Why Med School costs over $200,000 and why it should not

23 06 2009

Bruce Friedman over at LabSoft News had an interesting post today about the current state of affordability of medical school and what we can do to change it.

He first references an article published by the AMA about this topic:

“Medical students who went into debt could figure on owing $126,714 in 2007 on average, up from $88,331 in 2000, according to the Association of American Medical Colleges… Suggestions under consideration would take approval by powers greater than the AMA. They include providing tax deductibility for tuition and loans, and expanding state and federal scholarship opportunities. But another cost-cutting approach is investigating ways to reduce the length of medical schooling—perhaps through competency-based curriculums, or through combined B.A./M.D. programs.”

The article also goes on to say that 23% of medical students graduate with over $200,000 in debt (let’s not forget that you have to go to college first!).  In fact, my personal educational loan grand total was greater than $250,000 when I graduated, and after two years of interest, I’m almost afraid to see where it is now.

Dr. Friedman then goes on to offer his suggestions as to a solution:

  • “Medical schools should begin to accept students, as in former years, after three years if they have fulfilled all of their undergraduate course requirements. If this is impossible given the number of such prerequisites, this number should be reduced such that it is possible for most applicants to quality for the new program.
  • On a selective basis, medical school should allow some students to skip their fourth year and graduate in three. This should only be an option for the most mature students who have amply demonstrated their ability to function well as they pursue their post-graduate medical training. “

My response is as follows:
As a graduate from a combined college/med school program myself, I feel like I have some insight to share on this.  Where I went to med school they had 3 combined programs, mine was 8 years, and there was a 7-year and a 6-year program as well.  IMHO, those ‘kids’ who had only 2 years of college, while they may have been very bright, some of them were wayyyyy to immature for medicine (one of them had a breakdown, actually, and dropped out).  Having said that, however, to pick medical students worthy of graduating early based on their ‘maturity’ is vague and subjective, and, I think, ultimately not fair.

The issue of debt from education is undeniable, and GP is suffering as a result, for sure. And, while I think cutting years is a clever approach, I just don’t think it’s the answer.  Personally, I think the direct approach is the best here. Can ANYONE explain to me why med school was $55,000 a year for me? Sure people always say, “Well, you’ll be good for it in 8 years” or whatever, but that’s really not ok.  My medical school was one building, with quite a finite list of teachers and services, yet it cost twice as much as college and didn’t come with room OR board!  During my tenure as a medical student, we actually approached our dean about the outrageousness of the tuition (I think we were 3rd in the country for most expensive medical school at the time), and the fact that the tuition was continuing to go up almost yearly. Well, he sat our whole class down and showed us a 100-foot pie chart of our expenses.  And with that, we had our answer.  Now, I’m not 100% sure I’m recalling this EXACTLY, but if memory serves me: about 30% of our tuition went to float the hospital’s pro-bono work.  Is this true elsewhere?  I was outraged, we all were.  Absolutely, these people need to be cared for, but to place the burden of the medical students’ shoulders is grossly inappropriate.  In addition to this, we also had to pay a multi-thousand dollar ‘national security fee’ or something of like.  Unreal.  In the end we all just sucked it up, but it’s not ok. Things need to be fixed or the system will collapse in on itself.

Nobody likes people that complain and then don’t offer an alternative, so here are my ideas:

  1. My medical school is as expensive as it is because we have one of the WORST endowments in the country. There should be more focus on giving back, in the form of alumni office activity, and also, you attendings out there should do your parts!!
  2. If I decide to go to med school, I should be paying for my education and not ER work for the uninsured.  I suppose this could be fixed by adopting a nationalized health care system, but I’m not about to open that can of worms. Again, I’m not sure if this situation is recapitulated elsewhere in the country, but there must be some shenanigans to justify $55,000 a year.
  3. Go to a state school or live in a country outside the US.  LOL.  But seriously, many of my co-residents have ZERO debt because medical school is paid for by the government in their country.  Programs similar to this DO exist in the United States.  First of all, there are the Armed Forces.  Also, there are various programs (most of them in Family Practice, I believe) that will pay for medical school with a X-year contract to practice in underserved areas.  I think these could be some valid alternatives to signing away your soul to some people.

Now, I realize that #3 is a band-aid and not a cure.  But, IMHO, the key is to cutting costs by forcing accountability for tuition fee composition.  Also, I think the AMA is on the right track with tax write-offs and subsidies as well.  I’m not saying medical school should be free (as I think in the end, most of us are successful enough to pay our loans back so we shouldn’t have to burden the country with our educational expenses), but it should be affordable enough that what happens with my graduating class does not continue to happen across the country- we had four people (out of about 120) go on to pursue residencies in Family Medicine.  Four.  And that is just not sustainable.

Some food for thought.
What do you think? 🙂





Go to VA for colonoscopy, come home with HIV…

17 06 2009

Heard about this on CBS this morning, but the article has also been discussed by Keith Kaplan over at pathtalk.org.


Credit: CBSNews.com

10,000 veterans have received a letter warning them that they may have gotten a colonoscopy with a contaminated/not properly sterilized colonoscopes.  As it turns out, inspections have revealed that fewer than half of the VA hospitals surveyed had trained their staff to properly clean the instrumentation.

As a result, 6 veterans have now tested positive for HIV, 13 for HepB and 34 for HepC!  This is astounding.  Now admittedly, some of these people may have been infected prior to their exam, but these numbers, I think, speak for themselves.

I am currently rotating at the VA in Albany, and this news has visibly shaken the staff even as far North as here.  This is very tragic news and my sympathies go out to the families effected.





Wolfram Alpha does Medicine too.

9 06 2009

MedGadget has posted an article about WolframAlpha the next big “outside-the-box” stab at a search engine.  I have to agree, however, that Mr. Wolfram (btw, when was the last time you heard a new eponym??), might be on to something here.  From MedGadget:

“Stephen Wolfram, the British physicist and mathematician behind Mathematica software launched his latest project on […] May 18th, Wolfram Alpha. The site, now in public alpha after much hype and fanfare, calls itself a “computational knowledge engine,” and wants to “make all systematic knowledge immediately computable by anyone.” What exactly does that mean? Essentially it’s like an extremely beefed up version of Mathematica that’s linked to a large database of any and all structured information it can collect on the web.”

Having tooled around with it a bit myself, I’ve found it, so far, very difficult to return results for almost any query.  In fact, I believe there is a group of people that try and figure out what it *will* respond to and then post their results on-line.  It is clear that the engine is in its infancy, but the concept behind it is quite powerful.

From WolframAlpha’s mission statement:

“Wolfram|Alpha’s long-term goal is to make all systematic knowledge immediately computable and accessible to everyone. We aim to collect and curate all objective data; implement every known model, method, and algorithm; and make it possible to compute whatever can be computed about anything. Our goal is to build on the achievements of science and other systematizations of knowledge to provide a single source that can be relied on by everyone for definitive answers to factual queries.

Wolfram|Alpha aims to bring expert-level knowledge and capabilities to the broadest possible range of people—spanning all professions and education levels. Our goal is to accept completely free-form input, and to serve as a knowledge engine that generates powerful results and presents them with maximum clarity.

Wolfram|Alpha is an ambitious, long-term intellectual endeavor that we intend will deliver increasing capabilities over the years and decades to come. With a world-class team and participation from top outside experts in countless fields, our goal is to create something that will stand as a major milestone of 21st century intellectual achievement.”

Wolfram|Alpha’s long-term goal is to make all systematic knowledge immediately computable and accessible to everyone. We aim to collect and curate all objective data; implement every known model, method, and algorithm; and make it possible to compute whatever can be computed about anything. Our goal is to build on the achievements of science and other systematizations of knowledge to provide a single source that can be relied on by everyone for definitive answers to factual queries.
Wolfram|Alpha aims to bring expert-level knowledge and capabilities to the broadest possible range of people—spanning all professions and education levels. Our goal is to accept completely free-form input, and to serve as a knowledge engine that generates powerful results and presents them with maximum clarity.
Wolfram|Alpha is an ambitious, long-term intellectual endeavor that we intend will deliver increasing capabilities over the years and decades to come. With a world-class team and participation from top outside experts in countless fields, our goal is to create something that will stand as a major milestone of 21st century intellectual achievement.

MedGadget goes on to talk about the applicability to the medical field in particular:

“Wolfram Alpha is an ambitious project, and naturally, as part of its expansive scope, it’ll include a slew of medical data and formulas. Already it’s got quite a bit. Dr. Schwartz, over at A Disease a Day recently profiled 5 searches on Wolfram Alpha that’ll make you healthy. These include quickly calculating your BMI, seeing how many calories you’ve burned doing exercise, knowing your risk for heart disease, interpreting your medical test results, and estimating your birth due date. It’s even good for better understanding of your own blood pressure. Just try entering the query “blood pressure 145/90.”

Wolfram Alpha may also be useful to the practicing clinician. A search for “creatinine=0.9mg/dL, adult male” returns the 95% reference ranges for the test, a histogram of the general male USA population distribution for the test, and even the CPT codes and test panels.”

Ambitious indeed.  This is just another example of an emerging trend/idea on the web that may become more and more important to our field, depending on how the technology is refined and implemented.  Just a friendly heads-up… 😉

[via MedGadget]





Medical iPhone Apps at WWDC

8 06 2009

Today at the World-Wide Developers Conference (WWDC) (full coverage here courtesy of Gizmodo) there was brief mention of some interesting implementations for medicine-centric iPhone apps that are coming down the pipe.

Perhaps the most novel idea is to use push notification for things like critical labs.  The benefits of this are immediately apparent, let’s just hope you have good reception in the hospital…

They also made mention of remote monitoring of EKG strips, which is cool, but the ability to zoom and pan with multi-touch, but is that really necessary?

Interesting stuff, definitely head over to Gizmodo, for full coverage of the whole conference, med-tech content and more…








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