Wednesday, January 23, 2008

The Falling-Down Professions

As a recent piece in the NYTimes discussed, medicine is a falling-down profession, which I take to mean a profession that has seen better days. As the article notes:

As of 2006, nearly 60 percent of doctors polled by the American College of Physician Executives said they had considered getting out of medicine because of low morale, and nearly 70 percent knew someone who already had.

In a typical complaint, Dr. Yul Ejnes, 47, a general internist in Cranston, R.I., said he was recently forced by Medicare to fill out requisition forms for a wheelchair-bound patient who needed to replace balding tires. “I’m a doctor,” he said, “not Mr. Goodwrench.”

Sad, but true. As the brand of 'doctor' has been devalued over time, so has the morale within the profession. One thing that the article fails to mention though is the length of time needed to become a practicing MD. Any time people make a decision, especially a purchasing one, they are implicitly consider their 'return on investment,' or ROI. As students, we are purchasers of professional education, be it law or medical or business school. I don't know all the figures, but let's assume for the sake of argument that med school is $40k per year, law school $50k, and business school $60k. Now, to simplify this further, assume that people only consider the ROI as their first 5 years of employment. A lawyer invests $150k over 3 years, and typically will find a job starting around $100k, which translates into a ROI of roughly 233%. The b-school student invests $120k, probably gets about $100k coming out, for a ROI of roughly 316% over 5 years.

The med student? Pays out $160k, earns $40k per year for an avg of 5 years of residency. ROI? 25%.

25%!

Terrible when compared to 233% and 316%, no? Of course, these are averages of numbers I pulled out of the air and have no real application in reality. Still, they illustrate the general point. The morale in medicine will not improve until the ROI improves, no matter how benevolent we imagine ourselves to be.

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