Pay It Forward, Doctors

normanrockwelldrOkay we’re going to fix health care. Well, a part of it anyway. The biggest expense of most any organization is personnel costs, and in health care, that includes your physicians. Some of the discussion in the professional world (physicians and veterinarians) is that the costs associated of professional school are so outrageous that it doesn’t make financial sense to become a doctor anymore. Why on earth would you go to school for 10 or 12 years, just to be horribly in debt and working 80 hours a week just to service that debt for the next 20 years? Lots of kids are looking at many other options besides becoming a doctor or veterinarian. It’s not because they don’t love medicine – they are just getting financially smarter and know they need to make a living. It makes more sense to take your student loan and buy a pizza shop. However, we still need doctors, and I’m wanting my doctor to be American trained. This is where I have to throw some numbers at you and hopefully with my Aggie math, I can show you how we can shave some of the expense off the medical costs in Texas, keep our best and brightest in the healing arts, AND show the way to increase rural health care — that’s the bonus.  I’m also going to show how this works in the veterinary profession, which is a lot easier to calculate because we don’t play insurance games and don’t have to play Obamacare.

There are 70,000 licensed physicians in Texas. Texas graduates about 1200 physicians a year, and they each average about $200,000 or more in debt. That debt and the related monthly payment  has to be included in the doctors’  salaries. If they didn’t have that debt, then of course their salary would not have to be as high to retire that debt. Following me? Less overall cost of employing a physician means overall less expense associated with medical care. Another bonus of taking that financial pressure off the doctors will be reducing their patient load. With today’s pricing structure from insurance companies, the only way doctors make more money is to cram as many patients into their day as possilbe.  With a decreased patient load, a doctor would have more time for each individual patient.

Rural health care has many restrictions, almost all financial.  If you’re in a small town, there may not be enough patient load (money) to pay the physician. That pesky debt load again limits who can practice in small town Texas. We continue to expand the role of nurse practitioners, physicians assistants, and even pharmacists to increase the numbers of primary care givers.  There is a need for primary care physicians, but the Physicians and veterinarians are not going to “disadvantaged” or rural areas basically because the money is not there. Now the state has a fix – they’ll recognize disadvantaged areas and usually throw in debt forgiveness dollars to entice physicians and veterinarians alike to set up in rural areas. Not every area qualifies, and in those areas that do qualify, now you have a “subsidized” professional competing with someone who isn’t subsidized. Crazy outcome of good intentioned politicians trying to get more rural health care.  It wouldn’t matter if your small town was Hico, Hamilton, or Comanache, you’ll look around one day and wonder why you’re getting the short end of the medical stick.

Of course medical education is expensive, and Texas (or the feds) just can’t afford to fund medical education outright. This is where “pay it forward” comes into play. If every licensed physician would pay an additional $2000 a year into a scholarship fund for Texas physician students, it would build that fund at a rate of $140 MILLION dollars a year. In short order, this fund could pay for the entire professional education of all the Texas doctors. Once selected to medical school, all fees related to education are covered. The new doctors would have zero debt associated with medical school. If every physician sees ONLY 20 patients a day, a mere 50cents per patient visit would generate that fund.

With a minimal amount of student debt, new physicians would have the ability to service rural areas, the “home towns” and small towns we all love. No longer would that physician have to practice in larger cities or groups just to generate enough income to pay a $2000 a month student loan payment.

On to the veterinary profession. Our new veterinarians are graduating with $150,000 in debt. Really. So when you graduate, going to your small town to practice is no longer an option. If veterinarians did the same “pay it forward”, we could be graduating Texas veterinarians with zero debt associated with professional school. If the veterinarian no longer has to generate the extra thousands of dollars per month just to service the student loan debt, the cost of veterinary medicine will be reduced. Just for inside baseball talk, it takes about $5000 of income in a clinic to generate $1000 in the veterinarian’s net salary. How would it help? It will allow veterinarians to comfortably practice in rural America again, without the huge stress of making enough money to satisfy outrageous debt.

You may have to dwell on this one a bit. The golden ticket to medical or veterinary school is won by hard work and good grades. The students will still be the best and brightest, and now are there for the love of the profession. There are a lot easier ways to make decent money, but I think about those who love medicine, but chose a different path because earning a living is still a part of life. I can offer this perspective because of the conversations we are having in our professional worlds. It doesn’t make financial sense anymore to be a veterinarian. The cost of school is almost prohibitive to maintaining replacement doctors in our profession. It doesn’t make financial sense to be a physician either, especially since the government keeps jacking with payments. Why is it do we have so many foreign doctors here? Relatively speaking, they got a cheaper education and the money they make in the United States is pretty decent. Why don’t we have as many American doctors? They can’t afford the education!

Pay it forward. This program is self sustaining, requires no government funding, and preserves a couple of professions in America. We generate the best medical professionals in the world. Let’s not lose it. Press one for English.

About Mike Jones

Dr. Mike is a veterinarian from Glen Rose, Texas. He is a Tarleton State Alumnus, 1979 graduate of Texas A&M University College of Veterinary Medicine, and a veteran of the United States Army. He has practiced veterinary medicine in Glen Rose since 1984 on everything from small animals to exotic wildlife. His politics are distinctly conservative, and stays politically active (even in a small town). Open discussions are always welcome!
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6 Responses to Pay It Forward, Doctors

  1. Terry Martin says:

    Great idea. Problem is that great ideas have a very hard time being implemented these days. Why is that?

  2. Mike Dicks says:

    Wow, now here is a novel idea from a Texan – levy an income tax to increase the provision of a public service.

    • Mike Jones Mike Jones, the author says:

      Thanks Mike Dicks. The veterinary profession is not a “public” service, but we as a profession are being faced with the economic realities of out of control education costs. Your new vets are graduating $150k in debt, and their ability to retire that debt may take essentially a house payment for the next 25 years. Regarding the physicians (MD’s), someone is going to have to pay for any professional’s education, whether it’s government (socialism), your family money, or your increased health costs (re: doctor’s salaries). By paying it forward, the $2000 “tax”, if you please, is far far less than what it would cost if you have either the government pay for the education, forgive the debt, or have a personal loan to pay for education. I’m trying to reduce the overall cost of health care through funding the educational process in a different manner.

  3. Mike Dicks says:

    Of course being a clinical practitioner is not in and of itself a pure public service, but all veterinarians are involved in monitoring, controlling and eradicating animal diseases, some of which affect human health. Consider all the diseases that have been eliminated over the last century. Did this happen because of private enterprise?

    Finally, an educated public itself has the characteristics of a public good. Helping every American achieve their highest level of learning increases the value of the entire community. Each of this educated citizens offers the potential for innovation that can improve social welfare. Strapping them with debt, I agree, will hinder this process and force graduates into pursuing traditional employment to pay student loans.

    My point was, taxing everyone or just the doctors and veterinarians, there is certainly economic justification for taxing society to help people reach the top of their abilities. When you consider that public research returns $10 for every dollar spent, it should be pretty obvious that the public returns to education are enormous.

    Seems like we had this argument beginning in 1857 when Justin Morrill (R-VT) first introduced a bill to establish public universities in each state. Lincoln signed that bill in 1862 to establish the Land Grant University system and America never looked back. We have led the world in Agricultural Productivity, technology development, and lowest percent of disposable income spent on food. Public education, where students can learn without owing their life to the company store, works and we need to reconsider our movement away from this strategy.

  4. Dennis Marken says:

    Thanks for giving me a heads-up on this article. I across the board agree with you. I myself feel if we can send millions/billions to countries who care nothing about us and on wars; we could cut way back and put that money into those seeking a career in the medical field. That money could be used as a loan to start your business with little or no interest. Equipment etc. Which I am sure brings on a huge amount of your debt. Having the federal government mandate doctors and medical care through Obama Care is just one more step in destroying or medical system. My main concern is WHO is going to be the overseers of the money in your plan? Could one truly trust the state or federal government to take care of it. If the federal/state have such control my fear is the program would become impecunious per some government officials belief he/she needs the money for something else. Other than that concern, I am with you.

  5. Donald C. Martinson DVM MSU '79 says:

    I honor Dr. Jones’s thoughts and offer mine hopefully to continue a fruitful discussion. Should I be a high school graduating senior today, I doubt that I could afford to become a veterinarian, and possibly not want to. I am very happy that I am! Having now begun my 35th year of practice, my gray hair puts me very much in the minority of veterinarians. The profession is VERY much younger than I am. Additionally, my college loans, about $10K are long paid off. An additional $1000/year would not be a hardship. But, lets also remember, social security will not fund my retirement, so my extra better be going there.

    But, for those new graduates, with $150K of college debit, I am worried. Let me assume that they have a 5% interest rate on those loans. At a payment of $885 per month, the loan will be paid for in 25 years. So let’s saddle them with anther $83.33 per month [12 x $83.33 = $1000] thereby reducing their monthly payments to about $800. This will add on 5-1/5 years to their payments, and an actual $52,800 out of their pockets [5-1/2 years x $800 per month x 12 months per year = $52800]. But remember, this new graduate is also paying the $1000 per year, and if you practice, like me, more than 25 years, let’s say 35, that’s $35K. Therefore a new graduate today would in fact be paying $87,800, but only 35K would be going to the fund. Not the best of deal!

    Now I am not happy with our students debit situation, but I also doubt that the new grads would be willing to agree to what is being proposed. But, anything worth having is worth paying for, an appropriate amount anyway. Are there other solutions?

    There are about 19M adults in Texas. 50¢ per person per year will cover it. For the record, I am not a socialist, anything but. If Texas is anything like Michigan, there are probably 9 or 10 million dogs there. So add a buck to the dog license. OK, cats, horses, pigs, sheep, cattle; maybe it just really needs to be in the veterinary fees!

    So, maybe the people benefiting should be covering this. Well, that encompasses every citizen in Texas, and elsewhere, as public health is a benefit to them, and that would be where taxes come in. Animal owners too need to step up to the plate with veterinary fees. Expensive education, expensive equipment, expensive real estate, expensive everything equals cheap veterinary fees???? No! Do the math. We veterinarians have done a wonderful job of bringing excellent veterinary care to the public, at a very reasonable cost. To ask for more is simply not fair, possibly it is greed.

    I have long thought that we veterinarians need to demonstrate to the folks we serve what we are really worth. Restoring the hearing on my otosclerotic ear was $9,000 about 15 years ago, and worth it. My rotator cuff surgery, $30K, and worth it. My cardiac catheterization, $11K, in my mind priceless. But my most expensive veterinary patient ever, and this is over this dogs lifetime, is less than the half a day at the catheterization lab having my heart worked up. And, my last rabies vaccination, yes, for me, remember I am a veterinarian, was $138. Yes, the office visit was extra, $154. Thank you Dr. G. for taking such good care of me!

    The solution to this problem is far more complex than a simple tax on a veterinarian’s income. I would like to see much more discussion.

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