My girlfriend is training to get her CNA so she can have a decent job in college while she pursues a medical degree (she hopes to be a reconstructive sergeon). We have been watching all the Democratic presidential debates together, and while our positions on issues and candidates vary some, one thing we can both agree on is that Universal Healthcare is the most amiguous plank in any political platform EVER!
Clinton's and Barack's Healthcare plans sound great! Lets give free healthcare to anyone who wants it, anyone who can not afford traditional healthcare, and mandate it for children! Sounds great, Barack! And Hillary, who wouldn't want everyone to have non-competitive mandated healthcare rates nationwide? It sounds like the perfect plan. But one group of people no candidate has mentioned are the healthcare workers.
Currently, a reconstructive sergeon can expect and entry-level position in a hospital or clinic to bring in an average salary (according to http://www.salary.com) of $195,000/year. Sounds like a ridiculously large sum of money, right? In fact, most medical professionals will tell you that reconstructive surgeons sometimes bring home over $1,000,000/year. Again, that is a WHOLE lot of money. Now lets take a look at the average debt of a recently graduated medical student. Lets say my girlfriend goes to Duke for her Bachelor's degree in Biology (the first step to becoming a doctor). Thats $36,000/year X Four Years = $144000. Okay. First step complete. Now we have to go to Medical School. AMSA.org reports that average medical school debt can be upwards of $365,000. Okay, so now we have a total of $509,000. That is the total Educational Debt my girlfriend can expect.
Lets look at another expense. Medical Insurance. Malpractice insurance is very, very expensive. And whose pocket is the money taken from? The hospital? No! The doctor's. So how much can She expect to pay for Malpractice insurance? OBGYN's (some of the most-sued doctors) pay on average a premium of $84,000.
So my girlfriend might make $195,000/year. Her insurance is $84,000/year and, lets say her average yearly debt repayment with 7.5% interest is $28,000/year for 20 years. How much will my girlfriend make every year? $83,000. What does she do for a living? She saves your life.
Now, the question is, what will universal healthcare do to the healthcare workers? It could potentially lower the worker's salaries. Doctor's will no longer be able to charge as much for services rendered (which are so high because of the expenses doctors face to even be licensed practitioners).
Is universal healthcare a good idea? I think so. But it will take some serious planning to get a plan in place which will not harm the Healthcare industry.
Teachers are in the same boat. After six years of school, I will have over $100,000 in debt. It's not 500,000, to be sure, but I will never, ever make over $50,000 a year. I don't have to pay malpractice insurance, but my health insurance will be 20% of my salary, and it increases by 8% or so every year. The starting salary is $34,000 and raises, if granted at all, are usually between 0.5% and 1%. It's rough all over. But I might be able to figure out way to survive on $83,000. It's been working so far on $30,000 combined for myself and my partner. We both have cars, we own a house, we are never hungry. We even have some investments. It's a matter of prioritizing. We will never own a Mercedes, for example. But we're fine, and we're happy.
http://www.progressiveu.org/blog/ediblewoman
Couple things I see wrong with your post. First, the debt is not $365,000. I don't know many medical schools that CHARGE that much, PERIOD. My state school has a debt for out of state students of $275,000. The average debt is more around $150,000. People probably end up paying $365,000 with interest, but that's not how much in loans they take out for medical school.
Second, she probably won't be paying that much for malpractice. Also, if you're going to make an argument for a specific doctor, pick one and carry through with all the values, not pick and choose between the many physicians. An OBGYN has very different responsibilities than a reconstructive surgeon. In NY, the malpractice insurance for an orthopedic surgeon is $37,643, quite a bit different from your quoted $84,000.
And she's not going to be saving lives, exactly. If she was an ER doc, I could believe that. If she was a trauma surgeon, I could buy that. But not a reconstructive surgeon. Might better a life for someone, but someone who goes in for plastic surgery probably isn't in a life threatening situation.
Additionally, she's only going to be making around $45,000 for something like 7 years, if she continues on this path many years from now. But she doesn't have to pay anything towards her loans (at least, as of now... they've been messing around with the repayment laws, so by the time she gets to that point, she might have to). So she won't be making much money for many years now. And yet, people manage just fine.
~C
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I appreciate the comments. I do not doubt that many of the sources I've cited may have bloated figures, but the point is essentially the same: What little money she is going to make for changing someone's life could be dramatically reduced by universal healthcare.
J. Allen Jordan
But it all depends on how it's implemented. In other countries with universal healthcare, there is no debt coming out of medical school, so that's not something to worry about. Your girlfriend still has at least 4 years before she goes into medical school, so if we do switch with our next president, she'd fall under that.
Universal healthcare could also mean no malpractice, depending on how it's done.
Also, I highly, highly doubt that most of people undergoing reconstructive surgery are going to be covered under universal healthcare, so she may fall entirely outside of that realm.
But really, if she can't make a living on $83,000 a year, she has some major problems. My mom can own three homes and support three children, including myself in college, by herself on that much. Also, if she's going into medicine because of the money she'd be making, she might want to think of another career.
~C
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Fortunately enough, she is not going into the business because of the money. I appologize for misleading you to think this. However, it is a concern of ours that universal healthcare could potentially and unintentionally lower the quality of life for everyone involved. I guess we will have to wait and see how it will be implemented.
J. Allen Jordan
I certainly consider health care rationing a lowering of the quality of life.
I just started Dental school, and if med school costs anything like dental school does, then 350,000 in student loans is a reasonable estimate. Tuition cost for my dental school is now at $45,000 per year. However, that is just tuition. The school's calculated cost of attendance and tuition is $83,000 per year for a single person. Dental school requires 15 hours a day between classes, homework, and studying; which makes it extremely difficult to have a job. And the $83,000 does not include the cost if the student, like myself, has a wife and kids. So debt will end up being about $340,000 just for dental school.
Another point that you might think about is the amount of time spent in residency. Surgeons must spend several years in residency. And yes they do get paid for this time, the pay is very minimal compared to the hours that they spend at work. Average residents make about $38,000 a year and work upwards of 80 hours a week. This equates to less than $10.00 an hour. With the kind of debt incurred through med school and a family to support, there would be no way of beginning to pay down your student loans while in residency.
I've applied to medical school, and know many people in medical school now, I know the numbers for the cost of attendance. Mt. Sinai, for instance, only requires that students take out $25,000 in loans, and covers the rest of the cost of attendance in grants. That's $100K in debt upon graduation. My state medical school is one of the worst state schools for funding, and their budget for living expenses is only $22K more than tuition and fees (which appears to be about $26K this year for in-state students and $51K for out-of-state students). Our dental school costs about the same, maybe a little less (and they share the campus with the medical students). Of course, the actual cost will depend on a number of different factors, including how well someone can budget their money, whether they live with someone, and whether they are single and their significant other contributes to expenses, etc. But, you know, $70K every year for four years is still only $280K, which is still $80K less than $365K (a full year!). So, my point stands.
While having a job is not recommended in medical school, some people do manage to have it. It really depends on your study habits how much time it takes to get through the material. Some people put in full 8-hour days, and then go home to their families, leaving school at school, nothing like the 15-hour days you suggest. Some people probably do put in that much time to studying, but the classes themselves are typically only 4-8 hours a day, though most schools have broken away from the full 8 hours of classes and gone more towards individual learning through case study groups or preceptorships at doctor's offices in the area. In the end, each person manages the workload differently.
Most residents make more than $40K a year, though perhaps barely. There's a number of laws that are aimed at limiting the number of hours per week residents work, but that isn't always practiced. In the past residents worked more than 100 hours a week (leaving barely enough time to sleep), but there are movements to limit shifts to 24 hours, and mandatory napping periods. But you're not expected to pay down those loans during residency, as it is now, only the interest on them. People generally get deferments during this time. Also, again, it all depends on your budget and expenses at the time. And if you can live on $40K a year, when you actually become a fully licensed you should have no problems paying off those debts.
This all is assuming, of course, that universal medicine would not restructure how medicine is run, including who pays for medical school and how. No one would enter into medicine if there wasn't the hope of paying back all those student loans, so if physicians really took a huge pay cut because of universal health care, someone, somewhere along the line would have to pick up the tab for medical school if they want the hope of getting more people into the field to make up for our shortage.
~C
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It's a good argument. If Universal Healthcare is to be implemented, college tuition and costs would need to be changed as well.
I'm just scared of higher taxes...sorry to be selfish.
Taxes are a serious issue. I want someone to give me a good solution for implementing Universal Healthcare without raising the taxes of the middle class.
J. Allen Jordan
I am an ardent believer in universal health care. However, I do agree with you that the welfare of doctors should be guaranteed as they shall be the practitioners that shall try to ensure to welfare of the citizens. Therefore, Congress needs to draft a law that makes it difficult for a patient to bring about some ridiculous law suit for their own ends. Perhaps at that time, the premiums that doctors have to pay may come down.
-OxonGlass11
Why don't we do that IMMEDIATELY?
It would be a good idea under the current system too.
The problem is that the trial lawyers are heavy contributors to the Democratic Party and malpractice tort is one of their bread and butter sources of income. It will be the Democrats that implement universal healthcare and the trial lawyers are going to be twisting their arm to keep malpractice tort just the way it is.
I think healthcare needs to be more of a responsibility of employers. However, requiring all companies to provide it isn't wise. After all, if a small company can't afford to provide health insurance, how can they be expected to pay a fine? There are many problems with the systems, and probably no completely perfect answer.
Although, in some companies, universal healthcare provided by the government has helped the doctors, because they now have more customers. This statement was provided in my sociology textbook. I can provide the title if anyone would like to know.
Like what you've read? Well, then here's more:
http://www.progressiveu.org/blog/tricia0711
I'd like to see healthcare be less of a responsibility of employers. The current system limits employee mobility and runs a high risk of leaving them naked if they lose their job. If they change jobs the whole "pre-existing condiditons" clock get reset and can really bite. Also the system is perverse economically. Health insurance is paid with pre-tax dollars if it is paid for by the employer but has to be purchased with after-tax dollars if purchased by the employee. Also the system is disadvantageous to small employers and their employees because they are lumped into very small risk pools making their policies more expensive.
I would like to see individuals own their own policy and have it be tailored to their individual rather than their company's needs. One size does not fit all. Their policy should move with them as they move from job to job and should not leave them either naked or covered by crazy expensive zebra provisions if they find themselves unemployed. And they should be able to deduct the cost from their taxes as a credit against gross income. And they should be able to shop competitively for health insurance that assigns them to advantageous risk pools. For small states like Wyoming, it would be nice if these risk pools crossed state lines.
I would compromise with you on the employer thing though in that it would not be bad to require employers to reimburse the employee upto a certain amount if the employee provides proof that he has actually purchased health insurance. Employers would just treat this as part of the total cost of the employee and would likely be more reluctant to compensate them in other ways (like higher wages) though.
I don't know how other companies do it, but mine doesn't require employees to have insurance through them, and it pays me, as an employee ineligible for benefits, more than a part-time or full-time employee. Just thought I'd throw that out there.
~C
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and it pays me, as an employee ineligible for benefits, more than a part-time or full-time employee.
It sounds like you would benefit from the system I outlined above. I'm not sure where your insurance is coming from (through your mother? through your school? self provided? naked?) but you could use that higher paycheck to buy insurance and instead of paying for it with aftertax dollars you would be paying for it with before tax dollars.
It fits my theory that they might pay you more if they did not have to pay your insurance. Employers look at the total cost of compensation including benefits and the employer's share of employment taxes. I vaguely recall that you have an intern position but I'm not sure about that? How do you know you are being payed more? Payed more than whom? The CEO? I assume they are paying you what they think you are worth or what they think they have to pay you in order to gain and retain your services. Companies do have different philosophies with respect to compensation. Costco and Sam's Club are in almost identical businesses and yet they treat their employees very differently.
Yes I absolutely agree.its true even 365K debt may be an understatment as how much debt accumultate. auther is right on one thing. some med schools costing upward of 60K a year for tuiton then your applicationa fees adn interview fees( what med loan called " gap loans or Residency loans( to apply for residency and and interveiw prep: you have to send 100s of applications each can cost 25 bucks or more. some med student spend upward of 7-8000 dollars for applications fees thats not including your air plane tickets and rental cars and hotels you you need to sleep.( yet this is no guarantee you wil lhave job. you think everyone graduate from med school get residency and get a job as med resident ?? GUESS again. there are close to 20K-30000 apply for a job then competition is so high then there are 3 positions for 1000 people apply for each hospital.. so all this is money you have to spend not m knowing you ever hear from them. so debt can go up to close to 35oK easily. yOU MUST remember that its the interest you starting to accumulate that can kill you or hurt your finance and led to bankrupsy earlier then you thnk. ALOT of med students dont realize this when then begin school. so debt amount is relative to how soon you can pay off this loan. ( its a mortgage like you already have a half million dollar home on your back that you mus tpay off. no wonder why some wants high paying medical speciality. gettingpaid 25oK is a decepitve number. you really have to take into consideration how much you actually take home. after huge tax payment and malpratice insurance of upwared of 100K ( regardless how many patient s you see ) after that you have to pay your nurses, your office managers, etc you end up 50K a year/ dont you get this ? some have no idea what doctors are . I really think they should know the detail before you accuse doctors are rich( which many people have misconception of who doctors and what they do). Yes some high paid specialty like radiology and plastics do make money because its more ELECTIVE I meant perfectly normal people want to change their looks thus alot of payment are CASH business and out of pocket. Anyhow. YES DEBT can go up that high I asked med school loan company , underwriter told me that 350K for graduting med studnet is common ( unlike some AMA stateing its 120K total bogus claim htey really have no idea: this is not real life figure ) finishing medical residents can have debt upwared ot 500K !!!!. yess 500K ? why? becuase they are severely underpaid!. why would anyone wiht MD degree who brings hospitals 250K income only get paid onl y45K a year? an had to keep hteir mouth shut? because they want to finish traiing and hae this debt issues. even college graduates get paid more then medical residents! this is a national disgrace> Residents should get paid more then 70-80K min to pay for their loans and live to buy food for their survival. PEOPLE OUT THERE SHOULD HAVE REALLY A true view of whats really going on behind making of a doctors. so I will leave it to you what will happen if you cutting the salery to doctors will do in US.( you cant compare to other countries bc they run different system) ultimatiely who will suffer? its patients!. lack of money translates to more malpractice by studying doctors and lack of pay attention to patients from doctors. if you have 30 min to see docts they will end your appontment by 10 min or less why? becuase money constraints. they need to see more patinets to cover their Loss or go bankrupt!!
1) Correct grammar is your friend. Seriously.
2) The main reason there are a lack of residency slots is because in order to practice in the US, Foreign Medical Graduates (FMGs) have to go through a US residency in order to practice in the US. If it were just the American graduates, there wouldn't be a problem.
3) I know very few medical schools where the tuition and fees is upwards of $60K per year. I mean, my state school has the worst funding in the nation for higher education, and our out-of-state students only pay $54K for tuition. What gets the loans high is the cost of attendance... all the living expenses you need in order to live during medical school, since you can't hold a job. And 350K graduating is really high... the out-of-state cost of our medical students is 300K. Most is more around 200K.
4) By the way, there are just over 22K positions for almost 37K applicants. Much of the reason people don't match is because they're trying to match into a competitive residency and don't match in. And, again, FMGs make up a lot of that group.
5) The figure for salary is considered after malpractice insurance. So 250K is before taxes, but after malpractice insurance. And that's typically after the overhead expenses of your practice as well, though hospitalists don't have to worry about that... they get a salary from the hospital.
No doubt that medical residents are underpaid... that's why many moonlight after their intern year, or have historically. The new 80-hour week restriction prevents that.
~C
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Its sad even at my US med school classmates 10 years ago, over 20% didnt even match first time out of 200 students in class. I am now practicing near LA area. It has been very tough to get by considering how much burden I have over my past med loans and cost of running the practice. Now I can understand why so many physicians do their own side businesses to cover the losses,and cant stop even though they want out. Alot of Docs go out of business and so much for the economic issues they have. If I have to do this again I would not return to medicine, even though I love helping people get better.