August 1, 2012

"Is Medical School a Worthwhile Investment for Women?"

"Even though both male and female doctors both earn higher wages than their PA counterparts, most female doctors don't work enough hours at those wages to financially justify the costs of becoming a doctor."

46 comments:

edutcher said...

If all the guys bail because of ObamaTax, it just may work out.

Bob Ellison said...

Strange question. Is it worthwhile working hard for a long time to earn money?

chickelit said...

The question is analogous to that proposed for law students. If future medical and law students balk at those costs because of dimmer future prospects, who will pay those tuitions? In the past, such tuition costs have been "personalized," i.e., borne by individuals.

What happens if University cash cows dry up? Who's getting the milk and is it free?

AllieOop said...

In our economy I can see women docs working more hours, especially if their husbands have lost their jobs. My female GP works full time and has three children. My daughter, an attorney will be working full time for years to come, unless her future husband's Madison start up takes off big time.

Wally Kalbacken said...

OK, then.

Tim said...

The authors miss the lead. This just isn't some little pity party for female physicians.

Anyway, there are lots of ironies here: presumably (almost assuredly)female physicians work fewer hours because of child-caring issues; there is an ongoing shortage of primary care physicians (PCPs) that the ACA will only exacerbate - how many female physicians will respond by seeking to move the economic ladder by becoming specialists (which enjoy both greater income and job freedom, relative to PCPs)- thus making the PCP shortage even more acute?; the "promise" of the ACA to "bend the cost curve" (i.e., control costs) will have to, necessarily, focus on labor costs - this will, necessarily, result in caps on provider reimbursements (did anyone else catch the news out of Massachusetts today?), thus making the ROI of med school that much less attractive than it is now, thus suppressing the flow of new and vitally necessary PCPs to address the estimated 20% increase in demand for health care services resulting from the ACA.

Shorter version: yeah, health care is fucked up, but the ACA will make, with almost no exceptions, every aspect of health care more expensive, less efficient, and with lower quality.

Thanks, Obama voters!

Fucking morons.

Pogo said...

Under Obamacare, the question is now
"Is Medical School a Worthwhile Investment for Anyone?"

Reductions in pay will make it increasingly difficult to recoup the upfront training costs. The massive new regulations will make the work more and more unpleasant.

Unless your parents pay the whole thing, medical careers should be avoided for the next decade or two.

FleetUSA said...

Well, I'm deep into the aspects of these issues as I have 10 family members as MD -- male and female.

My old MD dad said it was a waste of med school space to give women a slot as they wouldn't work for a life time of medicine. His 3 MD granddaughters laugh at that and are great doctors.

My daughter - one of the above - works full time now (our help with kids) and does a wonderful job.

We need all the good doctors we can get - especially as the economics become disincentives for many.

The Drill SGT said...

As Tim expressed, it sucks to be a female PCP. Medical School Admissions boards used to anticipate that female docs would work fewer hours for fewer years. I have seen studies that show that Male PCP ultimate work twice as many hours over a career than females.

But the Admissions guys were forbidden to consider that....

ACA lowers rates per patient, which drives the demand to shorten the per patient/Doctor time window to increase revenue. This churing causes more females to flee.

The curve bends up....

dreams said...

My primary care Dr's group practice and Cardiologist's group practice are now part of a hospital so I guess they are employees now, not sure how that works.

Beldar said...

The barriers that historically prevented or deterred women from becoming physicians -- if they so chose and could qualify based upon merit -- have been knocked down.

Individual women can be as career- or family-oriented as they wish.

Can we stop talking about this now as if being a physician were somehow necessarily a gender-related issue?

Beldar said...

"Pat is considering becoming a physician. To make a wise and well-informed decision, Pat should give careful thought in setting priorities and evaluating different options. If Pat expects to be able to put in a whole lot of time at work, that's likely to translate to higher earnings that, in turn, might better justify Pat's decision to invest in medical school."

So what difference does it make if Pat has a penis?

Beldar said...

^^^ That's a hypothetical of my own device, not something I'm quoting from elsewhere, just to clarify.

MikeDC said...

Absurdly bad economics.

Female doctors work less because they marry male doctors.

They gain access to male doctors by becoming female doctors.

Thus, becoming a doctor is a great investment for a female, because it gives them access to wealthy husbands who make so much money they find it no longer worthwhile to work themselves.

DCS said...

FleetUSA is greatly mistaken about women MDs working less than men. The numbers show that overwhelmingly they work work fewer hours and also populate subspecialties like dermatology that don't exactly address the primary care physician shortage. Those are facts. It doesn't mean women are less capable than men, but it shows they take up space in medical school and don't justify, on average, the resources spent to train physicians. A lot of the cost of medical education is subsidized by tax dollars.Taxpayers ought to get a refund from physicians who work less than some fraction of full time in order to make women physicians think twice about displacing a full time worker.

David said...

Well, if money is the primary reason they go into medicine, they analysis might have some value.

Also the analysis assumes that the doctor herself is paying the cost of her education. Doubtful in many, many cases. There is a lot of scholarship and grant money available for doctors. The money on money return can be pretty good for docs. Money on time return is another matter.

Why is it assumed that child care is the reason female doctors work less hours? Is there a difference between married and single female doctors in hours worked? I'd like to now that. Is there a difference for doctors married to other doctors, and how does that shake out gender-wise?

And maybe the women don't work as much because they are perfectly willing to have the man pay for it. Women are smart that way. Men are not. Listen to what Allie said in this thread: My daughter, an attorney will be working full time for years to come, unless her future husband's Madison start up takes off big time.

In which case, the daughter will also take off big time.

John Lynch said...

Yes, because MDs have status. We're not economic animals.

John Lynch said...

Also, maybe they want to be doctors to heal people? Isn't that possible?

The Drill SGT said...

MikeDC said... female docs marrying male docs, etc, etc...


Like "Grey's Anatomy", slutty Female Dcos stealing husbands from the traditional field of slutty Nurses looking to marry up.

sydney said...

I would still rather be a physician than a physician's assistant. But Pogo is right. There are so many regulations and mandates now that it is hard to get through the day without unknowingly breaking a law or being distracted to the point of detriment to your patients. I tell my kids it isn't worth the investment.

AllieOop said...

David, I'm no feminist and not ashamed to say that child rearing done by the wife is very desirable. To carry the child and then have to leave it after 8 weeks is heart wrenching for many young mothers. It's a biological drive to take care of your child yourself if you are female. But this is not to say that the father would be less capable a caregiver to his children.

My daughter and her fiancé have discussed this at length and have agreed that ideally she be the stay a home parent, but It isn't an ideal situation and both their incomes are needed, so we grandparents are going to be the daily caregivers.

Such is life in our economy, I find I a bit sad. I guess some may look at it as having your cake and eating it too. The role of women in our society isn't as clear cut as it used to be.

AllieOop said...

Sheesh, "slutty nurses looking to marry up"?! I didn't marry "up", I didn't meet my husband while he was in med school, we met as undergrads. I didn't know any nurses who stalked docs to marry.

David said...

Dante's post from the previous thread:

Dante said...
Maybe they should have become nurses up at UC Davis Med Center. Lotsa jobs, lotsa upside!

Mae C Olavides NURSE, CLINICAL III UC Davis $226,685.70

Other nurses:
200K+ 9 of them
$190K 3 (in the decade of salaries 190K - < 200K)
$180K 10
$170K 5
$160K (10)
$150K (22)
$140 (78)
$130K (104)
$120K (168)
$110K (298)
$100K (267)
$90K (336)
$80K (237)
$70K (151)
$60K (127) :: Includes Vocational Nurses now

Sorun said...

I didn't know any nurses who stalked docs to marry.

I thought most nurses are lesbians.

Milwaukee said...

Beldar said...

The barriers that historically prevented or deterred women from becoming physicians -- if they so chose and could qualify based upon merit -- have been knocked down.

Individual women can be as career- or family-oriented as they wish.

Can we stop talking about this now as if being a physician were somehow necessarily a gender-related issue?


However, this isn't just up to the individual woman involved. Most states subsidize education. Taxpayers help pay the bill, hoping to get a physician who will be available for years and years. There is lost opportunity: A woman taking a seat in a medical school which could be used by a man might be a lost opportunity for society.

Men tend to define themselves by what they do, their occupation: tinker, tailor, soldier; while women tend to define themselves by their relationships: daughter, wife, mother.

Since society is involved, society gets to weigh in on this topic. Gender is very important. If society didn't subsidized schools after high school, and students paid everything on their own, then I would agree, what's the difference. But that isn't the case. You didn't get that medical degree by yourself: taxpayers subsidized it.

David said...

Allie, you made it too easy and I'm sure your daughter is a fine citizen and that she and her husband will work on this together. But no nurses ever "stalked" doctors for spouses? Gimme a break.

Upper class and upper middle class women still have a great gig. They can work if they choose to or not. It's lessening, and the women are realizing that work is not just a burden but an opportunity, but the feminist movement still is from, by and for women with some kind of privilege: class, money, education, big brains, beauty. Michelle Obama is not the first to whine about how expensive the nanny is.

AllieOop said...

David, I'm not saying it NEVER happened, but I didn't see any wide spread stalking of cute docs by desperate nurses. And very few nurses I ever knew were married to docs. One nurse friend of mine was the only one I knew and she met him all the way back in high school.

sleepless nights said...

It's certainly been worth it for the female doctors I know. You get other benefits - some become researchers or professors. There is the benefit of social status and circle, job security, etc.

Geoff Matthews said...

AllieOop doesn't understand the law of large numbers.

Beldar said...

@ Milwaukee: You write, "Since society is involved, society gets to weigh in on this topic."

If that's the standard, society, i.e., government speaking for society, gets to override our individual liberties.

I reject that approach. That is gender-based discrimination. You're stereotyping, overgeneralizing, and proposing that government ("society") put its thumb on scales it has no business disturbing.

Pat can make up his or her own damn mind. Get out of Pat's business.

Beldar said...

Put another way: Taxpayers may or may not find it useful to subsidize physicians' education.

But discriminating against would-be physicians based on their gender is sorting them into boxes and categories that are unfair to the individuals involved because their commitment to their careers isn't determined by, nor always even affected by, their respective genders.

You have no basis for giving Pat (the male) an advantage that you'd deny Pat (the female), or vice versa, other than bigotry.

David said...

Beldar said...

You have no basis for giving Pat (the male) an advantage that you'd deny Pat (the female), or vice versa, other than bigotry.


You are too harsh, Beldar. There's always stupidity.

David said...

I didn't say the stalking was successful, Allie.

And by the way I have the highest regard for nursing as a profession. Especially since Dante has illuminated what they can get paid (at least at UC Davis.)

Eric said...

Strange question. Is it worthwhile working hard for a long time to earn money?

The question is whether they're really getting their money's worth for all that hard work. Anyone who goes into medicine thinking that's a good financial decision is crazy. The lost opportunity costs alone in your twenties are enough to wipe out any advantage of a large salary later on. And then there's a few hundred grand of debt.

And if you're smart enough to be a doctor you're smart enough to be a computer programmer or investment banker or... whatever.

jeff said...

My Dr is about my age, married and has a dozen kids. Some adopted, some special needs. I have no idea how many hours she works. Or how she manages everything, but she is a excellent Dr.

Ralph L said...

the daughter will also take off big time.
Yeah, with half his money and a doctor she met at work.

Just a joke, I'm sure she's as loyal as Donna Reed, former nurse married to a doctor (on TV).

Paul said...

And, after all, it IS about the money.

Michael K said...

"
Reductions in pay will make it increasingly difficult to recoup the upfront training costs. The massive new regulations will make the work more and more unpleasant."

The French, who have in my opinion, the best medical system in the world, pay for medical education, then allow most docs to set their own prices subject to the willingness of patients to pay them. The medical system pays a fee schedule but, unlike the US Medicare, allows the docs to bill extra if they can get patients to pay.

Like the US, most French docs are women now and most follow the fee schedule but, if hey do so, there are fringe benefits, like pensions and vacations at health plan expense.

The incomes of French docs are lower than US but, with student loans eliminated, the net income is probably comparable. Especially as medical school comes after high school for most, not college.

Many women docs, in my own experience, do not marry other doctors but often marry cops and firefighters. One of my students, who was gorgeous, married her high school boyfriend, a mechanic.

Bob Ellison said...

"And if you're smart enough to be a doctor you're smart enough to be a computer programmer or investment banker or... whatever."

I would like to meet the doctor who is also capable of computer programming or investing. That mythical beast has eluded me thus far.

Pogo said...

I worked with 2 docs who programmed. One quit a few years ago to do apps in his own business. One started off in programming and worked in that for about 5 years before going back to school.

The MD investor however is even rarer, indeed. Well, good investors anyway. There're plenty of bad ones.

Kevin said...

"My female GP works full time and has three children."

Of course, that also depends on the definition of "full time". You could create a huge doctor shortage immediately if all doctors limited themselves to 40 hours a week of work.

Phil 3:14 said...

I'd have to see the actual study but my initial thought is "bad research" .

- how did they measure "hourly wage" , not a typical measure of physician earnings.
- were the PA comparison group also in primary care or all specialties
- did they consider the differences in PA school mix (i.e. more public) as compared to med school.

Personally, the female docs I work with are doing pretty well.

Astro said...

In 1976, women earned only 45 percent of bachelor's degrees in the United States; by 2006 that had increased to 58 percent. During that same interval, women have made even larger gains in advanced degrees. For example, in 1976 women constituted only 24 percent of first year medical students. By 2006, that number which doubled to 48 percent.

So women are getting increasing numbers of advanced degrees, but aren't using them? Does this just mean it's taking longer for a woman to earn her Mrs. degree?

ken in sc said...

My wife is a primary care doctor. She has never been in private practice. She has always worked for a clinic or a hospital or a government agency on a salary. She once was a private contractor to an Air Force hospital. She also has a masters in public health. She is currently the medical director of a community health center. The only real doctoring she does is when she fills in for someone else or volunteers at the free clinic. She knows she could make more money but she likes not having to get up in the middle of the night to deliver babies or tend to gunshot victims.

rp said...

In essence this says what I have said all along: that as med school classes become overwhelmingly populated by the daughters of physicians (generally Asian physicians) it will take an awful lot more physicians being trained (at great public subsidy, I might add) to make up for those physicians (males, working an average of 55 hours per week, according to the AMA) who are retiring. The article should have asked, “Is Medical School for Women a Worthwhile Investment for the Nation?” No, this is not a sexist comment; it is just a reality-oriented one. One could argue, of course, that the males currently graduating also are NOT going to work the long hours worked by the previous generation of physicians. Any way you cut it, the US is going to need a lot more physicians than the number currently being trained. If one keeps in mind my mantra, “Do it right the first time,” one also could argue that PAs and NPs are NOT really cost-effective in the long run – as MDs end up having to correct their mistakes – more so of omission than of commission.

Also, whoever it was earlier in this thread who spoke of there being a lot of grants and scholarships available for MDs -- Oh?? Public funds may subsidize tuition, but med students never have been viewed as charity cases, unless they are being pulled toward clinical research or public health or military service or some other very specific area of need.

Eric said...

I would like to meet the doctor who is also capable of computer programming or investing. That mythical beast has eluded me thus far.

You missed my point. If you're smart enough to do all the things you need to do do practice in the US, then you're smart enough to have been successful at computer programming or investing. I wasn't trying to say doctors make good programmers. They probably don't, in general, because they have other things to think about.