Friday, July 29, 2011

The Hidden Costs of Medical Student Debt

I just chanced upon reading this insightful article from the New York Times Blog, about (as its title implies) the hidden costs of medical student debt. The author (Dr. Pauline Chen), a practicing doctor somewhere in the U.S., offers a personal recount of her experiences of indebtedness out of the aspirations of becoming a doctor. The truth is, indebtedness for medical students has been the norm for many decades but has quickly increased over the past decade or so. I think the statistics offered by Dr. Pauline Chen are valid: over 80 percent of each medical student class will graduate with debt, and the average debt per student is $158,000.

This figure may not seem much given the purported salaries of doctors, but in reality, I think there are many misconceptions that need to be debunked (disclaimer: I do not work in the field of medicine). First of all, not all doctors are created equal. Depending on what field they specialize (e.g. internal medicine, pediatrics), their paycheck may range from $80,000 to millions per year. I think it would be ignorant to assume all doctors are filthy rich; I'd bet the vast majority do not make more than $200,000 per year.

Aside from the problems of the attitude toward personal debt brought up by Dr. Chen, I think there are a significant number of other problems that warrant attention. These problems --both individual and societal-- are the culprits behind the skyrocketing medical expenses and...colossal debt for students. A number of them are specific to the United States:
  1. Length of required commitment -- normally 12 years from beginning to end; 4 years of premed in college + 4 years of med school + 3-4 years of internship
  2. High levels of stress -- being given the responsibility over someone's livelihood is no laughing matter and will cause stress when things (inevitably) go awry
  3. Uneven supply and demand distribution -- the American Medical Association places quotes on the number of graduates admitted into and graduate from medical schools each year. The result is a huge demand for doctors but little supply.
  4. Misaligned incentives -- unfortunately, good doctors often do not stay in their specialty practice long enough to make a difference. They tend to pursue high-income venues like plastic surgery instead.
  5. HMOs -- these have infinitely both complicated and raised the costs of medicine in the United States. Healthcare insurance is no longer being used as your average insurance -- you don't call up your auto insurance company for an oil-check of your car, do you?
  6. Bottleneck in certification process -- see #3 above.
Did you know that I did not always want to major in economics? When I first arrived in college, I was unsure about what career path I would take. Medicine seemed like a legitimate path back in those days -- after all, both my parents studied medicine (although they are not doctors). It took a rigorous course in genetics to make me realize that medicine was not for me. I wanted to become a doctor and follow many of my friends to medical school, but I ultimately realized that I could not deal with being stuck in education for another decade.

In addition, another reason for my unwillingness to pursue the medical route pertains to point #2 (above). It is the responsibility over the lives of others. Practicing medicine is difference from experiments -- there is no turnarounds if you screw up. If you do screw up, someone will most likely die. I am a pretty sensitive person (if that is not already obvious) so concern over this will consume me. Call me a coward, but I do not want the burden of knowing that I could have saved someone by administering a different treatment...that I was responsible for the death of a patient.

[When I started this post, I believe I had another intention altogether about what to write.]

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