I would like to introduce you to one of my students. Brooke is a brand new fourth year medical student. I have known Brooke since the first month of medical school. She was assigned to my PBL (problem-based learning) group. This means that she and nine of her classmates were going to be meeting with me every month or so to work our way through a clinical case. Every basic science module has PBL cases. There are multiple purposes for these PBL groups: to learn about clinical medicine, applying basic science concepts to a patient case, to learn about the professional aspects of medicine, and to foster and promote interactions with medical school facutlty members. We get to do all of that and more.
The PBL groups are definitely one of my favorite parts about being a teaching faculty member. Our students come into school with such high expectations and aspirations. They are not cynical or jaded (yet). They have a lot of different motivations for medicine but generally have one thing in common--they want to help people. Usually, by the end of two years, I know these students pretty well. I learn about their families. It is great getting to know them individually as people, not just as students. I don't try to talk them into going into primary care, but they do get two years of listening to my opinions (for what that is worth).
So Brooke was in the last Family Medicine clerkship this year. By the time, I saw her, she had already taken Internal Medicine, Surgery, Geriatrics, Neurology, Psychiatry, Pediatrics, and OB/GYN. The students at the end of the year are an interesting group. Clinically, they are very accomplished. But often they are stressed. They are trying to decide what residency program they should try to get into. They are tired after a year of long clinical rotations. And, honestly, they are often a little cynical about the educational process and medicine. There is data that says that students' empathy and emotional intelligence falls throughout the third year.
But Brooke was excited. She could not wait to come to Family Medicine. She told me the first week that she had been thinking about it for a long time and had decided that Family Medicine was the specialty that she was going to choose. She is smart. She could do anything that she wanted to do. She is confident and poised. She is a class leader. Not formally, but informally. The other students on the rotation looked to her for leadership which she provided quietly without any fanfare. And she decided that she wanted to be a family doctor. I must tell you, that is one of the greatest thrills!
So, I asked her if she would write about her experience. She is going to blog from now until Match day and maybe beyond. She is going to write about her life and being a medical student. She is going to write about the process of applying to residency, interviewing, and the Match. I hope that if you work with medical students you will tell them about her blog. The name is: A Journey to Family Medicine.
Tuesday, July 5, 2011
Friday, July 1, 2011
How much should medical school cost?
It does not seem that many people care very much about the cost of medical education in the US. But we should be concerned. Did you know that the average debt for a medical student on graduation from a state funded medical school is about $150,000. To put that into perspective, the average cost of a four bedroom house in suburban Kansas City, where I live, is $225,517 not much difference.(1)
Many people will see that and say,"who cares, doctors are rich". I can't argue with that fact, doctors are rich. Physician salaries are in the top 5 percent of all jobs in the US. A recent blog from Dr Joshua Freeman described the top 10 paying jobs in America. Physicians held 9 of the spots. There are many ways to fund medical school, including loans, repayment plans, and my personal favorite-having a rich dad. I remember the first day of my medical school experience and one of the women in my class asked a question during the financial aid lecture. "Can you send the bill to my daddy?" Repayment programs can be very effective. Here in Kansas, we have one of the oldest and best. Students that commit to practice in an underserved county (that is most of Kansas), choose a primary care specialty such as family medicine, internal medicine or pediatrics, and maintain their academic standing are given a full tuition scholarship and a monthly stipend. Over its 50 year history the Kansas Medical Student Loan program has placed hundreds of students in communities across Kansas.
So back to why should we care about this? Well, as I discussed in a previous blog, Production of Primary Care Doctors, [ student debt is one of the primary deterrents to students choosing primary care specialties such as family medicine. The equation is fairly straight forward. More student debt leads less students choosing family medicine residency training (and other primary care specialties). Less students in family medicine residencies means less primary care physicians in practice. The data at this point is pretty clear. If there are less family doctors per capita in a county in the US, that county is less healthy. The citizens die more frequently, they are hospitalized more often, and over all they are less healthy.
Wow, all of that because medical school costs a lot? No, not all but enough that a recent Op-Ed in the NYTimes should be given some serious thought. Drs Bach and Kocher proposed that medical school tuition should be free. Then how would we pay for it? Their idea is a good one. Tax the students that want to choose specialty practices. Basically, the idea is that medical school is free if you choose to practice in a primary care field like family medicine or general pediatrics. If you decide that you want to be a dermatologist or a radiologist or another specialty then you have to pay for your training.
That may seem unfair to the students that want to go into dermatology, but remember the state and national government (and we the people) have a huge investment in medical education and the health care field. $1,400 for every car you buy from General Motors is for health costs, medicaid accounts for 1/3 of the budgets in most states, and even private medical school receive millions of dollars from the federal government to support biomedical research. And we don't need more dermatologists. We do need a strong and vibrant primary care infrastructure. The beauty of this idea is that it could be changed as the physician practice population changes. If we need more anesthesiologists then we make the payback less. If we need more general surgeons, then we make the pay back less to do general surgery. If we need less plastic surgeons then we just raise the payback more. How much? How ever much you need. Would a student choose to do orthopedic surgery if medical school was going to cost them a million dollars? How about 2 million? You get the idea?
Will this ever happen? Unlikely, but we can hope...
References
(1) http://money.cnn.com/pf/features/lists/hpci_data/index.html
Many people will see that and say,"who cares, doctors are rich". I can't argue with that fact, doctors are rich. Physician salaries are in the top 5 percent of all jobs in the US. A recent blog from Dr Joshua Freeman described the top 10 paying jobs in America. Physicians held 9 of the spots. There are many ways to fund medical school, including loans, repayment plans, and my personal favorite-having a rich dad. I remember the first day of my medical school experience and one of the women in my class asked a question during the financial aid lecture. "Can you send the bill to my daddy?" Repayment programs can be very effective. Here in Kansas, we have one of the oldest and best. Students that commit to practice in an underserved county (that is most of Kansas), choose a primary care specialty such as family medicine, internal medicine or pediatrics, and maintain their academic standing are given a full tuition scholarship and a monthly stipend. Over its 50 year history the Kansas Medical Student Loan program has placed hundreds of students in communities across Kansas.
So back to why should we care about this? Well, as I discussed in a previous blog, Production of Primary Care Doctors, [ student debt is one of the primary deterrents to students choosing primary care specialties such as family medicine. The equation is fairly straight forward. More student debt leads less students choosing family medicine residency training (and other primary care specialties). Less students in family medicine residencies means less primary care physicians in practice. The data at this point is pretty clear. If there are less family doctors per capita in a county in the US, that county is less healthy. The citizens die more frequently, they are hospitalized more often, and over all they are less healthy.
Wow, all of that because medical school costs a lot? No, not all but enough that a recent Op-Ed in the NYTimes should be given some serious thought. Drs Bach and Kocher proposed that medical school tuition should be free. Then how would we pay for it? Their idea is a good one. Tax the students that want to choose specialty practices. Basically, the idea is that medical school is free if you choose to practice in a primary care field like family medicine or general pediatrics. If you decide that you want to be a dermatologist or a radiologist or another specialty then you have to pay for your training.
That may seem unfair to the students that want to go into dermatology, but remember the state and national government (and we the people) have a huge investment in medical education and the health care field. $1,400 for every car you buy from General Motors is for health costs, medicaid accounts for 1/3 of the budgets in most states, and even private medical school receive millions of dollars from the federal government to support biomedical research. And we don't need more dermatologists. We do need a strong and vibrant primary care infrastructure. The beauty of this idea is that it could be changed as the physician practice population changes. If we need more anesthesiologists then we make the payback less. If we need more general surgeons, then we make the pay back less to do general surgery. If we need less plastic surgeons then we just raise the payback more. How much? How ever much you need. Would a student choose to do orthopedic surgery if medical school was going to cost them a million dollars? How about 2 million? You get the idea?
Will this ever happen? Unlikely, but we can hope...
References
(1) http://money.cnn.com/pf/features/lists/hpci_data/index.html
Subscribe to:
Posts (Atom)