage (around $11.50/hr). Add in free health insurance (another $1-2k a year) plus other perks as well (free food while working, which is ~70% of your meals; significant time off - often 4-5 weeks paid vacation time - and free parking/etc. while at work) and it's $12-13 an hour all told.Originally posted by DanS
If that's your attitude, then we might as well throw up our hands and fork over however much money is demanded of us. This is the crux of the supply bottleneck. This training regime is by far the most laborious of any profession. Getting a Ph.D. is much easier (and yes, TAs do get paid). There's no law of nature that requires this process.
There are market mechanisms that you can insert into the process that could circumvent this. Flooding the market with physician's assistants could be a start.
In any event, I think you were paid more in your starting job per hour. Residents get paid about minimum wage and the working conditions are harsh.
Compare that to what my GF makes, who is indeed a Ph.D. student in immunology, who works side by side with residents and full doctors; they get paid half that - around $23.5k a year - and work between 60 and 70 hours a week on average, including over the course of a year around 30 days working over 24 hours consecutively (on a long experiment) after year 2. Yes, about every other week. (Some students probably have experiments that can be delayed across several days, but they end up putting in the same hours, just more spread out.)
The program lasts about 7 years- which is roughly equivalent to a MD program for a basic doctor with no specialty - and then leads to a post-doctorate where you make a whopping $37k a year on average, for around the same amount of work (maybe slightly less, 50-60 hr/week). That lasts 2 to 5 years, depending on your skill level, or more (some stay at the post-doctorate level for a long time). You can also leave for industry after the 7 year span, in which case you presumably make more money, but that is basically a dead end (you have a much, much lower ceiling of money and importance). After the postdoctorate, you can again go into industry at a higher level, or become a Professor and P.I. (Primary Investigator), in which case you finally make the big bucks ... maybe $80k a year, unless and until you are a significant success.
Oh yeah, those T.A.s you talked about? $1000 per quarter at the U of C (11 weeks of 3hr/week classes). Most biology Ph.D. students T.A. maybe 2 or 3 classes in their entire 7 years (again, at the U of C at least).
(I'm not a big fan of the residency system either, and think anyone who would do this is totally mad; but it's not nearly as bad as you make it out to be.)
What is the driving factor in limiting doctors is med school, not residency or other elements (although that certainly delays the entry into the system, that effect is not felt in the total # of doctors). There are more medical school applications than positions.
Incidentally, do you know how many doctors there are per capita in the US? 2.4/1000, which is higher than the U.K. (2.2) and Canada (2.1). (OECD stats) Most European have around 3-3.5, which is somewhat higher certainly, and I'd certainly rather have around that number; but I don't know that this is the major sticky factor.
Also, look up residency details - most European countries have just as long of residencies as the US's average (Cardiac physicians and neurologists are the bleeding edge that way; most US end up with 5-6 years.) For example, [url=http://www.valuemd.com/residency-match-forum/132238-residency-iin-europe.htmlthis site[/url] and the database it links to.
I certainly agree that the AMA's power over selecting physicians is well beyond the power it should be, and is in part responsible for our exceedingly high health care costs. I don't, however, think it is the largest driver in that cost; and I think there are lots of things that can be done much more realistically. What those things are I am not entirely sure; and I'm not sure that true market forces will ever be able to take effect. Health insurers will always have a very substantial degree of control over the costs (through their reimbursement levels). I'm not even sure it's a good thing for market forces to govern health care - it's not necessarily a good thing that richer people gain better care, and there's been little evidence that market forces have improved physician health care (as opposed to drug development, which they certainly have improved). Physician health care does not significantly innovate - and in fact innovation is generally discouraged - and this is where the market is supposed to be the strongest.
I am not willing to give up on the market yet- I'm a conservative in the Adam Smith model after all - but I'm no longer sure that the current system has any chance of succeeding without actual governmental action. I don't care for any of the major health plans that are out there now (Clinton, Obama, Edwards - they're worse than what we have now - but I'm not sure that there isn't a good plan to be had, just not something that candidates for president are willing to state (for fear of causing insurers, doctors, and numerous others from turning on them).<Reverend> IRC is just multiplayer notepad.
I like your SNOOPY POSTER! - While you Wait quote.Comment
-
Point of information. Does your girlfriend pay for her schooling or is there some TA or TA-like work that offsets her tuition?I came upon a barroom full of bad Salon pictures in which men with hats on the backs of their heads were wolfing food from a counter. It was the institution of the "free lunch" I had struck. You paid for a drink and got as much as you wanted to eat. For something less than a rupee a day a man can feed himself sumptuously in San Francisco, even though he be a bankrupt. Remember this if ever you are stranded in these parts. ~ Rudyard Kipling, 1891Comment
-
She pays no tuition, but neither does a resident. Costs for public school medical employment is around $75,000 in tuition/fees, and about $120,000 for private(3 years $25k public $40k private) ... a pretty small amount given that can be paid back at around $3500 a year until residency is over (on the lowest payment level for public school), or probably even less (It wouldn't surprise me to see lenders allow a deferment until after residency - a med school loan is basically 99.5% safe money, and the more interest the better...)<Reverend> IRC is just multiplayer notepad.
I like your SNOOPY POSTER! - While you Wait quote.Comment
-
OK, that was quite a long post, so I'm telling you that it will take me some time to respond (perhaps not today). That said, you have given me a lot to think about and I am properly chastized by my "by far the most laborious training regime." I still consider it to be the most laborious and limiting in supply, but "by far" makes it sound like there are no other professions with difficult training regimes, which you have demonstrated isn't true.I came upon a barroom full of bad Salon pictures in which men with hats on the backs of their heads were wolfing food from a counter. It was the institution of the "free lunch" I had struck. You paid for a drink and got as much as you wanted to eat. For something less than a rupee a day a man can feed himself sumptuously in San Francisco, even though he be a bankrupt. Remember this if ever you are stranded in these parts. ~ Rudyard Kipling, 1891Comment
-
Happy to hear he succeeded with his studies.Originally posted by DanS
By way of illustration, my friend S spent about... 4 years undergrad, 4 years medical school, 1 year internship, 2 years internal medicine residency, 3 years cardiology residency, 1 year invasive cardiology fellowship, 1 year electrocardiology fellowship. By the time he was done with those 16 years of training at 80+ hours a week of work, he was able to insert pacemakers under his own name.
Hmmm... My timeline is off somewhere. I think he was only in 15 years.DISCLAIMER: the author of the above written texts does not warrant or assume any legal liability or responsibility for any offence and insult; disrespect, arrogance and related forms of demeaning behaviour; discrimination based on race, gender, age, income class, body mass, living area, political voting-record, football fan-ship and musical preference; insensitivity towards material, emotional or spiritual distress; and attempted emotional or financial black-mailing, skirt-chasing or death-threats perceived by the reader of the said written texts.Comment
Comment