Medical Education Broken Economic Model
I posted an article this past week featuring an article from CBS Moneywatch in 2013: $1 million mistake: Becoming a doctor that generated a few comments including comments about clinician burn out domestically and internationally and some questions about the current status and if this was getting worse or better.
It would seem that this problem is worse and spreading. Some countries that used to pay for higher education of doctors — the UK would have been one of those no longer do. Some time back they introduced fees that run to 9,000 GBP per year for 5 years
That’s $ 58,000 for the 5 years
– about the same as 1 years tuition in a US medical school => 1/4 the cost of medical school in the US
(Those fees rise dramatically to 39,000 GBP per term for over seas students)
There are wide variations and this article on the Student Doctor Network site: Attending Medical School on Foreign Ground offers some insights into the variations
The cost of attending medical school varies widely both inside and outside the U.S. Once tuition, fees, and the cost of living are figured in, American private schools come in on the high end of the scale and state colleges land in the middle. Average medical student debt ranges from $70K for medical students in Poland to $200K for medical students in Australia and Ireland.
Nearly 90% of U.S. student loans for medical schools outside the U.S. go to Caribbean medical schools, popular for proximity to home, tropical beach locations, and reasonable cost, which compares favorably to the mid-range schools in the U.S.
Medical schools in Mexico are cheap and so is the cost of living, but the high crime rate must also be taken into consideration.
Canada might be an appealing low-cost option if prospective Canadian med students were not saddled with similar issues faced by those in the U.S., more aspirants than programs.
The cost of attending schools in Europe range from very inexpensive Poland to astronomical prestigious schools such as St. Andrews University in Ireland…which costs over $250K in tuition alone, but comes with guaranteed admission to the University of Edinburgh for post-graduate studies.
The average student expenses in the Middle East are comparably low, but there are cultural and language hurdles.
Cost of Attendance
For clinicians delivering the care, all arrived at this point having selected the expensive assault course of education to train and qualify to be able to deliver care. For doctors its persistence and endurance that win out. The barriers to entry are high and tied to economics. If you manage to complete your first degree at a conservative estimate of $40,000 only then are you ready to apply to medical schools and that’s going to put you in debt to the tune of $240,000 or so. Taken together that is at least $280,000 of debt hanging over your shoulder when you conservatively emerge as a qualified doctor aged 26 with at least another 3–4 years on average of low-income work while you finish your apprenticeship as a resident. So by the time you are fully qualified and ready to start serving the public and doing the work you originally signed dup to do when you set your sights on medicine you lost 12 years of time to earn an income and accused a debt of $280,000. At age 30 this equates to a repayment (calculated based on the current educational loan rates averaged out of 5.31%) is a monthly payment of
- 10 year repayment $3,012
- 20 year repayment $1,896
- 30 year repayment $1,556
Lost Earning Potential
This lost income earning opportunity that is a minimum of 8 years in the US — 4 years for an undergraduate degree and 4 years in medical school. Add in a few years of post-graduate training, required to enter any specialty and you have a decade of lost income that at an average salary of $50,000 equates to a cool half a million dollars. Paying off the debt with interest pile on the burden and put newly minted doctors at least a $1,000,000 in the hole before they even start thinking about a family and a life.
Our clinical professionals all have the same desire to help patients — but economics and the burden of the educational system can overwhelm just about anyone and the post qualification economics drive them towards higher paying specialties to help ease the debt burden and are certain contributors to the high run our rates and extreme levels of dissatisfaction with the career of medicine.
There are some programs attempting to address this by steering newly qualified doctors to under served areas with a promise of paying off outstanding loans after 10 years of time committed to these areas. What to do about the fundamental issue for the many already saddled with this debt and struggling to find a path and how do we change rebalance the system? Given the reports that suggest the looming dearth of doctors available to treat the exploding populations — something that is amplified in many other parts of the world where there are many fewer doctors per head of population than we have here in the United States.
Its and urgent problem and one that I see few solutions or paths — do you have any ideas. Are there are simple incremental changes we could make that might start to move the needle and change this system to attract and support the type of doctors and clinicians we want treating patients. Is there an incremental change that could be applied to shift the cost of education or change the outcome that pushes so many into specialization when we need internists and family practitioners. Is it as simple as increasing the salaries/rates of pay for the specialties we want to encourage doctors to enter?
Leave your thoughts and comments below — I’d love to hear your ideas.
Originally published at incrementalhealthcare.com on May 25, 2017.