A regular reader, Cryn, whose blog I highly recommend checking out here, tweeted me and pointed out this article from the Wall Street Journal regarding our govt’s answer to addressing the Primary Care Shortage.
How about addressing the core of the problem why primary care is such an unpopular choice among med students? Increasing the number of residency slots is only going to entrap more poor souls into such a thankless overworked specialty. How about doing something about the out of control student loan debt levels and workloads? I recently wrote how an entering med student at Tufts University Med School in 2009 will graduate in 2013 owing $315,000! And that doesn’t include the interest! Payed out over 30 years at 7.5% interest and that is 3/4 of a million!!! Throwing a 50K pittance to defray these costs is utterly insulting for the immense importance of such a job. Leaving primary care after my internship and going into another specialty was a decision I don’t regret in the least. I don’t miss for a NANOsecond the days where I would preround on 15-20 very sick inpatients starting at 6AM, collecting critical lab values and reports, requesting endless consults from irritated fellows…an old lady moaning is rolling down the hallway in a stretcher…who is that????…..going to morning report, rounding again with the attending for another 3-4 hours till noon, getting pimped, not knowing the answer and getting assigned a presentation for the following day, devouring down lunch while attending an “educational noon conference”, co-intern is now in clinic so now I get to cover 25 patients! YAY for me! …..back to the floors to follow up on ordered tests and consults, discharging patients, discharge paperwork, medical student ran away- “where did he go? dammit!….does this mean i now have to draw blood from the IVDA whose veins the nurse can’t find?”, Ms. Clark’s husband wants to know why “nothing is being done”, finishing 15-20 daily progress notes, admitting new patients, ………Mr. Smith pulled his NG tube out!…..transferring one of my sicker patients who is suddenly crumping to the ICU, Mr. Jones is constipated…oh and by the way that old lady fell in the bathroom and you have to fill out an incident report, being dumped a new patient from Ortho whose problems are now considered more “medical”, Mr Smith’s IV is out too and he needs his afternoon IV ABX!!!, answering pages every 10-15 minutes from nurses, ortho patient is now having chest pain! IS IT TIME TO GO HOME YET? Not tonight because you are on call!!!! Hey Hippocrates, give me that gun so I can shoot myself before you do.
I am sick and tired of hearing about older docs telling premeds how “most doctors pay off their student loans in ten years”. These old timers have no idea how the student loan landscape has changed. Physicians who graduated in the past had MUCH lower student loan debts. It is like comparing apples to PIGSH!T. This 10 year figure no longer applies when many entering med students for 2010 will be graduating with 250K+ debt loads upon graduation. Also the interest you guys will be paying is mere INSANITY! 7.5% interest (avg of Staffords and Grad Plus) on a 300K debt load on graduation adds 21K a year to your principal. So someone doing a five year surgery residency or a five year IM-fellowship track will see that their debt has ballooned to 400k when they finish!!! Pay that off over 30 years and you are easily paying back a million dollars. Actually $1,006,000 but whose counting. You will be paying $2800 a month for 30 years (basically over your entire professional career). This is like being taxed 30% for 30 years IF you are able to NET 8-10K a month (assuming this number does not tank too much further because of Obamacare)!!!!!! You will be the US govt’s doctor bitch for sure.
You’ll be tied to the hospital as much as the 45 year old homeless drunk in delirium tremens who you admitted the night before whose now tied to the bed in four point restraints on a one to one watch. As if this weren’t enough, you may just find yourself suffering even more!
Americans are drowning in debt and our country continues to go down the tubes. Came across these numbers and was quite frankly blown away. Assuming a 7% interest rate, to service 300K of debt costs 21K a year! This requires roughly 30K of gross income to pay just the interest. And if you consider that the avg income in this country is around 40K, that means 75% of one’s disposable income is used to pay interest on debt. Unbelievable! Is it no wonder why the banks run this country?
If you apply this to physicians, you can throw in an extra 200-300K to account for super sized student loans which is now becoming the “new normal”. Now let’s say you are making 150K a year in good old primary care. According to paycheck city, that leaves roughly 95K for a New Yorker (90K if you are in the city), 92K for a Californian, and 102K for someone in Illinois. Deduct out your 40K in interest payments and let’s say another 10K for property taxes and you are left with 50K to live on. Digest those numbers for a moment. Do you realize that you are now in the same boat as the person making a mere 75K, HALF of your annual salary, who has no debts and eschews living a life of being in debt to others? How can this be? Let’s run some more numbers and see how. After taxes 75K in California is 49K, 51K in NY (48K in NYC), and 53K in IL. Subtract out ZERO interest payments and lower property taxes (by not living in a McMansioin) you are roughly even!!!
By owing money to the banks, you are not only flushing money down the toilet but you are also sacrificing your freedom. The freedom to have more leisure time to do whatever you wish or the ability to work in a job or industry that you would find much more appealing and satisfying. For those in debt, you can easily find yourself in a situation where you are working endless hours a week in a miserable higher paying job just to keep your head above water. So which would you prefer? 60-70 stressful hours a week seeing 35 cranky ass patients a day, filling out reams of paperwork, fighting with HMO’s over billing issues or waking up in the morning going to a job you love 35-40 hrs a week with weekends and evenings off for life? Sounds like a no brainer to me.
If there is any good that can be said of having major student loans like so many other med school grads it is that I have vowed to NEVER take out another loan again. NEVER! Fool me once shame on you, fool me twice shame on me. I am a firm believer that the banks in this country are an outright evil parasite draining this country of so much potential greatness. I also believe that CASH is KING. Everything I have purchased since graduating from med school was in cash and will continue to be in cash. This will include even cars and homes. I believe if you can’t afford it now, you have no business buying it despite what our culture and mass media tells you. Start off with a condo and move yourself up to a ranch and then ultimately buy that waterfront home as you save up money like mad not paying usurious interest rates. Don’t buy a McMansion straight out of the gate with a jumbo loan which is the American way. Need to have that Mercedes to complement your “prestige”. Unless you have 50K in the bank you can’t afford it. Rather than ogling with jealousy at the nice shiny Beamer or latest model Mercedes whenever I am sitting in my clunker at a traffic light, I instead find myself feeling so much richer than they are. It sure feels good having NO monthly payment rather than paying a mini mortgage payment every month. Americans want to live big…than they are going to pay big….with their time! Time away from family, friends, and most of all to yourself which you can never get back. We’ve all heard the saying how no one wishes they could’ve spent another day at the office on their death bed. Sadly for many physicians, we will ironically find ourselves in this very “office” even on our last day.
This recent article from CNN and some of the ensuing comments make for a good laugh! Here are the candidates:
Social worker: $43,200
Special events coordinator: $35,900
Probation/parole officer: $38,400
News reporter: $32,900
Music ministry director: $40,800
Membership manager: $42,600
Commercial photographer: $43,600
Assisted living director: $46,000
Marriage/family therapist: $44,400
Substance abuse counselor: $32,400
Film/TV producer: $47,600
High school teacher: $43,000
This list lost all credibility in my eyes when I did not see MEDICAL RESIDENT??!?! Film Producer? Are you kidding me! I wonder why I was the first to even mention newly minted doctors in their comments section. Maybe it is because residents are too busy working 80-90 hrs a week or are post call sleeping the day away after being up for the past 30 hrs to take the time to write just a couple words and comment. Even something like “CALL BLOWS” would’ve sufficed. With salaries hovering in the low 40’s, that comes to barely breaking minimum wage when you factor in the 3000+ hours you work a year! All the while your pager is going off at all hours as you try to cover 30-40 very ill pts, dealing with arrogant obnoxious senior attending doctors and ancillary staff, and worrying about not getting your pants sued off or inadvertently killing someone. Let’s not forget about the $200K+ in student loans you are going to have to pay off which will trap you in this career forever. I just finished such a residency and even though I am in my early thirties I am so burned out that I am ready to retire. Indeed a career in MEDICINESUX!
Zback on SDN came across this advertisement announcing the opening of another Walmart Clinic If you look very closely at the bottom of the ad, you will see the following:
“Wal-Mart is not responsible for the medical treatment provided in this clinic.”
So let me get this straight. Walmart wants to get in on the healthcare business yet not take any of the responsibility that goes along with it? Sorry, but in this highly litiginous society it just doesn’t work that way. And surely Walmart realizes that this “disclaimer” means absolutely nothing in a court of law just as a signed informed consent is nearly equally meaningless.
Besides, I couldn’t think of a more horrifying job than doing primary care in freaking Walmart. Imagine being one of those PA’s or NP’s! Here’s Big Bertha checking out the meat before waddling over to the weigh station for her cholesterol levels =>
Photo courtesy of www.peopleofwalmart.com
Octomom explains to Youtube’s notoriously famous Miss Teen South Carolina 2007, Caitlin Upton, where babies come from in this clip from last night’s Jimmy Kimmel Live. Is Nadya Suleman suffering from Postpartum psychosis?
Since early September, a popular thread titled, “Is Medicine worth $300K” has been making the rounds over on SDN in the general residency forum. I believe that the heading should’ve read, “Is Medicine worth $750K?” because that is what one will owe after paying 7.5% interest over 30 years with 300K owed on graduation. Yes, 750K!!!! If you don’t believe me than I encourage you to run the numbers yourself here. Keep in mind that this is only the financial toll and does not include any of the other mounting BS medicine increasingly dishes out. You really can’t put a price tag on the physical abuse your body will undertake working 70-80 hr weeks, the numerous sleepless nights, 30 hr marathon shifts and the emotional trauma of working under some revolting egotistical maniac attending all the while trying to not make any mistakes or face a multimillion dollar lawsuit. I HIGHLY recommend anyone out there contemplating going to medical school to take just ten minutes and give the above thread a read. It might just save you a pretax million dollar lotto win plus immeasurable happiness.