Why medical school shoud be free

http://www.nytimes.com/2011/05/29/opinion/29bach.html?_r=2&partner=rss&emc=rss

Op-Ed Contributors
Why Medical School Should Be Free
By PETER B. BACH and ROBERT KOCHER
Published: May 28, 2011


DOCTORS are among the most richly rewarded professionals in the country. The Bureau of Labor Statistics reports that of the 15 highest-paid professions in the United States, all but two are in medicine or dentistry.

Why, then, are we proposing to make medical school free?

Huge medical school debts — doctors now graduate owing more than $155,000 on average, and 86 percent have some debt — are why so many doctors shun primary care in favor of highly paid specialties, where there are incentives to give expensive treatments and order expensive tests, an important driver of rising health care costs. Fixing our health care system will be impossible without a larger pool of competent primary care doctors who can make sure specialists work together in the treatment of their patients — not in isolation, as they often do today — and keep track of patients as they move among settings like private residences, hospitals and nursing homes. Moreover, our population is growing and aging; the American Academy of Family Physicians has estimated a shortfall of 40,000 primary care doctors by 2020. Given the years it takes to train a doctor, we need to start now.

Making medical school free would relieve doctors of the burden of student debt and gradually shift the work force away from specialties and toward primary care. It would also attract college graduates who are discouraged from going to medical school by the costly tuition. We estimate that we can make medical school free for roughly $2.5 billion per year — about one-thousandth of what we spend on health care in the United States each year. What’s more, we can offset most if not all of the cost of medical school without the government’s help by charging doctors for specialty training.

Under today’s system, all medical students have to pay for their training, whether they plan to become pediatricians or neurosurgeons. They are then paid salaries during the crucial years of internship and residency that turn them into competent doctors. If they decide to extend their years of training to become specialists, they receive a stipend during those years, too. But under our plan, medical school tuition, which averages $38,000 per year, would be waived. Doctors choosing training in primary care, whether they plan to go on later to specialize or not, would continue to receive the stipends they receive today. But those who want to get specialty training would have to forgo much or all of their stipends, $50,000 on average. Because there are nearly as many doctors enrolled in specialty training in the United States (about 66,000) as there are students in United States medical schools (about 67,000), the forgone stipends would cover all the tuition costs.

While this may seem like a lot to ask of future specialists, these same doctors will have paid nothing for medical school and, through their specialty training, would be virtually assured highly lucrative jobs. Today’s specialists earn a median of $325,000 per year by one estimate, 70 percent more than the $190,000 that a primary care doctor makes. (Although a large shift away from specialty training may weaken the ability of our plan to remain self-financed, the benefits would make any needed tuition subsidies well worth it.) Our proposal is not the first to attempt to shift doctors toward primary care, but it’s the most ambitious. The National Health Service Corps helps doctors repay their loans in exchange for a commitment to work in an under-served area, but few doctors sign up. The National Institutes of Health offers a similar program to promote work in research and public health, but this creates more researchers, not more practitioners. Many states have loan forgiveness programs for doctors entering primary care. The health care reform law contains incentive programs that will include bonuses for primary care doctors who treat Medicare patients, and help finance a small increase in primary care training positions.

snip

Why should anyone work without being paid?

be dramatically lowered or eliminated, and instead go to pay for the tuition of all med students for medical school.

So specialty doctors would not be paid a salary for their first 5 years or so of training after med school. In exchange, they would be assured a highly lucrative career after those 5 years.

Maybe you'd propose next that medical school not be so....hard?

Professors would be getting paid. It is just that their funds would cone from a different source other than the med student, just like they do in most other countries. Comprehension is a good thing. Perhaps you should reread the article.

My father was one. He became an internist which is sort of a GP with a specialty in cardiology and geriatric care.

Soon, parents will be forced to "choose" the only grade school for their children that they can afford. Free medical school? As most doctors are Republicans, why would this come as a surprise?

I think a big problem is that Docs are no longer opening their own practices and instead are
becoming employees of huge corporate hospitals.
This might help more of them decide to work for themselves, esp if the reimbursement rate should rise
for primary care generally one of the lowest paid.

...to any person who qualifies on ability, etc. This IMO only makes for a better society.

:hi:

:fistbump:

are expensive to build, staff and maintain.

And who wants to be the first person that a rookie doctor slices the chest for the first time? Aren't those generally charity cases?

I really don't know. But if I'd consulted Mr. Knightrider/best heart surgeon in the state. I'd be a bit upset if I found out he'd handed over the scalpel to a novice to 'sperment.

but there's a progression of studying, watching, assisting, etc.

no different whether education is subsidized or not.

"I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:
To consider dear to me, as my parents, he who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
But I will preserve the purity of my life and my arts.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."
*******

I don't see a whole lot about money in this oath, but maybe I am missing something in the translation??