There is breakdown of healthcare system in US and particularly in California. One third of Californians are on Medicaid . More than 40% receive receive some sort of subsidy from the state.This is supported by higher taxes on the middle class making them flee the state. Well known and world famous Corporations based in state do not pay their share of taxes in the state. If politicians in California is concerned about taking care of the medicaid population they can start by decreasing the cost of tuition to minimum in state run its 5 medical schools. It can ask the medical students who are subsidized to execute bond to work in designated underserved area for certain number of years .
California is shifting the cost of taking care of medicaid patients to working middle class by the way of increased hospital costs and medical expenses
4
@Azad
Saying that there is a breakdown implies that the system worked better in the past, which is not the case
5
This is the future of healthcare. Doctors as government employees. What could possibly go wrong?
3
This is fundamentally a good thing. There are so many communities in CA without good access to medical care and this may help to bridge some of those gaps. Is Medi-Cal great? No. Is it a lifeline for many Californians? Yes. But that's not really the point. Glad CA is doing this for MDs, better still to improve access to affordable high quality higher ed for all.
So sad to read the negative comments about Medicaid patients. Let's keep in mind that millions of older Medicare beneficiaries also rely on Medicaid. Millions of children would have no health care coverage without Medicaid. Once again the troubling idea that poor people are somehow undeserving or "brought it on themselves."
14
New York State (Doctors Across New York) has a similar program which pays for $50,000 in loan forgiveness per year. National Health Service Corps have a similar loan forgiveness program which pays $50,000 in loan forgiveness per year if the physician works in Health Professional Shortage Areas. Neither stipulate that you must see medicaid patients. It is more location based.
2
Residents of California who are not on Medicaid should avoid the doctors participating in this scheme. A non-Medicaid patient risks being rushed out of the treatment room so the doctor can meet their quota of medicaid patients. There is also the risk of boilerplate treatment from fatigued doctors who have so many medicaid patients that all patients start to be seen as people who practice poor lifestyle habits that lead to bad health. 29% of adult medicaid recipients are smokers.
2
The recipe for attracting doctors is not rocket surgery. If Medi-Cal's reimbursement and billing red tape were reasonable, they wouldn't have to bribe doctors into accepting it. If all of my costs are higher in Ca, shouldn't the reimbursement follow suit?
Additionally, I am not aware of any legitimate research that supports the statement by the president of the AMA. She says, " loan forgiveness programs help to increase diversity in the medical profession by removing financial barriers. "In fact, all of my minority friends have significantly less educational debt than myself or my other white male associates.
I was penniless when I started my medical training, and I had to borrow all of the costs. I know this sounds like "uphill, both ways," but the best loans at that time had interest rates of 15% and higher. I borrowed just over $100,000 and paid back almost $300,00. People often told me that it was criminal, but I considered those loans as a blessing because I wasn't going to med school any other way. The point is: It's doable for anyone. If someone is willing to do the work, the money is available.
1
@Brian
I have never heard of rocket surgery!
I graduated med school in 2005 and consolidated my loans - I have interest rate of 1.625% for the life of the loans
1
@Brian
I have never heard of rocket surgery!
1
@Brian
I have never heard of rocket surgery!
I graduated med school in 2005 and consolidated my loans - I am at 1.625% for the life of the loans
5 years in MediCal prison or 300k in debt. Young docs between the Devil and the deep blue sea.
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@vbering
Exactly. Which is worse? Hard to say
2
These young physicians are still paying off their educational debts. The article fails to explicitly note that Medi-Cal typically pays specialists 5 cents on the dollar billed, pays it years in arrears (when it pays at all), does not cover the cost of extra billing staff to respond to all the denials of payment. In the end,
providers who serve MediCal patients are paying the State for the privilege of doing so. I spent nearly twenty years as faculty at the the major public hospitals mentioned in the article and we never turned anyone away from excellent medical care. Accepting Medi-Cal in a private practice would be an economic death blow. The business model of Medi-Cal, like all other insurance plans is: Delay, Defer, Deny.
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@Acute Observer Well said. Couldn't agree more!
Much like Medicare, Medi-Cal does not pay a reimbursement sufficient enough to cover cost of care -- hospitals and health facilities lose money for every patient they accept. It's not unusual for hospitals to recoup this money by over-billing individuals with private insurance: for example, SF General "hospital instead focuses on patients with public health plans, such as Medicare and Medicaid, recouping from patients with private insurance what the hospital loses treating the uninsured and underinsured."
https://www.newsweek.com/zuckerberg-hospital-er-private-insurance-medicare-medicaid-mark-facebook-san-1282274
Rather than helping improve this situation for *all* Californians by paying a reimbursement equal to cost of care, paying for more residency slots, encouraging physicians to become generalists rather than specialists, expanding what services nurses can provide, etc. the State has elected for this limited approach that's likely to be quite expensive relative to the benefits it provides. Indeed, doctors with more debt are no doubt more motivated to join in such a program than those without, even if both were capable of providing such services.
2
I'm confused. The women are doctors too, right? Then why don't they have their proper title like the men do? This is unacceptable, especially coming from an article in The New York Times. Fix this grievous error.
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@Elizabeth Garnett Thanks for pointing this out. Particularly disappointing since the authors are women.
8
One way to cut medical costs, or at least a frequently relied-on rationale for high fees charged by doctors, is to provide free or highly-subsidized medical education -- as many other countries do.
I know numbers of medical doctors (including surgeons), and -- to the one -- they refer to the high costs of obtaining a quality medical education when asked why they charge patients (or insurance companies) what they do.
Lower education costs should cut their credibility in that line of argument.
In return, doctors get assigned some patients with Medicaid or, if HCA is no longer as it is, then doctors get assigned a certain percentage of uninsured pro-bono patients. Or something similar. That might also better level the playing field between doctors.
7
Absolutely
French person here : our medical students pay less than 2 000€ a year for tuition.
The highest you could pay for a very famous Professor would be 150€ a visit but a GP is 23€ ( should be 30 to have more time) refunded if I remember 20€
A cavity repair is around 40€
And our doctors are misty OK with their income.
All is not heaven in France, we have to decide how we will deal with the raise of medical expenses (old age, chronic illnesses, obesity etc.)
But it is still much more efficient for a lesser cost than the American private system.
7
We need widespread student loan debt forgiveness, not just for docs. This would be a huge boon to the economy, would increase household formation, alleviate suffering for millions of Americans, and be a fair reset to younger generations who were saddled with college costs that have spiraled out of control for decades, well beyond the rate of inflation. At the same time, we need to find a way to force colleges to get those costs under control, their irresponsibility is mind boggling!
4
THIS IS SO COOL!!! #300K in medschool debt!!!
2
I don't understand how our government can justify compensating healthcare providers at different rates for the exact same procedure(s) and other professional duties (assessment, testing, etc.) simply based on whether the patient has Medicaid or Medicare. On its face, it makes no sense and seems unjustly discriminatory and should be unlawful.
4
Paying for education with service is a sound idea. My youngest son went to the US Naval Academy and was provided education, room and board and medical care at no cost. He also received a salary as he was active duty in the Navy during school. He is now a 2nd LT in the Marine Corps and will serve for the next 9 years (service requirement is longer because he was selected to be an aviator). Medical students can also join the military and get an education with no debt, paid for by service after graduation.
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How will work out as a solution for the entire country?
2
But at what cost? There is more to all this than money.
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@Anna Base Service to country is a good thing in and of itself. If it can also be a way of obtaining a quality education while avoiding debt, so much the better.
1
Very, very smart of California, and something I long advocated. Medicare also should be on the list. I know seniors who needed life-preserving treatment but had a difficult time finding doctors with needed expertise who would accept Medicare!
California and other states should add Master- and Doctoral-prepared licensed clinical social workers to the group of health care professionals eligible for loan forgiveness and other incentives to practice in their state and to take often-lower-paying Medicaid -- particularly since a high quality social work school graduate degree costs not so much less than the equivalent number of years of medical school (usually 2 for a masters), but social work salaries and insurance compensation rates are often significantly lower than doctors or even non-Master-degreed nurses.
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@MSW
Why would anyone ever get a doctoral degree in social work?!?
3
Maybe the California MediCal program leaders should ask themselves why they have to bribe physicians to take care of Medicaid patients. You don't need an MBA or MD to figure out the answer - the payment rates are so low nobody can afford to work in under served areas where there are large numbers of Medicaid patients. Now that Illegal immigrants can also get on MediCal the problem will only get worse. Free healthcare is very expensive.
13
Pretty hard to say this huge financial break should only be given to medical doctors, particularly since their lifetime earnings are among the highest in the country.
How about all the other in-demand doctoral (non-MD) specialties? Won’t they clamor for support?
Or is this just the camel’s nose in the tent toward total college loan forgiveness?
1
Most doctors’ earnings are meager compared to lawyers and business people. I am talking about doctors that are most needed on a regular basis for preventive care as well as psychiatrists.
12
um, no.
1
Agree. What about the other specialties? This is an incomplete and incorrect solution. By the way- these doctors are now obligated to work in CA for many years now...
This is needed for mental health treatments as well, particularly for those at the doctoral level!
9
I agree, with the caveat that many doctoral students (and, hence, graduates from doctoral programs) often receive partial or full tuition waivers, and sometimes living stipends, in return for conducting teaching sections for lecture classes, assisting professors with research, and/or teaching lower-level undergrad classes.
To my knowledge, neither medical school doctoral candidates nor master of social work candidates are eligible for nor receive such opportunities and financial help. They may receive loans, and perhaps small scholarships, but nothing like a full waiver of tuition or five-figure stipend for living expenses.
5
Most Excellent and a win for all!
5
GO TO THE SOURCE......
why is higher education so expensive ?
who controls their costs ?
4
@ZEMAN
Medical training is particularly expensive because of the cost of equipment and trainings facilities. It’s not like teaching English or history or marketing which can be done pretty much anywhere. But, still, it’s kind of crazy how it’s gotten exponentially more expensive these past few decades. I’d lay it on fancy buildings and administrative staffing run amok.
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@ZEMAN
"why is higher education so expensive ?
who controls their costs ?"
Wall Street. That is why the costs are so high.
1
@ZEMAN
Loans. Loans. Loans.
Eliminate loans or cap the amount of debt someone can take and the cost of higher education will drop over night.
For better or for worse, government policies have a tendency to distort the market.
3
Would it not be also more productive to accept more "qualified" students into programs than just paying off their debts? The biggest road block into medical school is the application process. Many who are qualified simply don't get in.
5
Some do get in but can’t afford the cost!
@Lue
Exactly. We already rely on foreign medical schools to train many of our doctors while turning away thousands of qualified applicants every year here in the US due to a lack of training spots. It seems a much better use of money to increase enrollment and decrease tuition, rather than paying off loans that have accumulated many years of high interest.
3
Why american medical students are required to have a 4 year college degree before they can be admitted in the medical school?
US routinely imports doctors from all over the world who went to medical school straight from high school. Those students started taking biology, chemistry and other premed courses in high school.
Making it mandatory to have a 4 year college degree in order to qualify for medical school admission does not work for the students, and the US. Just imagine how many doctors US will be able to produce.
9
@AIM Medical program abroad requires 5 year college as well but it is normally built in the medical program itself. That is why there is no pre med program. The medical student requires to have science degree related to the specialty of their choice. For example, radiologist can have undergrad degree in biology or physics in their medical program. By the way, those medical students normally do not have summer break. They spend their summer in the school hospital as part of their training.
5
Because, among other things, a sound grounding in social sciences and liberal arts/humanities is an excellent aid to doctors, who not only engage in hard science, but also must know how to interact with others as full human beings, must understand ethical guidelines and legal aspect of responsible medical practice, and, because they and their organizations may be involved in policy advising and development, they should also have some basic grounding in history, social sciences and law-ethics. A good bachelor degree program also better enables doctors and other medical professionals to more easily and appropriately work with and serve a wide range of individuals and communities.
Some, but not all, other countries may, like some US universities, allow students out of high school to complete a 6- or 7-year medical degree (expedited from 8 years of school), but in my experience the US does not routinely accept just-graduated foreign medical degree individuals. Rather, some teaching hospitals may offer an advanced type of practice-training called a fellowship to doctors from other countries. These fellows have already practiced for numbers of years, completing internships and residencies in their home countries before applying to and being selected, via a
rigorous process, by fellowship committees. The US does not typically "import" 21 or 22 year-olds with only 4 years of post-secondary education in medicine, as they wouldn't be eligible for medical licensure at that point.
6
Perhaps it is also because, for the most part, we want well-rounded, nature human beings as our doctors, and we don't think it's good for patients or the would-be doctors to suffer such intense role- (and mind-) foreclosure as teenagers. Their is also much to be said for the maturity and generally better judgement that just several more years of life experience and neurological development bring.
4
It may sound cruel but it is really difficult to take care of medicaid patients. Some people are poor because of bad luck but many of these people are non-compliant patients who will not take care of themselves. As doctors, we want to see patients do well. It is much harder with noncompliant patients. Loans can be paid with some belt tightening and loan payment is not worth sleepless nights caused by noncomplaint medicaid patients.
13
May I suggest you and your colleagues employ master of social work professionals in your practices? Such professionals have expertise in a variety of areas and interventions that encourage and support patients' and families' efforts at self-care and following medical advice. They are also expert liaisons for both patients, families, and other medical/healthcare professionals and systems.
Their services create added value for all patients, not just those with Medicaid for insurance. The cost of their salaries and benefits, or of their contractor fees, would be money well-spent, for both you and your patients (and may be billable to insurance, Medicaid or otherwise).
6
sk, Actually the majority of people are poor because of bad luck. They are poor because their parents were poor, so they couldn't go to a good school. They are poor because their neighborhood was poor, and they didn't have any roll models that showed them they could be more. They are poor because this country is stacked against anyone who isn't white, male, and rich. Sure, there are lazy people who happen to be poor, but they aren't poor because they're lazy. I have a suggestion. At least once a month, talk to someone less fortunate than you. Ask about their life, and how they got to the position they are in. Much more often than not, you will find someone who served in a war, and couldn't handle the psychological trauma they suffered. You will find someone who had a disease, and had to pay money they didn't have to live. You will find someone working multiple low-paying, gloryless jobs to support their family and it still not being enough. So yeah, just like rich people,a percentage of poor people are lazy. But unlike rich people, we tend to define all poor people by that percentage. It is stupid and wrong. Let's all work together to change the stereotype.
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@Elizabeth Garnett
I disagree
I was born really poor. Actually I did not see much money until 10 years ago. I am in my fifties. Very few people have seen the poverty that I have seen.
Poverty is caused by individual behavior and decisions. I was born into a poor family whose poverty was direct result of mismanagement and bad decisions made by my father and grand father. I do not blame any one else.
5
All states should do this. Medicaid patients deserve full access to ALL doctors, and I believe this is required by law, though never true in reality.
3
Why stop at physicians. This is very unfair. How about psychologists? Social workers. Nurses. And any other dealing with patients, Debts are found all over the healthcare business, some large, some not so much. And physicians overall earn more lieftime money than all the rest put together!
32
@Vinnie K Absolutely! Medical doctors are hardly the only doctors racking up $200,000-plus in student-loan debts. What about...scientists (who after all generate the knowledge & evidence that clinicians--medical doctors, use in the practice of medicine)?
5
In other countries, like some in Europe and India, students go directly from high school to med school without wasting four years as an undergraduate and without accumulating the associated debt. Why not here?
22
@E. P. Eklund Because you need to know more about more subjects, and life, before becoming a doctor. The fact that they do not, in those countries, means when they come here, they should have to do at least two years of liberal arts education.
8
Well said, Grittenhouse.
Also, as others have noted, it's not great for young people to have their education or future life career closed off and pre-determined in what would be middle school (in order to get into an appropriate high school program) or even high school.
Furthermore, medical and social sciences have
demonstrated that the human brain is most capable of engaging in, and people of enacting, good, sound judgement after the age of about 25 years. That happens to be the approximate age when most US medical school students graduate with their medical degrees and start the internships then residencies through which they exercise increasing levels of independent practice.
When it comes to the practice of medicine and to the provision healthcare and other professional services generally, better judgement and greater capacity for it are always good things.
4
@E. P. Eklund
I’m not sure skipping undergrad would make that much difference in debt levels. I’m guessing that most people who end up in medical school here are top students who incurred little or no debt in undergrad due to scholarships. Most of their debt is due to medical school. In some countries, students pay very little for medical school.
3
Loan forgiveness and programs which fund doctors in lower paying high need areas are about the only way a physician can afford to serve the under-served.
In the field in which I work, Medicaid reimbursements are about half of Medicare rates; and as you go up the food chain, it gets harder to find specialists necessary to do critical procedures. Any doctor who does take it runs the risk of being the only provider, and getting a disproportionate percentage of his practice reimbursed at stupendously low rates.
Forgiving debt is a good start. But imagine if we just increased the Medicaid reimbursements so that treating the publicly funded patients did not drive you practice into the dust.
Or ... crazy idea... we could eliminate Medicaid and have a single government program called Medicare, and fund it wisely. We could negotiate with giant pharma companies and actually pay the providers for care.
49
@Cathy, All good points.
We could also, to be more equitable among fields of medical practice and in order to prevent the glutting of one practice with low-reimbursement patients, simply require as a condition of professional license renewal that every doctor reserve and maintain a certain number or percentage of the medical practice caseload for Medicaid-insured and other low-income or low-reimbursement patients
6
Why do all the men in this article get “Dr.” before their name but the women don’t get that title before their name despite the fact that they are also doctors?
73
The opening Picture in the article shows a male and a female both titled doctor. Not sure what you’re referring to.
7
@Emily
Really? Reread twice , not true. One person cited without Dr in front is Not a Dr. can anyone find this?
8
@Emily There are actually 5 women doctors with Dr. before their name in the article.
5
The article says that medical school debt causes students to avoid lower paying specialties.
If anyone bothers to read the article that is cited to support, it shows that there are many studies that contradict this.
And shouldn't the program be used to encourage medical students to enter the lower paying specialties such as primary care and psychiatry where there are severe shortages of practitioners all over the country because they are low paying.
As far as I know there is no shortage of pediatric hand surgeons. Once he puts in his 5 years, Dr. Galvez will no doubt be offer to make the at least $500,000 per year if not more that many orthopedic surgeons make. How will that help anyone but himself? Why don't they limit it to those going into the lower paying specialties for which there is a need.
17
Personally, I believe that if medical students accept any form of federal loan and especially a federal grant, they should be required to take at least a certain number of patients, or percentage of patients, with Medicaid and, perhaps Medicare, insurance.
Or, to be more equitable in terms of not further burdening those students who cannot pay full tuition out of pocket, as some medical student do, why not make a condition of state medical licensure that a certain number or percentage of patients must be (verifiably) lower-income?
1
Psychiatry is definitely not lower paying (unless compared to dermatology or anesthesiology). Hardly any psychiatrists accept insurance or Medicaid. Most bill $250 to $350 an hour directly to patients, whom they see an average of once a month.
13
It is very low paying if the majority of your patients are on Medicaid.
9
@DC c Among physician specialties, psychiatry is one of the lowest paid, along with internal medicine, family practice and pediatrics.
6
So she has 320k in debts, and a monthly take-home pay of 15k. Yet needs the tax payer to bail her out???
I'd say: 4k for rent, 1k for transportation, 5k for debt service. That leaves 5k to live off a month. Where's the problem? And if she lived modestly for a few years, she could even pay down 8k a month...
37
@Beyond Repair - And those 7+ years spent in medical school, residency and fellowship? They should not be rewarded in some fashion?
25
Jack, no, they should not. It is a personal choice to go to medical school. My husband and I have a combined 25 years of graduate school and post-docs in STEM fields under our belts and don't make nearly as much as a dermatologist or anesthesiologist. We, too, have worked long crazy hours in labs and work in jobs that benefit society.
19
@Beyond Repair
Stop! This program is a great step forward, what our government, society ought to be doing. Nitpicky, myopic nonsense, like you state is what keeps our country stuck and less equitable. Yes, a few individuals, may make a bit more, but it's the collective that strongly matters. This program will help, not only the physicians in debt, but the poor patients who are in need of quality care.
40
Non Market based solutions are exactly what patients need! Our current system of "insurance" has been broken for decades and unless we want to become even more 3rd world we need to socialize most aspects of basic medical care.
I've been self employed, paying through the nose for private insurance my entire adult life. It's never paid for anything, and I mean that literally. The insurance companies make out great, the docs and the patients are the ones who suffer.
6
Increasing the number of persons attending medical school won’t help without also increasing the number of residency slots. That is a problem that requires Congress to become involved because of how medical residency is funded. Good luck with that!
25
@Kat
The problem isn't the number of residency slots. We have too many in some surgical specialties because we have too many docs already. And we don't need them in the lower paying specialties because we don't have enough graduates of American med schools to fill them. If we stopped foreign doctors from entering the country, most psychiatry residencies would have to shut down.
8
Steve, they were referring to the fact that if you read the entire article, you would notice when it profiles female doctors it doesn't use a title like it does with make doctors.
1
@Steve
Or we could increase the number of medical school slots in the US. Compared to other developed countries, we rank very low in the number of doctors we educate per capita. We turn away thousands of qualified, interested applicants each year due to a lack of training spots.
2
This is a very odd and non-market based response to the low reimbursement problem we face in California. This will allow MediCal to continue to have an excuse to pay below market rates. In my experience as an oncologist, having MediCal as a patient’s insurance is an independent prognosticator for poor outcomes and an earlier death than the rest of my patients.
15
@Ravi When we go to Single Payer in this country and I believe we will at some point, all providers will be forced to take a significant pay cut to put us "in line" with what others are being paid in Europe, in Canada, in the UK.
15
I agree that a calculation was made comparing what it would cost to fund this program verse what it would cost to increase MediCal reimbursements. It was a no brainer to go with this program vs increasing MediCal reimbursments. If we do go to a "single payer" and there is a major drop in payments the quality of physicians will drop also. In Canada physicians can still do quite well. So what ever plan may come in it may not have to include severe reduction in physician reimbursement. My concern as a physician would be even further loss of control in what I do. With statistically draw algorithms with lesser qualified personnel doing much of the medical care. Probably good most of the time but in those patients that don't fit the statistics things will be missed more frequently. This will continue the gradual erosion of expertise.
9
Is the insurance the causal factor here? Or poverty? Low reimbursement is certainly a factor in access to care, but we also know that poverty contributes all sorts of other problems that cause poor health in the first place. Let’s not make the assumption that outcomes will improve unless we address both.
6