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.]

Thoughts on the Death of Bin Laden

As most of the world found out last night, Osama/Usama (?) Bin Laden was killed last night in a nighttime raid by U.S. Navy SEALs on his well-fortified fortress in Pakistan. News reports indicate it was a short struggle -- 40 minutes and the architect of the September 11 attacks was dead, along with a few other collaborators. This news resulted in an amalgam of sentiments, an overwhelming amount which were positive, in addition to speculations of its implications. Most of the latter were on its impact on President Obama's reelection bid for 2012. I just thought to summarize the viewpoints I've been hearing about, as well as add in a few of my own.

Let's first examine at the implications being expressed by both individuals and by the media:

1. Obama just locked up the reelection bid.
2. Obama just capped up a "winning" week, with his snub of Donald Trump and this news.
3. Note to other terrorists: do not mess with the U.S. of A.
4. So proud to be an American!
5. This news just made my day!

Indeed the death of an individual responsible for more than 3000 deaths on September 11 and reshaping our world forever is to be celebrated. Al-Qaeda has certainly complicated the security issues surrounding our current environments. It also brings an end to a 10-year hunt for Bin Laden, who the former President Bush memorably conjured the "wanted sign" for a bounty on the person's head. But I feel that most people have either forgotten or just ignored the preface to the terrorist attacks.

(Before I proceed, I became a U.S. citizen last year through the naturalization process and am proud to consider myself to be an American. Yet at the same time, it is important to be critical of my government and the thoughts of the populace when I feel they are going down the wrong path. What I just stated is the essence of what being a patriot is all about.)

American imperialism is the main trigger for the September 11 attacks. Other explanations are negligible compared to the impact of America's attitudes and actions against other countries around the world. Yes, I know it doesn't sound pleasant but it is very true. We Americans live in a place very much secluded -- often voluntarily-- from the rest of the world. Most Americans simply do not care about the state of the world affairs, and possess this attitude of "We are better than anyone else". Representative of this arrogance, the American government has been at war with other countries for most of the last 200 years. We all know about the Second World War, Korean War, and Vietnam War. But how many of us know of the controversial actions taken by the government, such as the assassination of former leaders of nations (e.g. Salvador Allende) and the propping up of despotic governments (e.g. Shah of Iran, Cuba before Fidel Castro)? It is the latter that have profoundly instilled a mixture of fear and hatred towards the U.S. Unfortunately, the latter sentiment cannot be altered by sporadic humanitarian gestures.

When the U.S. attacked Iraq in the 1990s, it was rightfully under the guise to uphold the sovereignty of Kuwait. Saddam was beaten back and ultimately surrendered. But the U.S. often operates under the assumption that it is above the law of nations to which all countries are subject to. The political science term is "unilateralism", which stems from the U.S.'s position as the world's remaining superpower since the demise of the Soviet Union. This assumption results in taking actions regardless of opinions of other countries or peoples. For many in the Middle East and across the world, Bin Laden's planned attacks on September 11 were captivating for the sheer fact that he dared to stand up to the mighty of the American military machine. If anything, it damaged this image of America's invincibility and showed that she could be hurt in spite of all the military power.

Using film as an analogy, it is very much in the second Iron Man movie, where the villain Ivan Vanko stated his only reason to attack Tony Starks was to "make God bleed [because then] people will cease believing in him". Bin Laden, in a similar manner, destroyed the myth of America's invulnerability. And this is what makes things so dangerous, even following his death. Bin Laden was an inspiration for the haters of America to take up arms against her -- and inspirations tend to outlive their creators. Therefore, we should be weary (as some military strategists have declared already) of declaring total victory just yet. I will argue that unless this arrogance perception of the world is changed, very little will have. Another madman may come along to formulate another plan to make America "bleed". This just leads to an endless cycle of violence -- because of the hatred for the country we call United States.

Going back to the implications discussed in the beginning of this blog entry, Obama will take/receive credit about the death of Bin Laden and I think it is largely unwarranted. He simply inherited the operations from the previous president and it so happened that Bin Laden was found and killed during his presidency. He did not have an alternative to hunting down Bin Laden. If it does propel him to a second term, I really hope this is not the reason why.

Now now, I do not hate Barrack Obama. I think he is a positive change from Bush, but has largely fallen short of expectations and remains over-hyped. Inasmuch as Bin Laden was killed during his presidency, in the same way Obama inherited a dismal economy from Bush. He may not have done as much as I had hoped, but perhaps there is nothing more he can do.