medical school

xp yes you're right & this is always the catch with doctor salaries in the USA, because they work such long hours & are on call...we also could use a lot more doctors to make up for letting doctors work less, but the AMA keeps the supply artificially low by limiting the number of accredited med schools, for the purpose of keeping doctor salaries high.

everything in the US is really expensive

AMA keeps the supply artificially low by limiting the number of accredited med schools, for the purpose of keeping doctor salaries high.

yeah this is basically what it all sits on

everything in the US is really expensive

not gas and cheap pieces of plastic

parking too

wellll my point was more that doctors graduate w/ higher relative debt burdens, not that they actually need 20 yrs to pay back their student loans

but arguments about what is 'enough' are going to be p pointless, i suppose, particularly w/iatee

i think the problem is less with how much doctors make then how theyre paid tbh

also i wonder what patient outcomes are like in france. also salaries overall are a lot lower in france arent they? im skeptical of the 'best candidates' argument but i think theres some validity to it as well...

yeah, maybe i'm wrong.

everything in the US is really expensive

not gas and cheap pieces of plastic

or corn...

it's just a thought i have in irritation sometimes when my mom complains about the shitty doctors she knows; clearly these people only got into this profession for the money.

Salaries are lower in France, though French salaries are usually quoted net meaning tax, health care, pension, university don't need to be paid for.

A full professor in France makes about 3k-4k euros per month, net.

patient outcomes are great! french people are healthier than americans. the only complaints I've heard have been about sorta upper-income people, I think there's an income gap of sorts.

(and...anecdotal but the healthcare I received when I lived in france was basically out of this world compared to what I deal w/ here.)

some of my *thoughts* about doctor salaries come from the gap in pay between doctors and other health workers, which definitely breeds resentment. (i know some shitty radiologists who basically just rubber-stamp the readings performed by their techs...who must hate them! i always figured this could only be justified by how expensive medical school is.)

i thought certain programs were fee-paying in france?

my bf & i are renting an apt in paris over december again this year & im always amazed at what rent for a large-ish one bedroom in central paris goes for compared to the places in the us ive lived (bay area/nyc/conn) but i was looking at housing costs as a % of income and that was still p high. i guess this doesnt really have anything to w/ anything but we just booked the apt today so i was thinking abt it...

anyways i think lowering doctors salaries in isolation is probably kinda pointless but w/e

(i know there are also good radiologists whose expertise is valuable; my mom is one. still not sure her labor is worth 12 times more than her ultrasound technician's.)

yeah paris rent is kinda amazing compared to nyc or london or what you'd expect it to be, I've never understood the economics behind it. I've heard there are a lot of empty buildings / resentful landlords due to various rent control laws.

yeah apt costs are super high in the city of Paris; I just got back from an extended stay there a few days ago & had a nice 1 bedroom in the 6th & paid well over $2k for it. But when I lived there long-term last year we lived outside the city for under a thousand euros a month.

oh man my parents pushed hard for me to become a radiologist when I was in high school

i heard somewhere recently that radiology is going to be rendered obsolete in fifteen years. have no idea where i heard that or why it's supposed to happen.

so it's a good thing you didn't!

I think most professions we regard today as being 'high paying' are gonna be rendered obsolete in fifteen years. computers. =[

yeah apt costs are super high in the city of Paris; I just got back from an extended stay there a few days ago & had a nice 1 bedroom in the 6th & paid well over $2k for it. But when I lived there long-term last year we lived outside the city for under a thousand euros a month.

haha dont you live in kansas city? i think were paying c$1800 for a nice one bedroom and that felt like a p good deal!! thats not much more than my rent in toronto and less than i paid in ny.

Euler, lamp and I were saying they're cheap! I know someone who was paying 300e for a studio.

xp

for real? ok a 300 euro studio is gonna be the size of a closet.

I live near Kansas City right now & own a big house in a small town for about the same price as I'd pay for a decent apt in the Paris suburbs---I'm always playing with moving to France so these things are on my mind.

also the inner bans might as well be Paris / probably only aren't cause of a poor choice of wall/freeway construction. moving to a suburb on a metro or rer line is a lot different than moving to an American suburb.

I loved living in a first-ring Paris suburb last year, right off the RER. It took me the same time to get to e.g. Trocadero as it did from the 6th last month.

I am super fascinated by the first ring Paris burbs for some reason. its interesting how much they're ignored when they're such a big aspect of how Paris 'works' as an urban area. there is a good blog on the subject.

anyway, med school...

I'm always playing with moving to France so these things are on my mind

oh man i think about moving to spain all the time... i dont think i can make it happen tho w/o fucking up my job prospects...

my theory about french rents is that there isnt the same culture of compensation in france that there is in london or ny or the bay area, where the high end of the market exerts an upward pressure on rents. also that french rent controls are better/exist makes sense too

yeah but rich plutocrats from the Middle East & Russia are buying property in central Paris like mad so costs are going way up. I'm resigned to the fact that, should I get a position there, we'll live in the suburbs...which is totally fine! The doctors there are good too! My doctor, in Vincennes, worked in an apartment building; his office was just two apartments together, & he had no secretary or nurse. He handled the finances himself too, though those go through the central administration of CPAM / supplemental insurance companies, & is apparently not the burden it is here.

my theory about french rents is that there isnt the same culture of compensation in france that there is in london or ny or the bay area, where the high end of the market exerts an upward pressure on rents. also that french rent controls are better/exist makes sense too

that's pretty interesting I never thought about it like that. also having a pretty uniform architecture makes a building in the 16th look pretty similar on the outside to lots of 'poorer' neighborhoods + everywhere is pretty convenient - so you can def live in an 'upper class' part of the city but it's not as drastic a lifestyle thing the west village vs. the bronx. it's harder to be conspicuous even if you wanna be when everyone lives in pretty buildings and poor people dress well.

+ the rich people just aren't as rich

okay, so they make $160,000+ but is this net or gross or what? don't they have office expenses and insurance to pay, etc?
i don't know, i've just heard a lot of Canadian doctors talking about how when all is said and done re: expenses, they don't make "that much" money - like they are doing fine but aren't rich or anything, plus are overworked. but that is canada...

from what i've read, the richest doctors in canada are def plastic surgeons, oral & maxillofacial surgeons, dentists, whoever isn't covered under govt-funded health care system. but then, i knew someone in university whose dad is a gastroenterologist and whose mom didn't work and they had a sweet house on the beach, so...

I work in the Canadian medical industry and I'm friends with a buncha young doctors. Even the ones straight outta school are netting almost 100k a year and they don't have practices (hospitalists) so they have no overhead expenses of running one. I think Canadians just like to bitch.

I am walking away with somewhere between 200,000 and 300,000 in debt next year. I had 0 undergrad debt, actually turned a small profit on grad school, but went to a private university medical school in a city with a high cost of living. I interviewed at a few University of California schools (which would have been probably about $20,000 a year cheaper tuition-wise since I was a California resident, though San Diego, Irvine, and LA are not entirely dissimilar cost-of-living wise from DC; San Francisco is notably worse, but I didn't apply there). I also interviewed at Wake Forest, where housing prices were (probably still are) dirt-cheap, which also would have helped. But of the schools that would have been cheaper, I think I'd really only prefer UCLA (which by the way I am doing an away rotation at in a couple months! *Fist pump*). I know people who have undergrad debt, and a lot who took a special program here that costs basically the same as a year of medical school, in order to basically attend a significant part of the first year of medical school in order to improve one's chances of getting into medical school. If you count the people who are married to some sort of med student/law student/something there are almost certainly some people whose households will carry about a half-million dollars in student loan debt.

I am going to make somewhere in the neighborhood of $45,000-$55,000 a year starting next June/July, which seems to increase by a few thousand each year you get further along in residency; this is not terrible money, but it is not enough to really put a sizeable dent into my student loans, which will begin accruing interest six months after I graduate. So in all likelihood by the time I get to the point where a dumptruck full of money backs up to my house (after residency, and more likely given my professional goals, after fellowship), interest will have tacked on several thousand more dollars onto that sum. I'm not worried that I won't ever pay it off, but it's pretty likely I'm going to be in my mid-40s (or later) before that ever happens.

(For the record, the median salary listed for US Neurologists in the book they gave us all about specialty-choosing last year is $186,946. Neurosurg is $401,000; Ortho ranges from $350,000 to $482,000 for spine surgeons, Plastics is somehow $284,000 which seems really low, Derm is $221,000 which also seems really low. Obviously some people make way more and some way less. Primary care medians tend to be between $120,000-$150,000.)

the idea of that much debt is making me feel... not good.
but if you're making 100,000+ i guess it all gets paid off soon enough...
agh, they make you start repaying when you're still in residency? blargh

re: canada - i have a feeling rich canadians are the bitchiest of canadians

kidding! we are all bitchy (and rich)

yeah, I really have no sympathy for MDs complaining about their debt load. It's not like your debt/income ratio makes you un-creditworthy and you'll be living on the streets until it's paid off.

when I volunteered at a hospital I remember seeing a sign in the neurology department that said: NEUROSURGEON WANTED; 450000 a year. (MALPRACTICE INSURANCE: ONLY 210,000 A YEAR!)

but a large portion of the insurance bill (maybe even all of it depending on the organization) would be picked up by the hospital.

and even if it isn't, you're still making about 5x the national average.

heard the most amazing "aha" explanation for pre/eclampsia today, love it when someone gives you lightbulbs

want you to know that even though I don't know you personally I am proud of you. sticking it through is a real accomplishment and I have faith that you will make immense differences in people's lives

that is srsly the nicest thing anyone has said to me lately. thanks aero!

What was the lightbulb? I have Step 2 CK on Wednesday and haven't taken OB (or Peds) in like a year, and all I really know for sure on preeclampsia is "Give Magnesium, cure with delivery"

Although it must be said that if USMLEWorld is any indication, Step 2 is WAAAAAYYYYY less of a terrible beast than Step 1. Either that or I have gained hella knowledge since June 2010.

What was the lightbulb? I have Step 2 CK on Wednesday and haven't taken OB (or Peds) in like a year, and all I really know for sure on preeclampsia is "Give Magnesium, cure with delivery"

I am ON IPHONE and running out of batteries, but I'll post when I get home.

Teaser: search "renin like substance" and "estrogen liver angiotensinogen production"

heard the most amazing "aha" explanation for pre/eclampsia today, love it when someone gives you lightbulbs

― remembrance of schwings past (gbx), Monday, August 15, 2011 9:19 PM (2 hours ago)

a couple semesters ago i had like a 3 hr lecture on the role of the prefrontal cortex in schizophrenia - a fairly complex patho/therapy concept but i was just not_connecting_the_dots until i decided to look at the online powerpoints that were posted, and tucked away in the "additional notes" part or whatever of one of the 150 powerpoint slides were a few extremely clear but erudite paragraphs written by the professor that i only had to read once or twice to go "ohhhhh"

yeah love those moments too

ok. home now.

apologies if this is somewhat disorganized, but its been a long day. also, i've only done cursory fact-checking on this, but i think it's legit

first principles:
1. estrogen is increased in pregnancy
2. increased estro will increase hepatic production of angiotensinogen (among other things, like clotting factors)
3. pregnancy also increases volume
3a. increased volume means that you don't have to worry about JG cells kicking out renin, and thus activating that excess angiotensinogen (which would otherwise lead to AII-mediated vasoconstriction and aldo-mediated sodium retention).

so. angiotensinogen is being kept in reserve. file this.

NEW FACT (to me): placentae have the ability to produce a substance called, imaginatively, "renin-like substance" (here on out referred to as RLS).

why would a lil ol placenta do this? well, first, recall: normally, renin is produced 2/2 a decrease in volume*. "oh shit, i'm hypotensive, better jack up the vasculature (AII), maintain my GFR (AII), and hold onto all this fluid (aldo)." this (hypotension) is not generally a problem in pregnancy, since pregnant ladies are perfusing for two.

BUT. the placenta produces RLS in response to ~hypoxic injury~, not just hypotension. that is, ANY hypoxic injury. said injury could fall, roughly, into one of two categories:
1) mom is hypoxic, and so the placenta/baby is too
2) mom is ok, but the placenta is hypoxic for some other reason

let's consider (1). a generalized hypoxic state in mom (oops i did too much heroin OR wow its so beautiful here on everest) will compel the placenta to release RLS. this, in turn, activates all that latent angiotensinogen.

now this can be considered a pretty savvy adaptive mechanism. normally, renin gets jammed because of hypovolemia, not hypoxia*; however in this situation, "renin" is getting pushed because of hypoxia, fullstop. why? a: in order to induce vasoconstriction, which will maintain perfusion in the placenta. this makes sense---baby is a more delicate flower than mom, so a transient episode of hypertension serves his/her interests and mom can just f-in deal with it, because she can. eventually she'll get the O2 she needs (when she comes off the mountain), and in the meantime baby will have selfishly gobbled blood.

but what about (2)? in this case, the "other reason" might be a derangement in the vasculature of the placental barrier. pre/eclampsia, iirc, has been shown or suggested to have a genetic component. so if mom has some inborn difficulty in producing an efficient O2/nutrient exchange (2/2 some problem with placental angiogenesis), then placental hypoxia is bound to happen more frequently. even, say, when mom isn't hypoxic herself.

so if this not-quite-functional placenta is more sensitive to hypoxia than mom, then it stands to reason that it will be more susceptible to releasing RLS. thus, it will sustain some insult under "normal" conditions and respond with an outpouring of RLS. this, in turn, will mobilize mom's store of surplus angiotensinogen and induce a hyptertensive episode.

*technically, renin is produced 2/2 acute hypoxia anyway, but this doesn't really undermine the model here, i don't think. it's my understanding that normal hypoxic renin production favors vasoconstriction over fluid retention. again, this makes sense, because you'd want to maintain cerebral perfusion. so, in the case of eclampsia, unnecessarily high cerebral perfusion--->hypertensive encephalopathy. PAGING PLASMON.

I really know for sure on preeclampsia is "Give Magnesium, cure with delivery"

this is how my sister was born

fwiw all i can remember is that Mg sets a pick such that Na can't rush in and depolarize any membranes, so no seizures.