Medical students may find themselves without a job

“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables, and decided to work during his last summer of freedom before the slew of exams and clinical work that would follow. But as much as he enjoyed serving diners, his dream was to serve patients as a physician.

At the time, I thought that the prospect of medical students being unable to become practicing physicians was inconceivable, even absurd. But soon, despite the nation’s physician shortage of more than 16,000, it’s possible that MD students will be graduating with four years of intensive schooling, an average debt of $166,750 — and no job.

President Barack Obama’s proposed budget would cut $11 billion from Graduate Medical Education (GME) funding in the next 10 years. While I am deeply concerned about the future of medical graduates, I am even more concerned about the future of our nation’s healthcare. These proposed cuts could force teaching hospitals to lay off as many as 73,000 staff, reduce clinical research support, shut down training programs for health professionals, and eliminate services that are unavailable elsewhere in the community. Although there is a pressing need to reduce the federal budget deficit, this short-sighted solution will hinder our healthcare system.

With the Patient Protection and Affordable Care Act that President Obama championed, the demand for physician services will increase significantly in 2014 as 30 million Americans are added to the healthcare system. The United States is projected to face a shortage of 62,900 physicians across all specialties in 2015. That number is expected to double to 130,600 by 2025. But healthcare coverage is useless if there are no physicians to treat patients, or if long waitlists leave patients unable to access care.

Even with new medical schools and increasing class sizes in existing schools, the number of practicing physicians is limited by funding for GME, or residency programs. In fact, the number of residency slots funded by Medicare has been capped since the 1997 Balanced Budget Act. President Obama’s proposed cuts will only exacerbate the physician shortage, resulting in fewer doctors.

After medical school, MDs must complete an accredited core residency program to be certified by the American Board of Medical Specialties. Physicians must be certified to practice and to be included in insurance plans. Osteopathic and international medical graduates, many of whom become primary care practitioners, depend on residency funding as well.

Residents work under the supervision of fully licensed physicians for three to seven years depending on their specialty. During this time, residents provide care for one of every five hospitalized patients, including seniors, veterans, and the underserved.

Many residents train at teaching hospitals, which provide care for 28 percent of all Medicaid hospitalizations. While teaching hospitals make up 6 percent of hospitals in the nation, they provide 40 percent of all charity care at a cost of $8.4 billion annually.

Teaching hospitals rely on GME funding for clinical research and specialized services, including a large majority of Level-I trauma centers, pediatric ICUs, burn care units, surgical transplant services, Alzheimer centers, and ambulatory services for HIV/AIDS patients. President Obama’s proposed cuts could force hospitals to eliminate services that operate at a loss, affecting the most vulnerable patients.

GME benefits all of society by providing valuable services and producing physicians who provide a high standard of care. By urging your Congressional representative to protect federal GME funding, we can safeguard the health of our nation. Take action at www.SaveGME.org.

Although the $11 billion in cuts have not been made yet, we’re already seeing the effects of inadequate GME funding. This year, there were 1,958 more applicants competing for residency slots than in 2012. By 2015, there might not be enough residency slots for U.S. medical school graduates.

Even though 99.4 percent of available residency slots were filled — the highest fill rate ever — 528 U.S. medical graduates couldn’t enter a residency program this year. That’s more than double the number of graduates from last year.

Three percent of U.S. medical school seniors did not obtain a residency slot in 2013. If that rate holds up, six out of the 183 students in my class may not have residency positions despite being some of the most intelligent, compassionate, hardworking and well-qualified people I know. As for the medical student waiter? I wonder what will happen to him. I wonder what will happen to our patients, to my classmates, to myself. And I have to ask, “Would you like fries with that?”

Christy Duan is a medical student.

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  • NewMexicoRam

    I really think that is the ultimate goal:

    To create such widespread dissatisfaction with our healthcare provision, that single payer will look like the only way out.

    You may make more managing tables than doctoring in the years to come. (No, I’m not serious about that, just showing my pessimism)

  • guest

    Many of us docs are very much in favor of a single-payer system. The barrier to such a system appears not to be the medical profession, but the American taxpayer.

    Also, Federal funding for graduate medical education is not a “government handout for education and training.” All US trained doctors have personally paid staggering sums of money for their medical education, or have taken on huge personal educational debt. The median indebtedness of the typical medical school graduate here in the US is $170,000.

    After medical school, a doctor typically does 3-5 years of residency training during which time he or she provides “slave labor” for a teaching hospital, generally working 80 hours a week for a salary of about $50,000. Teaching hospitals would not be able to function without this cheap labor, which enables them to provide discounted medical care to the Medicare and Medicaid patients they treat for the government. Therefore, GME funding is NOT a “government handout” to med students, it is the government paying those resident doctors (and the attendings who supervise them, who typically make far less than market salary) for their work in caring for Medicaid and Medicare patients.

    • Deceased MD

      I think it private industry-Big Pharma, Medical Device Co., etc that have the most to lose and are controlling the system with endless money and lobbyists, not American Taxpayers.
      But I think you have some really good insights in your posts. It is incredibly disturbing.

      • azmd

        Well, them, too. But it’s the American taxpayer that is most dissatisfied with the medical system here (as well they should be) while also resisting paying the higher taxes that would be associated with a single-payer system.

        • Deceased MD

          Interesting. But higher taxes compared to inflated rates of medical insurance that many will pay out of pocket?In a way, what’s the difference? I still think industry has the control here but I suppose tax payers always fight any increases no matter what.

          • azmd

            I think as it begins to sink in for more and more people that it might just be cheaper to pay higher taxes instead of paying an insurance company CEO and his minions to administer a private plan, there will be less resistance to single-payer. Let’s hope, anyway.

            I suppose there will always be those folks who are just philosophically predisposed to think that having private industry do something is better than having the government do it. Kind of ironic considering that Medicare in this country is such a popular plan.

          • Deceased MD

            Well put. i think the average person is starting to finally take note of this, Prior to this, it was not their problem, and most people seemed sort of apathetic to HC. It was not their problem and others would solve it. I guess the best way to get their attention is with dollars as you say. You are probably right. At least let’s hope so. Even if it is single payer, azmd, if industry has it’s fingers in the pie, I don’t think it will be much of a change. And I personally don’t see them giving up their control. And I don’t see gov’t taking any control away from them or setting any sort of limits with them.

          • azmd

            Well, not as long as we have a legislative system that allows lobbyists to make the kind of money they do…

          • Deceased MD

            What’s that phrase-great minds think alike. But seriously az ,what you say is so true.
            When all that stuff came out about RUC in the newspapers, the AMA sent their lobbyists to Washington.
            I have never felt so helpless in the past 7 years. We have witnessed bankers practice in corrupt ways and then just get bailed out without repercussions. Big pharma has legalized breaking antitrust laws by buying off their generic competitors. THe list goes on and on as I’m sure you already know.
            America is no longer the land of opportunity.
            Obama made it sound like he was out to change the corruption but it seems like he has just become one of them. Sorry for the political rant but I think they are all related to this topic.

  • guest

    Unfortunately, it would appear that an unspoken goal of the Obama administration is to “punish” physicians by marginalizing medicine and making it an increasingly unattractive profession to pursue. I have no doubt that the underlying intent is to create a system which will tend to attract more “altruistic” types who don’t have an interest in making a normal upper-middle-class salary, with the assumption being that those individuals will make better doctors.

    Also unfortunately, if we look at what has happened in Russia, where the medical profession has been systematically marginalized over the last few decades, the actual outcome appears to have been significant declines in life expectancy due to compromised availability of decent medical care.

    http://english.pravda.ru/society/stories/18-10-2010/115411-doctors_russia_usa-0/

    http://www.du.edu/korbel/hrhw/researchdigest/russia/health.pdf

    I think we all, including the Obama administration, need to ask ourselves this: regardless of how angry we all are with the medical profession, and how much we think they should be “punished,” for their sins, is this really the type of medical care that we want to be available to us and to our children in the future?

    The fact is that no matter what changes are made, medicine will always be a demanding, stressful occupation, and in order for it to be well done, it needs to be done by intelligent and motivated people. With rare exceptions, those types of people will have the expectation that they should be able to afford to educate their own children decently, and they will not choose a profession that is both highly stressful while also not providing them with that opportunity.

    You get what you pay for.

  • guest

    Amusing suggestion, but not practical.

  • azmd

    Unfortunately, it would appear that an unspoken goal of the Obama administration is to “punish” physicians by marginalizing medicine and making it an increasingly unattractive profession to pursue. I have no doubt that the underlying intent is to create a system which will tend to attract more “altruistic” types who don’t have an interest in making a normal upper-middle-class salary, with the assumption being that those individuals will make better doctors.

    Also unfortunately, if we look at what has happened in Russia, where the medical profession has been systematically marginalized over the last few decades, the actual outcome appears to have been significant declines in life expectancy due to compromised availability of decent medical care.

    http://english.pravda.ru/socie

    http://www.du.edu/korbel/hrhw/

    I think we all, including the Obama administration, need to ask ourselves this: regardless of how angry we all are with the medical profession, and how much we think they should be “punished,” for their sins, is this really the type of medical care that we want to be available to us and to our children in the future?

    The fact is that no matter what changes are made, medicine will always be a demanding, stressful occupation, and in order for it to be well done, it needs to be done by intelligent and motivated people. With rare exceptions, those types of people will have the expectation that they should be able to afford to educate their own children decently, and they will not choose a profession that is both highly stressful while also not providing them with that opportunity.

    You get what you pay for.

    • Deceased MD

      It’s strange to have so many good points to say like you do. And as far as i can tell, no one is lobbying for us and making those points come across at all to Congress. In fact I get the idea from this site that most of these organizations are working against us instead of for us. It’s very demoralizing to come to that conclusion.
      With mental health, it is obvious it has been cut to the point where it is mostly unrecognizable. All this talk after Newtown shootings now nearly one year ago, and nothing has been done to fund mental health, except i think NIH got funding for some esoteric research. I am not sure why it would take a massacre to get folks attention to the lack of resources in mental health but even that does not seem to get anywhere.

  • NewMexicoRam

    What I dislike is the control our current “single payer” (for those over 65) have on the purse strings.
    As I have noted in another post, Medicare fees to “providers” have gone up about 6-7% over the last 13 years–TOTAL. Inflation is over 30% during that time. And the proposal is for payments to go up another 0.5% per year for the next 5 years. That’s an 8-9% increase over 18 years!
    Martha, I don’t know what your salary was in 2000, but add 8% to it. Would you be satisfied with that pay in 2018?
    All other government contracts do have a competitive bidding process in place. BUT NOT DOCTORS. It’s a one-sided contract. If Medicare only wants to pay a certain amount, I say fine. But let doctors balance bill the difference to the patients. Unless the law is changed to allow that, the future of medical practice will be very dim indeed.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Balance billing will effectively turn Medicare into a defined contribution system.
      As counter intuitive as this may sound, I think that having Medicare for all (including the poor) will actually increase payments to physicians significantly, simply because there will be more healthy people in the pool, and hence more money in the pot for the sick.
      I also think that while competitive bidding is most likely not feasible, and competitive bidding is not very helpful to say, defense costs, negotiated fees should be the rule, most likely by State within a national framework. It can be very advantageous to physicians to have a voice in this process (and I don’t mean the RUC), if they can come together and marshal their strengths effectively.
      It somehow seems more fair to me than either dumping most of costs on patients, or having doctors who serve those in most need, get the least compensation.

      • NewMexicoRam

        If you think single payor will increase payments to physicians, then go right ahead. I’ve seen what Medicare pays me and I can only believe it would be worse than it is now.
        Patients are the ones receiving the service. I believe it is only right that more of the cost falls there.
        There isn’t a perfect system. We only deceive ourselves if we think we can get close to one. But to expect doctors to keep doing much more for little more becomes closer to servitude.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          No one is arguing that the costs should not fall on patients (current, future and past). There isn’t one single cent paid out for health care that did not come from patients, either directly or indirectly.The question is not who pays, but how it is being paid for.
          In the current system, a portion of each “private” health care dollar is skimmed right off the top and diverted elsewhere. If we got rid of that little corporate entitlement program, and put the entire dollar into a universal pot, there will be more money to pay doctors with.

    • azmd

      The problem with the complaint about Medicare reimbursements only having gone up 8-9% in the last 18 years is that there has been similar, or worse, wage stagnation for almost all other workers other than the CEO class over the last decade.

      As has been widely noted, compensation and wealth for the upper 10% of the upper 1% has skyrocketed over the last decade, along with corporate profits–largely as the result of increased worker productivity. Translation: almost all of us are working harder, for less pay.

      In medicine, that increased productivity has led to decreased quality of care. You can’t take an occupation which involves cognitive work, decrease the amount of time provided to do the work in, and come out with anything other than an inferior product (actually this is probably true for non-cognitive work, too).

      I see this in my field where what would have been a standard psychiatric evaluation at any self-respecting hospital 20 years ago, (a 1-2 hour interview with the patient, a similar interview with family to obtain collateral information, psychological testing, brain imaging if indicated and medical assessment) is now considered such a luxury that it is increasingly available only to the privileged few who can afford to fly to Houston and check into Menninger’s for a “comprehensive psychiatric assessment” to the tune of $2200/day out of pocket. The rest of us are provided with what our insurance pays for which is a rushed 45 minute interview with a harried clinician who is seeing 15-20 patients a day.

      Doctors, particularly primary care providers, are also victims of the increasing polarization of our society. It’s a dangerous trend that will likely not get reversed if we all, doctors and patients, continue to squabble amongst ourselves.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        That’s a very important observation, azmd. The line has been drawn and doctors are under the line, along with most folks that work for a living. We can squabble among ourselves about who gets to take a little more or a little less from others, but the portion of wealth underneath that line is getting smaller and smaller, and tearing ourselves to pieces over contrived ideological straw men thrown at us from above, is not going to accomplish anything.
        I know buzz said in another thread the doctors should not be expected to fix all society’s ills, but I think they are in a good position (along with others) to lead the fixing process. Fairness is a concept a 2 year old can understand, and it’s very American, and we have practically none of that left.

        • azmd

          Of course you are right, Margalit. From a practical and specific standpoint, what would you suggest that doctors should be focusing on in order to be involved in a constructive way? I think about this a lot, as I have somewhat of a platform in my state, but it is hard to figure out what to focus on.

          Also, there is a division within medicine which to some extent mirrors what’s going on in our larger society. There is a relatively small but powerful (because they have the resources to get involved) group of specialists who are very invested in advocating for their continued prosperity, and then there is a larger, somewhat disenfranchised group of primary care providers who are so swamped that they can’t figure out how to advocate effectively for themselves. It has a polarizing effect on the profession and I think is one of a few reasons that we can’t get organized as a group.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Well, I’ve suggested this before, but I don’t think physicians by and large are ready to take charge of this fight. I think doctors are one of the very few groups that (still) have immense public trust capital, which is a very rare commodity nowadays, and people will listen if the message is right, and if they perceive physicians to be fighting on the side of patients.
            One thing I’m certain of is that complaints about physician pay, or the RUC infighting, no matter how justified and correct these things are, don’t resonate well with the increasingly impoverished public. And physicians need to understand that an impoverished public cannot support decent pay for its doctors (with or without balance billing, with or without single payer), so even from a purely financial consideration, the current social inequity is detrimental to all doctors, except the very few who serve exclusively the 1%.
            There is nothing wrong with having the medical profession take a social, non partisan, stand on behalf of those they are supposed to serve in a medical capacity. Gives a broader meaning to the term “health care”…

          • azmd

            I am not so sure that physicians are not ready to take charge of the fight, so much as that they are just not aware of the larger social trends going on in the world, and don’t have a lot of inner resources left over for any sort of fight anyway.

            Unless you do this sort of work, it’s hard to imagine how completely consuming it is, and how many doctors barely have time and energy left over for their family, let alone to read the paper and take an interest in social injustice that is not directly related to healthcare issues.

            I think I am one of a few who gets it, because of a few different factors, one of which is that I took an extended period of time off from medical work and did volunteer work in the community, where I had time to watch, and read, and think to myself about what it was that I was seeing.

            I think the trick may be to figure out a way to deliver the message in a way that relates somehow to population health and medical care.

          • Richard Willner

            AZMED, it is time to go to DC and advocate for HR 2472–due process rights for Physicians and surgeons. This would be huge. “Doctor’s Rights” mean patient rights.

      • Deceased MD

        Great post. Wow Menningers charges $66,000 per month. WHo can afford this? What insurance would actually pay for this?

        • azmd

          Unbeknownst to the vast majority of doctors, most of whom are just pretty busy trying to keep their heads above water, there is an entire class of people out there who are easily able to afford to pay out of pocket for such care. At a family dinner this summer an in-law of mine referred to “people who are struggling along on $600,000 per year.”

          That what we’re talking about when we talk about the division between the rich and the poor in this country. Most people just have no clue how bad it has gotten, because they don’t come into contact with the upper 0.1%

    • Deceased MD

      It’s ironic but the cost of colchicine re patented is more expensive than the office visit under medicare.

      • ninguem

        ^^^ what deceased said ^^^

        The story of colchicine is a classic example of crony capitalism.

        Manipulating regulatory mechanisms and using “lawfare” to gouge the price of a drug that used to cost pennies.

        LITERALLY, the drug went from a nickel a pill, to five dollars a pill, thanks to URL’s reprehensible behavior.

        I for one will never prescribe anything they make.

        • Original_Cait

          I’m glad you mentioned crony capitalism. A lot of people would point at that situation and crow, “See? That’s your ‘free market’ for you, it proves that the ‘free market’ doesn’t work, this is why we need MORE government regulation!” But it’s about as far from a free market as you can get.

          Like they say of crony capitalism, when buying and selling are controlled by legislation, the first things to be bought and sold are legislators. Rather than aim their arrows at wealth-creators like the Waltons, people should be asking how it is that nearly half of all Congresscritters are millionaires?

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    On a different note, it seems that private insurers are also of the opinion that we have too many doctors as they throw physicians out of their “networks” by the thousands, so maybe all those cuts in residencies are not just random dumbness, but part of a whole
    http://www.fiercehealthpayer.com/story/unitedhealth-drop-19-docs-medicare-advantage-plans/2013-10-09

    • Deceased MD

      Interesting. That’s weird that it is happening now. Wonder what that is about. Any ideas? Especially since many areas don’t have enough docs taking medicare-at least in PC.
      In the 90′s that was common that “networks” or “panels” were “full”. So you could never even get onto an insurance plan back then for many docs. I referred to it as “Mangled Care”.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Yes, Mangled Care is back. I think this is the airline syndrome where they eliminate commuter flights until every single flight is packed to the last seat. Having too many doctors, means having too many data sources to manage and too many cats to herd. Patients are irrelevant.

        • Deceased MD

          Really mystifying. There are clearly not enough PCP’s. If we are returning to the 90′s with mangled care, I am guessing that there will be doctors not accepting pts at united healthcare or incredibly long waiting lists to get in. What part of the country is this happening or is it just everywhere?

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            The article was about United Healthcare in Connecticut, but the concern was that if such a large payer sees fit to do this, than others will do as well.
            If you think about it from the payer perspective, it makes sense to have fewer doctors in the network, with each one having a larger percent of his/her panel paid for by that one insurer, in which case the physician is a lot more dependent on the particular insurer, and hence more “amenable” to being controlled.

          • Deceased MD

            The problem with this, is that the “customer”(pt) may switch plans if they don’t have access to care. And I think with the ACA, there will be more competition for them. Just a thought.

            I like what you said earlier about trying to make change and that the public trust doctors more than other fields-especially in these troubling times. It is very twisted though. Because the organization that is suppose to speak for us has its own agenda. How would one even start? Like az said earlier they have a ton of lobbyists, and endless money. Whereas the average physician is not a politician. Sounds like it would be a full time job. And in this day and age, it is hard to know where to start.

          • Original_Cait

            “the “customer”(pt) may switch plans if they don’t have access to care.”

            Not with the Obamacare exchanges. In many of them, there are only one, two or three different insurance companies participating. If you are unlucky enough to be in one of the many areas where there’s just the one insurance company offering plans on the exchange, there’s not much you can do about it. You see whoever they tell you to see, and that’s it.

          • Deceased MD

            I am assuming there are other plans that are not in the exchange to go to.

          • Guest

            You can only get the government subsidies if you go through the Obamacare exchanges. For singles who earn less than $44,680 and for families who earn less than $92,200, that’s a pretty big deal.

          • Original_Cait

            But then you can’t get the Obamacare subsidies. You can only get subsidies if you buy from the government exchange. Given that they’re estimating that up to 50% of Americans will be eligible for subsidies, the choice for those people is to sign up with the one insurer on the exchange, or go outside the exchanges and forfeit any subsidies.

  • azmd

    Of course, when I say that I’m in favor of a single-payer system, I am sort of thinking of a system where medical education is subsidized and where physicians are government employees and provided with generous benefits, a reasonable salary and a manageable work day.

    Not the hybrid we have now, where the individual practitioner takes on the risk and the responsibility for treatment, billing and compliance and accepts increasingly paltry payments for the government-paid patients he or she sees.

    Just my opinion, of course.

  • guest

    From NY Times: In all other developed countries, governments similarly use a variety of tools to make sure that drug manufacturers sell their products at affordable prices. In Germany, regulators set drug wholesale and retail prices. Across Europe, national health authorities refuse to pay more than their neighbors for any drug. In Japan, the price of a drug must go down every two years.

    • Original_Cait

      “In Japan, the price of a drug must go down every two years.”

      That’s probably why so many new drugs are developed in Japan. Gotta love those incentives!

      • Deceased MD

        There are multiple medications that have been around for decades that have been pennies to buy in the past. These meds for example are used for asthma(albuterol) or colchicine for gout are now a small fortune and unaffordable for many to buy in the US. The reason?
        Now they are re patented and being sold as a brand name. it might be worth for anyone to read the NY Times article.

      • Noni

        How many meds have been “innovated” in the US in the past decade? How many of those have actually HARMED people in the rush to get them onto market (i.e., score gynormous profits for big pharma?).

        Now big pharm wants to take meds that are cheap and make them expensive again. Just as insurance companies are facing some regulation now I only hope that one day the pharmaceutical industry is stopped from continually getting away with murder.

  • guest

    The six Walton heirs have the wealth of the bottom 130,000,000 of their fellow Americans. The Koch brother heirs have $34,000,000,000.00 each.

    The 400 richest Americans now have 1.7 trillion dollars. Four hundred people, and
    1.7 TRILLION dollars among them.

    That doesn’t consider the richest 1000 or more. And the money is not spent, and the money is sheltered from taxation even as they press for an end to the estate tax. It disappears from circulation, and we are continually vacuumed by corporate power for whatever we have left, as workers, as patients, as customers, and all.

    So here we are, spitting at each other, afraid to help, angry at any possible loss to ourselves and losing anyway. Deciding that the sick are pretenders, the uninsured are out to take advantage of us, the old are wicked, the students are spoiled.

    And on and on. We can hardly pool our money to help us all anymore. It feels like just another robbery, as corporations go on metastasizing, from the food we eat to the care we get to the spies who watch our mail and the war profiteers.

    Until we see where the money has gone and stop hurting each other, until we face the corporate/wealth machine down somehow, we will all go on losing. Until there’s nothing left. And the worst of it to me is the unmerited anger and hate that we are tempted (and sometimes encouraged) to turn against each other. It’s evil.

    • azmd

      You are 100% right. Any thoughts on what we can do about it?

    • Chiked

      Yep. Same wealth concentration occurs in third world countries. We just go about it differently.

    • Original_Cait

      OK, so you confiscate all the wealth of the Evil Rich, and redistribute it to those you feel are more worthy of it. Then what?

      You cannot make the poor, rich; by making the rich, poor.

      And “Eat The Rich!” isn’t exactly a sustainable long-term fiscal policy. You’re going to be hungry again next month, so who will you eat then?

      • azmd

        Actually, it’s Econ 101. There is a finite amount of money (in a stable and rationale economy) and if the rich have more of it, then there’s less for the poor.

        It’s not clear to me why there is such resistance to understanding this concept; it may be a uniquely American thing due to our optimistic belief that if you only work hard, you can get ahead and maybe be rich, too.

        Our society is approaching the point at which the rich have so much more than their fair share that there is not enough for other people to live reasonable lives, and certainly it’s well documented that their chances of moving up and doing better have never been worse.

        • Original_Cait

          “We’re not broke. This country is not broke. The state of Wisconsin isnot broke. There is a ton of cash. Trillions of dollars of it. But it is a finite amount. What’s happened is we’ve allowed a vast majority of that cash to be concentrate in the hands of just a few people. And they’re not circulating that cash. They’re sitting on the money, they’re using it for their own — they’re putting it someplace else with no interest in helping you with your life, with that money. We’ve allowed them to take that. That’s not theirs, that’s a national resource, that’s ours. We all have this — we all benefit from this or we all suffer as a result of not having it.” – Michael Moore

          ——

          You’re parroting rich fat white guy Michael Moore. Who is not an economist, and who is also quite wrong.

          Wealth does not follow the law of conservation of energy. We actually create wealth all the time. Is this world of ours poorer because of Bill Gates’ or Steve Jobs’ or the Google guys’ innovation and subsequent wealth-building exercises? If Warren Buffet had decided to be a career dole-bludger instead of an entrepreneur and “hoarder of wealth”, do you really think “the poor” would be wealthier?

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            There is nothing wrong with getting rich, due to hard work, innovation, genius or pure luck. There is everything wrong with getting exceedingly rich, by using your rich status to defraud everybody else.

          • Deceased MD

            Original Cait-very good name. So it’s true that many of the companies you mention have added value in the world. But how about the ones that don’t?
            For example anyone reading this might be interested in reading the front page of the NY Times. There are multiple medications that have been around for decades that have been pennies to buy in the past. These meds for example are used for asthma(albuterol) or colchicine for gout are now a small fortune and unaffordable for many to buy.
            The reason?
            Now they are re patented and being sold as a brand name.

            So are these older generation meds that are free in England, are they adding value? Examples like this are extremely common and books have been written about this. But the economic term is rent seeking.

          • Kropotkin

            Since you seem to generally be pretty accepting of whatever rich white guys tell you, I guess your dislike of Michael Moore must boil down to the fact that he is obese. Classy. It is an absolute fact that the levels of income and wealth inequality in America are the greatest they have been since the late 1920s (right before the Great Depression), and are still increasing steadily each year. Doesn’t bode well for our near-term future does it?

          • Original_Cait

            “Since you seem to generally be pretty accepting of whatever rich white guys tell you…”

            Actually, I get a lot of my ideas from Thomas Sowell, who is an actual economist rather than a hack propagandist & “documentary” maker. Google a pic of him and you’ll see how far off base you are.

      • Martha55

        Exactly. Why should the rich be taxed and pay for these government handout to hospitals?

        • Original_Cait

          The rich are already taxed. The top 10% pay 68% of federal taxes. If you “eat the rich and take all their stuff”, who’s going to be footing the bill for society for the rest of the foreseeable future?

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Obviously you can make the poor (and the entire middle class) poorer, by making the rich richer. I am fairly certain it can work the other way around just fine.
        No, “Eat The Rich!” is not a sustainable long-term fiscal policy, but neither is “Eat The Non-Rich!”, although this one may have better longevity because the eaten seem to be completely oblivious to the fact that they are being devoured….

    • ninguem

      So if you take every penny of the Walton’s wealth and sent them to the gas chamber, and redistributed that money to the bottom 130-million Americans, the income of that 130-million now doubles. For one year.

      What happens next year?

  • Deceased MD

    I am confused. I looked up in Modern Healthcare magazine and it says $780 million was the proposed cut for GME NOT $11 billion. Where did the author get this number from?

    • Christy Duan

      Deceased MD, you’re correct that the $780 is the 2014 number. But it’s important to note that the cuts increase each year until 2023. There will be $11 billion in cuts from GME funding in the next 10 years. You can find that number on page 196 of the President’s budget proposal at: http://www.whitehouse.gov/sites/default/files/omb/budget/fy2014/assets/budget.pdf

      I hope that helps!

      • Deceased MD

        oh I see.That is very disturbing.

  • Dan

    How many of these out of work residents did poorly on their step 1/ have bad grades and did not listen to their counselors and tried to get residencies that were beyond their realistic chances?

  • Original_Cait

    It is absolutely not the case that “the 90% can’t afford to get treatment”. And once again, eating the rich and taking all their stuff is not a sustainable fiscal policy, because sure as tacks you’re going to be hungry again tomorrow, and then what will you do?

    A country without wealth-creators is a country that can’t create wealth, is a country that ends up looking like Detroit does ever since they scared away all of their wealth creators.

  • Kropotkin

    “Although there is a pressing need to reduce the federal budget deficit…”

    No there isn’t. And realizing this will ultimately be the only effective way to resist the austerity being forced upon us by the wealthy oligarchy and their bought-and-paid-for politicians.

  • Richard Willner

    Young Podiatrists need a three year residency to get licensed. However at this time, there is a 20 percent shortfall in residencies. I am currently working with one young podiatrist who graduated with a student loan debt of $250,000 and after three years of unmatching, now has a debt of $360,000 ( $340,000 student loans and $20,000 VISA).

    I have offered him private coaching and have the following offer for him: Our group developed a business for him where he starts at $1,000 per week, private coaching with two orthopedists and an excellent Hyperbaric Medicine center, etc.

    Residents must understand that because of the Health Care Quality Improvement Act of 1986 and for other reasons, they do NOT have “Due Process Rights”. They do not have constitutional protections. I know that these statements are too extreme to wrap one’s mind around it. The ONLY right a Resident has is Procedural Due Process, or the right to a “Fair Hearing” with is not fair and it is hardly a hearing.

    Richard Willner
    The Center For Peer Review Justice

    “Doctors are our patients”.