Probably for the same reason they don’t fund budding annuity salesmen or private equity operators. Would you pay the tuition for a gastroenterologist that’s going to make $500,000/year?
Comment to article:
{{The idea that medical school is “expensive” is a canard. It’s a cash flow problem; it requires a current outlay for a future return.
First, an honest discounted cash flow valuation of a medical degree shows a quite favorable ROI, both in absolute terms and relative terms. Relative to, say, an engineer or teacher or psych or comm major.
Second, if med school is so “expensive,” riddle me this: why do so many (younger) doctors only work part time? I see it all the time in recruiting and in practices; doctors working three and four day weeks. Working eight hour days. One week on, one week off. (That’s half-time for those of you in Rio Lindo.) Answer? Because working part-time yields a monster income relative to the cost.}}
I wonder about that ROI calculation. A student who aces Organic Chemistry and gets into medical school would likely be at the top of his class in Chemical Engineering and get a $100,000+ starting salary at age 22. And if you’re working in a low cost of living Gulf Coast city, you could save 50% of your gross salary and retire by the time a doctor has finished his residency.
I did, in fact, ace Organic Chemistry and went on to get an M.S. in Organic Chemistry.
But my original dream was to be a doctor. I scored in the 99th percentile of the MCAT since I had majors in both Chemistry and Biology. But…in my senior year of college, I was told that interns and residents had to work 36 hour shifts. I’m a zombie if I don’t get 8 solid hours of sleep a night. So I pivoted to chemistry. I got my first job in industry in 1978 at age 24. Worked full-time and the company paid for my M.B.A. night classes. Then sales. Then product management. Raises every year. A home. A paid-for home. A retirement fund. Investments. Retirement at age 48.
Meanwhile, my college lab partner went to medical school. Internship. Residency. (At one point, he lived in the hospital since he was the only Chief Resident and the rules required the 24 hour presence of a Chief Resident.) Then a fellowship in surgical intensive care which lasted (as I recall) 7 years. By the time he was a full-fledged attending surgeon he was 37 years old. I’m not sure whether he was still in debt but the residencies and fellowships only paid a pittance. He worked in a V.A. hospital where the bureaucracy drove him crazy. He told me that he would never advise a young person to become a doctor today.
There is a real risk that a medical student’s huge investment in time and money will be interrupted by illness or accident.
Like everything else in our woefully inefficient medical system, medical education evolved into a monster. It would be impossible to redesign it at this point. But the high pay of specialists is needed to reimburse them for their massive investment.
The lack of needed general practitioners reflects med students’ realistic self-interest in light of their low pay.
Wendy
On the same basis that I would invest in a factory that would require a large capital investment to build equipment as a shareholder of stock that would pay future dividends.
If you read the article, they’re not really talking about “investing” in a doctor’s practice. They’re asking why people aren’t making big charitable contributions to absolve student doctors of their medical school debt. And the answer to that question is that if you’re in a lucrative 9 to 5 specialty like ophthalmology or dermatology you don’t need any help with student loans.
What we really need is student loan forgiveness for medical students committed to the less lucrative, but essential specialties like family practice, pediatrics, and psychiatry.
I’ve never understood what that kind of hazing adds to a medical education, other than that the wage theft of long unpaid overtime enriches for-profit hospital operators. It’s actually dangerous to have a medical intern on the 35 hour of a 36-hour shift working on a patient. That’s why the FAA has strict limits on how long a pilot can be on duty and how much off duty time he needs to sleep. Otherwise the airlines would be working them 24/7 without rest.
Well, it isn’t exactly hazing but, in many ways a simulation of what life might have in store for a physician out in the real world and in a hospital where there isn’t a brigade of attendings, residents, PAs etc. For a good many they are The Man/Woman who’s there to deal with any and every case because…can you believe it…some folk just get sick are the most inconvenient times.
Back when dh and I started dating he was still in his residency programme and had a much more demanding schedule than 36 hours at a pop. Even on the occasion of being “only” on call, many’s the time then and since I’ve gotten up with him at, say 1 am, driven him to deal with an emergency, slept in the car and driven him home…so’s to avoid potential widowhood should he fall asleep at the wheel. This was in England and the NHS in those early years, BTW. Not a dissimilar experience to many junior hospital doctors in other countries where training isn’t enriching for-profit hospital operators. A nice story while it lasted, though.
In real life people, in any line of work, not just doctors, when confronted with a challenge like that step up and meet it when they have to. When I was in the military we called it “practice bleeding.”
My dad and his 9.75 years older brother became doctors at the same time in Dublin. Dad dropped out of high school age 15 and went to Trinity Dublin at age 16. In Ireland at that time the younger doctors worked for the older doctors who controlled the beds. Dad was a total wise behind and better than them so he took his bride to America on their honeymoon. I was born the next year.
Uncle Michael was a GP in London after that. In 1965 on the way to the hospital for an emergency he has a car accident and died. He was passing on a hill and a truck came the other way.
Dad did his first internship in Ireland on Baggot street. The US did not recognize it. He did a second internship in the US.
He trained at the Institute for living as the youngest resident. He was chief resident in his third and final year. He was the very best in his specialty for some 25 or more years. In charge of intake for several years, he did all the intake diagnostics and made a complete course of treatment plan for each patient. The bed count went from in the 150s area to 470 with dad making all diagnostic decisions. He also served on the licensing board. He also in retirement three times ran a larger clinical system that was cutting the cost to the state for care. He finally found someone good to replace me there.
About ten years ago he said if he was training as a doctor today because of the width and breadth of study materials he would not have made it today.
As a 16 year old at Trinity he failed his first year. He did not know how much work it was going to be. He made it all up in the summer testing again and getting straight A’s.
Ireland does not have free college. The Americans do not know. It costs 3000 Eur per year and most people live at home. Medical school is 5 years. No undergrad is necessary. It costs 15,000 Eur to become a doctor in Ireland. Post grad is 15k Eur and therefor costs 75k Eur to be a doctor if you do not do it as an undergrad.
Doctor’s pay in Ireland is on a par with US pay. The debt in the US is a lame excuse. Doctors earn more. Someone has to earn more.
The unrecognized internship reminds me of my father who, as a newly minted doctor who had done his internship at Walter Reed, then shipped off to WWII and spent the war commanding a field hospital … but when it was all over and he was back in the states, he still had to do his residency.
False statement/summary. Yes the number of work days might be 1/2 the traditional work week, but the hours put in during those days are often twice as much. There were many times a call weekend (72 hours) resulted in 60 hours of work.
There are many (and growing) physician jobs were you are an employee of a clinic/hospital/something that you do work “9-5” or week on week off, but the in come is NOT monster. The benefit of those jobs, little to no managerial headaches. You are simply a cog in the machine.
Teaching hospitals break even at best. Residents/interns are the least efficient form of medical care whether considering time, resources, skill, etc. When I started in private practice, I almost had to relearn how to do anesthesia again. For example, hysterectomy could take 3 hours at the teaching hospital. Private practice, 30-40 minutes. Totally different approaches from my end. Hip replacement, 3 hours vs 1. What drove me bonkers, had one jack wagon ENT teacher would bring residents to our private hospital instead of staying at the local teaching hospital. Would turn a 10 minute pediatric PE tube surgery into 90 minutes. Screws everybody working in the OR over that day. Finally was able to run him off after several OR use reviews.
As an aside, don’t get sick the first week of July. That is when training years traditionally start, so at a minimum brand new doctors and brand new promoted residents. So no one fully understands their job/responsibilities.
At a certain level is it hazing. Kind of “tradition” that keeps getting passed down.
A remember going and hearing C. Everette Koop (US Surgeon General at the time) speak while I was in residency training. Interesting and entertaining. Had a Q&A afterwords. One person asked what he thought of New York contemplating putting an 80 hour work week cap on residents at that time (early 90s). He then went on a tirade about when I was in training I never complained, blah, blah, blah, intestinal fortitude. I thought, you arrogant and ignorant snob (filters prevent more appropriate stronger language). You just talked to us about penicillin becoming widely available during your training. How many times you could only console parents because the technology was not yet available to save their child. The “gun and knife” club gang culture wasn’t as prevalent as today. Total ivory tower disconnect. Yes you might have been up 24 plus hours, but were you working as much or as hard as the same 24 hours today. No.
Then had a very similar argument with my department head while I was chief resident. I’ll spare the details but was over frequency of call because back in his day…
The long hours are a result of tradition. Current doctors had to endure that regime and are loath that youngins can escape what they endured?
In any case, 20 some years ago rules were instituted limiting residents hours to:“a hard cap on the length of residents’ shifts: no more than 16 hours for first-year residents or interns, and no more than 28 hours in one shift for others.”
While the rules may have changed, the situation inside many hospitals hasn’t budged as much as you might have expected.
A 2008 study of three hospitals found that 87 percent of interns reported working past their shift limits. Two other studies, from 2006 and 2010, found that doctors routinely lie when reporting the number of hours they worked to get around the shift restrictions.
the reasons why this happens lie deep in hospitals’ work culture. She says some doctors who did their residencies before the new shift rules went into effect look down on new residents — something Arora calls “generation bashing.”
Residents can pick up on this and, as a result, feel the need to work longer hours and fudge their time sheets to impress their more senior colleagues.
Foolish behavior by otherwise very intelligent people. Those bullying senior colleagues won’t be impressed; they will simply egg on those submitting to the longer hours.
I would submit, “typical old phart response”. Had he given up bleeding his patients? Just because it was done in the past, doesn’t mean it was the right thing to do.
Did you follow the links to the studies in the bonded type? The studies used to suggest that residents “lie” when reporting work hours and the implication being that this is to gussy up their images in the eyes of their superiors.
These studies don’t appear to say that at all. First is on perceptions of “unprofessional behaviors” with no details. I won’t let my imagination run riot on what those might be. The other two (taken during a period shortly after the introduction of a the ACGME ruling on duty hours) again weren’t intended to and certainly don’t appear to show a culture of sucking up to the Old Guard.
Quite the reverse. It appears that, if anything, they underestimated/underreported their hours or no other reason than providing for appropriate patient care as any rational observer/patient might expect. Gives an idea of the difficulties of applying these reduced shift hours and the idea of working to rule in a “culture” where sick people didn’t get the memo.
Perfectly understandable. and common, brown-noser behavior. The assistant manager of the department I was in at the pump seal company always made a big show of heading out of the office every night with piles of paperwork under both arms, as if he was actually going to do anything at home with all that. He also wore some of the same suits as the boss, and drove the same sort of car as the boss.
As for unethical Docs, they have been with us forever, including the (person of questionable motives) oncologist in metro Detroit who performed extensive, and expensive, courses of treatment, on people who didn’t even have cancer, and quacks like Dr Oz and Dr Amen, who’s infomertials infest the local PBS station during pledge drives.
Interesting perspective…but a bit irrelevant in the context of the article I was responding to. The very studies the author quoted … and misrepresented in an effort to bamboozle the unwary…show something quite different (at least those that aren’t conveniently hidden behind a paywall. In fact, it seems from the responses to the study questionaires that the time overruns were mostly within the wiggle room of need to provide patient care/take advantage of educational opportunities. These were the studies that were selected by the article’s author and presumably were the best available that could be misrepresented as easily as.they were.
See, the thing that’s a bit different in the realm of residency/fellowship programmes vs life at the pump seal company is that they’re basically training programmes that’re designed to turn out graduates with a minimal level of competency and mastery of the skills needed in their chosen field. This translates to a minimal number of procedures performed under supervision. Quite apart from the need to accrue this in a shorter amount of clinical time (residencies and fellowships haven’t gotten any longer or requirements less) the savvy trainee clinician becomes very aware that there’s a much more limited time to achieve mastery. Especially in a procedure oriented discipline. Regardless of how the culture is supposed to change to accommodate these changes, strangely enough, I doubt patients would care to be the ones in receipt of being practised on for a bit longer by a brand new attending who’s the most senior person around. A re-reading of what the time in excess of contracted hours gets spent on might give some insight here.
Trained doctors going into their internship generally are not brownnosers. That level of education can go wherever they like in life. They are minted as bosses from day one.
Doctors are not really hired or fired all that often. Yeah the patient can go elsewhere. The contract with the insurer can fail in the following year to get renegotiated. But decent doctors have no real bosses. Not in the sense that they need to brownnose.