Why America Has So Few Doctors

[@lukemolitor8896]

Yes please call and harass medical schools about their high tuition costs LOL would love to see that. Why don't medical schools release their screening metrics when applying either? (i.e. GPA/MCAT cut offs) because if we knew what the cut-offs were, more people wouldn't apply, and the application cycle would yield less monetary return. It's all about the money

[@DrCellini]

All good questions!

[@cander6751]

You can see the range of MCAT and GPA on MSAR for all schools

[@toottoot24]

@@cander6751 that’s true, but the AAMC still charges you for it 😂

[@ryankelly8077]

Facts about the money part.. education is a business

[@lukemolitor8896]

@@cander6751 this is true but why not just explicitly tell us the cut offs? Also MSAR isn’t free

[@kaitlynstrabel7210]

I especially want to know why medical schools charge so much since everything went online during COVID. My school told us it was to pay for the costs of providing clinical experiences (placing us in the hospital first year and having "standardized" patient actors) yet when everything shut down that was no longer an option to us anymore, but medical tuition costs stayed the same.

[@whazzas5023]

There is absolutely no reason we need to pay amateur actors to pretend to be medical student's patients. I don't care if there is educational research that shows it improves bedside manner scores 1000%, that's a ludicrous waste of money. Get the students into the hospital, and observe how they interview and interact with real patients and give feedback.

[@medicostudy101]

@@whazzas5023 This' really sad to know. I've learnt everything on real patients itself. Yes, they change their history and everything but it did give me better exposure. That said it was a Govt. run med school so they couldn't even afford amateur actors.

[@Sam-by4bk]

Because in reality you're not actually paying for the education itself, but rather for the credential you receive at the end of it. I watch free videos on youtube all the time that are 100x better than any of the $60k content my med school profs put out, but unfortunately, watching (and learning from!) khan academy playlists still won't get me that sweet, sweet MD degree. More expensive schools don't have "better" education; they probably just have more a more bloated administrative staff.

[@Virdice]

Stay in the same is a god case,some raised tuition because fuck it

[@shantnubhanwala5972]

Lol 🤣

[@Zephyr6083]

Yes please! Contact medical schools and find out exactly where my tuition fees are going, especially as a fourth-year student who is barely in the hospital and still paying nearly $50k!

[@user-yj7es4iv2i]

the money is going to admin

[@Liuhuayue]

To line the near useless admins' pockets, of course.

[@sarthakchandra]

Fucking middlemen and administrative costs. they're bleeding healthcare dry almost worldwide. I'm from India, and the Administrative costs are literally skyrocketing. I understand some administrative functions are required, But how does it make sense to hire an MBA and pay him equivalent to 2 general medicine consultants, just to see where the hospital is losing money??

[@ninadeangelo9450]

As a person with serious chronic conditions this is SO scary! Doctors are the reasons I’m getting the treatments I need! It takes forever to get in, and sometimes with a chronic condition you can’t wait months on end. This is a serious problem, and I hope it changes soon! We need more passionate docs like you in our world!

[@williamsstephens]

@A. Brown You and Dr. C are suggesting a bandaid for a sucking chest wound. He follows up immediately, and he does recognize that the real issue is "$400k in student debt", SO HERE'S OUR REAL PROBLEM: A predatory financial system in league with a predatory education infrastructure = too few key workers (nurses, teachers, general physicians, etc) due to financial reality. This isn't just a med school issue, it's an American society issue across every sector.

[@cberryman9189]

The amount of time and debt required to become a physician today is very discouraging. The pandemic taught me to do better financially and to reduce my debt to thrive. And I can’t imagine going through 4 years of expensive education, just to be unable to do what you’ve trained to do for the last 4 years?!?! That’s beyond cruel. I know most physicians and med students would say it was all worth in in the end…but with inflation and everything else going on, I’m not sure I believe that anymore.

[@hanamimedspa]

It doesn’t stop after residency either! Don’t forget the crazy expense of yearly costs of required CME, medical society membership(s), malpractice, DEA, DPS, state board licensing, state prescription monitoring programs, recertification costs, and other required fees of a physician. With 3-4k debt or 6-8k if dual-physician household, banks won’t even offer you a decent mortgage even with earning a “high income”. Thanks for making this video!

[@velvetpaws999]

A career path of a German doctor in Germany: A woman studied medicine, after giving birth to her first child, a boy. She had her husband who, during the first year took the time to look after the boy during the daytime, while she was on campus. The second year, she took him to a kids crib on campus, where she could go by and see him around noon, and pick him up at the end of her day. The kid spent his first years like that, and his buddies were other student kids from around the world! The woman graduated and specialized in surgery. She did her residency and worked at the university hospital. After some years of working, she decided she wanted to specialize in anesthesiology, so she did that. She also did research at the clinic in the causes of "shock lung". In order to take her phd, she also had to show practical experience in all types of anesthesia, including pre-natal and neo-natal surgery. These two fields were not very developed in Germany at the time, so she managed to get a spot at Barnes Children's Hospital, in the USA, for two months. There she observed these two types of surgery with the anesthesiologist team. She found the working conditions of American doctors to be of a far higher quality than what she was used to in Germany. Better hours, regular relief during work, more respect and cooperation from the bosses.... just to name a few. She worked as an anesthesiologist in the clinics of the German university for many years. At the same time, she had specialized in doing several other things: she supervised the dialysis center two days a week. She was a prison doctor for one of the local penitentiaries. She was the emergency doctor on night call for ambulance service on weekends. In Germany, a doctor must be on each ambulance going out to an emergency. She also specialized in food allergies in children, because her son had severe asthma and allergic reactions to a whole lot of things, like peanuts, milk, animal hairs, eggs.. She ran a parent counseling center for kids with eczema and allergies. All this work for several decades got her worn out, so she left practicing medicine and found a job in a pharma company, where she was in charge of the development of some new drugs for pain management. After several years of this, she did not like it anymore, so she returned to medicine and opened a private clinic, together with another doctor. Basically, this is a clinic for general practitioner medicine. Her clinic is just down the street from where she and her husband built their home. And that's what she is still doing now, at the age of 68. I think she loves what she is doing! It stands to reason that she does..... Oh, and an interesting fait divers: when Clinton was invited to Germany to receive some "Peace Price" there, she was chosen to be his personal physician while he was in Germany, so for about a week, she was officially on staff with the White House!

[@dailydoseofmedicinee]

Important topic 👏

[@DrCellini]

facts

[@maxgoodsell3055]

I don't have to imagine not matching. 8 years of education, received my medical degree (DO), >$300,000 in debt, and no way to pay a dime of that. Most states require a year of residency (intern year) before they are able to practice medicine and therefore make money to pay off loans. I want to work, I want to help, but instead I am left unemployed at the moment. About 10% of DO's went unmatched after the 2021 cycle. Oh and they are opening more medical schools while some residencies have added one or two slots.

[@MustangRimsJason]

I’m an MD, and I know 2 of my co graduates who didn’t match. One went to nursing school and the other is in physical therapy school. I can only imagine all the debt they are in and how crazy must be for them as physicians not to have another option to find a job. Whereas a PA can go to 2 years of school (after college) and get hired in any specialty.

[@germaninvasion121]

@@MustangRimsJason Why would someone not match ? I don’t understand ?

[@Baldwinthefourth-1176]

So if you don’t match, are you pretty much screwed and can’t be a doctor ?

[@joshb2686]

@@Baldwinthefourth-1176 No, most will scramble into a residency position or apply again next year. Some states like mine (missouri) will let you work with the practicing rights of a midlevel during that time period.

[@joshb2686]

MD 92% DO 89% not that much of a difference. The biggest deal is that DO schools are more expensive and rates on debt aren’t very forgiving.

[@sunshinej9494]

Yes, I am curious about the educational costs in medicine! Thanks for sharing your insights. Interesting article indeed.

[@DrCellini]

Glad you liked it!

[@Kibagan]

Especially considering that now most of the preclinical content can be learned with third-party resources for a maybe 1-2k at most

[@dochudson9912]

@@Kibagan 100% true. but med schools are able to stop you by saying you need 4 year bachelor's degree from a university. There's no way to escape this terrible system.

[@OllieBurtonMed]

Hey Dr Cellini, UK doc here - thanks for the video, really interesting to see the US situation explained. We have a similar situation in the UK, albeit for slightly different reasons. I would be extremely interested for your take on the American NP situation - as an academic with an interest specifically in selection/training and the medical workforce, it seems as though the justifications for expanding NP programs (underserved/rural areas etc) do not actually seem to be happening looking at your figures, as well as a lot of concerning practicing beyond scope of qualifications. We have NPs in the UK but their education seems to be much more rigorous and they are by and large fantastic - mostly ex-ITU or cardiac nurses in my experience. We have similar bottlenecks into higher specialty training, and the elephant in the room is that you still need attendings/consultants to take ultimate responsibility for care - how do you predict this is likely to be addressed?

[@joshb2686]

NP education here is criminally poor. Nurse lobby groups are extremely strong here.

[@roshr897]

Definitely make a video on why med school costs so much! I’m a final year med student in England and it feels overpriced for what you get so I can only imagine what it’s like in America. Great video and it’s crazy how much politics there is when health is so essential

[@JasonKrastein]

I completely agree. I am at GW, which is the MOST applied to medical school in the nation and they charge $64k for tuition…

[@mdkb]

Very informative video about current situation Doc! Especially useful for foreign students wanting to study medicine in US👍.

[@Vendemiair]

The cost of medical education in the U.S. is insane. I finished 10 years of medical training paying the equivalent of a dollar per semester for the first five years; the latter 5 years I was already paid a salary (resident and fellow). This is in a third world country that's far less developed than the U.S. The situation pointed out in the video just reflects the fact that in the U.S. education as a whole is viewed as a business and a privilege rather than a right. The extreme costs are because of rampant capitalism where everybody needs to make a buck off someone, and the government just let it spiral out of control.

[@cbl6520]

The high costs of medical school is largely a combination of; high demand/high compensation for the physician career, the AMA’s monopoly on medical schools and medical education, and government intervention into the education system that started in the 50’s and 70’s with the National Defense Education Act and the formation of the Federal Department of Education. None the above has anything to do with capitalism. It’s corporatism that’s to blame

[@Max-jv6sx]

@@cbl6520 this has every bit in part to due with how predatory capitalism is and to believe otherwise is moronic. Being denied coverage for the sake of "breeding innovation" and turning health care into a business is simply not sustainable and does not belong in a successful healthcare system. We are Long overdue for an entire overhaul and to get with the times when the United States ranks last compared to other developed nations when it comes to key leading health indicators. We are the only nation that depends on health insurance, overhead costs, and beuricratic waste in order to appease elites who thrive on capitalism.

[@cbl6520]

@@Max-jv6sx Apparently you know not the difference between capitalism and corporatism. Capitalism is the free and equal exchange of goods and services, whether is be obvious or perceived, with limited government and 3rd party intervention. Corporatism is the coalescence of big government and large corporations/special interests, fostering a monopoly over the proverbial playing field, to rig rules in their favor. As far as denying coverage for the sake of breeding information, this is a false dichotomy, as the two are not related, nor correlated. Besides, would you rather have cheap, low quality healthcare with no innovation, or expensive high quality healthcare w/ innovation. Ultimately, you can have universality, quality, or affordability, but not all three. No country has achieved a system that provides all three of the aforementioned. And lastly, whether you like it or not, healthcare IS a business. You don’t get to determine what should or should not be profitable/a business just because you deem it as holding intrinsic value.

[@Max-jv6sx]

@@cbl6520 nah.

[@Batman-bh6vw]

@@cbl6520 Plenty of countries have quality care that's accessible and affordable. The US just isn't one of them.

[@tonigenxnurse]

Very informative. I am a registered nurse. Patients could be admitted and admitted but there aren’t enough of us to take care of them. Acuity is higher and with less help things are falling through the cracks. I don’t get why anyone would think it’s safe to overload a nurse with multiple patients? We can’t watch everyone. Then I’m sorry to say the doctors aren’t looking at things carefully enough and more orders are added which are difficult to carry out. The healthcare system has crumbled in my opinion. Too many politicians worried about money and not enough about people. This country has completely messed up and now we will forever try to catch up.

[@dochudson9912]

If nothing is done now, we will only delve further into chaos

[@rosanneshinkle4133]

The homicide conviction of Radonda Vaught for a medication error will drive more nurses out of the hospitals.

[@NolLiM1]

#1 reason for not going to med school - tuition/debt. I would definitely like to know why schools are allowed to charge as much tuition as they do in general; but especially for careers involved in community service, such as medicine. I'd rather self study and gain knowledge in other ways or on my own than pay any institution $100Ks. I'm an RN, btw (would like to hear your opinion regarding that 1 bullet point of physician responsibilities falling on nurses - the only thing I will say is: it's true) Edit: #2 reason - time. Many may feel compelled to use the '8 years of study minimum' as a badge of honor, but it really means nothing considering those first 4 years of premed are unnecessary, and is time that could be used more efficiently/wisely in contributing to med students' learning.

[@Kevin-438]

Thank you! I'm currently in premed classes and it is the biggest joke how you have to take all these nonsense classes! Like why tf do I need to take Organic chemistry 2? Physics 2? Music appreciation?? Statistics for biology with an emphasis on R coding?! These are all useless classes that most physicians will never use or think of again. College is great but at the same time, a huge money grabbing scam in the US. I could have finished two years ago if I didn't have to take all these unrelated classes to medicine. 🙄

[@rob6293]

Great video. Just an FYI, the UK has a longer training program. The shorted time to become a hospital consultant in most specialities is 14 years from the start of college.

[@oliviajohnson7602]

Thank you so much for making this video. This needs to be talked about more. Money is always the thing burring people from getting their basic human needs met and it’s so frustrating! I don’t even see a future in America anymore for my future family and plan to live elsewhere. As a Dietetic student there also a great amount of money grabbing because I have to pay for my internship (with no compensation and a 32-40 he work week) which is often $10,000 or more.Really depressing

[@bruhhmomentumm]

You made a great point about increasing doctors and lowering wages AFTER debt decreases. Dentistry is sort of in the hole because there’s a lot more dentists, but tuition is only getting higher. Some schools cost 600k to 1M for a DMD/DDS.

[@1yehny]

When I applied to med school in 1992, the lie was that there’s too many doctors. They closed and decreased med student spots around the country. They completely missed the large increase in need for more doctors as America was getting older. Now, we have massive shortages, causing the need for APP’s. Add the increase in medical capabilities, we have even more need for doctors. As an ED doctors, these last two pandemic years we saw dramatic fluxes in census which causes our MBA led groups to reduce doctor hours because they are leveraged to the hilt. Then ACEP comes out with bogus workforce study which hints that ED is over saturated. This is just like the anesthesia over saturated lie back in the 1990’s. Now, we have massive shortages in Anesthesia. Moral to the story? Don’t believe workforce forecasts because the authors are biased.

[@grantcivyt]

It's fine to look at forecasts, but it's not fine to implement policies that restrict market forces of supply and demand. If you think being a plumber will be a good bet in the next 5 years because you saw a government study, that's a fine decision for you to risk. But it's very different for the government to then start paying people to become plumbers. That will certainly lead to an excess of plumbers, collapsed wages, and then everyone will be upset that they were "pushed" into the plumbing business by bureaucrats and they deserve to be retrained or otherwise compensated.

[@LisaCulton]

Yep, I was also told that there was a severe glut of physicians (especially Pathologists) when I was finishing medical school in the late 90s and I would be searching desperately for employment. Never happened. Always in very high demand and since about 3 years, I am receiving job offers on a daily basis. However I'm thoroughly fed up and only working part - time. Too bad for the patients.

[@Uncharted95]

In Denmark you can become a doctor, or just any profession without student debt, as you don't pay tuition fees out of pocket... this is so nuts that you can have so much debt 💀

[@aamirrazak3467]

I wish our system in the US actually made sense like your guys

[@natanaelaraujo2328]

Same here in Brazil, Adel.

[@julietcrowson3503]

It's actually part of the plan to keep poor people down....

[@1984mrdale]

You pay for your tuition with your taxes. They still got you.

[@Uncharted95]

@@1984mrdale and yet we don’t drown in massive debt like Americans do. Try again.

[@drsagdic]

I'm a senior med student (6th year) in Turkey and I agree with you %100. I think 6 year medical education is quite enough and I even think that last year (which is practical year, working like U.S. intern doctors) can be optional. Plus, we mostly don't have student loan debt. For example, I want to be a Radiologist in America and studying for USMLE but a friend of mine she is older than me and trying very hard to get into medical school in the US. She will have to take student loan and pay it.. So I am thinking exactly same thing, why such a developed country making this process very hard ? It's not logical.

[@dochudson9912]

As a student growing up in America, I'm starting to realize how terrible of a country this is.

[@MK-ut2ee]

The system seems miserable indeed

[@Pistolo_]

Hi Hakku Serdar Sagdic, I’m also a med student (4th year) from Italy and I’m interested to work in the U.S. after the end of the specialization post degree. I would ask to you, which are all the stepts in order to manage to do that? Thank you 😊

[@pierzing.glint1sh76]

It's perfectly logical Everything is for profit in America... if it wasn't, then the average doctors would not be paid as much as the very best doctors in turkey and you wouldn't want to go to the US to practice medicine. If u want to profit off the system as a doctor you must first accept that initially you will also be profited off. The rules that allow a person to be a wealthy American doctor also apply to them too Peace ❤

[@teresemarinelli9421]

Yes, please do a video on med education. Great video. Keep up the good work!!

[@DrCellini]

Thanks for the kind words! Glad you liked the video

[@teresemarinelli9421]

@@DrCellini I would also suggest discussing US medical insurance companies, and how they have affected the mass exodus of physicians.

[@Kalahn54]

Really good and interesting video! I'm from Europe and went through the typical 6 years of medical school. Finding a residency spot is relatively easy. Also from what I understand, just like mentioned in the video, a premed of 4 years is required but doesn't necessarily have to be in a field related to medicine? So essentially your medical school is 2 years shorter compared to the European counterpart and likely much more stressful since you have to cram the same training we do in 6 years, in 4. Seems to me that when it comes to knowledge retaining that must be very challenging and far from optimal. And not to talk about residency where we typically have 40 hour weeks with lectures and learning scheduled into those 40 hours, whereas the US residents do 70+ hour weeks (correct me if I'm wrong), which has proven through studies to not only have a negative impact on learning during your training but in many cases also lead to burn out. To become a specialised physician in the US always seemed incredibly impressive to me.

[@Kalahn54]

Forgot to add that not only do you not have to pay anything to get your MD, you also get free money from the state (equivalent to some 300 dollars), and you can take a state loan as long as your studying to help with other expenses with an interest rate of some 0.2%. This applies to ALL educations (Scandinavian country).

[@Max-jv6sx]

...and ICD 10 codes, CPT codes, being hassled by insurance companies. Health care is a scam in the U.S. lead by predatory elites who thrive on capitalism.

[@dochudson9912]

I've never been more jealous in my life. I'm a student in America and you have a much much much better system than in my country. 😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭😭Crying because of how terrible it is here

[@Max-jv6sx]

@@dochudson9912 fuckin amen.

[@nicoleanjelica7702]

Would sincerely love to hear your professional take the NP topic. Currently, I’m finishing my last year of nursing school and would like to go to MD school. All my advisors are pushing NP. It sucks because I will have to take a few science classes to meet the criteria to apply to MD school and they have been making me second guess my choice on this. Obviously, I know it would be significantly less time and money to go to NP school. But the nurses I’ve talked to basically say they’re just paying for their degree and they don’t feel like they’ve learned as much as they should. Please know I’m not saying this is the case for all NPs. Just sharing my experience. Please, I would love if you did a video on this.

[@megancooper6130]

Hey there! I'm a DNP student at Oregon Health and Science University and I have loved my program thus far!! There are a ton of challenges to selecting a good DNP program, there's some super crappy ones out there that are basically entirely online with only like 500 clinical hours. Definitely not something you want. I would definitely say I am learning an INSANE amount, definitely drinking from a fire hose (I'm talking studying from 6:30 am to 10 PM, little time for other things, it's difficult but so, so interesting and amazing!). I was nervous that I wouldn't be learning the things that I wanted (I was pre-med in undergrad, ended up taking 3 years off of school and worked as an EMT and medical scribe, I ended up falling in love with the NP's way of practicing and wanted to be just like them, they just had this incredible patient relationship quality and immense amounts of knowledge and experience). I am very very happy with my program and I have just scratched the surface of what I will be diving deeper into in the coming 2 years (DNP is a 3 year program). Obviously the cons are that you still aren't getting the same depth of knowledge that you get in med school and the same autonomy and pay at the end, but here in Oregon NP's practice with full autonomy so it depends on the state. NP's do have a lot of flexibility which allow them to move around to different career paths if something changes, which is a great thing to consider (burnout is very real, you want to have options). I would also say you do not have to face the insane competitiveness that you have in med school while becoming an NP. I have several MD friends who are miserable and feel very isolated in their programs because of the competitive nature of med school. NP school is very team oriented and about working together (at least in my experience) and has been absolutely refreshing from the pre-med background that I came from in my undergrad degree. I know that probably isn't everyone's experience, but I can say the openness and teamwork aspect that I have experienced in NP school is not what I have heard from some of my med school colleagues. I'm very happy with my decision to go the NP route, but I think it is really dependent on the school you go to, I am very fortunate to be attending OHSU. If you imagine the future of yourself as an NP and have a gut feeling that it just isn't enough for you, then go the MD route! There are so many benefits to being a physician, and of course a giant amount of challenge, but no matter what you choose you will always be rewarded by your job. I hope this gives you some kind of personal perspective that might help! Best of luck to you : )

[@julietcrowson3503]

Learn regulatory law and practise defending yourself in court. In the UK, whistleblowers are struck off by regulators

[@samantha_pa]

I mean… PAs are an option too. PAs receive very similar training to physicians but it’s accelerated with little to no “breaks”

[@dochudson9912]

@@megancooper6130 as a confused pre med, thank you for the insight!

[@joshmcgoo]

I'm graduating from a 3 year MD program this year - it's becoming more popular in the US, and I got a guaranteed slot in an EM residency! Win win

[@joshmcgoo]

@A. Brown stony brook on Long Island

[@rereguru8698]

thanks for making these videos

[@smivlibee5936]

Dr. Cellini you are the man!

[@jjmandziuk8036]

I know you said you didn’t want to touch on it but I think a separate video of how mid level practitioners affect these statistics would be real interesting. The mid level practitioner is much more common in America compared to Canada and Europe and I’m curious how much that offsets the statistics we saw in this article.

[@iwatchkittenvids45]

Advanced practice providers were always the answer when there is such a shortage due to astronomical prices of med school and was in part created by physicians

[@virginiamoss7045]

This interests me a very great deal, as well.

[@navyfarrow5333]

@@iwatchkittenvids45 I think you meant to say midlevel

[@iwatchkittenvids45]

@@navyfarrow5333 no, I know what I said

[@fredastaire6156]

@@navyfarrow5333 no, I think simply Physician Assistant and Nurse Practitioners works well. They are not doctors so there is no "mid" for it to be had. To my knowledge there is no hierarchy of physicians. Each is specific to their own field of study. Thus a nurse practitioner is its own field of study as is Physician Assistant. Both are part of the health care team

[@maryannbatchelder8047]

I hope you do a video about mid-levels. I just finished NP school. I have a great deal of respect for physicians and I wouldn’t be where I am if it weren’t for the physicians who mentored and precepted me. I am in a state where I can practice independently but I have no desire to work apart from physicians.

[@joelskinna4330]

You look amazing dear

[@LJStability]

Damn man, you fuckin' nailed it on this video. I was talking to a professor whose son has had trouble applying to medical school. I was trying to explain all this but I think your video did the best job at showing some good visuals on what happened. Thanks man.

[@DrCellini]

Thanks for this! I really appreciate it

[@ruta1133]

I went to a Caribbean school. They teach absolutely nothing; you get trained by Boards and Beyond and UWorld and you pay a fortune. US graduates I talk to say they learn primarily using the same tools. IIRC NYU's medical school went tuition free in 2018 and I remember reading an article on it at the time. The long and short of it is that medical schools don't need to charge what they do, but they can so they will. The residency system provides an easy excuse for schools to keep their low seat counts, and thus entry effectively becomes a luxury item. They don't even need to do the advertising--all the medical dramas on prime time do that for them.

[@deena681]

This is a great topic but I would be cautious about “shortages” of doctors. It would be tragic for people to spend hundreds of thousands for tuition and years training to be a physician and then find that you can’t get a job due to oversupply. This has been happening to pharmacists since the early 2000s. In the 1990s pharmacists were in demand due to pharmacists shortages so pharmacy schools opened up everywhere and have been graduating many more pharmacy students but now many of them can’t find jobs. Their student loan debt has not decreased but pharmacy wages have been decreasing due to oversupply. Pharmacy like being a physician is very specialized so it is difficult to find something else in other industries or fields. For some reason nursing is one of the healthcare professions with more flexibility. The same thing happened to lawyers at one point but they managed to sue some of the schools because law schools lied about their job prospects and they had thousands in student loans. Swiss people have longer lifespans compared to the US for many reasons which don’t have much to do with doctors. They have better safety nets than the US. They probably eat less processed foods and they can probably get time off to go see a doctors appointment!! The concept of sick time is rare now. Doctors in the US have a difficult time scheduling their own appointments because of work demands. Doctors also live on average 7 years LESS than the average American due to stress and lack of work life balance!

[@iwatchkittenvids45]

The reason for nursing is that they can be highly specialized or generalists, and burnout is tremendous, and therefore, the turnover rates create jobs and on and on it goes

[@BedeliaMikk]

The part where law graduates sued law schools and got money compensation is very funny 😂

[@BubblyViolin11]

It’s a shortage, and it’s not the only industry that’s suffering. It’s a trend that’s been happening for over a decade now in the US, and Covid has only highlighted how bad it’s gotten.

[@madeline9538]

So true about how doctors in the US get way less time off to even go to their own appointments. I was a Medical Assistant for PCE and I worked with an orthopedic surgeon, and I remember at one point he had to reschedule his dentist appointment like 3 times.

[@deena681]

@@BubblyViolin11 I am not sure there is an actual labor shortage.

[@polarberri]

Even undergraduate studies are exorbitantly expensive in the US; there are a lot of degrees that don't get you much of a boost in earning potential. The system is broken through and through; so many are profiting off of students.

[@sunflowerpower642]

The bottle neck of residency spots is the elephant in the room. We created NPP (midlevels) in absolute surplus because it takes so freaking long to train a competent doctor that can practice independently and we are on the verge of deluding the public into thinking that residency isn't needed and NPPs are sufficient clinicians without physician oversight . Make MORE residency spots. Decrease medical school cost, increase residency pay and you will get the best and the brightest who are willing to become the best physicians they can be who will be able to shoulder the long training and the debt. This is the only profession outside of law? where the trainee goes into MASSIVE negative net worth with no hopes of re-cooping the losses for a DECADE. It's INSANE that we do this to doctors on top of the intense moral/ethical demands of being a physician. What do we think they are...martyrs? We don't ask any other profession to have their neck held to the ground for 10 years by a system before they can fend for themselves!

[@joshb2686]

NP education is so terrifyingly bad. Not speaking from message boards or anything like that. I have friends in it and its a literal joke. He is very dissatisfied and has thought about dropping out and applying to med school

[@sunflowerpower642]

@@joshb2686 Good luck to him. It will be worth it!...I hope!

[@dochudson9912]

Well said

[@DrProfX]

Plenty of physicians in suburban and urban areas. Unfortunately, rural areas consistently have shortages! So, you can add as many new MD and DO programs as you want, but areas with shortages will continue to suffer as will primary care specialties…

[@itzelr3514]

Good topic. What does the clearing of the throat mean after you read the phrase "you'd fight proposals to allow nurses to do the work of physicians" :)

[@chrisalexander9491]

America has been exceptional at 3 things over the last 40 years - stoking and entering conflict that is generally endless, letting corporations do whatever they want, and passing tax cuts like it’s a bodily function … since these three things are prioritized over everything else there is no wonder the system is not working and outcomes are terrible.

[@valvanikrishna2510]

Very helpful topics 👍

[@cierradawn490]

Great video. I would love to see a video of you calling Med schools and asking about their tuition price, it’s outrageous (so thankful I go to my public state medical school). I would also love to hear your thoughts on nurse practitioners being given rights to practice on their own. My state (Kansas) has current legislation on this.

[@tl9585]

no one is asking for input, but soo many of my fellow nursing students are pursuing a master to become a nurse practitioner since they could work independently. I find that mindset to be so alarming

[@joaquinescotoaleman4320]

@@tl9585 why?

[@bdx96]

I know it may be a difficult topic to address, but I'm a nursing student and would love your take on nurse practitioners and physician assistants.

[@badpixelproductions8437]

I never got the hate for them. I'm in EMS, and a lot of the NPs and PAs I've seen are amazing.

[@eloiinvestigates]

I have no problem with them except for the fact that they get paid more than residents, and that's not fair. In most countries outside of North America, the residency years are over a decade, and they're tough years. So, that's many years where ANPs and PAs are actually out-earning doctors. By a lot. Again, there are issues of fairness.

[@maxjabaay4408]

Something I think that could be a very interesting video series idea is you showing the viewers the steps needed to create a residancy. The reason this series would be interesting is it would show the amount of red tape that is in place and the effort that goes into creating a residency. I know from my experience of being in med school in southern Alabama many institutions/hospitals desire to create residency‘s, but the amount of time ,effort and cost to create it can be limiting. An other benefit from doing a series like this is you would be one of few video series on KZbin talking about the steps on how to create a residency. Just maybe you could motivate someone to start the process of creating a residency.

[@WNCIU]

Majority of medical program in South Korea is also 6 years. They tried to do something similar to the US system where students went to undergrad then to med school but most of those tracts are, as far as I know, gone.

[@abe948]

Dr. Cellini - I’m an M4 medical student in NJ and I completely concur with your idea of contacting Medical schools. Honestly, the idea is so good that it should be a documentary.. I know that you’re busy, but a Netflix documentary about an idea like that, might get people talking, and make a difference.

[@dochudson9912]

Yes! Exactly my thoughts. We gotta protest against the absurd costs of education. I feel powerless knowing theres nothing I can do to change how the system is. I have no choice but to go in debt to become a doctor.

[@tjwilsonster]

Very informative and eye opening. Thank you!

[@natew6203]

Great video, would love to hear more

[@jeremycarter2006]

Great vid. Would be interested in a breakdown of tuition costs as well - I can say as a current med student that most of my learning has come from outside resources

[@DDBMedia]

Post-secondary education is much more heavily publicly subsidized in Canada so Med school tuition is on average ~$15k/year (depends on the province). I’m in vet school in Alberta, Canada and I pay ~$12k/yr in tuition, when the actual cost of my degree to the government is ~$450k/4 years.

[@dochudson9912]

That's awesome

[@conniedelio]

Great job, Dr. Cellini. Well-organized and presented. Unfortunate that this is so poorly appreciated by many outside the healthcare sphere. I must disagree with your thoughts on the lifestyle of primary care physicians (family medicine, peds, or internal medicine). Most PCPs don’t “work 8-4” M-F. They’ve been keeping up with the demands of a 24/7 world for decades. Many have robust Saturday hours for sick visits, and take “real”, uncompensated call, particularly if they see children.Urgent care is excellent for certain needs, but most parents feel more comfortable talking to their child’s physician (or associate), and following their guidance (just my assumption, not pulled from data). Patient complexity is rising faster than we’re keeping up, for so many reasons. We *must* place greater value on the physicians that manage great complexity, and compensate the time they need. As you know, we’re only starting to recognize this. Thank you for shedding a light on this, and kudos to those in “The Atlantic” article.

[@Jayjr-jc2wi]

No, the key is "most". Most work M-F 9-5, 8-4, 8-5

[@HH_The_Great]

There are a few US medical schools that allow students to complete their undergraduate and medical schools over a total of six or seven years, University of Missouri Kansas City, for one.

[@lm3049]

Interesting that you did this video when I just watched a video on this topic done by John Stossel. He raised the exact points you did.

[@conniedelio]

Stossel’s piece is trash! Only about 10% of physicians are members. They don’t represent physicians’ interests, and they are not a union. Complete propaganda.

[@LJ-cp6qs]

US based MS2 here... In one of our Business of Medicine lectures we were told by a professor that our tuition dollars do not cover the full operating costs of the school. He said they rely on clinical income to cover the remaining cost of running the school. I was shocked to hear this and still don't quite understand it but I'm sure he wasn't lying (or was he?). Maybe something you could explore in your cost of medical school video?

[@melaninmonroe007]

@A. Brown that’s ridiculous. In a huge doctor shortage we are wasting amazing talent from other countries. I presently work with a Chinese physician who was a transplant surgeon in China. Now he’s a 2nd year IM resident because he has to residency over again, and he said the idea of redoing a surgery residency was too much to bare (one of the worst 5 years of your life). Places like Miami has so many foreign doctors from South America who become nurses and PAs because they can’t afford to go to redo residency It’s a waste of amazing talent, which could help push us to have enough people to maintain the medical system in our country

[@redflamearrow7113]

Tuition dollars not covering the cost of med school?? Only if med school doctors are demanding insane salaries!

[@ShanilR]

i have cleared both exams for USMLE had 3 interviews but didn't match only because I m not a US citizen or greencard holder

[@yamenmclovin6391]

Nice explanation

[@hannamonique853]

Yes please do a video asking about med school tuition! Super interested as to why

[@ambermilazzo3284]

Wow very good video has a lot of good thoughts and information really enjoyed it

[@FacundoMD]

Great stuff amigo !!! Keep it up ! STAY SAFE EVERYONE ! 🙌🚑👍

[@Athandatu]

FUnny, I read this same article just two days ago. This was like having the Audible version with Mike’s voice.

[@aamirrazak3467]

Would love to see you call medical schools and ask Doctor C. The fees are ridiculous for prospective physicians not to mention the debt they graduate with and the length of the process. It’s sad that our system here in the US seems to focus so much on money and is so broken, in addition to working residents like crazy and paying them peanut

[@Me2thesea]

I think one way to increase primary care physician is do what they do for teachers in inner cities or rural areas. Where the government covers their tuition debt for an equivalence of year. So I say for medical students that upfront commit to primary care can have their debt covered or significantly reduced. Do that along with all the things you said.

[@imixmuan9081]

They charge so much because they can! Because of the high salaries for MD's and DO's on the other side, they know that students will be able to repay loans. It's a vicious circle. I'm a vet and teach fourth year vet students in surgery and I am staggered by what vet school costs these days. Some of these poor kids will NEVER pay their loans back, thanks to the miracle of compounding interest. Someone would have to step in and tell medical and veterinary schools to STOP charging so much tuition, and that, in a capitalist society, is never ever going to happen. As I remind my veterinary students ultimately who is paying for their tuition? Their clients will, in higher fees. In human medicine who ultimately pays for an MD's tuition? Society does....in oh so many ways.

[@Groovygal2026]

I always wanted to be a dr but I’m poor to afford tuition and disabled and I haven’t been able to get a diagnosis which would finally lead to treatment, to be reliable enough to employ. I watched house md instead of cartoons as a kid, I crave ddxing.

[@ovardmelchior20120]

I would LOVE to hear you talk about the ‘midlevel’ encroachment issue

[@HelloMoto_]

We need more spots to open both from medical schools and residency programs. The medical system in the States is all kinds of messed up honestly.

[@lindyesmond5247]

DO medical student here! It would be interesting to see these graphs including DOs as well. We pay the same and go through the same schooling to become physicians and typically become primary care physicians at a greater rate than our MD counterparts. Love your videos!

[@ztk7789]

He is a DO physician, but he hides it for some reason.

[@conniedelio]

I don’t think he “hides” it. Nothing to hide about it! Plenty of DOs specialize.

[@ztk7789]

@@conniedelio I know. He's posted videos making fun of chiropractic techniques when he had to learn the exact same thing. Other DO students have asked him in the comments to do a video on his thoughts about OMM, and he doesn't respond or just says no. All his videos revolve around him having the perception he is a MD when he isn't. It's not a big deal, it's just weird imo.

[@DrCellini]

@@ztk7789 lol you really have my “figured” out. I am an ACGME trained board certified Interventional Radiologist by the American Board of Radiology. Why on earth would I talk about OMM?

[@ztk7789]

@@DrCellini There's many reasons, just hear me out. First, You get more content to make. For example, you could make 2 separate videos with nice click-bait titles. The first video being the usefulness or lack of usefulness of OMM training since every DO in the nation has to learn it. Many of us applying to med school want to know if we are going to waste our time learning OMM, or if it's useful in any specialty. Second, there's not many youtubers making videos about their thoughts on OMM, so you're setting yourself apart. Third, you're a radiologist who is a DO. You're a rare breed, and you can make a 2nd video on how you got into that competitive specialty. People like myself respect you 10x more for being a DO and getting into that specialty because you have to take both USMLE, COMPLEX, and I'm sure there's other factors limiting you're chances of getting into radiology as a DO you could speak on.

[@jen4492]

The shortage of primary care physicians is caused by medical students choosing specialties based on how much they can make in order to pay back the debt that they incur from their education. NPs and PAs have been trained to fill the gap essentially while most med students specialize. I wouldn’t recommend anyone pursuing medical school unless they have a rich family member footing the bill or unless they’re going to have the military pay for it. I mean you can say oh I’m gonna be making 300 grand a year as I work in a specialty, but you never know what’s gonna happen to you or your family. Having that much debt is just unreasonable and too much of a burden for most people to even think about, so I can see why more people are reconsidering that career path and opting for something less expensive instead, such as NP, PA, or just something totally different.

[@deshkavikas1484]

Today I read about a feed stating that Indian doctor from Fortis Delhi removed 3 botfly from a patient after US doctor failed......... Is the standard of medical facility is decreasing in US??

[@medicostudy101]

guess it could be Medical tourism which India is supposedly famous for

[@dr.pewpew2619]

It's not a money issue. Both hospitals and schools have bloated and redundant administrations. That's why there's a money shortage. EM physician, with fellowship, makes $350k/yr. EM physician with fellowship in administration, makes $750k/yr. College professor makes $100k/yr. College administrators make $400k/yr.

[@CassandraBarthelemy]

Great video. I like the direction your channel is going. Very informative. Could you do a video on the physician home loan and thoughts as to if it’s a good idea and specifically at what stage in medical school or training do you think it would work well. Also, the NP topic would be a great video. Definitely would touch some nerves but maybe you and your wife could do it together.

[@davidlakhter]

9:27 haha. great point. Dr. Kevin Jubbal would comment on this too

[@taimalik1110]

Keep in mind, it's immigrant physicians from places like Pakistan and India that take up residency in downtrodden parts of America, where there is a severe shortage of doctors but no shortage of medical problems...

[@melaninmonroe007]

Part of the problem with medical school is how much it costs to get in. I can’t tell you how much I paid to apply. Then…. How much it costs to stay in. Study supplies can end up costing well over $1000 and that’s out of pocket (not covered by tuition. But everyone NEEDS UWorld). Not to mention the cost of every exam (ugh, Step 1) and to even apply for residency. People easily drop thousands on it. It’s nice that interviews are online, but before that you had to go out of pocket to pay for accommodations, flights, etc to GET to your interviews. It’s a hella expensive process that affects students in lower socioeconomic levels. And data shows that competitive Step scores correlate more with how much money your parents have to give you instead of how good of a doctor you’re going to be. There’s basically a pay wall to be successful in medical school.

[@NurseLiz]

I'd love to hear what your thoughts on the Nurse Practitioner Topic are. Happy to chat with you if you want to discuss it together! - Family Nurse Practitioner who definitely knows I'm not a physician but still think we play a great role in the medical system.

[@truthteller2711]

Hot take- purposefully giving patients mediocre medical care compared to Drs is not good actually..l

[@NurseLiz]

@@truthteller2711 good thing I don’t give mediocre medical care!

[@wendishaver9520]

@@NurseLiz I follow you as well and I would to see you guys collaborate on a video.

[@Nick21392]

Team up with Dr Jubbal at MedSchoolInsiders. I believe he left plastic surgery residency to face these issues more directly, particularly burn out.

[@christinebutler7630]

Why do we require med school applicants to have a bachelors before they can apply to med school? European med school education consists of a freshman college year of basic sciences, followed by...med school. It eliminates three years of messing around with courses they don't need, racking up six figures in debt in the process.

[@SixOhFive]

I'm currently getting my bio degree so I can apply to med school, and what it feels like is a filtering process. To weed out anybody who can't make it through. Chem is very difficult for some and bio is very difficult for others. But you have to take three chem classes to get a bio degree and they are not easy. Some people feel the same about the bio classes. It weeds out a large amount of students. It's a filter for excellence or competence.

[@ooolala53]

Hello...I moved from CA to CT, and have RA...I could not get an appt. for a Rheumatologist for months! I tried to make an appt. with my choice, and it would have been 5 months to see her! And I only needed to establish with her. I finally got in with another one. But geez....all the other doc's were not easy also

[@nancyfeldman3464]

One reason med schools are charging more is because states are funding less. And with fed loans and private lending abundant, there’s little incentive for states to reallocate. And it isn’t just med schools. I know people who have jumbo student loans for degrees in fine arts. Our system is pretty messed up. There are no small number of smart, motivated people who want to learn but aren’t able to. They can’t afford it. There are no small number of conscientious people who want to stay healthy but may not because they fall through the health care cracks. Ex: I lost my health insurance after a divorce. Went back to school to gain a hard skill but couldn’t work as much so earned below the poverty line. Which meant I didn’t qualify for ACA subsidy. And my state (NC) has no expanded Medicaid. So every day I just prayed I wouldn’t step on a land mine. I wanted to go back for a graduate degree but couldn’t afford that. Got a 2 year degree in allied health.

[@medicostudy101]

very painful :(

[@Hunter-ok1cu]

My medical school cut our physical exam skills class in our first year due to risk of SP safety due to the (at that time) Recent Covid pandemic. They did not refund any of the students a penny for the loss of classroom instruction. It was never supplemented despite constant cries from students that they felt inadequate when it came to physical exams. I love the idea of calling these medical schools and seeing where the dollars go, though I would feel safe betting that it goes into admin pockets.

[@victoriaprawitz8934]

2nd year Med student in America here. Please call the schools!

[@BrandonRodriguez283]

In Mexico, med school costs about 3600 dollars for the whole 6 years (at least in my school)

[@ibakeandlift3586]

also in Mexico you get paid 3600 per year as a doctor lol.

[@High_Rate136]

The quick answer: the Dean needs a new Yacht.

[@joshbritton]

Yesterday I found out my dream dental school is 125k per year. How am I supposed to live laugh love in these conditions??

[@DrCellini]

lol. Scholarship?

[@joshbritton]

@@DrCellini yea. The only problem is how many are available versus the total number of scholarship applicants. If I’m lucky enough to get one then yes

[@dochudson9912]

😂

[@pierzing.glint1sh76]

Don't go to your dream school then. Manage your expectations.

[@GemaSpringer]

I love that you are discussing these topics! I really don’t understand why med school tuition has to be so much. I’m interested to hear what they have to say when you call them

[@chudasamabhargavrajchudasa8249]

in india only 18% do match in recidency and i included management quata slots also where your paying 200k usd fees for 12k usd per annum salary

[@fortbball24]

Great video! PGY3 rad resident here with about 490k in purely medical school student loans. With that number, one can't help but consider future salary as a factor when one chooses what field to go into.

[@fortbball24]

@Timmy Tran medscape produces an annual physician salary report which takes data from around the country (with limitations due to uneven distribution of survey responders and other things) and it might give a good overview. It differs with practice style and region (academic vs private vs government, Midwest vs NE vs west coast) but im anticipating something in the high 300s to mid 400s as a non partner, non academic, fellowship trained new attending.

[@fortbball24]

@Timmy Tran Cellini may have done a video about this topic too but I can't guarantee that off the top of my head

[@fortbball24]

@Timmy Tran My pleasure! Hopefully I didn't mislead you, I was speaking generally and off the top of my head. So ballpark my numbers are correct but not necessarily spot on.

[@LisaCulton]

This is a problem worldwide. I trained in the US, but I work in Switzerland.

[@rooherm8529]

Note that most other countries have almost entirely public universities which are low tuition. Also most other countries have national health systems

[@monicaperez2843]

Noticed the last year or two (COVID?) that my doctor's practice has been hiring a lot of foreign doctors.

[@TseeDu23]

Our education system is screwing us. It’s all bouts dat monies doe.

[@DrCellini]

Heard that

[@christopherherodotou2055]

It isn't accurate to say that US doctors have 2 additional years of medical education. Europe: 6 years including pre-medical and medical courses USA: 2 years of premedical courses + 2 years of other random things (humanities, languages, advanced maths and science, various pointless electives) in order to get a Bachelors + 4 years of medical degree. Really those extra 2 years have nothing to do with medical or pre-medical training and are purely filler designed to keep you in school 2 years longer and increase the amount of money you pay to Universities. This is a consequence of having the for-profit education system that we have. In a country where medical training is subsidized by the government and available to students who achieve certain scores in high school. the design is aimed towards training doctors in the most efficient and least time-consuming way. In the Unites states, the goal is to get as many people as possible to pay for a four year degree, knowing that only half of that educations is pertinent to becoming a physician, and that only about half of the students completing those degrees will even be able to get a place in medical school. If you become a doctor you have waisted 2 years and thousands of dollars for some pointless courses. If you fail to get into medical school, then you have lost 4 years and even more money for a useless pre-medical degree that is not remotely worth what you payed for it.

[@jenniferwatts3777]

Thank you doc

[@dogdonut]

I knew I wasn't imagining it! I was wondering why I couldn't get an MD. It's been years since I have been able to see one.

[@andrewareva4605]

The AMA and AAMC lobbied Congress and Clinton in the 90s to reduce the number of residency spots in order to maintain high wages. The Balanced Budget Act of 1997 capped residency spots and established limits on medicare reimbursements for resident salaries. The AMA is ultimately a trade organization meant to protect the "rights" of doctors including prioritizing physician pay over accessible patient care. The AMA also has long opposed universal healthcare hiring actor Ronald Regan to create the phrases ""socialized medicine" to target the public against Medicare.

[@ArielMayer96]

I'm in school in Long Island, NY and my tuition is 63k a year. Please call them and ask why it's so expensive 😅😅 cause as of now, with tuition and living expenses, I'm looking at 400k in debt

[@mrinmoyroy269]

Yes, you should make a video on the cost!

[@SeffStandley]

Yes! A video of you calling the medical schools or even telling us what they told you would be fun!

[@susann4278]

All true. And as to med school costs, the last year of medical school is often an expensive waste of time. Undergrad should be 2 years premed, 2 years med, then med school 2 years clinical and on to residency.

[@seaofbenevolence]

NYITCOM 63k/yr. Half the graduates go to primary care. Students have no idea where our tuition goes to cuz its not like we have a fancy campus or descent cafe food or an extraordinary education.

[@jay_ds4800]

I think student debt forces doctors to work, if there were no student debt then doctors who were burnt out or didn’t like the system would just stop practicing. In the UK you hear about doctors taking a sabbatical after residency because there’s not as much pressure to work asap.