Thursday, August 21, 2014

Tuition

From what I've read, tuition of private medical schools is now upwards of $50,000 a year. I think that is insane.

When I started medical school at a state school, my tuition was about $10,000 a year. Very reasonable. I was almost able to pay it myself.

While I was in school, they decided they needed to raise tuition for state schools. Actually, to double it. They felt we weren't paying nearly enough. It had to do with earning revenue, although they probably would've earned more money from a $100 a year raise for college students than they did for doubling the tuition of a couple hundred medical students. Whatever money they made was peanuts compared to the enormous burden that it placed on individual students.

They didn't raise tuition for college students though. They didn't raise it for law students or graduate students. Only medical students.

There was some talk of raising it even further after I left, to maybe $30K. The exceptions would be:

--You get a (slightly) lower tuition if you stay in state

--You get a (slightly) lower tuition if you choose a primary care field

I'm not sure if this is fair. I guess that it's important to encourage people to go into primary care, but I also don't think it's fair to force medical students and residents to live in poverty. Many of us could have easily gone into investment banking or some other field where we could've gotten rich right off the bat. Why drain us dry preferentially over all other students?

21 comments:

  1. Tuition is the biggest expense, but med students have a lot of other big expenses:

    - Three board exams (then another one during internship). Cost = several hundred each.

    - Boards prep course(s). Some schools mandate all students take a boards prep course ($600-1200) before each major USMLE Step so they don't have to deal with singling out the academically poor students.

    - Medical books. Even when one buys them used, these are really expensive. Some get by with lecture notes, but books were critical for my knowledge and deeper understanding. I spent several thousand dollars on books during med school & residency.

    - Away rotation travel and lodging costs. This is in addition to rent paid at home.

    - Educational conference and related travel fees. These are optional, but often very educational and can help shape students' specialty (including primary care) goals.

    - Residency application & interview travel/lodging costs. Easily $5-6k for those going into specialties that require separate internship and residency (and no, not all of these specialties are high-paying. Neurology, anyone?). God forbid you choose to interview for two different specialties because you're not sure you'll get your first choice.

    - Moving. Most med students move for med school and again for internship. Many move again for residency. But that's ok, because moving is cheap. And easy.

    The costs only increase after medical school with more exams and licensure costs reaching several thousand $$$, all to be paid before finishing residency.

    No non-medical person will believe me, but the post-residency costs could make another long post like this one. I'm not sure how most non-wealthy current med students will ever pay off their loans and bills.

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    1. If you feel like making a post on the topic, I'd be happy to put it up.

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    2. I worked with many studens/residents who were postponing their required exams, because they did not have money to pay for exams. One such fellow even rented a room from someone trying to save on living expenses. Medical training is very hard to pull off financially.

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    3. Thanks, Fizzy. I may take you up on that.

      But first I have to scrape together $2000 to pre-pay for next year's oral board exam. The board requires payment ~8 months prior to the exam. If you pay "late," add on a $500 late fee.

      Paid $1400 for Part 1 (9 months early, with same $500 "late" fee) during residency.

      Docs re-certify every 10 years, but I only just learned that we have to pay an additional yearly fee to "maintain certification." What a racket!


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  2. The costs are absolutely ridiculous. As a 4th year med student, I sometimes regret choosing this profession, especially since I plan on being a general pediatrician. It's interesting that we not only sacrifice so much of our time and personal life to this profession, but we pay for it monetarily as well. Big time. What's the point then? I knew friends who were considering quitting during med school but couldn't because of all the loans they've already accrued from attending. We take care of people's health. We save lives. You would think they'd let us catch a break somewhere.

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  3. Amen, Anonymous August 21, 2014 at 10:32 AM. --from another 4th year med student

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  4. Because of the money you all make as a general rule after residency. They count on the 70% specialist split, that on the whole, you all will make that money and can pay it back. Regular school, most of those who graduate in the business section wont make what the engineer section does who don't make what the social studies are art people do. Maybe 5% of those graduates make big $$$. Salaries on the whole for docs are in the $150 and up range. That's why they hit you.

    The other - if you look at the latest study that came out 25% of medical school graduates have no debt. That's because of 2nd and 3rd generation kids going into it. Realize that after MD & MD marriage kids are becoming common, since the 90's started the range of almost 50% women in med school, the money is there to pay for them and that's what is being seen. To be quite frank, medicine is seen as a rich people's thing, much like Harvard and Yale and Duke Law is a rich kids' thing.

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    2. I would gladly take a lower salary if it meant having low cost tuition. Most of us go into medicine primarily because we care about patients and not for the money, but debt becomes an issue. Even someone going into medical school straight out of college is likely to be in their late 30's before they pay off that massive debt. And that's no longer the norm; more and more people are getting masters or PhD's to be more competitive applicants for medical school, so that puts things off even longer. Someone who starts with a lower salary but less debt can live quite well much sooner.

      Could you provide a link to this study? Everything I have read has painted a much different picture.

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    3. You are right Therese. And anonymous at 3:27 above clearly does not know what he is talking about. I can't believe he just stated that "medicine is seen as a rich people's thing". Most of my med school classmates are from middle-class backgrounds who are working hard to become doctors. We all are very worried about paying off our loans. Also, I find it ridiculous that you stated most doctors marry other doctors, so their combined income makes it okay to charge them higher tuition. Wow, the administrators really took all that into consideration when they decided on tuition? How sad it is that you're implying that doctors should only marry other doctors so that they'll be able to pay off their loans?! How romantic.

      And absolutely NO ONE can put a price on HOW much personal sacrifices med students and physicians make everyday except for those in the profession. And the level of stress in our line of work never deteriorates cuz people can die on you. Not many professions can say the same.

      Medical students have to study pretty much non-stop for 8 years. (Yes I am counting undergrad because we need good grades and MCAT scores to be even considered for med school). In med school, you basically feel like there's a final every week. You go to class or study from the moment you open your eyes to the moment you hit the bed. Then there's 3-7 years of residency afterwards where you are a hospital slave working 12-16 hour shifts. This includes being on call where you have to stay up the entire night to take care of very sick patients. You don't make decent money until you hit your 30s, but you're also in 250k+ in debt.

      You can NEVER put a price on 10+ years of intense education and training lightly. Physicians gave up most of their 20s, their prime, hitting the books and hospital wards, taking care of everyone else. I find that to be enough of a sacrifice. We shouldn't be burdened with the cost of loans as well. Honestly, we should be able to enjoy our salaries because we earned it.

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    4. @Anon just above: "Honestly, we should be able to enjoy our salaries because we earned it."

      Some will agree with you, but many folks think doctors should suffer financially just like everyone else. They feel they work hard, too, and doctors are no different. I worked [yes, hard] in a couple of different fields before med school and being a doctor is so much more difficult, not only in terms of hours and chronic sheer physical/mental exhaustion, but also in terms of degree of responsibility.

      I personally would rather my doctor feel financially secure so they can focus on ME, but maybe that's my own preference to fully focus on one patient at a time so that I can do the very best job I can for him.

      Doctors sat on a pedestal for many years, but now it seems the American public is rooting for our fall from grace. I've come to accept that a lot of people hate our profession. Most patients won't share that with me personally, but anti-physician comments that follow mainstream health-related articles outweigh supportive comments.

      Some of their hatred would be better directed toward the insurance companies and system that dictate we spend less time with the patients, spend most of the visit looking at a computer screen, and focus on cookie-cutter quality measures that often have no bearing on the patient's reason for visiting. We need to bring back the historical doctor-patient relationship that we as physicians have allowed insurance companies to abolish.

      And regarding doctors marrying other doctors, the other problem with Anon 3:27's logic is that doctors who marry doctors have double the student loans. Ouch!

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    5. I feel the same way, pretzel. I've held other jobs where I worked longer hours (by choice because I needed the overtime), but those jobs did not require the mental power that medicine does. I could function alright sleep deprived. In medicine we're expected to be able to make life and death decisions at 3 am! Going through med school and residency changes you; I don't think anyone can really understand unless they experience it themselves.

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  5. Hmm, I don't want to be nearly 3/4 of a million dollars in debt, I don't want to do research, I really just want to do patient care....
    Oh, that's right. I'm becoming a Physician Assistant. YAY!
    Why anyone would want to be an MD still blows my mind. Maybe if you wanted to do surgery I could see it.

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    1. Well, if there were no MD's there would be no one for you to assist. What an annoying comment!

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  6. Hi, two articles for you to read before you start making "you make 150k a year" argument:

    http://qz.com/67304/i-just-finished-my-87-hour-work-week-and-have-230000-in-medical-school-debt/

    http://benbrownmd.wordpress.com/

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  7. Salaries on the whole for docs are $150 K a year and up. Really? Maybe in certain specialties in the NE or NW where the cost of living is also very high. Here in the NE, PAs and NPs sometimes start at higher salaries than the physicians they work with. Many docs are still paying for med school well into their 40s at monthly rates higher than their mortgages. How many other professions can you say this about?

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  8. Next time you need a doctor call a plumber and see what they charge!

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  9. I am a primary care and I do not have money for many beautiful extras that affluent people spend on. I live a modest life style in a middle class community, drive 1997 vehicle, I am known to accept donations - i.e. my friends clothing. As a foreign grad I do not have any debt and I work full time.

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  10. I'm Canadian and applying to med school now. Across the board, our post-secondary tuition tends to be much lower than the US equivalent. My undergrad tuition is about $5k/yr.

    We have 17 med schools with tuition ranging from $3k-$24k a year. Quebec's in province students and MUN students pay the least, Ontario students pay the most. We don't have 'tiers' like the US schools do, though.

    But still, on average Canadian med students graduate with over $100k combined (undergrad and med) debt. Because I have a family, I'll be pushing $200k, but there's various programs I can take advantage of to cut that in half fairly easily.

    The landscape for Canadian medical grads and US grads is very different. I'm not even considering applying in the US, despite it being easier to get in, because of the tuition. It seems to get worse and worse every year down there.

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  11. Sorry, not a lot of sympathy. Vet school costs $150 -300K. And starting salaries are in the $60-70K range. We have to be able to do medicine and surgery on every system at every age in multiple species. We take and read our own films, anesthetize our own patients and then perform the surgery, and handle the aftercare. We do everything from derm to obstetrics, and people complain when they have to pay $200 for anesthesia, surgery, hospitalization, and all meds for major abdominal surgery like an ovariohysterectomy. (of course that's 'cause the subsidized non-profit down the street gives it away for $50). It seems crazy to me that a physician can earn 3-4 times more working on one system, at one age of one species, and not even do medicine and surgery on that one system (ex: pediatric pulmonologist). Of course we can kiss our patients without getting in trouble, and we don't have to touch (gross!) humans.

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