Great video as always, the part where you mention the egalitarian streak in medicine really hits home. The rising cost of colleges, competitive fever for all metrics, the cost people spend on MCAT and MCAT prep, and the increasing difference between low and high-tier schools seem to be strongly stratifying applicants and then future physicians. Anecdotal but I help premed students all the time with applications and this whole process is getting more opaque, more costly, and way easier to mess up without realizing, especially among people who start in more disadvantageous positions.
I say this in all seriousness - if were a DO president I would leverage all connections to get introduced to the Walton family. They’ve already got an MD school - why not add a DO school, too?
Truly asking no insult, but would patients want to see a DO or an MD? I'm curious what the argument would be to differentiate between the 2. Because that would the question patients ask.
@@karensmithfam3187from my anecdotal experience, patients generally don’t care. However, as a DO I’ve had numerous patients tell me how much more they like DO than MD. I’m sure MD prob hear the same thing about their degree versus a DO.
As much as it galls me to say it, the earnest answer to this “why not add a DO school too” is equal parts simple & pragmatic: Brand Management What compelling value-add can they really resulting from investing in an institution with fewer community/professional/political ties, increased barriers to entry into competitive space for student rotation placements, increased reputational risk 2/2 anti-DO stigma still permeating many halls of medicine, AND a budget cycle which relies heavily on tuition (esp out-of-state) revenues as its primary source of funding??
I agree with what you said about tuition free and speciality selection. I was given a full tuition scholarship at my medical school but had to choose a primary speciality (FM, IM, PEDS, OBGYN). The parameters of the scholarship recently changed and studies no longer have to commit to primary care. My next move was to start building my CV for Radiation Oncology or potentially Vascular Surgery.
Good analysis. Programs like CUNY School of Med Bs/MD do much more to improve access to medical education. Still... the focus then turns to equal access to quality K-12 public school education to be college-ready (and competitive for a low cost BS MD).
Great conversation and insights, as always! I find that among my medical school classmates, those who go into primary care truly had a passion for it from the start of medical school, and never thought much about the money. Those folks are unlikely to be swayed by free tuition, which is honestly more of a minor financial strain over the course of a specialist physician’s lifetime earnings. If you’re really interested in money, you’d be much better off going to the most expensive medical school if it helps you match Derm or Neurosurgery, and the subsequent career earning difference would far outweigh the relatively minor savings of free medical school. On the whole though, I still think that primary care specialties would improve their recruitment with improved salaries and valuation in the healthcare system, which currently tends to deprioritize primary care investments in favor of lucrative ambulatory surgical centers or infusion centers.
Another great video (as usual)! I thought many of the same things you did when I heard the announcement. Definitely agree that financial help needs to be deployed earlier in the premed stage if they truly want to make med school economically diverse.
I would like to bring up another demographic in the “rich kids” section, that being people with affluent families who are NOT having their education covered by their family. While this is circumstantial, I know more people than not whose families make >300k, but are still taking out their own loans for medical education. I think most analyses of who will be affected by these changes focus on the minority of these students whose expenses are covered by their families, rather than the larger cohort who are still taking out loans. A free education is still a massive change for students in this circumstance. Great analysis as always.
Thank you for watching - and I agree. This is a demographic that includes many students whose parents are physicians. (If my own children decide to go to medical school one day, they’ll be in that group, too.)
I love your videos, thank you for breaking down complex topics. Have you ever done a video highlighting people who are trying to address some of the issues you bring up in your videos? Like the over importance on metrics unrelated to clinical performance, lack of economic diversity in medical schools, too much emphasis on sub par research as a means of getting to competitive specialties, etc?
Thanks for your perspective. I agree there should be a better push to donate scholarships or grants designed for aspiring medical students to alleviate financial burdens. These funds could cover MCAT prep courses, research expenses, and clinical experiences. Sadly, many students shy away from or are encouraged to focus on something other than the premed track because of the time and expense needed to be a competitive medical school applicant, regardless of the school or specialty interest.
Thank you for watching. And you are right. Of all the places that the pipeline leaks less affluent medical students, I think the final step of actually applying to schools is probably one of the least leaky.
Ehh. I disagree with this. As a MD-PhD student myself, sure the no debt is essential to making the MD-PhD program accessible, but I would have (and most of my classmates) would have chosen this path even if MD was free. Sure there are those who fall into the faulty logic that MD-PhD is better financially, but those people aren’t going to be physician scientists when the graduate
@@mikeytaylorjr Definitely agree that the supply of physician-scientists won’t change. And it sounds like you’re in a good MD/PhD program. I disproportionately hear from regretful MD/PhDs who end up pursuing non-research careers and wish they’d saved themselves the time/struggle of doing the PhD. It might be that these folks would only recognize that they don’t want a research career by doing it for a while. But I think that the financial incentive of “free” medical school factors in.
@@sheriffofsodium I agree that free school is definitely a factor in individuals choosing to enroll in MD-PhD programs, and people who justify their own MD-PhD with "free school" definitely get burned down the line. I think that as a collective, free MD would actually improve the overall research quality of MD-PhD cohorts as those spots would be replaced by only those most passionate for research as the financial aspect has been eliminated.
I can't wait to watch the DO school & debt video. I'm a DO student and my debt 100% affected my choice to pursue a specialty over primary care. I know the data is 'null' but not in my case.
My vibe as a premed, which you touched on, is that the med schools that go tuition-free become radically competitive, understandably so. More privileged premed students are generally more competitive, especially in terms of MCAT/GPA. You could argue that free tuition schools may even harm students from disadvantaged backgrounds, by raising the bar for matriculants. NYU was never especially diverse economically, but it's even less so today, representing a total failure of their supposed goals. KP actually did great in this regard, having many disadvantaged students. Hopefully Einstein matches that. I'm just not confident in these schools to perform holistic review that really comprehends and reasonably frames struggle/the detriment on competitiveness stemming from being disadvantaged. JHU going "tuition free" is great, if they didn't accept so many privileged students to begin with (or made plans to restrict this). Even 150k for a household, the lowest threshold, is quite high for most of America.
The only way to make primary care a more desirable specialty is to increase the reimbursement of active attending PCPs. Little to nobody who goes into medical school wants to go into primary care, this is usually something they end up opting to because other more competitive specialties become unachievable. This is especially true for any top 20 medical school where pretty much everyone wants to specialize and has means/connections to do so. This was true for NYU and this will be true for Hopkins. But increasing PCP reimbursements probably won’t help either because it’s more of a distribution of physicians issue. I just don’t think this is something that you can fix at the medical school level.
Great analysis, especially the part on billionaires. I think the overarching theme that needs to be addressed more is that we live in a broken economic system where you have to get lucky that a billionaire (who usually accumulated their wealth through dubious means) decides to donate to your school. There has to be a better distribution system than relying on the whims of a billionaire taking pity on your existence.
Thing is, most of the matches the school counts as “primary care” won’t end up resulting in someone who actually practices primary care: most of the IM/peds/OBGYN matches will specialize. How many graduates *really* go into primary care can be a hard thing to put your finger on. I’m not a big fan of the U.S. News & World Report rankings, but one thing I liked was that they have been trying to come up with better ways than just counting matches into certain specialties as “primary care.” For the past couple of years, they’ve used data from the Robert Graham Center in Washington to figure out what percentage of graduates are actually practicing in primary care after 8-10 years.
Agree-resources for URIM should be distributed way earlier than the finishing line. Maybe the Third Grade…then you will find research shows family involvement is one of the major reasons.
Only thing that scares me the most is that medical school will matter now and as IMG I am already at disadvantage. So I hope I get match in internal medicine 🥺🥺
This video isn't about you and putting yourself out there. Don't sell yourself. Apply to places where there isn't competition. Because there are many IMGs who come from other countries with amazing scores and are vl extremely smart next to an American IMG. The only advantage is that they are American and less paperwork for the hospitals.
Love your content but very disappointed you chose to perpetuate the myth that Billionaires only pay 1%. Per the IRS, the top .1% of earners paid 25.6%.
The issue is that what the IRS considers income is not what a regular person might consider income. I don’t know what the real tax rate for the top 0.1% is, but from 2014-2018, Michael Bloomberg’s wealth grew by $22.5 billion, but he paid $292 million in income tax - which is 1.3%. www.propublica.org/article/the-secret-irs-files-trove-of-never-before-seen-records-reveal-how-the-wealthiest-avoid-income-tax
I appreciate you watching - but in my videos, I’m gonna call it as I see it. I’m not really a political person, and don’t believe I’ve advocated for any particular political position. But as an American who cares about the ongoing function of the republic, I do find secret gifts to judges very troubling (and deserving of much more of a rebuke than some gentle mockery in a video on an ultra-niche UA-cam channel).
@sheriffofsodium dude the "gifts to judges" is a fringe conspiracy narrative being advanced by political operatives who want to radically change the Supreme Court. The same people who cite "gifts to judges" equally advocate for court packing - which should tell you the extreme company you are in when fringe narratives somehow make it into off-the-cuff remarks about medical school tuition. I find if kind of embarrassing when people are so overtly political that they actually are incapable of the restraint required to not talk about their politics. It's not only detrimental to the otherwise high-quality content you produce, it's a nasty habit of physicians broadly that is increasingly destroying physician credibility. There aren't many professions that maintain a well-respected status by interjecting their narrow partisan politics into everything they say. We need to return to professionalism as an ethos in medicine because I promise you the public is not responding kindly to this more activist generation of physicians.
Lemme share something with you. Maybe it’ll help you see where I’m coming from. From time to time, I get invited to give a talk to an organization that has some skin in the game of medical education. When I do, I’m offered an honorarium. The amount is usually pretty small - a couple hundred to a couple thousand dollars - and the amount offered to me is the same as would be offered to any other speaker. But I always decline, or ask that the honorarium be donated to charity. Why do I do that? Because I want to avoid *even the appearance* of influence. If I decide to say something nice about that organization or its policies in the future, I don’t want someone to think I’m saying it just because they gave me a few dollars. And it should be obvious that the stakes for anything I write or say are LOW. So it just astounds me that someone in a position of authority who knows their words actually matter would *ever* get themselves to a place where they’re letting a billionaire fly them around the world on a private jet or pay for a family members’ education. Again: I think that’s shameful, and reaching that conclusion doesn’t require any particular political bent. It doesn’t even require an intact moral compass. You should be able to reach that conclusion independently just based on the effect it’s gonna have on a functional democracy. And once you reach the conclusion accepting these favors isn’t good for our country, actually - well, then, you ought to have enough courage to acknowledge that, at least in the privacy of your own mind. I said before that I’m not really a political person. But I’m also gonna share with you the single thing that I find most distasteful about politics and political discussions. And that is that too many people lose their ability to think critically. We’ve somehow reached a point where supporting a particular political candidate is supposed to mean you have to automatically subscribe to the whole package deal of groupthink on completely unrelated issues. Look at the conclusions about me that you’ve jumped to. I actually agree with your point about most physicians taking strong public political opinions (which may alienate half of their patients). But listen again to the actual words I said. Ever-so-gently ridiculing billionaires who befriend high court judges isn’t advocating for any particular political position. If the mere mention of the situation I alluded to makes you to become defensive - rather than rightously upset as an American - you may want to think about if your politics are as concealed as you think they are.
Snarky Sheriff of Sodium is a welcome distraction from STEP 2 dedicated
Thank you for taking the time to watch.
Good luck
Great video as always, the part where you mention the egalitarian streak in medicine really hits home. The rising cost of colleges, competitive fever for all metrics, the cost people spend on MCAT and MCAT prep, and the increasing difference between low and high-tier schools seem to be strongly stratifying applicants and then future physicians. Anecdotal but I help premed students all the time with applications and this whole process is getting more opaque, more costly, and way easier to mess up without realizing, especially among people who start in more disadvantageous positions.
Thank you for watching (and sadly, I agree).
If anyone knows a Billionaire that wants to donate to a DO school. I can hook him up
I say this in all seriousness - if were a DO president I would leverage all connections to get introduced to the Walton family. They’ve already got an MD school - why not add a DO school, too?
Truly asking no insult, but would patients want to see a DO or an MD? I'm curious what the argument would be to differentiate between the 2. Because that would the question patients ask.
@@karensmithfam3187from my anecdotal experience, patients generally don’t care. However, as a DO I’ve had numerous patients tell me how much more they like DO than MD. I’m sure MD prob hear the same thing about their degree versus a DO.
As much as it galls me to say it, the earnest answer to this “why not add a DO school too” is equal parts simple & pragmatic:
Brand Management
What compelling value-add can they really resulting from investing in an institution with fewer community/professional/political ties, increased barriers to entry into competitive space for student rotation placements, increased reputational risk 2/2 anti-DO stigma still permeating many halls of medicine, AND a budget cycle which relies heavily on tuition (esp out-of-state) revenues as its primary source of funding??
I agree with what you said about tuition free and speciality selection. I was given a full tuition scholarship at my medical school but had to choose a primary speciality (FM, IM, PEDS, OBGYN). The parameters of the scholarship recently changed and studies no longer have to commit to primary care. My next move was to start building my CV for Radiation Oncology or potentially Vascular Surgery.
Good analysis. Programs like CUNY School of Med Bs/MD do much more to improve access to medical education. Still... the focus then turns to equal access to quality K-12 public school education to be college-ready (and competitive for a low cost BS MD).
Great conversation and insights, as always! I find that among my medical school classmates, those who go into primary care truly had a passion for it from the start of medical school, and never thought much about the money. Those folks are unlikely to be swayed by free tuition, which is honestly more of a minor financial strain over the course of a specialist physician’s lifetime earnings. If you’re really interested in money, you’d be much better off going to the most expensive medical school if it helps you match Derm or Neurosurgery, and the subsequent career earning difference would far outweigh the relatively minor savings of free medical school.
On the whole though, I still think that primary care specialties would improve their recruitment with improved salaries and valuation in the healthcare system, which currently tends to deprioritize primary care investments in favor of lucrative ambulatory surgical centers or infusion centers.
Another great video (as usual)! I thought many of the same things you did when I heard the announcement. Definitely agree that financial help needs to be deployed earlier in the premed stage if they truly want to make med school economically diverse.
I would like to bring up another demographic in the “rich kids” section, that being people with affluent families who are NOT having their education covered by their family.
While this is circumstantial, I know more people than not whose families make >300k, but are still taking out their own loans for medical education. I think most analyses of who will be affected by these changes focus on the minority of these students whose expenses are covered by their families, rather than the larger cohort who are still taking out loans. A free education is still a massive change for students in this circumstance.
Great analysis as always.
Thank you for watching - and I agree. This is a demographic that includes many students whose parents are physicians. (If my own children decide to go to medical school one day, they’ll be in that group, too.)
Can you please make the video on old NBME exams and how we went from a comprehensive test to just mcq based test
Yes, I will - though I can’t promise when. But it is on my list.
I love your videos, thank you for breaking down complex topics. Have you ever done a video highlighting people who are trying to address some of the issues you bring up in your videos? Like the over importance on metrics unrelated to clinical performance, lack of economic diversity in medical schools, too much emphasis on sub par research as a means of getting to competitive specialties, etc?
Thanks for your perspective. I agree there should be a better push to donate scholarships or grants designed for aspiring medical students to alleviate financial burdens. These funds could cover MCAT prep courses, research expenses, and clinical experiences. Sadly, many students shy away from or are encouraged to focus on something other than the premed track because of the time and expense needed to be a competitive medical school applicant, regardless of the school or specialty interest.
Thank you for watching. And you are right. Of all the places that the pipeline leaks less affluent medical students, I think the final step of actually applying to schools is probably one of the least leaky.
Loser: MD/PhD programs
GREAT point. Ashamed of myself for missing that.
Ehh. I disagree with this. As a MD-PhD student myself, sure the no debt is essential to making the MD-PhD program accessible, but I would have (and most of my classmates) would have chosen this path even if MD was free. Sure there are those who fall into the faulty logic that MD-PhD is better financially, but those people aren’t going to be physician scientists when the graduate
@@mikeytaylorjr Definitely agree that the supply of physician-scientists won’t change. And it sounds like you’re in a good MD/PhD program. I disproportionately hear from regretful MD/PhDs who end up pursuing non-research careers and wish they’d saved themselves the time/struggle of doing the PhD. It might be that these folks would only recognize that they don’t want a research career by doing it for a while. But I think that the financial incentive of “free” medical school factors in.
@@sheriffofsodium I agree that free school is definitely a factor in individuals choosing to enroll in MD-PhD programs, and people who justify their own MD-PhD with "free school" definitely get burned down the line. I think that as a collective, free MD would actually improve the overall research quality of MD-PhD cohorts as those spots would be replaced by only those most passionate for research as the financial aspect has been eliminated.
I can't wait to watch the DO school & debt video. I'm a DO student and my debt 100% affected my choice to pursue a specialty over primary care. I know the data is 'null' but not in my case.
My vibe as a premed, which you touched on, is that the med schools that go tuition-free become radically competitive, understandably so. More privileged premed students are generally more competitive, especially in terms of MCAT/GPA. You could argue that free tuition schools may even harm students from disadvantaged backgrounds, by raising the bar for matriculants. NYU was never especially diverse economically, but it's even less so today, representing a total failure of their supposed goals. KP actually did great in this regard, having many disadvantaged students. Hopefully Einstein matches that.
I'm just not confident in these schools to perform holistic review that really comprehends and reasonably frames struggle/the detriment on competitiveness stemming from being disadvantaged.
JHU going "tuition free" is great, if they didn't accept so many privileged students to begin with (or made plans to restrict this). Even 150k for a household, the lowest threshold, is quite high for most of America.
Wake up babe, new Sheriff of Sodium just dropped
The only way to make primary care a more desirable specialty is to increase the reimbursement of active attending PCPs. Little to nobody who goes into medical school wants to go into primary care, this is usually something they end up opting to because other more competitive specialties become unachievable. This is especially true for any top 20 medical school where pretty much everyone wants to specialize and has means/connections to do so. This was true for NYU and this will be true for Hopkins. But increasing PCP reimbursements probably won’t help either because it’s more of a distribution of physicians issue. I just don’t think this is something that you can fix at the medical school level.
3:25 - lol at “little lebowski urban achievers”
Great analysis, especially the part on billionaires. I think the overarching theme that needs to be addressed more is that we live in a broken economic system where you have to get lucky that a billionaire (who usually accumulated their wealth through dubious means) decides to donate to your school. There has to be a better distribution system than relying on the whims of a billionaire taking pity on your existence.
5:35 Actually a pretty decent primary care match list in last year’s NYU class though.
Thing is, most of the matches the school counts as “primary care” won’t end up resulting in someone who actually practices primary care: most of the IM/peds/OBGYN matches will specialize.
How many graduates *really* go into primary care can be a hard thing to put your finger on. I’m not a big fan of the U.S. News & World Report rankings, but one thing I liked was that they have been trying to come up with better ways than just counting matches into certain specialties as “primary care.” For the past couple of years, they’ve used data from the Robert Graham Center in Washington to figure out what percentage of graduates are actually practicing in primary care after 8-10 years.
Agree-resources for URIM should be distributed way earlier than the finishing line. Maybe the Third Grade…then you will find research shows family involvement is one of the major reasons.
Only thing that scares me the most is that medical school will matter now and as IMG I am already at disadvantage. So I hope I get match in internal medicine 🥺🥺
This video isn't about you and putting yourself out there. Don't sell yourself. Apply to places where there isn't competition. Because there are many IMGs who come from other countries with amazing scores and are vl extremely smart next to an American IMG. The only advantage is that they are American and less paperwork for the hospitals.
Love your content but very disappointed you chose to perpetuate the myth that Billionaires only pay 1%. Per the IRS, the top .1% of earners paid 25.6%.
The issue is that what the IRS considers income is not what a regular person might consider income. I don’t know what the real tax rate for the top 0.1% is, but from 2014-2018, Michael Bloomberg’s wealth grew by $22.5 billion, but he paid $292 million in income tax - which is 1.3%.
www.propublica.org/article/the-secret-irs-files-trove-of-never-before-seen-records-reveal-how-the-wealthiest-avoid-income-tax
Man I like your videos but you should steer away from politics, it just alienates parts of your audience. Wtf does this have to do with SCOTUS?
I appreciate you watching - but in my videos, I’m gonna call it as I see it. I’m not really a political person, and don’t believe I’ve advocated for any particular political position. But as an American who cares about the ongoing function of the republic, I do find secret gifts to judges very troubling (and deserving of much more of a rebuke than some gentle mockery in a video on an ultra-niche UA-cam channel).
@sheriffofsodium dude the "gifts to judges" is a fringe conspiracy narrative being advanced by political operatives who want to radically change the Supreme Court. The same people who cite "gifts to judges" equally advocate for court packing - which should tell you the extreme company you are in when fringe narratives somehow make it into off-the-cuff remarks about medical school tuition. I find if kind of embarrassing when people are so overtly political that they actually are incapable of the restraint required to not talk about their politics.
It's not only detrimental to the otherwise high-quality content you produce, it's a nasty habit of physicians broadly that is increasingly destroying physician credibility. There aren't many professions that maintain a well-respected status by interjecting their narrow partisan politics into everything they say. We need to return to professionalism as an ethos in medicine because I promise you the public is not responding kindly to this more activist generation of physicians.
Lemme share something with you. Maybe it’ll help you see where I’m coming from.
From time to time, I get invited to give a talk to an organization that has some skin in the game of medical education. When I do, I’m offered an honorarium. The amount is usually pretty small - a couple hundred to a couple thousand dollars - and the amount offered to me is the same as would be offered to any other speaker. But I always decline, or ask that the honorarium be donated to charity.
Why do I do that? Because I want to avoid *even the appearance* of influence. If I decide to say something nice about that organization or its policies in the future, I don’t want someone to think I’m saying it just because they gave me a few dollars.
And it should be obvious that the stakes for anything I write or say are LOW. So it just astounds me that someone in a position of authority who knows their words actually matter would *ever* get themselves to a place where they’re letting a billionaire fly them around the world on a private jet or pay for a family members’ education.
Again: I think that’s shameful, and reaching that conclusion doesn’t require any particular political bent. It doesn’t even require an intact moral compass. You should be able to reach that conclusion independently just based on the effect it’s gonna have on a functional democracy. And once you reach the conclusion accepting these favors isn’t good for our country, actually - well, then, you ought to have enough courage to acknowledge that, at least in the privacy of your own mind.
I said before that I’m not really a political person. But I’m also gonna share with you the single thing that I find most distasteful about politics and political discussions. And that is that too many people lose their ability to think critically. We’ve somehow reached a point where supporting a particular political candidate is supposed to mean you have to automatically subscribe to the whole package deal of groupthink on completely unrelated issues. Look at the conclusions about me that you’ve jumped to.
I actually agree with your point about most physicians taking strong public political opinions (which may alienate half of their patients). But listen again to the actual words I said. Ever-so-gently ridiculing billionaires who befriend high court judges isn’t advocating for any particular political position. If the mere mention of the situation I alluded to makes you to become defensive - rather than rightously upset as an American - you may want to think about if your politics are as concealed as you think they are.
@@sheriffofsodium This is worded so well it's a shame it will fall on his deaf ears.