Let's talk about Healthcare EDUCATION reform

[bossy22]

We all know that our nation's health system is a mess, but what is rarely talked about our medical education system. according to reports such as these https://www.aamc.org/download/328322/data/statedebtreport.pdf medical school tuition has increased on average of 6.3% each year for the last 30 years. Today's graduates are graduating with higher and higher debt loads- some in excess of $300,000 when we add in undergraduate tuition. This debt can take half a life time to pay it off. Personally, i know of attending doctors who have been in practice for over 15 years (not counting residency) and still have half their loans left. At their current rate, they will finish paying off their debt when they are in their late 50's. This is leading to many young adults looking away from medicine for their careers. While medicine is still a "lucrative" career choice it might not stay that way forever. Insurance/medicare/medicaid reimbursements keep declining and many doctors are having trouble keeping their income constant. Again, doctors are still making a comfortable living now but i'm talking about the future. Stagnant income plus increased debt load are becoming problems.

I would like to put forward an idea. This idea is modeled after the armed forces medical school programs. The army/navy/airforce will often pay for your tuition (along with giving you a living stipend) in return for 8 years of service after you graduate. Though your income for those 8 years is less than you would make privately, you come out 8 years later debt free with usually a decent amount saved (the military pays you a fair salary). Why not apply this type of program to "civilian life". We could develop a program where DHHS will pay for your medical school tuition in return for 8 years of public health service post residency. This could be structured to something like requiring a participating doctor to work at a free clinic (in their specialty) for 2 weeks a year for 8 years. This would have the added benefit bringing healthcare to those who can't afford it.

What do you guys (and gals) think?

[Erich Bloodaxe BSN]

1. Or we could restructure how we pay doctors afterwards as well.

Pay all of the college costs upfront, and quit paying doctors through the nose afterwards, to cut the cost of healthcare in this country. Pay them more along the same lines as nurses, since they won't have any giant bills to pay off after graduation. That would seriously drop the cost of surgery, for instance.

[bossy22]

3. you can't pay a doctor the pay of a nurse

there is a lot more responsibility that a doctor has that a nurse doesn't. Not to mention the differences in training (some surgical specialties require 14 years of post high school education as compared to an RN that requires only 4 years) and knowledge.

Nurses are a vital part of our healthcare delivery system, but they can't replace doctors.

[Erich Bloodaxe BSN]

5. Actually, Nurse Practitioners are replacing a number of doctors.

And you can become a registered nurse after only 2 years, not 4, although there's a push on to replace most of the two year nurses with at least 4 year types in the next decade. Personally, I've had 6 of the nursing, and will probably go on to grab another few for that NP designation as well. But the point is not to 'replace' doctors with nurses, it's that we shouldn't pay people simply based on how much college they've had. Hell, I've got something like 18 years of college under my belt, but I'd be happy for a job that paid 30k or so a year.

As to the responsibility, take the liability insurance off them as well. Have all of the facilities cover that.

[bossy22]

8. I was referring more to RNs in my post

yes, NPs are supplementing doctors when it comes to things like family medicine and primary care. But that isn't where the big bucks are- they are in surgery, dermatology, anesthesiology, etc.

I agree, you shouldn't be paid simply by how many years of college you have. When it comes to the medical field, it isn't the years of formal classroom education you have, but the years of graduate medical education you have- your residency. This is equivalent to years of experience. That experience gives them a niche skill that very few people have.

As for liability insurance, that may partially work for large medical centers, but what about private practices? Someone has to take responsibility and that responsibility will almost always fall on the doctor- he is the "general" of the healthcare delivery "army". It's his/her's patient.

[bossy22]

11. on the cost of surgery

I think alot of problems in this area (and hospital admissions are included as well) is that hospitals bill absurd amounts knowing that only 2/3 of those billed will actually be able to pay in full or a significant portion of the full amount. It is what i believe is one of our major problems in healthcare financing in the U.S. Instead of a single payer system where the hospital has a good idea of what compensation they will get from each patient, our system makes it a "crap shoot". Some insurances pay more, some less, some people pay out of pocket, others don't pay at all. I mean, we are the only western country that has an entire industry that is devoted simply to making sure doctors and hospitals get paid.

[frazzled]

2. The government already thought of your idea (and implemented it)

The NHSC Loan Repayment Program: The FY2014 Loan Repayment Program is currently closed. This program is open to licensed primary care medical, dental, and mental and behavioral health providers who are employed or have accepted an offer of employment at an NHSC-approved site and will begin working by July 15, 2014. Awardees receive up to $50,000 in exchange for two-years of service if they practice in a Health Professional Shortage Area (HPSA) of 14 and above (Tier I). Awardees can also receive up to $30,000 in exchange for two-years of service if they practice in a HPSA of 13 and below. In FY2013, all of the NHSC’s loan repayment awards were made to providers located in a Tier 1 HPSA. There were a total of 4,505 awards made (2,106 new and 2,399 continuations) totaling $169.7 million.

The Students to Service Program: This program accepts students in their last year of medical school and provides tuition and loan repayment assistance. In return, students commit to serve in Health Professional Shortage Areas (HPSAs) with the greatest need. This program is open to allopathic and osteopathic medical students in their fourth year at an accredited medical school. Awardees receive up to $120,000 in exchange for at least 3 years of service. In FY2013, 86 awards were made.

The State Loan Repayment Program: This program provides cost-sharing grants to more than 30 states to operate their own loan repayment programs for primary care providers working in HPSAs. The program is open to primary care providers deemed eligible in participating States. Providers apply to the individual State program, not to the NHSC. The number and amount of awards varies by state and by year. A minimum 2 year service commitment is required.

http://nhsc.hrsa.gov/loanrepayment/

[bossy22]

4. I did not know this- thank you for the information

[frazzled]

6. It goes for law schools too ...

I know about this because my niece graduated from law school recently and would like to work in the nonprofit sector to reduce or eliminate her loan payments. (Actually, she would choose to work in nonprofit anyway, but this makes it more alluring, even.)

It's not entirely easy to get these positions: they're sought after, for obvious reasons, and there are not enough for everyone. But it's a good program, I think.

[bossy22]

10. I've heard that those programs have been scaled back significantly

since our country has ventured into "austerity land". From what my friend told me it used to be after 10 years of work in the public/non-profit sector your loans would be forgiven, now it's 20 years and only a portion of your loans.

[jwirr]

7. There are also doctors and nurses that work in remote areas of this country to pay their loans back.

I knew many of them on reservations. However, I would not want anyone to have to go into the military.

I think there is a another model that was used to supply teachers. Teachers could get student loans for their education and then work in schools in low income areas for so many years to pay it off. This encouraged more to become educators and it allowed areas that had a lot of trouble to get teachers in their area. Today we have a shortage of doctors and this same idea could be used wherever there was a shortage not just in low=income areas.

My sister did this and taught school on an Indian Reservation in Montana for about 10 years. Each year some of her loan was forgiven.

[bossy22]

9. It sounds like a good idea

I would tailor it though for primary care physicians because that is what we are lacking most of in this country (it also happens to be the one that pays the least- go figure). I think we need to find a way to encourage more young doctors to go the primary care route.

As for the military, hey don't bash it. I have friends who went into the navy program and love it. The military isn't for everybody but from what I've seen it seems like a good program. If I wasn't as fortunate financially as I was (my family was able to help me pay most of my schooling without taking loans) I'd probably go into the military program.

[Sgent]

12. That National Health Service

is part of the Public Health Service and is "quasi" military. This includes the Indian Health Service and some others.

A family member was an officer, and never owned a uniform, never attended OCS, never even learned how to salute. They had to go to the local national guard armory to get an ID card, and got a paycheck and a DD-214 when they separated.

In theory they could have been called up but that hasn't happened to the PHS since WWII. If they want to get more involved, the PHS supplies the USCG and NOAA with their medical service and can do so if desired.

Its much more like being a reservist, but with no boot camp, no weekend / month or 2 weeks a year, etc. It also prevents non US citizens from joining (a requirement to be an officer).

[jwirr]

13. Then this would work for a lot of people. I was worried about being sent to war. I have friends who

joined and ended up in Iraq for more than one shift. When he got back he said - I wasn't counting on going to two wars when I enlisted.