Re: Physicians predict US family physician shortage

[Guest guest]

The shortage is hardly surprising.

Debt weighs on med students

Some change career plans to pay off their rapidly rising tuition bills

BY PAUL TOSTO Pioneer Press

Tonkin once dreamed of life as a small-town family doctor. But

then came the tuition bills and the rapidly rising debt, which will

top $170,000 by the time he graduates this spring from the University

of Minnesota Medical School.

Tonkin now sees his future in urological surgery.

" Up to a year ago I was committed to being a small-town doctor. For

various reasons, I got turned off on that, " said Tonkin, 27, an Eden

Prairie native who studied at the U's Duluth campus because of its

history training rural physicians. " I'm not going to say debt played

a 100 percent role, but it certainly played some role. "

Debt is an uneasy topic for would-be doctors at the U, now the

nation's most expensive public medical school. Tuition and fees have

doubled in the past six years. Graduates this spring will owe about

an average of $130,000, up $20,000 from two years ago and greater

than the national average for public colleges.

Doctors remain among the country's highest-paid professionals, so few

may cry over a med student's debt. School leaders, though, worry the

rising burden has more students eyeing medical careers based less on

their hearts, or Minnesota's needs, and more on what they'll owe.

That doesn't bode well for a state that struggles to find rural

doctors and, lately, sees fewer Minnesotans applying anywhere to

medical school.

When Tonkin researched graduates from the U from 1997 to 2001, he

found students on the Duluth campus with the most debt were more

likely to choose a surgical specialty or internal medicine rather

than family practice. He didn't find a strong link on the Twin Cities

campus but suspects that might have changed in the past few years.

" If you're going to go practice family medicine on a reservation in

northern Minnesota and you're making $45,000, if that, and you have

$200,000 in debt compounded by interest, that's a tough row to hoe, "

he said.

Resident tuition and fees of $29,638 for a first-year student last

year made the university the most expensive of 74 American public

medical colleges, according to the Association of American Medical

Colleges.

" Debt has not been a significant issue until recent years, " said

Deborah , dean of the university's medical school. " Most of us

who are baby boomers and who graduated didn't have to deal with this.

We dealt with very low salaries, but we didn't have this crushing

debt load. … If we don't do something soon, the situation is going to

get extremely bad. "

Vu, a second-year medical student from Rosemount, expects his

school debt to top $100,000 by the end of this school year and reach

$170,000 or more by the time he's done. A lower-paying primary care

practice would be a last option.

" To make those payments you're talking a grand a month when you're in

your third or fourth year of residency and you'll never get your head

above water, " said Vu, 25, who can recall practicing his doctor

signature back in third grade. Like many Minnesotans, he didn't want

to go to medical school anywhere else.

He's leaning toward trauma surgery. His friends are interested in

radiology and pathology, " where you get paid for the amount of work

you do. " Even after graduation, he notes, a student must work years

of residency at a hospital for a salary that typically comes to less

than $10 an hour in an 80-hour week.

Flavio Casoy knows students who wanted to enter primary care to

contribute to society but then reconsidered based on their own

lifestyle choices, which usually means better paying specialties with

better hours.

" If you're going into medicine with a debt of $150,000, there's a

certain amount that you have to pay per month to cover the debt

payments, malpractice insurance, all that other stuff, " said Casoy, a

student at Brown University in Rhode Island and debt coordinator for

the American Medical Student Association. " There's definitely a

selection away from providing care to the underserved. "

University of Minnesota leaders say the debt is high because tuition

is high, and tuition is high because state funding hasn't kept pace

with the need. Officials have been working with the university's

medical foundation to raise more scholarship money to ease the

burden, but the cost will remain high.

There's no hard evidence, but some believe it's a reason fewer

Minnesotans are applying to medical school anywhere — 639 last year

compared to more than 900 in 1996, according to data from the medical

colleges association.

Corey certainly didn't expect he'd owe $190,000 after

medical school on top of the $20,000 from his undergraduate days. But

that's the tab the fourth-year student from Champlin faces when he

leaves next spring. Though he believes he can manage it, he worries

whether he'll be able to support his young daughter if the unexpected

happens and he can't work.

" I really just try to ignore it right now, " said , 26, who

plans to specialize in anesthesia. " When you take it over 30 years,

the payments come down to a reasonable thing. But it's just like

another mortgage you tack on. "

, who chaired a national panel on the debt problems of medical

students, says Minnesota may need to look at some kind of creative

loan forgiveness.

" What if we said, as a state, we'll forgive your loan if you promise

to practice one day a week for an underinsured population, for one

year or 10 years or 20 years … take care of the people who don't have

the means to pay? I'm not sure all the students would do that, but

many would. "

Some students say you'll find them in small-town Minnesota no matter

the cost.

, 23, has a four-year full-tuition scholarship to the

medical school. An Ashby, Minn., native who started planning her

medical career as a 3-year-old bandaging her teddy bear, said she'd

have done everything possible to be a rural doctor even without the

aid, though without it she concedes she, too, would have felt the

lure of higher paying jobs in the Twin Cities or a lucrative

specialty.

She has heard from friends about the huge loans they've taken on in

the first two months of medical school.

A couple of weeks into school, some had yet to buy books.

www.twincities.com/mld/pioneerpress/news/local/12969961.htm?

source=dist & content=twc_news

[Guest guest]

Well, that's a fine kettle of fish. We already have to wait 4 hours in the waiting room to see our family doctor. Ridiculous! Judging from all the tv shows about it they must all be studying to be plastic surgeons instead. The almighty buck strikes again!Lee <jackalope_lepus@...> wrote: Doctors predict family physician shortage By CARLA K. JOHNSON, Associated Press Writer Wed Sep 27, 12:35 AM ETCHICAGO - A doctors group expects a serious shortfall of family physicians in at least five states by 2020.

Population growth and rising numbers of elderly people in Nevada, Arizona, Florida, Texas and Idaho will make the need in those states most critical, said Dr. Pugno of the American Academy of Family Physicians."As Americans age, they need more health-care interventions, and primary care is the most cost-effective way to help them maintain their health," Pugno said.The number of U.S. medical graduates going into family medicine has been falling — by more than 50 percent from 1997 to 2005 — with many young doctors preferring specialties that pay better and offer more control over work hours.The group scheduled a rally in Washington, D.C., on Wednesday, timed to coincide with the release of its workforce report, which estimates the number of family doctors must grow by 39 percent during the next 14 years to keep up with the nation's needs. All states will need more family doctors by 2020,

the report says, with Nevada topping the list.The doctors group wants Congress to increase Medicare payments to family doctors to help ease the shortage, Pugno said. The group also urges voters to question candidates about health care, an issue as important to those polled by the group as the war in Iraq and terrorism, Pugno said.There are about 100,000 licensed family doctors in the United States, a number that has been growing slightly because doctors stay in the workforce longer, said Dr. Larry Fields, president of the American Academy of Family Physicians.http://news./s/ap/20060927/ap_on_he_me/family_doctors_1

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[Guest guest]

Docs got to pay off their student loan debts. They have no choice.

Medical school is expensive. If only the USA better funded its

educational system...

[Guest guest]

Those who go into medical specialties instead of into general or family practice will be mighty surprised when they actually begin their practice. Many specialties demand long hours and tons and tons of paperwork. Then there is an office staff and the day to day expenses which have to be paid. My cardiologist typically works a 12 hour day which normally begins at 7am with the surgeries and various procedures he has to do. Then there are all his hospitalized patients to be seen before he's able to see anyone during stated office hours. He works until 6 or 7 in the evening because of all the paperwork he must do. He works 5 days a week at this grueling pace. Life in some medical specialities is not exactly what I'd call a Sunday School picnic. I know that I could not do it myself. Lee <jackalope_lepus@...> wrote: Doctors predict family physician shortage By CARLA K. JOHNSON, Associated Press Writer Wed Sep 27, 12:35 AM ETCHICAGO - A doctors group expects a serious shortfall of family physicians in at least five states by 2020. Population growth and rising numbers of elderly people in Nevada, Arizona, Florida, Texas and Idaho will make the need in those states most critical, said Dr. Pugno of the American Academy of Family Physicians."As Americans age, they need more health-care interventions, and primary care is the most cost-effective way to help them maintain their

health," Pugno said.The number of U.S. medical graduates going into family medicine has been falling — by more than 50 percent from 1997 to 2005 — with many young doctors preferring specialties that pay better and offer more control over work hours.The group scheduled a rally in Washington, D.C., on Wednesday, timed to coincide with the release of its workforce report, which estimates the number of family doctors must grow by 39 percent during the next 14 years to keep up with the nation's needs. All states will need more family doctors by 2020, the report says, with Nevada topping the list.The doctors group wants Congress to increase Medicare payments to family doctors to help ease the shortage, Pugno said. The group also urges voters to question candidates about health care, an issue as important to those polled by the group as the war in Iraq and terrorism, Pugno said.There are about 100,000

licensed family doctors in the United States, a number that has been growing slightly because doctors stay in the workforce longer, said Dr. Larry Fields, president of the American Academy of Family Physicians.http://news./s/ap/20060927/ap_on_he_me/family_doctors_1 . Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind. -Dr.Seuss . It don't mean a thing if it ain't got that swing. - Duke Ellington . Never place a period where God has placed a comma. - Gracie

[Guest guest]

<<years of residency>> In fact, most residencies are but two years long, not "years". Lee <jackalope_lepus@...> wrote: The shortage is hardly surprising.Debt weighs on med studentsSome change career plans to pay off their rapidly rising tuition billsBY PAUL TOSTO Pioneer Press Tonkin once dreamed of life as a small-town family doctor. Butthen came the tuition bills and the rapidly rising debt, which

willtop $170,000 by the time he graduates this spring from the Universityof Minnesota Medical School.Tonkin now sees his future in urological surgery."Up to a year ago I was committed to being a small-town doctor. Forvarious reasons, I got turned off on that," said Tonkin, 27, an EdenPrairie native who studied at the U's Duluth campus because of itshistory training rural physicians. "I'm not going to say debt playeda 100 percent role, but it certainly played some role."Debt is an uneasy topic for would-be doctors at the U, now thenation's most expensive public medical school. Tuition and fees havedoubled in the past six years. Graduates this spring will owe aboutan average of $130,000, up $20,000 from two years ago and greaterthan the national average for public colleges.Doctors remain among the country's highest-paid professionals, so fewmay cry over a med student's debt. School leaders, though, worry

therising burden has more students eyeing medical careers based less ontheir hearts, or Minnesota's needs, and more on what they'll owe.That doesn't bode well for a state that struggles to find ruraldoctors and, lately, sees fewer Minnesotans applying anywhere tomedical school.When Tonkin researched graduates from the U from 1997 to 2001, hefound students on the Duluth campus with the most debt were morelikely to choose a surgical specialty or internal medicine ratherthan family practice. He didn't find a strong link on the Twin Citiescampus but suspects that might have changed in the past few years."If you're going to go practice family medicine on a reservation innorthern Minnesota and you're making $45,000, if that, and you have$200,000 in debt compounded by interest, that's a tough row to hoe,"he said.Resident tuition and fees of $29,638 for a first-year student lastyear made the university the

most expensive of 74 American publicmedical colleges, according to the Association of American MedicalColleges."Debt has not been a significant issue until recent years," saidDeborah , dean of the university's medical school. "Most of uswho are baby boomers and who graduated didn't have to deal with this.We dealt with very low salaries, but we didn't have this crushingdebt load. … If we don't do something soon, the situation is going toget extremely bad."Vu, a second-year medical student from Rosemount, expects hisschool debt to top $100,000 by the end of this school year and reach$170,000 or more by the time he's done. A lower-paying primary carepractice would be a last option."To make those payments you're talking a grand a month when you're inyour third or fourth year of residency and you'll never get your headabove water," said Vu, 25, who can recall practicing his doctorsignature

back in third grade. Like many Minnesotans, he didn't wantto go to medical school anywhere else.He's leaning toward trauma surgery. His friends are interested inradiology and pathology, "where you get paid for the amount of workyou do." Even after graduation, he notes, a student must work yearsof residency at a hospital for a salary that typically comes to lessthan $10 an hour in an 80-hour week.Flavio Casoy knows students who wanted to enter primary care tocontribute to society but then reconsidered based on their ownlifestyle choices, which usually means better paying specialties withbetter hours."If you're going into medicine with a debt of $150,000, there's acertain amount that you have to pay per month to cover the debtpayments, malpractice insurance, all that other stuff," said Casoy, astudent at Brown University in Rhode Island and debt coordinator forthe American Medical Student Association.

"There's definitely aselection away from providing care to the underserved."University of Minnesota leaders say the debt is high because tuitionis high, and tuition is high because state funding hasn't kept pacewith the need. Officials have been working with the university'smedical foundation to raise more scholarship money to ease theburden, but the cost will remain high.There's no hard evidence, but some believe it's a reason fewerMinnesotans are applying to medical school anywhere — 639 last yearcompared to more than 900 in 1996, according to data from the medicalcolleges association.Corey certainly didn't expect he'd owe $190,000 aftermedical school on top of the $20,000 from his undergraduate days. Butthat's the tab the fourth-year student from Champlin faces when heleaves next spring. Though he believes he can manage it, he worrieswhether he'll be able to support his young daughter

if the unexpectedhappens and he can't work."I really just try to ignore it right now," said , 26, whoplans to specialize in anesthesia. "When you take it over 30 years,the payments come down to a reasonable thing. But it's just likeanother mortgage you tack on.", who chaired a national panel on the debt problems of medicalstudents, says Minnesota may need to look at some kind of creativeloan forgiveness."What if we said, as a state, we'll forgive your loan if you promiseto practice one day a week for an underinsured population, for oneyear or 10 years or 20 years … take care of the people who don't havethe means to pay? I'm not sure all the students would do that, butmany would."Some students say you'll find them in small-town Minnesota no matterthe cost. , 23, has a four-year full-tuition scholarship to themedical school. An Ashby, Minn., native who started

planning hermedical career as a 3-year-old bandaging her teddy bear, said she'dhave done everything possible to be a rural doctor even without theaid, though without it she concedes she, too, would have felt thelure of higher paying jobs in the Twin Cities or a lucrativespecialty.She has heard from friends about the huge loans they've taken on inthe first two months of medical school.A couple of weeks into school, some had yet to buy books.www.twincities.com/mld/pioneerpress/news/local/12969961.htm?source=dist & content=twc_news . Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind. -Dr.Seuss . It don't mean a thing if it ain't got that swing. - Duke Ellington . Never place a period where God has placed a comma. - Gracie

[Guest guest]

Waiting for 4 hours to be seen is unacceptable. The doctor has overbooked himself far too much. This means that each patient gets short-changed, which I equate with poor medical care. Tammy Pennell <tamarin1988@...> wrote: Well, that's a fine kettle of fish. We already have to wait 4 hours in the waiting room to see our family doctor. Ridiculous! Judging from all the tv shows about it they must all be studying to be plastic surgeons instead. The almighty buck strikes again!Lee

<jackalope_lepusHotmail> wrote: Doctors predict family physician shortage By CARLA K. JOHNSON, Associated Press Writer Wed Sep 27, 12:35 AM ETCHICAGO - A doctors group expects a serious shortfall of family physicians in at least five states by 2020. Population growth and rising numbers of elderly people in Nevada, Arizona, Florida, Texas and Idaho will make the need in those states most critical, said Dr. Pugno of the American Academy of Family Physicians."As Americans age, they need more health-care interventions, and primary care is the most cost-effective way to help them maintain their health," Pugno said.The number of U.S. medical graduates going into family medicine has been falling — by more than 50 percent from 1997 to 2005 — with many young doctors

preferring specialties that pay better and offer more control over work hours.The group scheduled a rally in Washington, D.C., on Wednesday, timed to coincide with the release of its workforce report, which estimates the number of family doctors must grow by 39 percent during the next 14 years to keep up with the nation's needs. All states will need more family doctors by 2020, the report says, with Nevada topping the list.The doctors group wants Congress to increase Medicare payments to family doctors to help ease the shortage, Pugno said. The group also urges voters to question candidates about health care, an issue as important to those polled by the group as the war in Iraq and terrorism, Pugno said.There are about 100,000 licensed family doctors in the United States, a number that has been growing slightly because doctors stay in the workforce longer, said Dr. Larry Fields, president of the

American Academy of Family Physicians.http://news./s/ap/20060927/ap_on_he_me/family_doctors_1 Get your email and more, right on the new .com . Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind. -Dr.Seuss . It don't mean a thing if it ain't got that swing. - Duke Ellington . Never place a period where God has placed a comma. - Gracie

[Guest guest]

You are right. I have an HMO and they require that so many patients be seen every hour. Because my doc has to follow their rules and see that many, we wait. He tries to give everyone the time they need and that is why the wait is so long. He is way overworked but he listens to me and, in my experience, that is hard to find! I trust his opinion and I have some rare health issues so I have to stick with him. But it is a pain to spend my whole day there for an appointment. It is a catch 22 for me, having gone through many doctors who do not care or listen. C'est la vie! Tamarin B <rboylern@...> wrote: Waiting for 4 hours to be seen is unacceptable. The doctor has overbooked himself far too much. This means that each patient gets short-changed, which I equate with poor medical care. Tammy Pennell <tamarin1988 > wrote: Well, that's a fine kettle of fish. We already have to wait 4 hours in the waiting room to see our family doctor. Ridiculous! Judging from all the tv shows about it they must all be studying to be plastic surgeons instead. The almighty buck strikes again!Lee <jackalope_lepusHotmail> wrote: Doctors predict family physician shortage By CARLA

K. JOHNSON, Associated Press Writer Wed Sep 27, 12:35 AM ETCHICAGO - A doctors group expects a serious shortfall of family physicians in at least five states by 2020. Population growth and rising numbers of elderly people in Nevada, Arizona, Florida, Texas and Idaho will make the need in those states most critical, said Dr. Pugno of the American Academy of Family Physicians."As Americans age, they need more health-care interventions, and primary care is the most cost-effective way to help them maintain their health," Pugno said.The number of U.S. medical graduates going into family medicine has been falling — by more than 50 percent from 1997 to 2005 — with many young doctors preferring specialties that pay better and offer more control over work hours.The group scheduled a rally in Washington, D.C., on Wednesday, timed to coincide with the release of its workforce report, which

estimates the number of family doctors must grow by 39 percent during the next 14 years to keep up with the nation's needs. All states will need more family doctors by 2020, the report says, with Nevada topping the list.The doctors group wants Congress to increase Medicare payments to family doctors to help ease the shortage, Pugno said. The group also urges voters to question candidates about health care, an issue as important to those polled by the group as the war in Iraq and terrorism, Pugno said.There are about 100,000 licensed family doctors in the United States, a number that has been growing slightly because doctors stay in the workforce longer, said Dr. Larry Fields, president of the American Academy of Family Physicians.http://news./s/ap/20060927/ap_on_he_me/family_doctors_1 Get your email and more, right on the new .com . Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind. -Dr.Seuss . It don't mean a thing if it ain't got that swing. - Duke

Ellington . Never place a period where God has placed a comma. - Gracie

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[Guest guest]

It occurs to me that you also must belong to the same HMO. Since that's probably the case, perhaps you could phone the office on the day of your appointment to find out what is actually a realistic time for you to show up for your appointment, or how long you have to wait. It seems outrageous to have to wait for 4 hours. Sometimes you have to make a very cumbersome "system" work a little for you since you're the one who's paying the monthly premiums. Are you in the Kaiser system? Kaiser is notorious for this kind of thing. As a nurse, I think it just stinks because it makes the patient feel like a victim of circumstances and sort of trapped. Of course, I don't want to belittle your own doc. He's doing the best he can under such a ghastly system; and I'm glad that he does take time to listen to you. This is a very important part of good medical care. A lot of docs in HMOs often give the patient

the "short end" of the stick because they have to work under such pressure. Tammy Pennell <tamarin1988@...> wrote: You are right. I have an HMO and they require that so many patients be seen every hour. Because my doc has to follow their rules and see that many, we wait. He tries to give everyone the time they need and that is why the wait is so long. He is way overworked but he listens to me and, in my experience, that is hard to find! I trust his opinion and I have some rare health issues so I have to

stick with him. But it is a pain to spend my whole day there for an appointment. It is a catch 22 for me, having gone through many doctors who do not care or listen. C'est la vie! Tamarin B <rboylern > wrote: Waiting for 4 hours to be seen is unacceptable. The doctor has overbooked himself far too much. This means that each patient gets short-changed, which I equate with poor medical care. Tammy Pennell <tamarin1988 > wrote: Well, that's a fine kettle of fish. We already have to wait 4 hours in the waiting room to see our family doctor. Ridiculous! Judging from all the tv shows about it they must all be studying to be plastic

surgeons instead. The almighty buck strikes again!Lee <jackalope_lepusHotmail> wrote: Doctors predict family physician shortage By CARLA K. JOHNSON, Associated Press Writer Wed Sep 27, 12:35 AM ETCHICAGO - A doctors group expects a serious shortfall of family physicians in at least five states by 2020. Population growth and rising numbers of elderly people in Nevada, Arizona, Florida, Texas and Idaho will make the need in those states most critical, said Dr. Pugno of the American Academy of Family Physicians."As Americans age, they need more health-care interventions, and primary care is the most cost-effective way to help them maintain their health," Pugno said.The number of U.S. medical graduates going into family medicine has been falling — by more

than 50 percent from 1997 to 2005 — with many young doctors preferring specialties that pay better and offer more control over work hours.The group scheduled a rally in Washington, D.C., on Wednesday, timed to coincide with the release of its workforce report, which estimates the number of family doctors must grow by 39 percent during the next 14 years to keep up with the nation's needs. All states will need more family doctors by 2020, the report says, with Nevada topping the list.The doctors group wants Congress to increase Medicare payments to family doctors to help ease the shortage, Pugno said. The group also urges voters to question candidates about health care, an issue as important to those polled by the group as the war in Iraq and terrorism, Pugno said.There are about 100,000 licensed family doctors in the United States, a number that has been growing slightly because doctors stay in the

workforce longer, said Dr. Larry Fields, president of the American Academy of Family Physicians.http://news./s/ap/20060927/ap_on_he_me/family_doctors_1 Get your email and more, right on the new .com . Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind. -Dr.Seuss . It don't mean a thing if it ain't got that swing. - Duke Ellington . Never place a period where God has placed a comma. - Gracie How low will we go? Check out Messenger’s low PC-to-Phone call rates. . Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind. -Dr.Seuss . It don't mean a thing if it ain't got that swing. - Duke Ellington . Never place a period where God has placed a comma. - Gracie