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The latest news and trends in medicine.

A Near-Sighted Look at Our Growing Medical Student Debt Problem

One of the many things I love about my five year-old son, Connor, is his ever-evolving imagination. For instance, about a year ago he wanted to be a “knight” when he grew up, and a couple months before that he wanted to be a “stop sign.” So several weeks ago, while getting his first pair of glasses, you can imagine my relief when he came bounding through the door saying, “I want to be an eye doctor for children.”

Of course my initial reaction was to say, “Son, let’s sit down and talk about the benefits of joining your local medical society.” Hey, at least you know I am always working.

So, I am his parent and obviously I believe that this bright little boy is capable of achieving anything he puts his mind to, including becoming a pediatric ophthalmologist (even if he can’t pronounce it yet). Which leads to my second reaction: how the %^#^ is he going to pay for this!!

So the next day I did what any self-respecting neurotic parent would do:

I started to calculate how much it would cost for my little guy to be called Dr. Connor Huckleberry. What I found made me half wish he stuck with wanting to be a stop sign.

I began to factor in some of the necessary variables. First, knowing my son, he is going to want to follow in his father’s footsteps and attend Drexel University’s hallowed halls for his undergraduate degree and he’s going to want to live on campus. Now, although I have all the confidence in the world that Connor will get a full ride scholarship for basketball, to keep this article fair and academic, I omitted all possible financial aid.

I also factored in the trends of yearly tuition increases, which hover slightly above 5% a year, as well as cost of living increases which I estimated at about 3% a year. So I started my research by going on Drexel’s admissions and financial aid pages.

Connor’s Estimated Undergraduate Expenses

In 2017, Drexel’s tuition and fees were set at $48,791. Ok, that I can live with…. Room and Board and meals are an estimated $14,367. Whoa! What the heck happened to Raman noodles and a tinder box of an apartment held up with pizza boxes and beer posters?

Books and supplies are an estimated $2,554. Does each book come with a Faberge egg?

Drexel was also kind enough to factor in other “personal” expenses estimated at $4,278. Where are these kids coming from, Buckingham Palace?

That creates a grand total of $69,900 in tuition and expense for 2017. Which is fine, until you remember Connor is only five. So let’s factor in $69,900 with an annual 5% tuition increase and a 3% cost of living increase…compounded over 14 years, shall we? Click…clickety…click…click…click… carry the two…and…Thud…………………………………

I am sorry, I just came to.

According to my figures, when Connor starts freshman year at Drexel, tuition and expenses could possibly be starting at $128,668.23. And over the next four years, he could potentially accumulate close to $550,000 in undergraduate college debt.

Now I know you are thinking, “T.J., Connor can dribble with his head up with both his right and left hand. At age 5 surely that will correlate to a full basketball scholarship by age 18.”

I am sure you are right, but we still haven’t calculated his medical school bills.

Connor’s Medical School Expenses

Again, being the supportive and nurturing father I am, I did what any parent would do and actually called the Perelman School of Medicine Admissions Department at the University of Pennsylvania, and confidently explained to an totally bewildered admissions director that, “I have a five-year-old son who wants to be a pediatric ophthalmologist and attend your University. I would like to know how much tuition and expenses would be in 2035.”

To my utter amazement they did not have that figure available. But they were kind enough to provide me with their current four-year tuition and expenses plan.

2017 tuition for Perelman School of Medicine is set at $58,809. An additional $3,528 in health insurance and education expenses and $22,200 in living expenses is also factored in. In all, a 2017 medical student is paying about $84,557.00/year.

Ok, that’s fine, but what about in 2035 when Connor starts? Well, using the same formula of compounding the current tuition by 5% and cost of living at 3% over 18 years, my aspiring doctor will start his first year of medical school at about $185,365.12/year.

When he finally earns the right to be called Dr. Huckleberry, he will have a grand total of about $793,401 in college loans from just medical school.

When he finishes his residency and starts Huckleberry Eye Care, he will have accrued $1,343,921.84 in college debt.

Of course, this number will only further explode once you factor in his not-yet-discussed student loans. Assuming he is lucky and all his loans average around a 4% annual interest rate for a 20-year payback length, Connor’s total consolidated loan payback could be close $1,900,000.

Paying for the Learjet he will never fly

It’s important to state that these numbers are by no means beyond the scope of error and I do not possess a crystal ball to draw some unequivocal data to support my estimates.

Of course, I picked two very good schools that are extremely competitive and are at the higher end of the tuition scale. Certainly these are not the only options students have and there are many wonderful schools that also have a lower price tag as well. And again it is worth noting, these numbers would certainly go down with any grants, scholarships or financial aid packages made available.

However, even with a generous financial aid package, the figures are still alarming, and if the rates of tuition increases remain as they are, these numbers could very well represent the debt load the future of medicine will face.

To put this situation in medical terms, this problem is systemic.

According to the Association of American Medical Colleges (AAMC), 84% of medical school graduates are averaging over $176,348 in debt. In 2011, it was averaged at $160,000.

Furthermore, ten years ago the Association of America Medical Colleges reported that, from 1994 to 2004, medical school tuition and fees increased by 165% in private schools and 312% in public schools.

When I was looking at colleges and tuitions, I remember my guidance counselor likening my student debt to paying for a car that I will never drive. For current medical students, it seems that they are paying for homes they will never live in…and in Connor’s case, he will be paying for a Learjet he will never fly!

My Last Rant

Our feature article Behind the Curtain of Medical School Debt will provide you all an illustration of the long-sweeping effects this debt load could have on the medical community as a whole. It will also address what Pennsylvania is doing now to combat this matter. I encourage you all to read it.

But before you turn the page, I would like to leave you with this. I grew up the proud son of a mother who worked multiple jobs to keep our family comfortable. The individual that inspired me the most was my grandfather, a veteran of World War II and a self-made man – he owned our local gas station. I was raised with food on my plate and an unwavering awareness that with hard work, I could be whatever I wanted to be.

Now, my wife can attest that I worry very little about things I cannot control, but the very thought of my children failing to achieve what they want out of life because of sheer economics frightens me. For me, failure due to lack of merit or talent is not only acceptable, it’s noble, it’s American. Choosing the life of a physician means that you take on extra risks and sacrifices. That is why the title of Doctor is earned, not acquired.

As a community, we need our young and bright minds to take these risks and accept these sacrifices to further the art and science of medicine. But with the student debt spiraling towards the ridiculous, could this be too much to ask of them? How many potential physicians could we stand to lose?

I can only hope that when Connor finally settles on his chosen profession, Physician, knight, stop sign, whatever, he can do so with certainty that he will achieve his standings on his own merit and not because he could or could not afford the necessary training and preparation. In the meantime, I salute all parents of physicians, who at one point sat down and crunched some numbers and said, “$33,000 for medical school? How the #$%$ can anyone afford this?” and still supported their child anyway.

Also to my BCMS Executive Council: it’s never too late to talk about my next raise. My two-year-old, Nolan, is fascinated with ears and noses…

Paying for Value?

by Heath Mackley, MD, FACRO

Our politicians, fond of catchphrases, have endorsed the latest Medicare reform agenda as a move from “volume to value.” But what is value? A health economist will tell us that value can be quantified as outcomes received per dollar spent. The rest of us non-economists out there might say that value is the usefulness, or worth, of something. So what value do we as physicians bring, exactly? Most of us in medicine don’t think about value on a daily basis. We tend to focus on doing the best we can, on each patient encounter, every day. And as much as we might be tempted to keep focusing on our job and hope these new reforms don’t disrupt our ability to care for patients too much, I think we need to understand how this affects us. Furthermore, I think a rational focus on value can be a positive force for change, beyond patient care and reimbursement, by giving us a paradigm to evaluate where we need to be as a society, both on the county and state (PAMED) level.

Behind the Curtain of Medical School Debt

by Lucy J. Cairns, MD, and T.J. Huckleberry, MPA

The debt incurred by students in the process of completing medical school in the U.S. has certainly ballooned to levels likely to give aspiring medical students (and their parents!) pause. But the implications for current and future students are not entirely clear, since physicians are a relatively highly compensated group. In this feature we will examine the question of whether we should be concerned about the rising debt burden of the average medical student. What are the consequences for the individual students? What are the implications for the wider community?

As a starting point, we reached out to some recent medical school graduates – resident physicians in training at our local health systems. The following are answers we received to a questionnaire we created to ask for some insight. Keep in mind that these physicians have all chosen a career in a primary care specialty.