Would free medical school entice you to primary care?

[NREMTP]

I just saw this on MSNBC.com and thought it was interesting. Basically the University of Central Florida is opening up a new medical school and are giving the new incoming class of 40 a free 4 year ride. The dean who is a Harvard grad and received a full ride there wants to give back (not with her own money of course) but from $7 million in donations. She thinks that without having to worry about paying for medical school, these students will be able to concentrate on becoming better doctors and ones that will be more tempted to enter primary care fields due to not having any medical school debt.

So my question to everybody here is if you were one of these students would you be more tempted to consider primary care making less but with no debt or still consider a specialty or subspecialty field making more money but having a lot more debt? Keep in mind who knows what is going to happen with the salaries in the near future.

http://www.msnbc.msn.com/id/21134540/vp/29696185#29695061

Ohh and I love how the guy in the video says they attract the best students with the first one accepted had a 4.0 and a perfect MEDCAT score!!!

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[nogolfinsnow]

I think anything that reduces the debt load will at least free people's minds to think about primary care.

 

[beachblonde]

Ohh and I love how the guy in the video says they attract the best students with the first one accepted had a 4.0 and a perfect MEDCAT score!!!

I love how every student being interviewed was wearing a black suit (except one). Apparently that's the pre-med uniform.

My father insists upon calling the MCAT the "medcat" for reasons I don't quite get. Did it used to be called that? Or is it that older white men just call it the medcat for kicks?

(and free tuition would definitely make primary care more attractive....I was thinking about it anyways, so it's not like I'd be giving up on my dream of becoming a neurosurgeon)

 

[Steiner]

I'd be more open for sure.

 

[MediumDef]

It makes sense intuitively that decreased debt would raise the chances that someone will go into a relatively lower paying specialty but unfortunately there is no evidence that this actually works. These studies are done comparing debt to specialty choice though so theoretically an entire class that all graduate with no debt may have a different outcome, I wouldn't bet on it though.

 

[NonTradMed]

It will probably attract more people into primary care, especiall those on the bubble, but it's not just the debt that drives people away from primary care, it's the salary differences between specialities and primary care. If someone has to go through the same med school hoops and suffer through similar years of residency, but end up making 1/3rd the salary, it's hard to convince people primary care is worth the trouble. This is especially true if said med student has family and mortgage to think about (not that primary care docs can't live off their salaries).

 

[Bartelby]

It will probably attract more people into primary care, especiall those on the bubble, but it's not just the debt that drives people away from primary care, it's the salary differences between specialities and primary care. If someone has to go through the same med school hoops and suffer through similar years of residency, but end up making 1/3rd the salary, it's hard to convince people primary care is worth the trouble. This is especially true if said med student has family and mortgage to think about (not that primary care docs can't live off their salaries).

I think NonTradMed captured one of the biggest problems very well here-- primary care doctors don't have it easier than many higher paid doctors, they just get paid less. I think you can pay back $140k in debt with $140k a year salary and still live comfortably, but the thought that the income gap for primary care will just not close probably does not sit well with many physicians.

I don't think graduating debt free would push me to primary care unless that happens to be what I decide on anyway after rotations. If I do like primary care best, it will not be repaying my debt that stops me from following it.

 

[ACSurgeon]

I just saw this on MSNBC.com and thought it was interesting. Basically the University of Central Florida is opening up a new medical school and are giving the new incoming class of 40 a free 4 year ride. The dean who is a Harvard grad and received a full ride there wants to give back (not with her own money of course) but from $7 million in donations. She thinks that without having to worry about paying for medical school, these students will be able to concentrate on becoming better doctors and ones that will be more tempted to enter primary care fields due to not having any medical school debt.

So my question to everybody here is if you were one of these students would you be more tempted to consider primary care making less but with no debt or still consider a specialty or subspecialty field making more money but having a lot more debt? Keep in mind who knows what is going to happen with the salaries in the near future.

http://www.msnbc.msn.com/id/21134540/vp/29696185#29695061

Ohh and I love how the guy in the video says they attract the best students with the first one accepted had a 4.0 and a perfect MEDCAT score!!!

Granted I haven't done any formal rotations yet, but from the time I spent with PC's, I know that I wouldn't want to do it. I'd like to be an expert in a field. I also like to see results. PC does not offer either.

 

[ACSurgeon]

I think NonTradMed captured one of the biggest problems very well here-- primary care doctoors don't have it easier than many higher paid doctors, they just get paid less. I think you can pay back $140k in debt with $140k a year salary and still live comfortably, but the thought that the income gap for primary care will just not close probably does not sit well with many physicians.

I don't think graduating debt free would push me to primary care unless that happens to be what I decide on anyway after rotations. If I do like primary care best, it will not be repaying my debt that stops me from following it.

So to entertain that thought, you are suggesting that a 3 year FM/ IM/ Peds residency is "not easier" than a 9 year track to become a transplant/CT/vascular/spine surgeon? You certainly start paying the loans back a lot sooner (less interest?)

Also, I don't think you can compare the lifestyle of a family doc to that of a surgeon. Plus, the difference in salary is usually not as big as suggested (3 fold?), although the max earning potential might be.

I agree that certain fields are overpaid, and others are underpaid, but you have to keep all factors in mind, not just the pay check as an attending.

 

[smq123]

Granted I haven't done any formal rotations yet, but from the time I spent with PC's, I know that I wouldn't want to do it. I'd like to be an expert in a field. I also like to see results. PC does not offer either.

There's definitely a lot of truth to that.

The things that drive people away from primary care are NOT just about money. People don't enjoy some of the more mundane stuff that you see as an FP, for instance, or they aren't all that interested in "continuity of care," etc.

I don't know how much free medical tuition is going to change the percentage of people who end up going into primary care. There might be some who would allow themselves to be more tempted by the idea of a shorter residency, but, ultimately, a lot of it comes down to what you enjoy.

 

[WellWornLad]

The things that drive people away from primary care are NOT just about money...ultimately, a lot of it comes down to what you enjoy.

Yes, if only primary care was as interesting as dermatology!

Sorry for the snark. I think you're right to some extent, but I don't think it comes down to one factor, it comes down to many. If you tweak/ameliorate even one of those factors in favor of primary care, you'll see some movement towards the field. It'll be a modest change for sure; you'd be better off increasing PC salaries. If there's one thing doctors are good at, it's deferring instant gratification for the long-term reward.

I think you can pay back $140k in debt with $140k a year salary and still live comfortably...

Well, that should come as some relief to med students in the 90's. The emerging problem is not one of $140k debt, but $300k+. That kind of debt will put a primary care doc about average with college-educated workers as long as he's paying it off, with more hours to work and less time to earn money after med school and residency.

 

[smq123]

Yes, if only primary care was as interesting as dermatology!

Have you done your clinical rotations yet?

While I actually enjoyed FM, there is something to be said for how routine most of the problems you encounter in the FM office are. HTN, HTN, HTN, diabetes, diabetes, "weight gain," HTN, meds check, meds check, diabetes, HTN....etc., etc. There were also some incredibly frustrating non-compliant patients, something you only see in another poorly-paying specialty, general IM.

I also didn't find derm all that interesting. But there IS something to be said for unusual skin rashes, melanoma, and somewhat exotic skin infections.

Most people are drawn to FM for the continuity of care, the mostly clinic-based practice, and because they believe strongly in the importance of community and public health. And yes, FM CAN offer a wide variety of problems and conditions, if you build your practice that way. But, generally speaking, I've never seen anyone get thrilled at the idea of treating HTN and diabetes all day.

 

[Gibbles]

I was offered a job during my second, third, and fourth year of medical school to come back to the midwest and work in primary care as an Internist. All of these offers were from towns of 15,000-30,000 with the stipulation that if I work for them for a particular amount of time, my medical school will be paid in full by those clinics or hospitals. Pay has ranged from $180,000 to over $200,000 to function as an Internist. So, that wage with no repayment worries and a desire to live here anyway =

It isn't difficult to get your medical school paid for in these times. Especially, if you're from a small town and want to come back to a small town. The demand for primary care physicians is unreal. Look at a map, pick a town any town, decide to practice there, and all your finances are taken care of long term.

 

[WellWornLad]

Have you done your clinical rotations yet? While I actually enjoyed FM...

You kinda disproved your own point within the first two sentences there...

I am merely suggesting that the difference between dermatology and primary care (not just FP) is NOT the difference between how interesting treating a skin rash and treating hypertension is. Fine, dermatology is *marginally* more interesting. We both know that's not the reason it's so popular.

 

[Law2Doc]

...

So my question to everybody here is if you were one of these students would you be more tempted to consider primary care making less but with no debt or still consider a specialty or subspecialty field making more money but having a lot more debt? Keep in mind who knows what is going to happen with the salaries in the near future. ...

Your post acts like this is a new concept. For many years now, there have a number of med schools and state programs that offer debt forgiveness to folks who go practice primary care for underserved populations for X number of years after graduation. These places aren't luring away the applicants from the top ranked schools, but certainly have no problem filling their classes.

 

[Gibbles]

You kinda disproved your own point within the first two sentences there...

I am merely suggesting that the difference between dermatology and primary care (not just FP) is NOT the difference between how interesting treating a skin rash and treating hypertension is. Fine, dermatology is *marginally* more interesting. We both know that's not the reason it's so popular.

The fact is that everything that is encountered in Dermatology will either be encountered first in a primary care setting and referred, or it will simply be treated.

To say that Derm. is more interesting is utter nonsense. Especially, when every disease process that Dermatologists treat are seen by Family. Med., IM, or Peds on a pretty regular basis.

 

[scube]

There are several state and federal gov programs that do just that. you agree to primary care(peds, obgyn, psych, fm, gen im) they pay your way. then you do time where they say. so it works.

 

[scube]

The fact is that everything that is encountered in Dermatology will either be encountered first in a primary care setting and referred, or it will simply be treated.

To say that Derm. is more interesting is utter nonsense. Especially, when every disease process that Dermatologists treat are seen by Family. Med., IM, or Peds on a pretty regular basis.

while all the disease processes are seen in primary care specialties. getting to treat them is interesting. a lot of primary care is moving away from doing the skin procedures. I like skin procedures. my two cents.

 

[PreMD86]

I think you only need to look as far as already existing state schools to find the answer. My school's tuition is $8500, with 2/3 of it forgiven if a student practices primary care for 4 years. That's around 12k in tuition for all four years, leaving 22k in subsidized stafford loans for living expenses. Many PC practices already offer to pay off the rest of the debt. Still, even with increasing financial incentives, 50% match into primary care every year with very little fluctuation. This means 50% of students are simply uninterested in FM for w/e non financial reasons already mentioned. I suspect this will be the case in UCF as well.

 

[justdoit31]

Still, even with increasing financial incentives, 50% match into primary care every year with very little fluctuation. This means 50% of students are simply uninterested in FM for w/e non financial reasons already mentioned. I suspect this will be the case in UCF as well.

Though of those 50% how many actually stay in primary care? I am leaning towards Peds Hem/Onc which means I would do a primary care residency and then specialize.... with an IM residency you can go into GI, Cardio, Pulm, Endo, etc.

 

[Law2Doc]

Though of those 50% how many actually stay in primary care? I am leaning towards Peds Hem/Onc which means I would do a primary care residency and then specialize.... with an IM residency you can go into GI, Cardio, Pulm, Endo, etc.

The number of IM folks who subspecialize is a relatively small number compared to the number that remain in primary care. And this figure is a constant anyhow, as there are only so many fellowship slots.

 

[JeffLebowski]

Free medical school itself will not appreciably increase the number of primary care graduates. It may be interesting to see the extent to which it does, though.

In my opinion, there are three sets of students in every class (as pertains to primary care):

1) Students whose specialty choice at the end of the day is not at all impacted by their student loan debt - and they're not going into primary care.

2) Students whose specialty choice might be swayed by concern for being able to cover their student loans.

3) Students whose specialty choice at the end of the day is not at all impacted by their student loan debt - and they're already going into primary care regardless.

My impression is that the vast majority of students fall into 1 & 3, in that they really aren't basing their career choice on their student loans. Lowering tuition costs (or eliminating student debt) will allow those few students who are in group #2, whose career choice is actually significantly influenced by the amount of student debt they will graduate with, to choose more objectively.

I'm going to graduate with so much student loan debt that honestly, I didn't even consider primary care specialties. But to be truthful with myself, even if I had no debt I still wouldn't go into primary care. I'm betting that (A) most students don't want to go into primary care anyway and (B) the barriers for students "on the fence" about going into primary care are mostly unrelated to student debt.

That said - it's NOT FAIR that everyone's crying about how badly we need primary care physicians, but then undercut them at every turn by overcharging them for their training, underpaying them for their services, and whoring out their jobs to lesser trained and cheaper "alternatives" (i.e. NP's, etc.). Many/most of us choose to go into a specialty based on what turns us on, what we really like. But seriously, it's going to be increasingly hard to entice people to go into primary care, for students to be turned on by the career, to really feel valued and fit in with the specialty if you set them up for failure, and not just as it relates to student debt. My hunch is that the graduates of this new school will NOT choose primary care to any significant degree greater than they do at comparable schools.

The only effective way to ensure graduating students who go into primary care is to really choose your matriculants wisely. The University of Minnesota - Duluth campus seems to do this well. Their mission is to produce primary care physicians in rural Minnesota, and thus they base their admissions decisions on factors they KNOW predict that. If you want to produce primary care physicians, you have to consider more than just one factor and you have to be realistic about what people want from a career in medicine. Plastic surgeons hate student debt just as much as primary care docs. You've got to consider more than that.

 

[confuse]

Well said JeffLebowski. Debt is only one of the many factors that influences specialty choice; I think the main factor is still interest. If you want to increase the # of primary care physicians that your school produce, select those who are interested in primary care going in and design awesome rotations and research opportunities in primary care field for students. Even a student with an interest in Ob/Gyn with an awesome family medicine rotation and a terrible Ob/Gyn rotation will likely choose to specialize in family medicine over Ob/Gyn.

 

[sirus_virus]

This thread will soon expose our greed. I thought all the whinning was about "how can I pay my debt if I dont have X salary?". So you get free tuition but you still want better paying specialty . Guys, why don't we just cut through the bull, it's all about money/lifestyle. All the other metrosexual nonesense reasons we try to come up with why we like bla bla bla specialty is only self deceit.

 

[JeffLebowski]

This thread will soon expose our greed. I thought all the whinning was about "how can I pay my debt if I dont have X salary?". So you get free tuition but you still want better paying specialty . Guys, why don't we just cut through the bull, it's all about money/lifestyle. All the other metrosexual nonesense reasons we try to come up with why we like bla bla bla specialty is only self deceit.

Well that's just not true. It's not "all about money/lifestyle", but those are significant factors. I mean your take on it is very cynical - it's not greed, it's wanting fair compensation based on: (A) our level of training (B) our sacrifice & investment to get there (C) our value to society (D) the hours we put in.

To say that doctors want to make money out of greed is ridiculous. I would say for as much education & training we have, as many hours as we work, as much sacrifice & personal investment we make, and as much as society needs us, paying a doctor 200-500k a year is a ****ing bargain.

 

[MOHS_01]

I will go on record stating that the percentage increase in people choosing primary care will NOT significantly increase, and most definitely will not justify the costs incurred. This does very little to address the perceived problems (when, actually, the problem is fixed delusions, not the politically correct talking points).

If you want more docs to enter primary care, you have to make the job more enticing, which means more than just more pay.

 

[dilated]

This thread will soon expose our greed. I thought all the whinning was about "how can I pay my debt if I dont have X salary?". So you get free tuition but you still want better paying specialty .

I wouldn't do it if they made 400k a year. Because the policymakers in the US have no respect at all for primary care and while they're blah blahing about how important it is out of one side of their mouth, they're pushing the idea that PAs and NPs can completely replace MDs out of the other. I don't believe for a second that they don't plan on using midlevels as a cudgel to beat PCPs into compliance (which is to say low salary and obedience to government "guidelines").

 

[dragonfly99]

If you want more docs to enter primary care, you have to make the job more enticing, which means more than just more pay.

I agree with Mohs and dilated, for the most part.
Free tuition might entice a few more folks into primary care, but I'll bet it won't change the number of students picking primary care by more than 5-15%. I seriously wanted to do primary care going into med school, and money totally is NOT the reason I'm not doing it. I seriously don't care whether I make 120k or 220k...that's all good money. I seriously do care that primary care has a crappy lifestyle, gets buried in patient care, gets little respect (from some other docs, patients, gov't bureaucrats, etc.) and it's very existence is threatened by gov't bureaucrats and insurance companies who think that they know how we should practice medicine (and it's according to the little flowcharts and cookbooks they are concocting right now). Also, I do have grave concerns that the gov't is thinking they can replace fp and general IM and pedi docs with PA's and NP's and they'll be equivalent, which I don't think they are (not that I have anything against them, but I don't think their training is really equivalent).

While salary may not have influenced me (with my 130k student loan debt at 2.9%) it certainly would and probably should influence people who are going to have 200k or maybe 250k of debt at 6.9% interest. I do think that we need some reasonable tuition levels (i.e. not the rampant undergrad and grad/professional school tuition inflation we've had in recent years) and financial aid. I'm not sure that "free" med school is any solution to the primary care shortage, though.

 

[confuse]

I would since I'm very interested in internal medicine. I don't think internal medicine is just taking care of htn/diabetes, since those are not the reasons that myself or most of my friends go to the doctor. Personally, debt is not as important as earning potential when it comes to specialty choice but I have to be interested in the field. As of now, the practicing rural=forgiving loan is very enticing. I think that makes more sense than giving people a free ride to med school without any strings attached.

I wouldn't do it if they made 400k a year.

 

[docB]

Disclaimer: I can't watch the video because I'm at work and they block all high bandwith stuff.

I am curious how they will deal with someone who gets to the end of their "free" med school career and decides they want to do a non-primary care specialty. Do they convert it all into loans? Sue the guy for breech of contract? Have him arrested and taken in chains to an FM residency?

Also how do they deal with they guy who does a fellowship out of IM?

I would not have done this as I never wanted to go into primary care. I do think that a program like this will attract people who are already interested in primary care specialties rather than entice people into going into primary care.

 

[Habeed]

Why would someone with a 4.0 and a 45 MCAT ever go into primary care? Wouldn't that person feel like his or her genius level intelligence was wasted? I would expect a person like that to be interested in a specialty that requires a lot of brain power, apart from financial concerns. That person might choose an internal medicine fellowship, but they also might try for radiology, pathology, surgery, ect. Don't see how someone like that would be likely to choose family practice under any circumstances.

Why is everyone so 'worried' about the shortage of U.S. grads doing primary care? There are a fixed number of residency slots in the United States every year, and nearly all of them fill. Thus, what's the problem? If more U.S. grads decided to go primary care, that would mean that more foreign grads would go to specialties.

At the end of the day, the number of primary care doctors and specialists would be the same no matter what.

 

[meister]

Well, Habeed, your three points are all pretty worthless. Your first one is stupid because you think a 4.0 and a 45 are indicative of some sort of super intelligence. You then infer from that that anyone who scores that high on a pre-medical test performance is no doubt the best physician out there. Do I need to expand further to explain why this is 100% stupid? Your second point makes the glaring error of assuming primary care physicians do not utilize higher intelligence. Why you think this is not really interesting to me, but the fact that you do is very telling. Your third point is equally stupid because Congress could simply increase the number of primary care spots to alleviate this problem. So, "the number of primary care doctors and specialists would be the same no matter what" is true only if you except the one circumstance where it wouldn't be true.

Hope this helps.

 

[Habeed]

Focus on the last point, then.

Why would Congress increase the number of primary care spots? They haven't done so, yet. In any case, all this griping about "more doctors need to go into primary care" is kind of pointless unless the number of spots is raised. And if it is raised, there still wouldn't need to be more U.S. grads going into primary care.

 

[docB]

Habeed's remark that the primary care specialties don't require much brain power is insulting and incorrect.

I'd like to throw out the suggestion that the primary care shortage is not due to a shortage of doctors. It's due to the poor reimbursement for primary care office visits. If the pay were better PMDs could afford to lenghten appointments to fully address patient's issues rather than having to rely on the vary common "one complaint per visit, if you have more come back next week" approach. It would also allow for schedules to have open appointments to see urgent care patients rather than putting them off or dumping them in the EDs.

If you buy this then the creation of more PMDs is less important than properly funding the existing PMDs.

 

[Habeed]

Habeed's remark that the primary care specialties don't require much brain power is insulting and incorrect.

Primary care physicians aren't allowed to do any of the complex interventions such as surgery, radiation, or chemo. They are trained to refer to a specialist when a case is complex. Their residencies are the shortest, with the least training, and it is commonly thought that even a 3 year family practice residency is usually overkill.

None of those things sound all that attractive to a person who is in the top 1% of intelligence, like someone with a 45 MCAT most likely is. It is generally felt that complex subspecialties of internal medicine, neurosurgery, radiation oncology, ENT, and other fields require more brainpower than family practice. For whatever reason, these specialties have always attracted the best and the brightest according to test scores, decade after decade.

Perhaps family practice is "just" as complex, and everyone tries to be a specialist because the pay is better, driving up the average board scores. That would certain explain why dermatology is #1. Nevertheless, every one of my classmates who is an A student in med school thinks family practice is dumb, and would rather quit medicine than give physicals and write scripts all day.

My point is true even if family practice docs are just as smart. Someone with a 45 MCAT and a 4.0 is much less likely to choose family practice than the average U.S. allopathic student.

 

[michaelrack]

Have you done your clinical rotations yet?

While I actually enjoyed FM, there is something to be said for how routine most of the problems you encounter in the FM office are. HTN, HTN, HTN, diabetes, diabetes, "weight gain," HTN, meds check, meds check, diabetes, HTN....etc., etc.

.

Most of the problems encountered by specialists outside of academia are also routine; 90% of the practice of most specialists consists of 5-10 (at the most) diagnoses.

For endocrine it's DM, DM, hypothyroidism, DM, with an occasional case of hyperthyroidism thrown in.

For sleep medicine, it's OSA, OSA, OSA, OSA + RLS, OSA, insomnia.

 

[JeffLebowski]

Primary care physicians aren't allowed to do any of the complex interventions such as surgery, radiation, or chemo. They are trained to refer to a specialist when a case is complex. Their residencies are the shortest, with the least training, and it is commonly thought that even a 3 year family practice residency is usually overkill.

None of those things sound all that attractive to a person who is in the top 1% of intelligence, like someone with a 45 MCAT most likely is. It is generally felt that complex subspecialties of internal medicine, neurosurgery, radiation oncology, ENT, and other fields require more brainpower than family practice. For whatever reason, these specialties have always attracted the best and the brightest according to test scores, decade after decade.

Perhaps family practice is "just" as complex, and everyone tries to be a specialist because the pay is better, driving up the average board scores. That would certain explain why dermatology is #1. Nevertheless, every one of my classmates who is an A student in med school thinks family practice is dumb, and would rather quit medicine than give physicals and write scripts all day.

My point is true even if family practice docs are just as smart. Someone with a 45 MCAT and a 4.0 is much less likely to choose family practice than the average U.S. allopathic student.

Man, you're spinning your wheels here, it's just not a fight you want to engage in, and you're just wrong. It's a huge gray area confounded by numerous academic and non-academic factors. People aren't computer programs to satisfy an idealized version of SMART=HIGH ACHIEVER=SHOULD GO INTO COMPLEX MEDICINE, they go into whatever career fits their personality, priorities, other responsibilities & commitments, challenges, patient population, practice environment, vested interest, background, life experiences, and every other little thing that makes a person commit to a field and a style of practice. You can't and shouldn't make the assumptions you're making.

 

[Habeed]

So if I had access to test scores of allopathic students, and I figured out which specialties that students with 40+ MCAT scores went in to, you are saying my "study" would not find them mostly in specialties? Ok, then...

I don't have the data for that study, but
1. There's a statistical link between higher USMLE scores and higher MCATs
2. People with higher USMLE scores on average go into specialties much, much more often than average allopathic grads.

Original point : a school that offers full ride scholarships to all accepted students, and preferentially accepts the most numerically competitive applicants in the United States, is going to produce fewer primary care physicians.

 

[JeffLebowski]

Original point : a school that offers full ride scholarships to all accepted students, and preferentially accepts the most numerically competitive applicants in the United States, is going to produce fewer primary care physicians.

Assuming they could attract the most numerically competitive applicants in the United States. But no matter how you slice it, the lower tier/average-midtier schools ALL have a big bulk of students go into IM & peds, with a smattering of students in the various specialties, depending on their student body. The only schools that are skewed towards "competitive" specialties (and even in these cases, most of these elite students go into IM & peds, etc.) are the elite institutions, and I honestly doubt that students will take a full ride to bumbletown florida Univ. of Central Florida vs. Columbia or Duke or whatever...but I guess that remains to be seen. So my opinion is that Univ. of Central Florida, if they are choosing students strictly on the "best and brightest" they can attract (without consideration whether they are legitimately interested in primary care), will produce:
1) NOT specialized physicians preferentially, because I'll wager they won't have much higher avg. MCAT/GPA than many other mid/lower range schools as you claim
2) NOT primary care physicians preferentially, because I'll wager students from the overall pool of applicants aren't picking schools based on projected student debt and aren't choosing specialties based on projected student debt.
3) Physicians who distribute themselves very similarly to the general population of graduating medical students (big chunk of IM/Peds, a handful of EM/Rad/OB/Surg, a few plastics/radonc/derm/ortho/ent/neurosurg, and so on.

 

[Zosyn79]

Well that's just not true. It's not "all about money/lifestyle", but those are significant factors. I mean your take on it is very cynical - it's not greed, it's wanting fair compensation based on: (A) our level of training (B) our sacrifice & investment to get there (C) our value to society (D) the hours we put in.

To say that doctors want to make money out of greed is ridiculous. I would say for as much education & training we have, as many hours as we work, as much sacrifice & personal investment we make, and as much as society needs us, paying a doctor 200-500k a year is a ****ing bargain.

Haha I have to laugh at this statement even though you are correct but let's be real. MD's aren't making us healthier as human beings. All you guys do is manage disease nowadays and make corporate America HUGELY profitable. It's sad actually MD's are paid pennies on the dollar compared to their Wall Street counterparts. You guys deserve to make every penny based on your education but don't act like you are really making a difference in the real health of people, especially Americans. Medicine and the AMA is one big college fraternity. As a society humang beings are more physically degenerate than ever. If there were no wars the Military industrial complex would collapse. Without disease and cancer MD's would be jobless. If we spent 1/3 of what we do treating disease on prevention we'd all be much healthier and need a hell of a lot less specialists and Primary MD's anyways. But that's just how Rockefeller and corrupt AMA, FDA, NCI, etc. etc. want it!

 

[MOHS_01]

Haha I have to laugh at this statement even though you are correct but let's be real. MD's aren't making us healthier as human beings. All you guys do is manage disease nowadays and make corporate America HUGELY profitable. It's sad actually MD's are paid pennies on the dollar compared to their Wall Street counterparts. You guys deserve to make every penny based on your education but don't act like you are really making a difference in the real health of people, especially Americans. Medicine and the AMA is one big college fraternity. As a society humang beings are more physically degenerate than ever. If there were no wars the Military industrial complex would collapse. Without disease and cancer MD's would be jobless. If we spent 1/3 of what we do treating disease on prevention we'd all be much healthier and need a hell of a lot less specialists and Primary MD's anyways. But that's just how Rockefeller and corrupt AMA, FDA, NCI, etc. etc. want it!

Sounds great on paper, my friend... and, in theory, I agree to degree. MD's do, however, provide the services, advice, and information that would make people healthier -- if they would listen and adhere to said advice. They do not, and talking until we are blue in the face is pointless, fruitless, and does not pay the bills... therefore we do our best to manage the damage caused by "society's" weaknesses, vices, and, frankly, ignorance. We are in the business of attempting to save the stupid and/or ignorant from themselves, and it does NOT pay the way that it should for E&M, pays a little better than it should for some minor things, overpays for new procedures, and has an at-cost or below reimbursement for many procedures.

The AMA sucks, by the way. Anyone who does not believe that the AMA is not led by a halter held by CMS really needs to do some more homework.

 

[Zosyn79]

Sounds great on paper, my friend... and, in theory, I agree to degree. MD's do, however, provide the services, advice, and information that would make people healthier -- if they would listen and adhere to said advice. They do not, and talking until we are blue in the face is pointless, fruitless, and does not pay the bills... therefore we do our best to manage the damage caused by "society's" weaknesses, vices, and, frankly, ignorance. We are in the business of attempting to save the stupid and/or ignorant from themselves, and it does NOT pay the way that it should for E&M, pays a little better than it should for some minor things, overpays for new procedures, and has an at-cost or below reimbursement for many procedures.

The AMA sucks, by the way. Anyone who does not believe that the AMA is not led by a halter held by CMS really needs to do some more homework.

Vices and weaknesses that make corporate America VERY VERY wealthy including the medical/healthcare establishment. Let's take kids for example. Why do you think kids are so unhealthy? Do you have kids? Ever try to take your kids to the grocery store nowadays? The minute a parent steps into the average grocery store in America they have lost the battle. The food corporations spend BILLIONS of dollars marketing their food to children. Kids food is LOADED with preservatives, high fructose corn syrup, hydrogenated oils/vegetable oils etc. What does the medical community recommend for women who can't breast feed their children? LMAO! Soy based crap like Enfamil. I'm as frustrated as anyone that works in healthcare with non-compliance among especially adults. But blaming all the ills of health and nutrition on noncompliance is a short sighted and UNREALISTIC. It's not that people in general don't heed a doctor's advice......it's that for the most part doctors' advice revolves around the food industry, the pharmaceutical industry and what they learn in medical school. It's really not their fault. They are just a cog in the wheel of corporate America and their scope of nutritional practice is molded and guided by big business, not nature, not science, etc.

For example,
The Lipid Theory of heart disease is just that a theory and if researched with an open mind a piss poor one at that. And yes the AMA is and has been one of the most corrupt organizations in America. The University of Chicago still glorifies that ***** Dr. Morris Fishbine.

 

[Zosyn79]

Like MOHS said throwing money at the problem doesn't mean people are going to follow those suggestions. You can give a horse a diamond-plated trough but it won't necessarily drink.
/ducks out of TIH forum...

Do you think kids are unhealthy because they are "noncompliant" with medical advice? LMAO! Kids are unhealthy because our food supply has been hijacked by a billion dollar corporate food industry that spends millions of dollars marketing junk food to kids. If or when you have kids the first time you take them to a grocery store and they reach out for all the colorful, engaging cartoons and other advertisting on junk food you'll understand what I mean. Combine that with an increasingly sedentary childhood surrounded by the internet, tv, etc. and a host of other societal problems and bam you have high rates of obesity, childhood diabetes. I mean my god there is a record number of kids with KIDNEY STONES! Kidney stones in kids was UNHEARD OF 50-100 years ago. Take a woman who can't breast feed her kids. What does the medical establishment recommend? Soy based infant forumla ala Enfamil for christ sakes. You know what would happen if you fed soy based formula to a baby goat, a baby cow, or other newborn mammals? They'd die!!!!!!!!!!!! But somehow we as human beings seem to think we are so far removed from our mammalian brethren in nature we need something like Enfamil to nourish are most precious population. Why do you think childhood food allergies are sky rocketing? Because our food is junk and "dead" nowadays. If I told my primary MD that I eat upwards of a dozen raw eggs a week along with raw milk and the occassional pound of raw beef he'd look at me like he just saw the devil incarnate. LOL. Look at what happens when you give an ape an Apricot.....he goes directly to the seed, crushes it and devours the apricot kernels. Apricot kernels are loaded with nitrilosides and nitrilosides have been used for A LONG time as an alternative form of cancer treatment. If you said to a medically trained doctor in the US that you'd like to complement your cancer treatment with B17 he'd probably chuckle or worse refer you to the crackpot website Quackwatch.

 

[oldbearprofessor]

What does the medical community recommend for women who can't breast feed their children? LMAO! Soy based crap like Enfamil.

You know what would happen if you fed soy based formula to a baby goat, a baby cow, or other newborn mammals? They'd die!!!!!!!!!!!! But somehow we as human beings seem to think we are so far removed from our mammalian brethren in nature we need something like Enfamil to nourish are most precious population.

I may be a lacky to industry, but at least I'm an informed Lacky.

Enfamil is the trade name given to a large group of infant formulas produced by a company, Mead-Johnson, Nutritionals. Only one of the formulas carrying the Enfamil trade name, Enfamil Prosobee Lipil is soy protein-based.

In general, the use of soy protein based formulas in the US has diminished considerably in recent years. Few pediatricians would recommend the use of a soy-based product for women who "can't" breast-feed their children as a first line product. Almost all would recommend a cow milk protein based formula as these are considered "routine" and are generally less expensive.

Regards

OBP

BTW, do you have a reference for the idea that soy based protein is lethal for all non-human newborn mammals? Assuming they are raised in a sterile environment, of course.

 

[Zosyn79]

I may be a lacky to industry, but at least I'm an informed Lacky.

Enfamil is the trade name given to a large group of infant formulas produced by a company, Mead-Johnson, Nutritionals. Only one of the formulas carrying the Enfamil trade name, Enfamil Prosobee Lipil is soy protein-based.

In general, the use of soy protein based formulas in the US has diminished considerably in recent years. Few pediatricians would recommend the use of a soy-based product for women who "can't" breast-feed their children as a first line product. Almost all would recommend a cow milk protein based formula as these are considered "routine" and are generally less expensive.

Regards

OBP

BTW, do you have a reference for the idea that soy based protein is lethal for all non-human newborn mammals? Assuming they are raised in a sterile environment, of course.

Reduced Minerals Whey, Nonfat Milk, Vegetable Oil (Palm Olein, Soy, Coconut, and High Oleic Sunflower Oils), Lactose, and Less than 1%: Mortierella Alpina Oil [a Source of Arachidonic Acid (ARA)], Crypthecodinium Cohnii Oil [a Source of Docosahexaenoic Acid (DHA)], Mono- and Diglycerides, Soy Lecithin, Carrageenan, Vitamin A Palmitate, Vitamin D3, Vitamin E Acetate, Vitamin K1, Thiamin Hydrochloride, Vitamin B6 Hydrochloride, Vitamin B12, Niacinamide, Folic Acid, Calcium Pantothenate, Biotin, Sodium Ascorbate, Ascorbic Acid, Choline Chloride, Inositol, Calcium Phosphate, Ferrous Sulfate, Zinc Sulfate, Manganese Sulfate, Cupric Sulfate, Sodium Chloride, Sodium Citrate, Potassium Citrate, Potassium Hydroxide, Sodium Selenite, Taurine, Nucleotides (Adenosine 5'-Monophosphate, Disodium Guanosine 5'-Monophosphate, Disodium Uridine 5'-Monophosphate).

Oops my mistake...... My "crap" statement still stands The only reason Mead decreased it's soy based formulas is because of political correctness and the emerging research coming out against soy. But this was never really emerging research as the research on soy and human beings has been around for decades. My point was nutritional advice changes like the weather among the healthcare establishment. And no I don't have controlled, randomized, triple blind research studies on the effects of soy on baby goats and cows and other mammals at this time. Do you? But I have seen it first hand personally.

 

[MOHS_01]

Zosyn,

If you were half as learned as you were passionate, you would be a formidable fellow indeed.

Regarding the "kids food is crap" -- again, goes back to compliance, self discipline, and parenting. If you let your kid live off of Apple Jacks rather than apples, banana Popsicles rather than bananas, and Spam rather than (non-steroid fed) chicken, beef, etc, then you reap the benefits of your efforts (or lack thereof).

Crazy is as crazy does, and grass (hemp) skirt wearing hippies definitely have their own brand of craziness. I agree with you that industry has, and continues to, fund and direct much of the research that gets published, subsequently quoted, and ultimately published in textbookss to be handed down through the generations as gospel, but to want to set the clock back to the dark ages and risk mass bacterial and parasitic disease through the consumption of non-pasteurized or raw foods is a little nuts.

The problem with Darwinian theory is that we no longer allow it to run its course......