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    Joined: Feb 2010
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    We often talk about accelerating education and reducing its cost. One way to do that would be to reduce the number of careers for which
    the bachelor's degree is a prerequisite.

    English Literature Isn’t Brain Surgery: Why is American medicine so expensive? One reason is that doctors are forced to get bachelor’s degrees.
    By Chris Pope and Tim Rice
    Wall Street Journal
    April 23, 2018

    Quote
    The U.S. spends about 18% of its gross domestic product on health care, far more than most countries. One contributing factor that often goes overlooked: the high cost, in time and money, of becoming a physician. In a recent paper for the Mercatus Center, Jeffrey Flier and Jared Rhoads argue that the amount of time it takes to become a doctor—almost always at least a decade—constrains the supply, driving up prices. Physician incomes in the U.S. well exceed those in Europe; American generalists earn twice as much as Dutch ones.

    Much of this education, especially courses required for a bachelor’s degree, has little to do with medicine. In the U.S., aspiring physicians must spend four years in college before med school (another four years) and then residencies. Europeans can begin studying medicine immediately after high school—usually with a five- or six-year course.

    While the share of Americans with postsecondary education exceeds the level in most European countries, the U.S. has a much smaller proportion of medical doctors graduating each year: 7.5 per 100,000 residents, compared with 11.3 in Germany, 12.8 in Britain, 9 in France, and 14.6 in the Netherlands. Only Canada, which has undergraduate requirements and high physician costs comparable to America’s, comes close, with 7.8 per 100,000. The U.S. faces a projected shortfall of between 42,600 and 121,300 physicians by 2030, according to the Association of American Medical Colleges.

    The status quo also does a disservice to young doctors, most of whom emerge from med school in debt (a median of $195,000 in 2017) and don’t begin to practice until they’re in their 30s. Why prolong the process, especially when 53% of newly enrolled med students say that before college they already had “definitely decided” to study medicine?

    Last edited by Bostonian; 04/24/18 04:59 AM.
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    Count me already on board with cutting costs.

    However, doctors need a wealth of skills apart from just medical knowledge, and wouldn't English Literature be a useful proxy for thing like:

    - Reading and interpreting abstruse language
    - Communicating with patients from a variety of backgrounds and communication modes, understanding the spoken and unspoken

    ?

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    I could just as easily put my comments below in the thread(s) we've been discussing college costs.

    I think the OP is simply part of a larger problem in at least the U.S., I can't speak intelligently about other countries. That problem being that an undergraduate degree has become not necessarily necessary in order to perform certain jobs but instead a sorting tool for companies.

    It wasn't that long ago where it wasn't unusual, at least where I live, for companies to employ people as engineers who didn't have a college degree in engineering but had demonstrated keen ability in their field of engineering. Most companies these days don't allow that anymore, the degree in the field of employment is a requirement for being hired.

    No doubt the internet has done amazing things and provided us with opportunities that never existed prior to it's wide spread use. In the market, it lets the world become our customers......on the other hand, it also allows the world to become our competitors.

    It used to be that when a new job was available, a company would post it in the local and perhaps most popular read state wide newspaper, that was the extent of who knew about the job opening. Now, the newspaper is generally ignored and anyone in the world can look at the help wanted ad posted online. That creates a huge amount of competition for a new position opening. That's of course a good thing from the perspective of the company, however, they need a way to start sorting out candidates. An undergraduate degree is often that first measuring stick to begin the process or sorting....and why not? One with an undergraduate degree has demonstrated at least SOME ability to stick with it and complete a task, they have demonstrated the ability to learn, and it's a fair bet they had to complete quite a few assignments in groups. It doesn't though, mean they'll be a good employee or that their degree is needed to accomplish the job.

    This has created a situation where companies are using a very expensive means for the job seeker as a basic sorting method making that sometimes unneeded means an expensive requirement with little application to show for it after the initial sorting process.

    So how do we remedy that? Good question. I'm going to have to chew on that one for a while.

    Last edited by Old Dad; 04/24/18 06:51 AM.
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    Interesting idea. It would be useful to understand how health outcomes vary for patients of doctors with various levels of pre-med accreditation.

    In Canada, not all medical schools require that the prerequisite undergraduate degree be earned in a STEM field (though students contesting the MCAT are certainly better positioned if they have a strong science background).

    A similar case could be made for many professional certifications--law, business, communications--because students don't explicitly need undergraduate studies to be able to complete the programs. However, to a large extent extent, personal maturity and life experience factor into the ability of professionals to carry out their work effectively and efficiently, especially in fields where work tasks are heavily EQ loaded.

    IMO, an argument could be made in favour of such programs requiring a certain amount of meaningful life experience (e.g. entrepreneurship, work experience, patented discovery, full-time volunteering, post-secondary education, etc.) as prerequisites to the core studies. This is the challenge with developing cookie-cutter accreditation programs, because individual experiences, maturity, EQ, communication skills, and technical qualifications vary substantially.


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    Adding quickly: medical school in most other countries begins directly after secondary school and lasts for 6 years. AFAIK, this is the model in Europe, Australia, and elsewhere.

    Also, other countries subsidize education because their leaders see it as an investment in the health of the society and its economy. This means that people aren't paying $85,000 a year on top of whatever they paid for a BA.


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    Yes, doctors incur a lot of debt, but most of that usually comes from med school. In this case, eliminating bachelors degree wouldn’t really lower costs in any meaningful way.

    Second, doctor’s salary’s are not the factor driving up healthcare costs. It’s how the field is structured, with pay being tied to procedures and tests rather than treatment efficiency.

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    One could argue that the recent movement toward having routine primary care increasingly provided by bachelors-plus and masters-level professionals, such as PAs and NPs, is a response to the length and expense of doctoral-level medical training. and its impact on the supply of healthcare providers.


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    Originally Posted by SarahMarie
    Yes, doctors incur a lot of debt, but most of that usually comes from med school. In this case, eliminating bachelors degree wouldn’t really lower costs in any meaningful way.

    Sure, that's true for doctors who attend public universities (especially with scholarships). But eliminating some or all of the time spent in a bachelor's program does augment the time in which doctors can earn income and repay debt by 2 years, which is meaningful.

    This isn't to say abandoning a bachelor's is the way to go, just that there are financial benefits from doing so, provided the doctor is equally well trained under both models.

    Originally Posted by SarahMarie
    Second, doctor’s salary’s are not the factor driving up healthcare costs. It’s how the field is structured, with pay being tied to procedures and tests rather than treatment efficiency.

    Salaries are cumulative fees per procedure less overhead. The difficulty is pricing within an HMO insurance model, which superimposes an insurance-motivated pricing structure over an otherwise functioning market.


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    Originally Posted by SarahMarie
    Yes, doctors incur a lot of debt, but most of that usually comes from med school. In this case, eliminating bachelors degree wouldn’t really lower costs in any meaningful way.
    Parents would be more willing and able to pay for at least part of medical school if it were not preceded by four years of college bills. My wife's medical schooling was funded by her parents in a country where you take pre-med courses in the last 2 years of high school and then go to medical school if you are accepted. She knows her medicine as well as American-trained doctors do (she passed the USMLE exams on her first attempts) and could start her residency in the U.S., debt-free.

    Instead of shoveling ever greater amounts of money into a needlessly slow and expensive educational system, change the system.

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    Originally Posted by aeh
    One could argue that the recent movement toward having routine primary care increasingly provided by bachelors-plus and masters-level professionals, such as PAs and NPs, is a response to the length and expense of doctoral-level medical training. and its impact on the supply of healthcare providers.

    This exactly. My firm does a lot of work on optimal health system design and has found a strong argument--both in terms of costing and patient outcomes--for adopting a tiered care model.

    (It's also part of the reason why I always choose a family practice that is housed inside an academic health team affiliated with a university and hospital.)


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