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Enormous malpractice insurance and also most other rich countries subsidize the training of doctors. In the US by the time you hang out your shingle, unless yo

by gozur88 11y ago

Enormous malpractice insurance and also most other rich countries subsidize the training of doctors. In the US by the time you hang out your shingle, unless you've gotten someone else to pay for your schooling (scholarships, say, or the military), you're a quarter million dollars in debt.

chimeracoder 11y ago
> and also most other rich countries subsidize the training of doctors. The US actually does subsidize the training of doctors, to the tune of tens of billions of dollars per year through Medicare alone. That said, most people don't realize how heavy of a debt load doctors carry. Doctors reported incomes are much larger than their actual take-home pay due to things like malpractice insurance, which means that in the end, it's not unusual for a doctor these days to plan to make their last payment on these loans in their forties. Put another way: most doctors are literally past what is thought of as childbearing age by the time their "investment" has broken even, and that's not even counting things like a mortgage, etc. that many people would want to have when starting a family.
- carbocation 11y ago
  > it's not unusual for a doctor these days to plan to make their last payment on these loans in their forties To underscore this, take someone who goes straight through: finish undergrad at 22, med school at 26, internal medicine at 29, cardiology at 33. Again, no gap year, no research, certainly no PhD. At age 33, this person will have enough income to start making meaningful payments toward their debt, rather than just paying subsidized interest. It would be near-heroic to pay this off before 40 unless they were in private practice in the Midwest. And this is the best possible case: shortest training time, lucrative specialty, private practice.
  - gozur88 11y ago
    Right. If you don't consider the training period you have a ridiculously rosy picture of the economics for a doctor. And as you say, this is the best case. Few doctors make anything like what cardiologists make. In addition to all the debt you rack up, finishing your schooling in your 30s represents a huge opportunity cost - in the US a software developer with a BS has grossed something like a million dollars by then.
geodel 11y ago
I'd really like to know how much is malpractice insurance. Google search tells me that it is ~25K max, which does not seems enormous for someone earning 500K.
- riahi 11y ago
  This varies by specialty/subspecialty, state, and even zip code (I'm an resident). Rates are tough to find. I found a carrier in California that publishes their rate ranges, but California is one of the few states that has malpractice reform and damage caps. Their rates are considerably lower than in other areas. Physicians can safely carry $1million/$3million policies and be adequately protected, and as a result, premiums are much lower. http://www.gallaghermalpractice.com/state-resources/california-medical-malpractice-insurance/ http://www.gallaghermalpractice.com/state-resources/californ... By contrast, in Massachusetts, many HUGE verdicts have come out against physicians recently ($14 million against a radiologist in 2014), so now $3million/$5million is becoming the minimum, with physicians taking out ever larger policies in more litigious specialties. To get down to brass tacks, the only physicians reliably making $500k annually are orthopedic surgeons these days. Their rates range from average $25,281, with minimum $10,995 and max $56,363. That's 5-10% of their pre-tax income just to practice medicine. I know of obstetricians that had to sell their practices and join the local academic center because their individual malpractice premiums hit $120k a year.

by gozur88 11y ago

chimeracoder 11y ago

> and also most other rich countries subsidize the training of doctors. The US actually does subsidize the training of doctors, to the tune of tens of billions of dollars per year through Medicare alone. That said, most people don't realize how heavy of a debt load doctors carry. Doctors reported incomes are much larger than their actual take-home pay due to things like malpractice insurance, which means that in the end, it's not unusual for a doctor these days to plan to make their last payment on these loans in their forties. Put another way: most doctors are literally past what is thought of as childbearing age by the time their "investment" has broken even, and that's not even counting things like a mortgage, etc. that many people would want to have when starting a family.

carbocation 11y ago
> it's not unusual for a doctor these days to plan to make their last payment on these loans in their forties To underscore this, take someone who goes straight through: finish undergrad at 22, med school at 26, internal medicine at 29, cardiology at 33. Again, no gap year, no research, certainly no PhD. At age 33, this person will have enough income to start making meaningful payments toward their debt, rather than just paying subsidized interest. It would be near-heroic to pay this off before 40 unless they were in private practice in the Midwest. And this is the best possible case: shortest training time, lucrative specialty, private practice.
- gozur88 11y ago
  Right. If you don't consider the training period you have a ridiculously rosy picture of the economics for a doctor. And as you say, this is the best case. Few doctors make anything like what cardiologists make. In addition to all the debt you rack up, finishing your schooling in your 30s represents a huge opportunity cost - in the US a software developer with a BS has grossed something like a million dollars by then.

geodel 11y ago

I'd really like to know how much is malpractice insurance. Google search tells me that it is ~25K max, which does not seems enormous for someone earning 500K.

riahi 11y ago
This varies by specialty/subspecialty, state, and even zip code (I'm an resident). Rates are tough to find. I found a carrier in California that publishes their rate ranges, but California is one of the few states that has malpractice reform and damage caps. Their rates are considerably lower than in other areas. Physicians can safely carry $1million/$3million policies and be adequately protected, and as a result, premiums are much lower. http://www.gallaghermalpractice.com/state-resources/california-medical-malpractice-insurance/ http://www.gallaghermalpractice.com/state-resources/californ... By contrast, in Massachusetts, many HUGE verdicts have come out against physicians recently ($14 million against a radiologist in 2014), so now $3million/$5million is becoming the minimum, with physicians taking out ever larger policies in more litigious specialties. To get down to brass tacks, the only physicians reliably making $500k annually are orthopedic surgeons these days. Their rates range from average $25,281, with minimum $10,995 and max $56,363. That's 5-10% of their pre-tax income just to practice medicine. I know of obstetricians that had to sell their practices and join the local academic center because their individual malpractice premiums hit $120k a year.