At “Number Needed to Treat,” Josh, a public health expert and blogger, provides a welcome addition to my recent post on med school tuition http://numberneededtotreat.wordpress.com/2008/09/09/how-about-the-cost-of-applying-to-medical-school/
I wrote about how the cost of med school narrows the pool of applicants. Josh explains that even the copy of applying is well beyond what many students (and their families) can afford.
Josh writes:
“What struck me about Mahar’s discussion of the subject was a quote at the end of her article:
“According to the NEJM, a recent national survey of under-represented students reveals that the cost of attending medical school was the number-one reason they did not apply.
“I have no doubt that many under-represented students hear figures like $140,000 in debt and plainly quiet any inner voice telling them to pursue a MD. However, I also wonder how many students do the math, realize that the tremendous earnings potential of a physician would help pay off that mountain of debt, but also realize they can’t even afford to pay to apply to medical school.
“How much does it cost to apply to medical school?
“At a minimum, $370. This covers ONLY the MCAT fee ($210) and the AMCAS fee for one school ($160). This does not include any sort of preparation material for the MCAT, fees for applying to more than one school (rarely would a person put in the enormous amount of effort to simply reach the application process for medical school–4 years of hard science–and put all their eggs in one basket by applying to one school), secondary application fees (which are generally about $100 per school), or travel expenses for visiting a school for an interview.
“MIT’s Career Office conservatively estimates the cost of applying to 15 medical schools to be between $3,414 and $4,290 (see slide 29; also note–this estimate doesn’t include any prep materials for the MCAT which can cost up to $2,000 alone).”
Roughly $3,500 to $6,000 –just to apply? This is beyond the pale.
I couldn’t agree more with where I “think” this is going…
By the way, what does it cost to apply to 15 community colleges?
Of course funding this out of someone else’s pocket is not a solution. Keeping the expense high but shifting the cost of those expenses onto someone else is nothing more than “pass the buck” and is not a solution at all (Of course IT IS politics as usual).
Continue to focus on educational productivity and you just might do some good.
JUST ABSURD
I helped prepare application for ex-fiancee to well-known medical school in Cambridge, Mass. (she got in).
1. Yes, testing price is an issue. As with most monopolies — such as single-payer systems.
2. Apply to 15 schools — WTF? Five would do the job — three if really careful (definite-accept, maybe-accept, shoot-for-stars).
3. MCAT prep? I’ve never known anyone who took one — no $$$. Besides — at Harvard Med, they could fill their ranks with the 99%-crowd, easy.
If one is that weak academically — one might want to consider another field. Like public health.
Just absurd. Really.
that’s what the undergraduate loans are for. and jobs. if you want to go to medical school and you can’t figure out a way to apply, you won’t succeed at medicine, let alone medical school.
don’t forget the costs to apply to residencies and fellowships are probably along the same lines during the lean years. you have to pay your own way for those things too, despite your post graduate degree and potentially qualification as a board eligible surgeon or internist or whatever.
and i disagree with josh about the earning potential allowing it to be affordable-until you live the dream of $2000+ monthly payments for 30 years, it is easy to project out that you will be able to pay it off. maybe they are smart enough to know that getting that deep into debt is not something they really want to undertake, rather than not realizing it is doable?
the reality is that many physicians are struggling to maintain their incomes. 30 years of payments effectively serve as handcuffs that limit your job mobility and sense of freedom . that assumes you are not going to get ill for a period of time, that you will not lose your job, that your practice remains profitable, you will not have a catastrophic lawsuit, all of which are certainly not guaranteed. you cannot easily move to another state.
Add this to the mix:
http://news.yahoo.com/s/ap/20080910/ap_on_he_me/med_fewer_docs
“Only 2 percent of graduating medical students say they plan to work in primary care internal medicine, raising worries about a looming shortage of the first-stop doctors who used to be the backbone of the American medical system.”
Many countries provide free medical education, and their societies don’t fall apart as a result. In fact the west makes the situation worse by poaching their doctors and thus avoiding the expense of training them. This seems especially true in the UK.
The more priorities get distorted in the US the more it starts to resemble the last days of the French Monarchy. Those who stay on top are the toadies to the ruling elite, while the rest of the country gets impoverished.
One hopes that things get corrected without another 1789, but I wonder sometimes.
Robert, anonymous and Frank- Thanks for your comments.
Robert–The fact that, unlike other countries, we don’t recognize medicine as a social good, and so don’t subisdize medical education is, I think a great mistake.
Our system drives doctor’s fees higher becuause so many doctors wind up with enormous loans and great financial anxiety.
No doubt, some med students could do a better job of managing their money and keep their loans in check. But much depends on where you go to med school. If you’re in New York, housing, entertainment, restaurants etc are all going to be very expensive, and your loans are likely to be exorbitant
And most med schools are located in expensive cities.
But I don’t see us headed for a 1789-style revolution. Low-income Americans are just too depressed to stage a revolution– and I’m not being facetious. Look at the data on mental illness among the poor.
At best, we’re headed for something close to a Great Depression–and a New, New Deal.
At worst, we’re like Rome after it peaked– heading into an era of greater and greater decadence and ignorance, with more and more Americans leaving the country over the next 50 years as they become disgusted with our inability to elect strong, competent, visionary leaders, our inabiity to reform our health care system, our inability to fund good public education, our inabillty–despite our wealth–to bring an end to poverty. (In this way, we’re luckier than the Romans. It was much harder for them to emigrate).
anonymous–
You are right, many physicians do struggle with their loans for years.
But it is also true that a great many specialists and surgeons move into the $500,000 to $600,000 bracket pretty early in their careers–and then move on to the $1 to $2 million salaries.
In addition, a significant percentage of med students come from wealthy families who can and do help them, if not with med school tuition, with a downpayment on a home, etc.
There is nothing wrong with that. But what is unfair is that if you don’t come from a wealthy family, and choose a relatively low-paid specialty–not just primary care, but pediatrics, ob/gyn, being an ER doc or even a hospitalist (in demand, but not terribly well-paid), you face a financial struggle.
As for the notion that poor students should be able to come up with the money to apply by using their undergarduate loans and income from jobs . . Most truly lower middle-class and low income students (in the botom 40 percent, coming from homes where JOINT income falls somwhere below $40,000, before taxes,)are struggling to make ends meet in college. The loans are not that generous, and the amount they can earn on campus and in the summer is not that great, IF they can find a job (If you’re a black male, your chances are greatly diminished even if you’re a college student. )
Frank– You wrote “IF one is that weak academically, maybe one should consider another field, like public heatlh.”
This is exactly the attitude that has so undermined the health of this country. You imply that “public health”–which focuses on the health of the population as a whole, and problems ranging from AIDS to Obesity to the environmental factors that make us sick is a lower-level profession for less-smart people.
In my experience truly intelligent doctors understand the importance of public health. Many have a MPH (master in public health) as well as an M.D. Mediocre medcal minds can’t quite grasp the importance of public health.
There are brilliant public health experts just as their are brilliant M.Ds.
I have to say your ex-fiance is a very lucky woman.
You are right, many physicians do struggle with their loans for years.
But it is also true that a great many specialists and surgeons move into the $500,000 to $600,000 bracket pretty early in their careers–and then move on to the $1 to $2 million salaries.
The percentage of doctors making 1 million or higher is so ridiculously small that its absurd to use it as a reference point in the larger discussion of healthcare.
“I have to say your ex-fiance is a very lucky woman.”
—
Yes, she was. She got a sap to help her get into Harvard Med (e.g., the five success factors, including essay editing) — then dumped him for someone younger.
Madam, if you cannot face the fact that there are limited resources — 15 applications, my God! — you will never be happy. Never.
And that unhappiness shows, big-time.
One more thing, madam —
Records indicate you received a PhD in English from an Ivy, then worked in publishing.
It then stands to reason that you, like Mr. Obama, have never had direct, front-line, and hands-on responsibility for financial matters.
Therefore, it is understandable that your lack of authentic experience with limited resources (staying within a budget) leaves you unable to comprehend the economic world. My apologies, and good luck.
“At worst, we’re like Rome after it peaked– heading into an era of greater and greater decadence and ignorance, with more and more Americans leaving the country over the next 50 years as they become disgusted with our inability to elect strong, competent, visionary leaders, our inabiity to reform our health care system, our inability to fund good public education, our inabillty–despite our wealth–to bring an end to poverty. (In this way, we’re luckier than the Romans. It was much harder for them to emigrate).”
————-
If the repubs win the next election, this option will actually begin to sound appealing, but where do these disgusted Americans tend to go?
Frank:
I’m not sure I understand your point. Are you saying that Maggie’s doctoral degree in English disqualifies her from having any knowledge of financial issues? Warren Buffett, no financial slouch, thought very highly of her book about the stock market (http://www.businesspundit.com/10-investing-books-recommended-by-warren-buffett/). It seems to me it would be hard to write a book like that without knowing a good deal about money, budgets, and such.
Frank seems to be assuming that your comment “I have to say your ex-fiance is a very lucky woman.” referred to the fact that she got into medical school. My assumption, based on his postings, is that you were congratulating her on being rid of him? Talk about “unhappiness showing”? Sheesh!
I am applying to med school now, and it is interesting that no one has mentioned the fee waivers that are available when applying to medical school. That can drastically reduce the cost… but you still have to fly out to interview if you don’t live close by.
And 15 applications is totally reasonable when you look at the number of people applying for the available spots. It is not like college. There is not necessarily a “sure thing” for med school acceptance.