Topics
Navigation

KevinMD.com

One simple question that is the essence of medicine

| Patient | May 25, 2012

A friend recently told me his daughter has been accepted into medical school with hopes of becoming a pediatrician. Along with this accomplishment will come $250,000.00 in debt.

I could not help but think of how her educational experience and future practice model will be so different from those who hold leadership positions in medicine today. Tablet computers will replace books and she will live in a 24/7 wired world.

I came to the medical blogging world a number of years ago as a patient looking for an answer to the question: Why does my doctor sound like a very bad advertisement for the latest drug? Sadly, on a number of occasion’s doctors and nurses have physically blocked me from leaving the exam room demanding I submit to additional test, or take the latest branded drug, due to my insurance. In one instance a doctor was very blunt telling me I was taking food from his children’s table.

That early blog world of doctors and patients ranting about each other has morphed into a sophisticated academic world with thought leaders and venture capitalist. A doctor’s reliance on drug reps and journal articles represents an attitude that has become out of date and simply will not work today, or in the future.

NNT has entered the vocabulary of most patients. Despite the best efforts of the pharma spin machine legal settlements are now widely publicized. Pre-publication debate of major guidelines by a learned doctor/patient base is now the norm. Technology has not only increased the amount of information available to patients and doctors, but also changed what has been a sacred relationship.

Computers drive revenue in what has become a medical industrial complex where medical leaders are touted as titans of industry. Time has become a resource that is now measured in seconds, not minutes with a patient.

Medical school, with an abundance of applicants, appears to have taken on the role of educating our future doctors while wishing to participate in their future earnings through high tuition cost supported with school sponsored loans. Now medical academic centers are lobbying government to increase continuing educational requirements in order to trap and hold students.

Debt service will drive the decisions this young woman makes about her professional career and her personal life. A spouse and children may be postponed due to financial issues.

Through the noise of the technology. The constant din of information. The pressure of the practice or corporate employer I wish for her success and the ability to set the tablet computer aside with all of the patient’s information and nurses notes, and ask one simple question: How can I help you today?

This is the essence of medicine.

Steven Lucas is a long time commentator on a number of medical blogs.

Submit a guest post and be heard on social media’s leading physician voice.

email

Tagged as: Patients, Primary care

Related Stories

More in Patient

< Previous post

Next post >

  • http://www.facebook.com/lucky482 Lisa Luciano

    This is still an issue that scares me as I start to study for my MCATs this coming January.  I’m already 60K in debt from my undergraduate education and by the time I get through medical school, I’ll be much more in debt from that.  As much as I want to help patients, it’s so hard to be able to do that and give them the standard of care that they deserve when cost determines everything.

    • NewMexicoRam

      You are correct.  I was only $15,000 in debt when I graduated from medical school in 1986, and my parents did not give me a dime.  I had saved money with my high school job and work during summers in college, and my wife made enough while I was in med school to keep us in an apartment and food on the table.
      It shocks me to hear the debts students have today. I really hope help comes in some fashion, or the medical field will completely come apart in the future.

    • http://twitter.com/RDBowman Rachel Bowman

       Lisa! I’m here to tell you it will be OK! I started with over 150k in debt, which grew to over 170k while in residency. The good news is that in less than 3 years I’ve been able to pay it down to almost 100k with loan repayment programs. It really is a workable amount.  I work for an FQHC, most of my patients do NOT have insurance, and I know they get great care, b/c we are a patient centered medical home and we track our data.  Are there some days I tell people they need a specialist procedure or consultation that they can’t afford? Yes, but most days we do just fine prescribing what’s on the $4 list at the local pharmacy. Cost does NOT determine everything.

  • http://www.facebook.com/profile.php?id=762893788 Dave Miller

    “…
    doctors and nurses have physically blocked me from leaving the exam room demanding I submit to additional test…” Given the fact that doctors are ethically (and often legally) barred from benefiting financially from the tests they order, I find this a bit difficult to take seriously.

    “A doctor’s reliance on… journal articles represents an attitude that has become out of date and simply will not work today, or in the future.” Really, doctors no longer need journal articles in order to stay current? When did this transition occur? Did medicine suddenly become less complicated or stop changing so quickly? I missed that memo.

    I’m sorry but, while I sorta understand what you’re trying to say (medical education has become so onerously expensive that future docs may choose their specialty based largely on financial considerations), statements like the two I highlighted make it hard to take the rest of the article seriously.

    • NewMexicoRam

      If doctors and nurses really did “block him” then that only confirms the levels of despiration the health professionals are feeling right now.
      Yes, it’s probably not true, but if so, it only weakens his own argument.

      • http://www.facebook.com/profile.php?id=762893788 Dave Miller

        The point is that there is no reason for them to. The doc should not be benefiting financially from ordering more tests unless they are committing legal and ethical violations.

  • John Key

    Physicians have lost control of medicine.  The power is held by administrators, government, and third party payers.  Physicians were not defeated, they captiulated.  Doctors have traditionally just wanted to do the medicine, and not worry with costs, bills, collections, etc.  We are reaping the whirlwind.

    Can it be reversed? I don’t know.  Not likely, if they support of younger physicians and trainees for the PPACA is any guide–they are voluntarily lining up for professional suicide.  We need to return to our roots.

    Your posting title is apropos…helping patients must remain the essence of practice and the measure by which we measure our success.

    • NewMexicoRam

      Helping patients is what the doctors tried to do when all the outsiders took over, just as you write.  You criticized that approach as the way the medical profession lost the upper hand.

      Then you say that helping patients “must remain the essence of practice…”

      Which is it?  Just wondering what you mean.

    • John Key

      Physicians are helping patients–but insurers or other nonclinicians decide what treatments or tests may be allowed.

      Physicians are helping patients–but a PharmD may over-rule the therapeutic choice, or refuse to approve a change in spite of previous therapeutic failure.

      Physicians are helping patients–but nonclinician administrators,or sometimes even BBAs and MBAs, decide on tests, treatment, monitoring and frequency.

      I work in a clinic run by a large medical school system.  The decisions are made by just about everyone but physicians.  When I have complained, I’m told “this is an administrator-run system”.

      Professional suicide.  The doctors gave away the control.

      • NewMexicoRam

        That’s why I have been saying for several years that the only way physicians will be able to regain control is a nation wide work stopage.

        Just shut it all down.

  • http://twitter.com/Cascadia Sherry Reynolds

     250,000 for four years of grad school? Must be a private school with no financial aid? Amazing that people manage to go to college and graduate school and still don’t know how to manage their debt? Perhaps they should talk to the social workers ask them how they managed to go through 7 years of college and graduate and work in clinics for $15 an hour. Or to their MBA friends? Or law school friends. Why is it that we only hear about the doctors who are drowning in debt. What is the average income of a radiologist? $387,000 so you owe less than 1 year of income? That sounds pretty reasonable to me.

    People also seem unware that the actual training (residency and internship) is paid for by US Taxpayers through CMS (medicare and medicaid) to the tune of 100,000 a year per resident (40 k to student and 60 to training hospital). So the real medical training is being subsidized to the tune of 400,000 to 1.1 million (that is also why they are expected to treat medicare patients for less – they are paying back the cost of their education).

    • Future_Doctor

      Yes, medical school is very expensive and there is generally no financial aid (aside from loans) – that has nothing to do with it being a private school or a public school. There just aren’t really many scholarships or grants available for medical students. I am a medical student at a public school in Canada where tuition is a bit less than it is in the US ($17K/year at my school – I believe that it’s closer to $40-50K at many American schools), and I am expecting to have close to $150K of debt when I finish. I could easily see an American medical student having at least $250K of debt. It’s not that I can’t manage money – I worked to pay my way through undergrad, a master’s degree, and a PhD with almost zero debt (I was debt-free up until the end of my master’s but had some unforeseen expenses during my PhD). But in medical school there is no financial aid and there is no time to work to earn money, so not only are we borrowing to pay our tuition, we are borrowing to pay for 4 years of (very modest) living expenses (and no, living with family is not an option for me – they live in a remote rural area far from my school). For those of us without wealthy parents, that means borrowing a lot of money. I’m not worried about paying it back, but I still do what I can to minimize it. Yes, I know people in law school/graduate school who are working to pay their way through. I was a grad student and worked to pay my way through that. But you just cannot do that in medical school. Even in pre-clerkship years there is simply not time to work. I spend nine hours a day in classes and other mandatory academic activities on weekdays and have to study in the time outside of that. We do not get summers off at my school. I do not plan on letting my debt drive my career decisions (and nor do my classmates), but that’s much easier to do here in Canada where family doctors are paid well. But I hope I have helped to explain why it’s not just poor money management that leads us to graduate from medical school with quite a bit of debt.

    • http://pulse.yahoo.com/_GXO5UT3MGTPBRYKXHHFG6NCRO4 S

      Sherry:
      The average med school debe for ALL students is north of 150K so 250 k is not a hard number to hit.. Your MBA or law grad walks into jobs making 6 figures, No 3-7 years of indentured servitude for minimum wage or less per hour. Yes social worker pay sucks, which is why my own social worker sister made the effort to go to pick a school that allowed her to walk out with less than 20K in total debt between loans and grants (at the masters level). Try finding a med school that will do that. Quoting the average number of one of the highest specialties is disingenuous at best. As a medical subspecialist I makes less than half of that average salary (after a decade). I am not whining but  I certainly wish you would get your facts correct. Lastly, as every residency trained doc knows and you appear to be unaware of is, that hospitals MAKE MONEY off of medicare residency funds. At my institution it was 130 K and the resident pay was 30k (some years ago). This is for a doc trainee from every specialty inhouse 24-7. Try finding that in the community hospitals with that availability. For every dollar wasted by a trainee (the excuse hospitals use to keep 60-75% of the funds medicare gives them for GME), it is more than made up via 24-7 availability. You honestly think outside of an emergency an academic attending is going to show up at 03:00? Let me guess, you haven’t been through the process correct? . 

  • http://profile.yahoo.com/KNZ22VMISM6D26MXSJ4PKMGXXM James

    I owed $40,000 after graduating from medical school in 1981. I am thankful my average interest rate was 5% and I had 10 years after fellowship to repay. $250,000 in 2012. The direction is problematic unless we go back to the days of aristocracy where only the wealthy can become doctors. I have no answers, only questions. hopefully not the same question my ex-wife asked after I finished my Oncology fellowship. You went to medical school and could have been a plastic surgeon making $1,000,000+. Why didn’t you become a plastic surgeon?

  • erintolbert

    Medical school is very expensive, especially for students looking to practice in the primary care setting who will not earn over $250,000/ year.  For students looking to practice primary care, I think a nurse practitioner/ physician assistant career path should be considered.  A nurse practitioner program can be completed for less than $20,000 in two years and graduates can have an income of greater than $100,000. If a student is able to save $200,000 in school expenses and also able to graduate more quickly and start earning money years sooner it may be worth it.

Trending

Subscribe

The Book

Establishing, Managing and Protecting Your Online Reputation "A comprehensive and extremely useful roadmap for doctors."
-Eric Topol, MD, author of The Creative Destruction of Medicine
Learn More...

Greenbranch BooksAmazon.com

From MedPage Today

CME Spotlights

FM banner ad kevin md