Is it still worth it?

[NLengr]

How did they handle the issue of universal coverage/accessibility? i.e. "I'm a poor person in 1920's America and I become seriously ill. What do I do?"

 

Usually die relatively quickly and cheaply. Modern medicine is a completely different beast than 1920's medicine.

[Exocytosis]

Usually die relatively quickly and cheaply. Modern medicine is a completely different beast than 1920's medicine.

 

I know, but I'm curious about whether these systems made medical care open to the lower classes or if it was still sharply gated by class.

[medigeek]

If you do it right in medicine, you'll be much better off than in other fields. (considering likelihood of success)

[ralk]

I'll tackle this is bits.

Firstly in a free market medical training wouldn't be that expensive, as no one could go. There would be true competition within the market thus driving prices down and quality up. (If people can't afford your product, you won't be in business very long) This in of itself solves your problems within your first question. I would also add that you would pay much less taxes and could thus save up for education, not to mention that it would eliminate those who go into medicine more on a whim (sorting through the price system). Do you pay tens of thousands of dollars for a computer? No as there is competition in the electronics market. Whenever someone has a monopoly supply decreases and drives prices up to non EQ levels.

 

Ideally the government would not be in the hospital business, plain and simple. (They're doing such a marvelous job right now aren't they?) is a hospital truly such a marvel that only the government can provide them? If so why doesn't the government provide us with cars and clothes and computers? (the way you phrased your response leads me to believe that you would enjoy the government providing everything for you as it is the only way to get efficient allocation of a service/good)

 

Lastly I HATE when people use the US as an example of privatized health care. IT IS NOT! HMO's are all in bed with the government, being 'selected" to be the ones who succeed or don't, as opposed to a market system where the market itself (consumers) support those who offer the best products at the best prices. In a true free market you eliminate these monopolies/oligopolies that are oh so too often found in the current system of crony-capitalism.

 

Hopefully I answered some of your questions.

 

Price elasticity and information asymmetry - they're where your entire argument falls apart. These impact both medical education and medicine itself, and are part (though not all) of the reason free-market health care simply doesn't work.

 

Let's start with medical education. You're right in that if people can't afford a product, they won't buy it, but people are willing to pay a substantial amount to go to med school. We already see this with Canadians studying abroad, some of whom are paying $60,000+ a year for medical training that puts them at a disadvantage to practice in Canada. Taking away subsidies for medical education would raise the price to the consumer - students and their families - substantially. This would certainly drive people away from medicine, but there are so many people who want to be physicians that there would still be sufficient demand for medical school spots given current supply levels. Demand responsiveness to price is quite low. The result would be a continuation of the trends seen in CSAs compared to CMGs - that is, medical students from wealthier families with less academic merit.

 

Would the free market at least lead to better quality education? Probably not. It might lead to an increase in perceived quality, but that's a different beast. For example, there's research demonstrating that having high-quality athletic centres positively influences students to attend a university, but doesn't do much for their education. It is, however, quite expensive. Med students are subject to the same biases - a posh study space looks great, but the difference between studying there versus studying in a dingy cubicle probably isn't that significant. This is the information asymmetry; prospective students really don't know what a good-quality medical education looks like, so they decide based on superficial considerations. Keep in mind that's there's already a competitive incentive for schools to have high-quality education. The bottleneck for students is currently the (hopefully) merit-based admissions process, but past that point the ball is in the student's court. A high-quality student, the type every school wants, often gets admission to multiple schools. A school that is perceived to be poor in its education will get passed over for other schools at that point. This has happened, specifically at Queen's. Their waitlists used to move substantially, but they made significant changes to their education model (and their admissions process), and that movement has slowed significantly.

 

There are also secondary effects of these policies. Low-income candidates have been squeezed out of the market by cost, many of whom were more qualified than their richer competitors still in the market. Even if education quality did increase, candidate quality just decreased. Evidence suggests that the quality of candidates matters more than the education itself. It's the Ivy League effect - students who go to Ivy League schools have higher earnings than those who go to other schools, yet students attending other schools who could have gone to Ivy League schools earn just as much. Again, I doubt a free market in medical education would provide higher quality education, but even if it did, by squeezing out high quality candidates, the physicians it produces would likely be of lower quality.

 

Medicine itself is subject to much the same problems. Patients are willing to pay a lot for medical care. Say what you want about HMOs, but the uninsured individuals in the United States definitely exist in a free market, yet they typically face the highest costs (where's the price-reducing effect of competition there?!) and many are still willing (grudgingly) to pay those prices. They also don't necessarily know what constitutes better care - heck, physicians, experts in the field, don't always understand what constitutes better care. That's lack of price elasticity and information asymmetry again.

 

Just to throw another few issues with free market medicine, there's time-limitations and the presence of local monopolies. You don't go into emerge with an appendix that's about to burst and say "Oh, one sec, before we go into surgery, let me call around to the other hospitals to see if they'll give me a better price" because: a) there often aren't other hospitals nearby able to offer those services and; YOUR APPENDIX IS ABOUT TO BURST.

 

Austrian free market economics makes everything neat and tidy, but the world is not neat and tidy. The free market works wonderfully for many products, but it can fail in certain situations. Those market failures cannot be ignored and that's where the concept of free market medicine - which tries to pretend those market failures can't exist - diverges from reality and subsequently falls flat when implemented in a real-world setting.

[A-Stark]

(My argument is based on the Austrian economic theory, which is not taught in schools).

 

That's because it's a bunch of hokum based on the premise that you can "deduce" economic principles from arbitrary axioms without any appeal to, oh, empirical evidence.

 

Not that mainstream economists are always that much better, but they at least allow for evidence that contradicts vaunted theory.

[aaronjw]

Very good post!

 

Price elasticity and information asymmetry - they're where your entire argument falls apart. These impact both medical education and medicine itself, and are part (though not all) of the reason free-market health care simply doesn't work.

 

Let's start with medical education. You're right in that if people can't afford a product, they won't buy it, but people are willing to pay a substantial amount to go to med school. We already see this with Canadians studying abroad, some of whom are paying $60,000+ a year for medical training that puts them at a disadvantage to practice in Canada. Taking away subsidies for medical education would raise the price to the consumer - students and their families - substantially. This would certainly drive people away from medicine, but there are so many people who want to be physicians that there would still be sufficient demand for medical school spots given current supply levels. Demand responsiveness to price is quite low. The result would be a continuation of the trends seen in CSAs compared to CMGs - that is, medical students from wealthier families with less academic merit.

 

Would the free market at least lead to better quality education? Probably not. It might lead to an increase in perceived quality, but that's a different beast. For example, there's research demonstrating that having high-quality athletic centres positively influences students to attend a university, but doesn't do much for their education. It is, however, quite expensive. Med students are subject to the same biases - a posh study space looks great, but the difference between studying there versus studying in a dingy cubicle probably isn't that significant. This is the information asymmetry; prospective students really don't know what a good-quality medical education looks like, so they decide based on superficial considerations. Keep in mind that's there's already a competitive incentive for schools to have high-quality education. The bottleneck for students is currently the (hopefully) merit-based admissions process, but past that point the ball is in the student's court. A high-quality student, the type every school wants, often gets admission to multiple schools. A school that is perceived to be poor in its education will get passed over for other schools at that point. This has happened, specifically at Queen's. Their waitlists used to move substantially, but they made significant changes to their education model (and their admissions process), and that movement has slowed significantly.

 

There are also secondary effects of these policies. Low-income candidates have been squeezed out of the market by cost, many of whom were more qualified than their richer competitors still in the market. Even if education quality did increase, candidate quality just decreased. Evidence suggests that the quality of candidates matters more than the education itself. It's the Ivy League effect - students who go to Ivy League schools have higher earnings than those who go to other schools, yet students attending other schools who could have gone to Ivy League schools earn just as much. Again, I doubt a free market in medical education would provide higher quality education, but even if it did, by squeezing out high quality candidates, the physicians it produces would likely be of lower quality.

 

Medicine itself is subject to much the same problems. Patients are willing to pay a lot for medical care. Say what you want about HMOs, but the uninsured individuals in the United States definitely exist in a free market, yet they typically face the highest costs (where's the price-reducing effect of competition there?!) and many are still willing (grudgingly) to pay those prices. They also don't necessarily know what constitutes better care - heck, physicians, experts in the field, don't always understand what constitutes better care. That's lack of price elasticity and information asymmetry again.

 

Just to throw another few issues with free market medicine, there's time-limitations and the presence of local monopolies. You don't go into emerge with an appendix that's about to burst and say "Oh, one sec, before we go into surgery, let me call around to the other hospitals to see if they'll give me a better price" because: a) there often aren't other hospitals nearby able to offer those services and; YOUR APPENDIX IS ABOUT TO BURST.

 

Austrian free market economics makes everything neat and tidy, but the world is not neat and tidy. The free market works wonderfully for many products, but it can fail in certain situations. Those market failures cannot be ignored and that's where the concept free market medicine - which tries to pretend those market failures can't exist - diverges from reality and subsequently falls flat when implemented in a real-world setting.

[naspec]

OP asked whether it's still financially feasible to go to medical school expecting to work in a large urban centre, and whether we would still choose it if we had the option of going into something else like engineering. It's a highly personal decision about what you want to do with your life. I can answer a few of those questions for you.

 

Regarding the financial aspect, there is a lot of support available to medical students. If you are at least four years out of high school and in Ontario, OSAP will start considering you as an independent student and will no longer reduce your funding based on your parents' income. Others may correct me, but I think this will amount to around $14,000 per year. The university will also have bursaries available to apply for as well, and at my school the last I heard it was $3000 per year.

 

As you may have seen in other subforums, there are also large lines of credit available to us from banks with interest rates at prime and very favorable repayment terms ($200,000 divided over four years at 3% per annum back when I started). There is some underlying some doom and gloom about interest rates going up, but unless you are living a high-roller lifestyle, with student loans, school bursaries, and covering the difference with your line of credit, you will not be financially hurting throughout your time in medical school even if they do increase. It is perfectly feasible to finish medical school having used less than a quarter of that line of credit. You will easily be able to pay that back when you first start working, even if you are doing locums until you find a permanent position.

 

Also I'm interested to find out more about your desire to work in a large urban centre. There are many small communities who are actively trying to recruit new family physicians and who are well within commuting distance of at least the suburbs that ring a large city. This may be an option for you if all you want is to live in a city but don't care as much where you work.

 

About whether I would choose medicine over engineering if I had to do it again, I can offer some insights regarding that as well. My old classmates from engineering had a very difficult time finding jobs when they graduated because of the economic downturn. Those who found work in urban areas are certainly not savoring an upper-middle class lifestyle giving current living expenses. I would say that my financial freedom as a medical student is comparable to most of my former classmates. Even though I am supported by debt, I remain confident that it is perfectly manageable and that I will easily be able to repay it. Engineering graduates who want a ballin' lifestyle may go into management and they put in the effort of networking and gaining extra qualifications that goes along with that. In order to make it down that path I estimate is more competitive and fraught with uncertainty than applying for medical school.

 

In summary, never be afraid to go to medical school (at least, a Canadian one) because you are afraid of going broke.

[rmorelan]

Oh, I'm not so sure about this. Freezing sure. Maybe cuts for the top billings. But you gotta give Canadian physicians competitive reimbursement or else you will start losing your best and brightest. This is also not politically advisable nor will win elections. The CMA and the provincial professional associations also carry a decent amount of political clout.

 

We will see strong med school enrollment cuts before any significant salary hits IMHO.

 

Freezing is a pay cut - you have to factor in inflation. Over the past two years for instance residents in Ontario have had say a 2-3 percent pay cut with inflation factored in.

[aaronjw]

Oh, I'm not so sure about this. Freezing sure. Maybe cuts for the top billings. But you gotta give Canadian physicians competitive reimbursement or else you will start losing your best and brightest. This is also not politically advisable nor will win elections. The CMA and the provincial professional associations also carry a decent amount of political clout.

 

We will see strong med school enrollment cuts before any significant salary hits IMHO.

 

 

44% since 1999 above and beyond the rate of inflation which generally floats around 1% per year. Many are very well compensated - generally diagnostic and laboratory medicine (Source: http://www.premed101.com/forums/showthread.php?t=87356). Saving lives? Few. Inventing new practice procedures? Few. Revolutionizing population health? Most could care less (health patients, less patients). So the best and brightest argument really isn't. They are smart and that's about it for most of them.

[Dongzhuo]

Before anyone flames me for asking this and yells at me to search, I have. The post about unemployed specialists seems really off topic right now.

 

What I really wanted to ask (as someone applying this cycle), is it still financially feasible to go into medical school with the goal of working in a metro area?

 

I feel as though there are many like me who entered the premed stream naively anticipating 400k+ salaries working in cities > 250000 and have reached the point where were about to graduate with a useless biology / life sciences degree and no alternatives but medical school. I like being a hero as much as the next guy but I'm not going to lie and say I wasn't in this for the good upper middle class lifestyle that was all but guaranteed.

 

For those of you having done your clerkships and entering your residencies does it appear that anyone is working on a solution? Or will we be perpetually outputting more residents than we can possibly employ?

 

Are there any rumours of cutting med school enrolments (hopefully)? Any signs of a massive pandemic causing widespread disease/illness/eliminating every physician over 70?

 

Basically given what you know now, going back to your senior year of undergrad would you still take that offer given an alternative career path like engineering?

 

Let me give you a little parable. You are the owner of a nice café in town. You seek out good staff to make your restaurant more efficient. You hire good cooks to make the food tasty. You choose a good area in town to maximize customer flow. But there is one thing that will make customers come back for more and more like no tomorrow. That is FREE FOOD.

 

Can you imagine the cafe`s cash registry if every customer`s meal is free and paid for by the government. People would flock to this café. Line up for 4 hours if they have to.

 

That, in a nutshell, is why medicine will always provide a very good living.

 

Given the job shortages in other specialties, family medicine may, at least from a financial perspective, make a lot of sense

[Fullmetal_Biochemist]

Let me give you a little parable. You are the owner of a nice café in town. You seek out good staff to make your restaurant more efficient. You hire good cooks to make the food tasty. You choose a good area in town to maximize customer flow. But there is one thing that will make customers come back for more and more like no tomorrow. That is FREE FOOD.

 

Can you imagine the cafe`s cash registry if every customer`s meal is free and paid for by the government. People would flock to this café. Line up for 4 hours if they have to.

 

That, in a nutshell, is why medicine will always provide a very good living.

 

Given the job shortages in other specialties, family medicine may, at least from a financial perspective, make a lot of sense

 

That's right, assuming that healthcare policy never change

[rmorelan]

Let me give you a little parable. You are the owner of a nice café in town. You seek out good staff to make your restaurant more efficient. You hire good cooks to make the food tasty. You choose a good area in town to maximize customer flow. But there is one thing that will make customers come back for more and more like no tomorrow. That is FREE FOOD.

 

Can you imagine the cafe`s cash registry if every customer`s meal is free and paid for by the government. People would flock to this café. Line up for 4 hours if they have to.

 

That, in a nutshell, is why medicine will always provide a very good living.

 

Given the job shortages in other specialties, family medicine may, at least from a financial perspective, make a lot of sense

 

Thoughts:

 

The vast majority of people don't like the food in the cafe. They go there when they run out of food at home and don't have much of a choice. Don't usually hear people wanting to go to the doctor. They want their pain or condition to stop, the doctor's office is a necessary evil. At the cafe there are often long line ups, sometimes even with the best intentions the food is cold, and rarely someone gets food poisoning at the cafe.

 

Second the picture is nice and rosy except for the cafe owners. They are looking at the balance sheet and going - wow, we are sure losing a lot of money by giving away all this free food and hiring all these expensive skilled people to prepare it. Fortunately we are a charity organization and have all these donations (ahem taxes) but even so things are getting pretty tight and we help in other areas as well (like giving free education to people, places to stay for the less fortunate, supporting equal rights for everyone etc, etc). They are constantly wondering if the money at the cafe could be better spent elsewhere or could they provide less free food - so they can help in other areas. Worse the people donating the money are wondering why at a charity cafe the chiefs (ahem doctors) are making so much money. I mean they are good and all but wow expensive. Some people on the charity board of directors think we can pay them less and they would still keep working - out of the goodness of their hearts in part. Some people think that the food would be just as good or even better if some of the other people involved in making the food would take over parts of it. They wonder do we really need that many chiefs in the kitchen? The chiefs themselves probably can figure out how to do it better but that sounds like a lot of work and worse the sort of work they aren't always that good at - they just want to make the food, be recognized as the skilled chiefs they are, and earn what they feel is appropriate for the sacrifices they made to develop their abilities.

 

Ha - I am probably straining this a bit. The point is no matter how much people like health care in Canada there are finite resources and people don't like taxes. There are competing forces going on and nothing is EVER certain. There is a necessary and constant battle to ensure medicine under our system is effective and efficient with shifting politics, ideology, changing demographics and advancing technology all thrown in. It is a wild, wild world out there and nothing except the struggle is guaranteed

 

Is it still worth it? I think absolutely yes, but it does remind me of my favourite Q line:

 

"If you can't take a little bloody nose, maybe you ought to go back home and crawl under your bed. It's not safe out here. It's wondrous, with treasures to satiate desires both subtle and gross. But it's not for the timid."

[Orcamute]

Why would it be useless...

[aaronjw]

Why would it be useless...

 

Yeah, its not useless at all. Biologists make the best barista

[peachaso]

There are actually quite a few biology jobs in Alberta. Things like fish tagging, bird surveying, environmental assessments, pipeline planning, etc. But those aren't the types of things most biology majors want to do, both from a financial and interest perspective.

[Teflon Don]

Pre 1920 US, 1600 Britain, both rose from the :ashes" to become world powers

 

At aaronjw if University in Canada teaches you anything it's the direct opposite of what i just stated. The humanities are very much left leaning, so how exactly is this taught in a first year economics class? (My argument is based on the Austrian economic theory, which is not taught in schools).

 

Lastly I don't hear a counterargument, all I hear is bashing.

 

if aaronjw thinks that anything but Keynesianism is being taught in Canadian unis then he hasn't even taken the intro econ classes yet. how ironic.

[Teflon Don]

Very good post!

 

no, it is not a good post. medical education is not a human right. even if cost does not come down to levels that the average person can afford it will still be significantly cheaper than it is now. also, private medical schools still have academic standards so its not as if any rich kid will be going to med school.

 

here is a revolutionary idea, if someone wants to go to medical school then maybe they can work a few years and save their money or take a loan and attend. what a thought.

 

Here's something interesting: people don't deserve anything in this life, they get what they get

 

stop being a hypocrite.

[The Journey Man]

Before anyone flames me for asking this and yells at me to search, I have. The post about unemployed specialists seems really off topic right now.

 

What I really wanted to ask (as someone applying this cycle), is it still financially feasible to go into medical school with the goal of working in a metro area?

 

I feel as though there are many like me who entered the premed stream naively anticipating 400k+ salaries working in cities > 250000 and have reached the point where were about to graduate with a useless biology / life sciences degree and no alternatives but medical school. I like being a hero as much as the next guy but I'm not going to lie and say I wasn't in this for the good upper middle class lifestyle that was all but guaranteed.

 

 

Depends on what you do. I think you either have to be flexible in location or persistent. Its true that the many of the specialist job markets sucks but there are many factors to it.

 

Royal College has too many spots still open in specialist fields relative to the job market and probably not enough for Family, Psych, Emergency Medicine and the CCFP-EM slots where there is a need. There should be no cases of people not matching to ER because there are so many of them still needed, any we almost certainly don't need more Community Medicine, Cardiac Surgeons or Nephrologists.

 

It seems like the Royal College is at least looking at it. They're studying trends, making reports about it. I have yet to see anything done to training positions substantially, just minor tweaks year to year.

 

Problem is that people still need the work to be done in academic centres and keep many of these slots open. My solution would to potentially close some of these slots for a year or two and simply keep the work in academic centres going through people like the Saudi's who just train here and leave anyways (I believe they cannot stay anyway, correct me if I'm wrong?) This would correct the job market in time and still keep work flow going for academic centres and not saturated the market further.

 

Furthermore many people restrict themselves geographically (not all I'm sure, but lots) for a variety of reasons including spouses' job, kids, family etc. Its difficult t move your life for a job in another city or province. Others just want to work in Toronto or Vancouver and think that 2 hours north of them is impossible. So you get a mixed bag when people talk about "no jobs". It depends how they restrict themselves.

 

I think most people who are specialists that are in saturated fields will find work if they are willing to move provinces or potentially head down south. Thats whats happening to the specialists currently in Neurosurgery, Cardiac Surgery and Interventional Cardiology. They are either moving to places in like Thunder Bay, Manitoba/Saskatchewan, or the US. Or residents in these specialties stay on and do fellowship after fellowship, Masters/PhD and hope they can get a job their province of choice.

 

Its not like that for specialties that don't rely on hospital resources significantly as you can set a private practice or get a job without too much problems in most bigger cities.

 

If you get into medicine, you will likely do well financially regardless especially if you're willing to work hard. No one is going broke, everyone will likely be able to payoff their loans, live in nice places, drive decent cars. Just try not to be an IMG with boat loads of debt with the high probability of not matching in Canada, but as a CMG, it just depends on what you want with life. Are you willing to move potentially to undesirable places to practice your specialty? Are you willing to sacrifice your specialty of choice to stay in your locations. You usually can't get 100% of both, however their are always exceptions. Thats the decision factor most days.

[ralk]

no, it is not a good post. medical education is not a human right. even if cost does not come down to levels that the average person can afford it will still be significantly cheaper than it is now. also, private medical schools still have academic standards so its not as if any rich kid will be going to med school.

 

here is a revolutionary idea, if someone wants to go to medical school then maybe they can work a few years and save their money or take a loan and attend. what a thought.

 

 

 

stop being a hypocrite.

 

At what point in my post did I claim medical education was a human right? My point was about getting the best doctors for the least cost, not some vague moralist rationalization. Stop attacking strawmen.

[Teflon Don]

At what point in my post did I claim medical education was a human right? My point was about getting the best doctors for the least cost, not some vague moralist rationalization. Stop attacking strawmen.

 

 

all you did in your post was walk about how terrible it would be for lower income people to be priced out of a medical education and then concluded that we need government subsidization to ensure these lower income people can get a medical education because they may become better physicians than wealthier students. but capable students of any income bracket can receive a medical education. they can take out a loan from a bank, they can take out a loan from the school itself and they can even work and save until they have the necessary funds to attend. your whole argument is just one long drivle full of outright nonsense.

 

also, in a privatized healthcare system the consumer will be spending his own money for the utilization of healthcare providers and so he has an incentive to choose based on effectiveness and cost. no rational person can make the claim that a government will better utilize the wealth of its citizens than the citizens themselves can. if someone does not feel that they need health insurance then they alone should benefit from not paying the premium and they alone should be responsible for covering the cost of receiving care while being uninsured.

[rmorelan]

all you did in your post was walk about how terrible it would be for lower income people to be priced out of a medical education and then concluded that we need government subsidization to ensure these lower income people can get a medical education because they may become better physicians than wealthier students. but capable students of any income bracket can receive a medical education. they can take out a loan from a bank, they can take out a loan from the school itself and they can even work and save until they have the necessary funds to attend. your whole argument is just one long drivle full of outright nonsense.

 

also, in a privatized healthcare system the consumer will be spending his own money for the utilization of healthcare providers and so he has an incentive to choose based on effectiveness and cost. no rational person can make the claim that a government will better utilize the wealth of its citizens than the citizens themselves can. if someone does not feel that they need health insurance then they alone should benefit from not paying the premium and they alone should be responsible for covering the cost of receiving care while being uninsured.

 

Really? We make that argument all the time. Police, firefighters, water supply, public education, Canadian pension plan, military..........in all seriousness I can go on all day here

 

The argument is it is simply more efficient in some cases to have specialists handle aspects of life. Those specialists require small collective contributions from the general population to support themselves and provide back greater returns in theory than the individual contributions to the majority of contributors.

[ralk]

all you did in your post was walk about how terrible it would be for lower income people to be priced out of a medical education and then concluded that we need government subsidization to ensure these lower income people can get a medical education because they may become better physicians than wealthier students. but capable students of any income bracket can receive a medical education. they can take out a loan from a bank, they can take out a loan from the school itself and they can even work and save until they have the necessary funds to attend. your whole argument is just one long drivle full of outright nonsense.

 

also, in a privatized healthcare system the consumer will be spending his own money for the utilization of healthcare providers and so he has an incentive to choose based on effectiveness and cost. no rational person can make the claim that a government will better utilize the wealth of its citizens than the citizens themselves can. if someone does not feel that they need health insurance then they alone should benefit from not paying the premium and they alone should be responsible for covering the cost of receiving care while being uninsured.

 

People of any income bracket can go to medical school under current conditions. This is because of the high government subsidies that exist, coupled with the near-guaranteed high earning potential of medical students. Removing the subsidies would push the cost of medical school paid by students from the current ~$20k-25k much higher. Cost-of-training estimates in the US run in the $75k range, and would likely be similar here, all before any sort of profit margin for the instructing university.

 

Taking away any sort of government-supported financing like OSAP and including costs of living which run about $15k per year for students, and you end up with $360k which needs to be financed over the course of four years, minimum.

 

Can a person straight out of university cover that cost by working? Not unless they already have a job that pays six figures. Say they somehow manage to save $45k a year, it would still take them 8 years after university to pay for medical school.

 

What about financing from the banks? Currently, in Canada, medical students receive one of the most favourable financing schemes available to anyone. A little under $200k at prime interest with no cosigner? That's very close to a loss for the bank, but one they take because it's generally low risk and they hope to maintain the physician's business when they're in practice. If the cost to the bank more than doubled without any return on that extra cost, they aren't likely to continue to make such a deal. Either rates would go up, or as is the case with many CSA financing plans, they require a cosigner - something students from less affluent families don't have.

 

Without subsidies, deserving students will be unable to realistically pay for medical school, or will have a powerful disincentive to pursue medical education. Unless you believe that only richer students can make good physicians, that means we lose good physicians in favour of physicians who come from wealth. It has nothing to do with fairness for those who aren't wealthy, that's not the point - it's about getting the best doctors for our patients.

[Teflon Don]

Really? We make that argument all the time. Police, firefighters, water supply, public education, Canadian pension plan, military..........in all seriousness I can go on all day here

 

The argument is it is simply more efficient in some cases to have specialists handle aspects of life. Those specialists require small collective contributions from the general population to support themselves and provide back greater returns in theory than the individual contributions to the majority of contributors.

 

well i'm not advocating for anarchy. government should have a responsibility to protect life, liberty and property and so services like the police, firefighters,water supply protection and national defense would fall under this criteria.

 

however, the Canadian pension plan is a ponzi scheme that has enriched a small segment of public workers at the cost of everyone else in society and will soon collapse as all ponzi schemes do.

 

public education could be something that Canadian society is willing to provide but it can only work if we scale back the dictatorial powers of teachers unions and give students the option to opt out of the public system. perhaps we could provide students with tuition coupons valued at a fraction of the total cost of a public school education per year and allow them to redeem these coupons at a private school of their choosing. the private schools would then compete for these students and their coupons by offering quality education at the lowest possible cost.

 

overall, I'm just saying we need a lot less government and a lot less of the entitlement mentality that is plaguing Canadian society.

[Teflon Don]

People of any income bracket can go to medical school under current conditions. This is because of the high government subsidies that exist, coupled with the near-guaranteed high earning potential of medical students. Removing the subsidies would push the cost of medical school paid by students from the current ~$20k-25k much higher. Cost-of-training estimates in the US run in the $75k range, and would likely be similar here, all before any sort of profit margin for the instructing university.

 

Taking away any sort of government-supported financing like OSAP and including costs of living which run about $15k per year for students, and you end up with $360k which needs to be financed over the course of four years, minimum.

 

Can a person straight out of university cover that cost by working? Not unless they already have a job that pays six figures. Say they somehow manage to save $45k a year, it would still take them 8 years after university to pay for medical school.

 

What about financing from the banks? Currently, in Canada, medical students receive one of the most favourable financing schemes available to anyone. A little under $200k at prime interest with no cosigner? That's very close to a loss for the bank, but one they take because it's generally low risk and they hope to maintain the physician's business when they're in practice. If the cost to the bank more than doubled without any return on that extra cost, they aren't likely to continue to make such a deal. Either rates would go up, or as is the case with many CSA financing plans, they require a cosigner - something students from less affluent families don't have.

 

Without subsidies, deserving students will be unable to realistically pay for medical school, or will have a powerful disincentive to pursue medical education. Unless you believe that only richer students can make good physicians, that means we lose good physicians in favour of physicians who come from wealth. It has nothing to do with fairness for those who aren't wealthy, that's not the point - it's about getting the best doctors for our patients.

 

 

do you not understand basic economics? medical school tuition (and regular university education) is expensive because schools know that no matter what price they charge students will just take a government guaranteed loan and pay that amount. without these government subsidies the number of applicants would be reduced and schools would be forced to immediately cut costs until students could afford to attend once more. there is absolutely no need for medical education to be expensive if government gets out of the way and stops interfering in the free market.

 

and stop bringing up the US model as if its an example of a free market economy at work. the US system is not capitalism, its crony capitalism (i.e fascism) and is worse than socialism. if you want an example of a free market economy at work then look at the economy of 19th century US which gave rise to the wealthiest nation in the history of humanity.

[rmorelan]

do you not understand basic economics? medical school tuition (and regular university education) is expensive because schools know that no matter what price they charge students will just take a government guaranteed loan and pay that amount. without these government subsidies the number of applicants would be reduced and schools would be forced to immediately cut costs until students could afford to attend once more. there is absolutely no need for medical education to be expensive if government gets out of the way and stops interfering in the free market.

 

and stop bringing up the US model as if its an example of a free market economy at work. the US system is not capitalism, its crony capitalism (i.e fascism) and is worse than socialism. if you want an example of a free market economy at work then look at the economy of 19th century US which gave rise to the wealthiest nation in the history of humanity.

 

well first off universities are not obeying free market economics - they don't make a profit, they are publicly funded to a large degree, and the number and location of them is highly restricted by the government. They charge the tuition they do because the provincial government lets them charge it - they were only allowed to follow the guidelines assigned to them. You have to model them somewhat differently.

 

we can play in the economics sandbox though! Assuming they did obey fundamental economics then the first axiom would be that there was complete and free exchange of information required by all in order for it to reach optimal utility by the participants. Actually that is exactly why I am on the forum still - ha, there isn't equal access to information and people don't know how the system works early enough to make the sorts of choices that even the playing field. This is in part why I think the distribution of people attending medical schools by parental income has shifted over the past decade in favour of higher incomes. Medicine isn't viewed as a viable career right from the starting gate - or more correctly to extend the analogy, it is actually before that in the training period before the race. Disparities in information create sub-optimal outcomes and inefficiencies. The right would call that a failure of the market and resulting less skilled doctors (potentially), and the left would call it a form of classism. I don't care what you call it but I don't like it

 

Second off medical education simply put is expensive. The base cost is about 60-70K+ a year per student - seen the numbers, worked on the models, know the costs. Getting the government out of it would simply result in a loss of control and subsidy and the price would natural rise (as it has anywhere else in the world where free economics has been applied to medical education). We have a free educational market with respect to yes the US but also all the other international schools. The competition there hasn't exactly dropped the cost of the schooling.

 

Next we may now be in a period of incredibly low interest rates and are amazingly lucky that it looks like those will continue for a bit longer (US and Can are suggesting some point in 2015 for a rise. For us with fixed loans that is pretty good thing). Of course basing the entire system on the assumption that interest rates are stable at historical lows seems unwise . It is unlikely tuition could for instance fall if rate rose to maintain some for of balance (when was the last time a tuition fell for anything that anyone recalls?).

 

and the 19th century US economics had free and unrestrained capitalism and age of great expansion and growth of wealth. It also resulted in the worst workers rights violations imaginable, child labour, insane working conditions and hours, lack of education for most and environmental destruction on a massive scale. It fueled the rise of the unions and many of the social structures that we now take for granted. We have to be very careful if we are cherry picking good things from that time period.

 

You have to ask yourself what is the point of the economic system you chose to setup and what fundamental limitations does that system impose. Pure communism creates equal slices of pie for everyone but the pie itself is much smaller. Pure capitalism creates a bigger pie but some people are left with crumbs to eat (if that) while other gorge. Economics - a social science after all - is concerned with maximizing utility (ie net happiness) and most models such some from of balance between the two is more optimal (surprise, surprise balance in all things after all). What exactly is the goal here? What are we trying to accomplish? If you aren't focused on the goals all you are doing is screaming ideology after a point and frankly that is a) unproductive and boring.