did someone muck with the backend here

Re: Free Stuff That You Already Paid For

1

I haven't even had twenty-four hours of not being at a medical school yet.


Posted by: Moby Hick | Link to this comment | 08-16-18 2:30 PM
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it's kind of astounding how much wealth has been captured by higher education in this country.

Captured by a very tiny slice of higher education, no?


Posted by: heebie-geebie | Link to this comment | 08-16-18 3:01 PM
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Math departments in parochial colleges that are Hispanic-serving institutions?


Posted by: Moby Hick | Link to this comment | 08-16-18 3:20 PM
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Can you look at this rash, Dr. Ogged?


Posted by: apostropher | Link to this comment | 08-16-18 3:41 PM
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I would like one of those free Medicare bongs please.


Posted by: Moby Hick | Link to this comment | 08-16-18 4:36 PM
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What does regardless of merit mean? I really would prefer my doctors to have merit.


Posted by: Zb | Link to this comment | 08-16-18 4:42 PM
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It means they've created a dichotomous assessment of merit instead of a more granular formulation of merit where you needed a sliding amount of merit depending on how much money you could pay to attend.


Posted by: Moby Hick | Link to this comment | 08-16-18 4:47 PM
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All rejected applicants get the same level of funding. Some may claim to need to be paid to go away, but the offer is this: they get nothing.


Posted by: fake accent | Link to this comment | 08-16-18 5:14 PM
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It's hard to feel sympathy for doctors, but the NYU School of Medicine graduating class of 2018 comes close.


Posted by: Todd | Link to this comment | 08-16-18 6:26 PM
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Captured by a very tiny slice of higher education, no?

Yes, this. Most schools are living hand-to-mouth, and are utterly dependent on the funding priorities of dumbass state legislatures.

But NYU, with its capture of a whole lot of valuable real estate in the south-of-14th-St area, really does exemplify the higher-ed dynamic of which ogged speaks. And it now offers advanced degrees in global asset management and investment strategies!


Posted by: Just Plain Jane | Link to this comment | 08-16-18 7:06 PM
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Got to love the bait and switch:
Annual tuition is roughly $55,000. [...] The plan does not cover room and board or fees, which together are an additional $27,000, on average.


Posted by: Mossy Character | Link to this comment | 08-16-18 7:53 PM
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I think I broke my pinky toe this morning. As soon as someone has a medical degree please let me know.


Posted by: E. Messily | Link to this comment | 08-16-18 9:23 PM
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Fees for what?


Posted by: Ginger Yellow | Link to this comment | 08-17-18 7:01 AM
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Right? Lab coats? Cadavers?


Posted by: Mossy Character | Link to this comment | 08-17-18 7:03 AM
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$27k for housing in New York seems like a very good deal. The fees can't be much.


Posted by: Moby Hick | Link to this comment | 08-17-18 7:14 AM
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$27k for housing in New York seems like a very good deal.

People get exaggerated ideas of housing costs in NYC. There is no reason a single person should be spending that for housing unless they just feel like burning money or insist on living alone with no commute (the latter more reasonable than it used to be because of the train situation, I gotta admit). I think that list price is probably university dorm housing(?) and if it is I'm sure it's overpriced. This was 20 years ago now, but my best friend lived in NYU housing and paid something like $800 a month to live in a tiny two-bedroom apartment with three other people. It was way overmarket, even for the East Village; the university was just bilking people who didn't have the energy or knowledge to look elsewhere. So you can probably opt out of their housing plan and spend 12k a year on housing if you're willing to live like a student, i.e., with roommates.


Posted by: Tia | Link to this comment | 08-17-18 8:11 AM
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Manhattan real estate really is something.


Posted by: dalriata | Link to this comment | 08-17-18 8:18 AM
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It's high variance. My roommate pays 1100 dollars to live in a spacious two bedroom apartment with a gym and an elevator a half block from the subway, also in Manhattan.


Posted by: Tia | Link to this comment | 08-17-18 8:24 AM
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I can't find anything that nice on Zillow. I take it to get a deal like that you gotta know a guy, and us rubes from the provinces are stuck with awful things like I posted (or, god forbid, live in Brooklyn)?


Posted by: dalriata | Link to this comment | 08-17-18 8:32 AM
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It's usually the case that campus housing costs more than cheaper housing in the same community. You pay more for convenience and also meals.


Posted by: Moby Hick | Link to this comment | 08-17-18 8:50 AM
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She didn't know me, her landlord, prior to moving in. I think we met on Roomi or some site like that. Admittedly this is slightly on the low end of market because I don't feel like bleeding people, but it's not totally below market. It's not like this isn't a challenging, expensive housing market; of course it is. But everyone always does this thing where they judge the cost of housing by finding the most ridiculous looking space in a very central location (you found an apartment very near Penn Station/Madison Square Garden). Manhattan has a lot of neighborhoods in it, as do the other boroughs. You could live in Brooklyn or Queens and have a reasonable commute to NYU. I'm just saying there's no reason a single student needs to be spending 27k on housing (a few years ago I was managing to live in Manhattan for $600 a month with three roommates!). Like I said, if they want to, because they insist on living alone right next to campus, they can.


Posted by: Tia | Link to this comment | 08-17-18 9:06 AM
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If you look at my link and click the X to go back to the search I used, it shows every available rental listing in Manhattan below $1500/month. I picked that one because it was literally the only one satisfying that criteria that was south of 125th Street. Sorry, I was just being an ass about Brooklyn, there clearly are lots of reasonable options. I hear people even live in New Jersey these days.


Posted by: dalriata | Link to this comment | 08-17-18 9:19 AM
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I suspect that to live right next to things like classes, the library, and the corpse-room is a common and reasonably desire for medical students


Posted by: Moby Hick | Link to this comment | 08-17-18 9:23 AM
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Emphasizing a short commute seems really reasonable for a med student.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 08-17-18 9:34 AM
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Ok, you're not saying something different than I am. Manhattan doesn't end at 125th St. If you insist on living alone in a very central location, you have to pay a lot for that. But as you say, there are lots of other reasonable options. It gets much harder when you have a family, have children you need to house in separate bedrooms.


Posted by: Tia | Link to this comment | 08-17-18 9:36 AM
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Oh I am procrastinating by looking at real estate now. I don't know what the deal is with this place, but this claims to be a furnished studio for $1300 in the E. Vill. Some NYU Med student should snap it up.


Posted by: Tia | Link to this comment | 08-17-18 9:43 AM
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Yeah, I was just saying that the lower four fifths of Manhattan, which is quite a large area (about 17 sq mi), is very expensive, leading to the cheap options (in a world where we pretend $1.5k is cheap) being rare, weird, and small. (And FWIW, north of 125th only has 10 sub-$1.5k apartments listed, all of which are quite tiny, but not as ridiculously so as the one I mentioned.) And yes, I'm unfairly ignoring larger units that could be subletted.


Posted by: dalriata | Link to this comment | 08-17-18 9:46 AM
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Another fun search is, within New York State, how close you can get to NYC and pay less than $1k/month for a two-bedroom. (The two in Yonkers are mislabeled.)


Posted by: dalriata | Link to this comment | 08-17-18 9:50 AM
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29

For your next trick, map those prices onto presidential votes by precinct.


Posted by: Mossy Character | Link to this comment | 08-17-18 9:51 AM
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27: This is perhaps not quite so fascinating to everyone else, but I also don't think Zillow is a good source for this area. I've never heard of anyone using it. Craigslist and StreetEasy would both be more informative. Also, by only looking at apartments being rented empty by landlord you're excluding some options even for living alone. People might sublet their place, etc.


Posted by: Tia | Link to this comment | 08-17-18 10:04 AM
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31

I thought everyone looking for roommates on Craigslist was a serial killer. I guess that's mostly just Ohio.


Posted by: Moby Hick | Link to this comment | 08-17-18 10:06 AM
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32

I thought everyone looking for roommates on Craigslist was a serial killer. I guess that's mostly just Ohio.


Posted by: Moby Hick | Link to this comment | 08-17-18 10:06 AM
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33

Stupid phone.


Posted by: Moby Hick | Link to this comment | 08-17-18 10:06 AM
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30: That's sorta what I was asking about above. I figured there had to be at least a little insider knowledge necessary there--it can't be quite as awful as Zillow is showing.


Posted by: dalriata | Link to this comment | 08-17-18 10:08 AM
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And, excepting the richest serial killers, they probably do need to keep at least some people alive to help with rent.


Posted by: Moby Hick | Link to this comment | 08-17-18 10:09 AM
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36

Or sell them to med students who don't want to commute all the way to campus.


Posted by: Mossy Character | Link to this comment | 08-17-18 10:13 AM
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37

THE FIRST RULE OF SERIAL KILLING IS DON'T KILL WHERE YOU LIVE


Posted by: OPINIONATED "THE LEARNING ANNEX" SERIAL KILLER 101 CLASS | Link to this comment | 08-17-18 10:20 AM
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32: Even in Ohio less than 10% of people seeking roommates on Craigslist are serial killers.


Posted by: peep | Link to this comment | 08-17-18 10:23 AM
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31: Craigslist is how I found my old roommates, in the DC area. Of course, that's 10 years ago now.


Posted by: Cyrus | Link to this comment | 08-17-18 10:23 AM
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40

And they haven't been heard of since.


Posted by: Mossy Character | Link to this comment | 08-17-18 10:25 AM
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Craigslist is how I found my old roommates, in the DC area. Of course, that's 10 years ago now.

And have any of us heard from those roommates since? Hmm? Did you think you could escape suspicion just by not living in Ohio?


Posted by: Tia | Link to this comment | 08-17-18 10:30 AM
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42

goddamn not previewing.


Posted by: Tia | Link to this comment | 08-17-18 10:30 AM
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Man, this place is a freakin' lynch mob.

I'm sure you have an innocent explanation, Cyrus.


Posted by: peep | Link to this comment | 08-17-18 10:36 AM
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44

Publicly dismembering them to encourage your army doesn't count.


Posted by: Mossy Character | Link to this comment | 08-17-18 10:55 AM
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45

Public dismemberment has an undeservedly bad reputation, that's all I'm going to say.


Posted by: Cyrus | Link to this comment | 08-17-18 11:25 AM
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46

A quite convincing Slate pitch that this is a terrible idea

https://slate.com/business/2018/08/nyu-medical-school-plans-free-tuition-for-all-what-a-waste-of-money.html


Posted by: peep | Link to this comment | 08-20-18 11:19 AM
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47

46: I'm not convinced. The kinds of programs the article prefers to encourage primary care careers, working in disadvantaged communities, etc. have existed for a long time. In practice they are piecemeal; they not, and are unlikely ever to become, sufficient to counteract the huge burdens of debt imposed on doctors, or the vicious cycle that feeds. (High tuition => high debt => doctors chasing the lucrative career paths => more pay for doctors collectively => universities feel freer to increase tuition.)

Preferable would be a national reform to make all medical school free, forgive existing debt, and cut reimbursement rates all at once. But in the meantime, NYU is illuminating where we could go.


Posted by: Minivet | Link to this comment | 08-20-18 11:27 AM
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48

Slightly OT: are there any good universities anymore?


Posted by: lurid keyaki | Link to this comment | 08-20-18 12:33 PM
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49

No.


Posted by: teofilo | Link to this comment | 08-20-18 12:34 PM
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50

47: also, high debt burdens make doctors more likely to oppose insurance system regulation that would reduce their salaries.


Posted by: Tia | Link to this comment | 08-20-18 12:37 PM
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50: Yes! And higher-cost health care adds more cost burden to universities themselves... the vicious cycle has a lot of interlocks.


Posted by: Minivet | Link to this comment | 08-20-18 12:46 PM
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52

In truth, not so much a vicious cycle as a vicious bowl of noodles.


Posted by: Mossy Character | Link to this comment | 08-20-18 12:53 PM
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53

I've done a lot of divorces involving doctors. I have very little sympathy for the claim that they have such crushing debt.

Doctors, hospitals, and hospital administrators simply need to make less money. Screaming about the socialization of medicine seems whiny to me since very few individuals can individually afford to pay the cost of most medical procedures.


Posted by: will | Link to this comment | 08-20-18 1:21 PM
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54

That's pretty bold talk for a profession that's a transaction cost.


Posted by: Moby Hick | Link to this comment | 08-20-18 2:13 PM
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55

I really don't see how lack of debt is going to magically make doctors want to take less prestigious jobs that pay less money. People want more prestigious jobs that pay more money because they like prestige and they like money.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 08-20-18 4:07 PM
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56

I've heard good things about prestige.


Posted by: Moby Hick | Link to this comment | 08-20-18 5:13 PM
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>People want more prestigious jobs that pay more money because they like prestige and they like money.

I don't know, people aren't one thing or the other.

I recently decided to leave an industry where I could reasonably have gotten a job making more than $100k (I say from the example of my identically trained peers) to going back to being underemployed doing very similar work but in a setting where that work is much more meaningful to me, and with people with values and interests like mine. I'm making less than I need to live, really, but it is an improvement in my circumstances overall. Only baseline financial security and debt freedom made that choice feasible.

Not having debt wouldn't make all aspiring doctors magically insensitive to salary, but even if you start off with some idealism, one of the things that has a lot of power to take that away is $200k+ of debt and the choices you make early on to get rid of it. If you're debt free early in your career and you feel free to take a job you find meaningful and satisfying, you might get a taste for it that you can't give up. I've noticed a contrast between me and other people I've talked to who have never had the experience of having meaningful work (their representation of the situation). They can't really imagine making choices to move towards more meaning in work because they don't know what it looks like, whereas I was too miserable going back to doing something that felt like bullshit to me; it was way too much of a eudaimonic backslide.

My best friend is an early career doctor; she paid for school out of inheritance money and has gone into relatively lower-prestige, lower-salary family medicine and has consistently maintained a sense of wanting to care for people more than she particularly wanted to make a bunch of money. I can't see the alternative universe her who took on a lot of debt -- I just know she's an example of someone who without it is not primarily motivated by money.


Posted by: Tia | Link to this comment | 08-20-18 5:28 PM
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Exactly. People who want prestige can go into investment banking, like they always have. People who want to do good can afford to choose to go into general medicine, pediatrics, remote clinics, part-time work, or any of the other medical career choices that provide societal benefit but don't pay as well.


Posted by: F | Link to this comment | 08-20-18 5:34 PM
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Let's all watch Magnificent Obsession and complain about how the doctors don't exactly throw money around but they do better than epidemiologists.


Posted by: Moby Hick | Link to this comment | 08-20-18 6:25 PM
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60

I also think there are social network forces that can have wider results than the direct effect of material changes. The more accessible doctor-ing is to people who might choose it for idealistic reasons, the more those people choose the profession, and the more pleasant education and work becomes for other people like them, who will then be increasingly drawn to the profession. I like my current job in part because I work with people who are like me in important respects, and I felt less that way when I briefly worked in the private sector. My friend found med school alienating because there were a lot of douchey future plastic surgeons clogging it up.


Posted by: Tia | Link to this comment | 08-20-18 6:28 PM
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People who want prestige can go into investment banking, like they always have.

I don't know many people who went into investment banking for prestige. They almost all went into it for money. And a handful because what else are you going to do with a PhD in theoretical physics?


Posted by: Ginger Yellow | Link to this comment | 08-21-18 1:54 AM
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62

Write quark pornography.


Posted by: Moby Hick | Link to this comment | 08-21-18 3:43 AM
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Heedless of Rule of Acquisition 94, Quark finally resolved to let his feelings known, for his lust for Major Kira Nerys had grown boundless and the tingling in his ears told him that he could wait no more.


Posted by: Barry Freed | Link to this comment | 08-21-18 3:56 AM
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62: "There are six types, known as flavors, of quarks: up, down, strange, charm, bottom, and top."

It practically writes itself.


Posted by: Doug | Link to this comment | 08-21-18 4:09 AM
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Write quark pornography.

I'm sure there's plenty of DS9 slashfic already.


Posted by: Ginger Yellow | Link to this comment | 08-21-18 6:26 AM
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66

Apologies, Barry, I see I have been pwned.


Posted by: Ginger Yellow | Link to this comment | 08-21-18 6:26 AM
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67

Founders will do that to you.


Posted by: Mossy Character | Link to this comment | 08-21-18 7:07 AM
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I also think there are social network forces that can have wider results than the direct effect of material changes. The more accessible doctor-ing is to people who might choose it for idealistic reasons, the more those people choose the profession, and the more pleasant education and work becomes for other people like them, who will then be increasingly drawn to the profession.

This seems right. Clearly medical debt is A FACTOR in doctors going for the mercenary options. It's not as bad as law school, where you come out and find there is literally no way to make money helping people, but still they are hugely driven by the debt that has been weighing on them since school and their low-paid residencies.

It's annoying to see left-wing people responding to this by saying "Actually this will change nothing about NYU graduates' incentives, because the lucrative specialties are still the lucrative specialties". Congratulations, through cynicism about the motives of everyone with more money than you, you have now joined your supposed political foes and become a homo economicus believer.


Posted by: Cryptic ned | Link to this comment | 08-21-18 7:42 AM
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If only Keynes had lived long enough to need a Twitter account.


Posted by: Moby Hick | Link to this comment | 08-21-18 9:06 AM
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Clearly medical debt is A FACTOR in doctors going for the mercenary options

Actually, it's our excellent benefits plan that really brings them in.


Posted by: Opinionated Blackwater Recruiter | Link to this comment | 08-21-18 9:31 AM
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I had one last bit of pontification in me, an expansion or maybe revision of my last comment. I think when I said "people aren't one thing or the other" I meant to be clearer that even individual people aren't one thing or the other, and are susceptible to influence. But then I divided people into camps in my comment. Some people are very crystallized in their values and interests, others less so. I definitely find myself getting nudged around by the people in my environment and my close relationships. People tend to be pretty young when they go to med school and even more susceptible to ideological molding than older adults. It's also not always the best thought out decision -- all the more reason that questions like why am I here? what do I believe? what kind of doctor do I want to be? -- might get answered by their interactions with people around them. It's just another way social network effects can effect the character of the profession, and allowing people to prioritize money less might influence everyone around them.


Posted by: Tia | Link to this comment | 08-21-18 10:32 AM
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Thanks for your thoughts in 60 and 71 Tia. It's good to hear that this could have positive ripple effects.

I know what you mean about choosing a specialty young-- part of the civil engineering BS was picking a specialty. My good experiences in wastewater classes (and poor structure teachers) almost got me into a very different line of work within engineering overall.


Posted by: Mooseking | Link to this comment | 08-21-18 10:49 AM
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Med school debt isn't at all like law school debt. Average salary in internal medicine is $200K/year not $65K/year. Maybe this frees up a few people to do genuinely low-paying work, which would be good, but on the basic issue of there being too many specialists making too much money and not enough GPs I just don't see it doing much.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 08-21-18 11:01 AM
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effect the character

Oh, gr.


Posted by: Tia | Link to this comment | 08-21-18 11:03 AM
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I think it moves the Overton window on the idea of free tuition to have a relatively privileged group receiving it as a whole group. It's merit-based in the sense that they have gotten admitted to a prestigious medical school, but within that group it's being framed as something everyone ought to have. I'm not saying tuition trends are going to reverse overnight, but if you're a person advocating for lower tuition costs, this is a nice detail to have on hand.


Posted by: heebie-geebie | Link to this comment | 08-21-18 11:06 AM
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Medical school will become graduate school?


Posted by: Moby Hick | Link to this comment | 08-21-18 11:31 AM
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77

Starting salary for GPs looks to be more like $150k, and average med school debt is now $190k, so average med school debt is about 1-1.3 full years of salary. Just because law school is much worse (~2 years of salary) doesn't mean that med school debt isn't bad or doesn't cause someone to make the choice to nearly double their salary by specializing.


Posted by: F | Link to this comment | 08-21-18 11:49 AM
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I think that analysis ignores residency and fellowships.


Posted by: Moby Hick | Link to this comment | 08-21-18 11:59 AM
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79

I'm now feeling sorry for myself because I sold out but am still poor.


Posted by: Moby Hick | Link to this comment | 08-21-18 12:03 PM
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I'm now feeling sorry for myself because I sold out but am still poor.


Posted by: Moby Hick | Link to this comment | 08-21-18 12:03 PM
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81

Really sorry.


Posted by: Moby Hick | Link to this comment | 08-21-18 12:04 PM
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82

79-81: Join the club.


Posted by: peep | Link to this comment | 08-21-18 12:10 PM
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83

You just want to collect dues.


Posted by: Moby Hick | Link to this comment | 08-21-18 12:20 PM
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Once he's raised $600 million it'll be free.


Posted by: Mossy Character | Link to this comment | 08-21-18 12:21 PM
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85

retail therapy for everyone's problems, indebted doctors and impecunious sellouts alike


Posted by: lw | Link to this comment | 08-21-18 1:12 PM
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Starting salary for GPs looks to be more like $150k

That sounds about right overall, and the real dogooder jobs can pay less than that.


Posted by: ogged | Link to this comment | 08-21-18 2:17 PM
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87

Nobody wants to pay for dog ooding.


Posted by: Moby Hick | Link to this comment | 08-21-18 2:22 PM
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88

If one-and-a-half year's salary of debt is going to make the difference in your choice of speciality, how are you not going to be convinced by *getting one extra year of salary every single year*. Med school debt is like a rounding error compared to the salary differences.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 08-21-18 2:58 PM
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Doctors aren't very good at math.


Posted by: Moby Hick | Link to this comment | 08-21-18 3:10 PM
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90

Also, the point with income for sensibly greedy people is to avoid falling below the middle class minimum with the minimum amount of compromise to your values. And one of your values is not too work too hard.


Posted by: Moby Hick | Link to this comment | 08-21-18 3:24 PM
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My point is that the cost of paying of loans is say 1K/month for law school and 1.5K/month for med school (assuming 4.5% interest and 10 year repayment). So say you're comparing a 60K job vs 160K job as a lawyer, the debt is making that actually 48K vs. 148K. The difference between making 48 and making 60 is pretty big. Whereas you're a doctor and deciding between 150K and 250K, and the debt changes that to 132K vs. 232K, that's... Basically the same decision. I just don't understand the mindset of "Oh, yeah I'd happily forgo the extra 100K/year so long as I'm making 150K, but only having 132K/year would be a total dealbreaker."


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 08-21-18 3:27 PM
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Kinda pwned by 90. But right, that's my point, for lawyers the debt might actually make you fall across "middle class minimum" depending on your definition and where you live, but for doctors no matter what choices you make or what debt you end up with you're way clear of that line.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 08-21-18 3:30 PM
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I think you're all missing an important point: 63 and 64 are more like quark erotica. Physics is a hard science, people.


Posted by: fake accent | Link to this comment | 08-21-18 3:50 PM
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I would quibble with 91 because it leaves out the residency. Which could also work the other way, because you need to add years to that if you want to be a specialist. Also, I don't think an appreciable number of lawyers with a real chance of making the $160k are turning it down out of law school* for reasons of ethics**.

* I'm deliberately not claiming nobody who starts out with the $160k track will jump off of their own volition after trying it for a while.

** As opposed to political careerism.


Posted by: Moby Hick | Link to this comment | 08-21-18 5:02 PM
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OT: America can now certify that that none of our Nazis are collaborators.


Posted by: Moby Hick | Link to this comment | 08-21-18 5:07 PM
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77: It's $230K here. A huge chunk of the primary care doctors are pretty burnt out, though.

I work at a major teaching hospital, and we have some doctors who are researchers and administrators in addition to their clinic sessions, but:

in primary care full time is 8 sessions a week. (A morning is a session as is an afternoon). The other two are for administrative responsibilities - reviewing results and other paperwork. We are changing our compensation model, but a lot of doctors find it hard to keep up with the number of patients they are supposed to see. I see a number of women who are less than full time - even without academic responsibilities 4 sessions a week for one who does a ton of extra admin time and following up and checking in on her patients after reading specialist notes and coordinating with specialists, but 6 is pretty common. So, full time is $240K, but someone might earn $180k to make life liveable. With a mortgage, daycare and student debt, you're doing fine in Boston, if your spouse makes a good salary (and we have some loan forgiveness/signing bonuses). But the student loan payments of $3K/month aren't chump change.


Posted by: Bostoniangirl | Link to this comment | 08-21-18 5:17 PM
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