State of the healthcare system in America: Let's discuss why it's failing

Kate Collins67 said:At the facility where I work, the nurses don't even have the authority to filter patients. Every single person who walks into the internal medicine clinic has to get an exam—it’s a direct order from the top brass...
If you get referred to internal medicine because of ear pain—which is obviously the wrong department, by the way—you still end up getting stuck with a full internal medicine exam, and naturally, you walk away without any actual solution to your problem....

Do some digging into those obligations before you jump in; for some people, if you don't handle things properly, you're looking at debt climbing to ten years or over a million dollars.

There are supposed to be some changes coming down the pipeline, but the big question is whether they're going to apply retroactively.

Come on, tell us where you work! That kind of info is pure gold.🤣

I honestly have no idea, this is the first I'm hearing of it.
A million dollars? My goodness, for what?!
I get that there are certain conditions attached, but seriously, what could possibly be worth a million bucks?

jadesailor14 said:Come on, tell us where you work! That kind of info is pure gold.🤣

I honestly have no idea, this is the first I'm hearing of it.
A million dollars? My goodness, for what?!
I get that there are certain conditions attached, but seriously, what could possibly be worth a million bucks?

I’m worth it, so now you see why I have such high self-esteem.☕
And with a salary like this, if I ever decided to quit, I wouldn't be able to pay back my loans in this lifetime.

jadesailor14 said:Honestly, I'm not sure how you're obligated
I know some people currently doing their residency or specialized training, but I haven't heard of anyone being tied down like that!

Look, I don't know the exact fine print in everyone's contracts, but for the most part, almost all residents are tied down by an agreement stating they have to serve a specific amount of time as specialists at the very institution that's paying their salary during their training. The only exceptions are the "nepo babies"—those kids with "bright futures ahead of them" who don't have any obligations at all, they don't even have to finish certain parts of their residency if it doesn't interest them, because someone else will just swoop in and do the work for them...

Back when I was an intern, I was basically acting as an assistant for laparoscopic procedures—if you've ever actually performed one or even watched one, you know exactly what kind of chaos that implies—mostly because the clinic where I was working was drowning in staffing issues. They had plenty of people on paper who were supposed to be there, but in reality, they were just ghosts protected by bureaucracy... luckily enough, I was "thrown into the fire" in surgery, so I kept myself busy and, hey, everyone survived... 😉

jadesailor14 said:Come on, tell us where you work! That kind of info is pure gold.🤣

I honestly have no idea, this is the first I'm hearing of it.
A million dollars? My goodness, for what?!
I get that there are certain conditions attached, but seriously, what could possibly be worth a million bucks?

It's the salary, the benefits, and all the other overhead costs the hospital incurs to support a resident during their training, plus a little extra penalty fee, and that's pretty much it...

When you factor in the cost of living and everything else, plus actual tuition and professor fees—just looking at a medical school like Johns Hopkins, it costs roughly $350k-$400k $0.00 per student at today's rates, and on top of that, the student isn't even getting a paycheck; naturally, a portion is covered by the student or their family, while the government picks up the rest, but still...

Kate Collins67 said:I’m worth it, so now you see why I have such high self-esteem.☕
And with a salary like this, if I ever decided to quit, I wouldn't be able to pay back my loans in this lifetime.

Unless we're talking about plastic surgery, it’s going to be a tough climb! 😁

Kevin Garcia12 said:Look, I don't know the exact fine print in everyone's contracts, but for the most part, almost all residents are tied down by an agreement stating they have to serve a specific amount of time as specialists at the very institution that's paying their salary during their training. The only exceptions are the "nepo babies"—those kids with "bright futures ahead of them" who don't have any obligations at all, they don't even have to finish certain parts of their residency if it doesn't interest them, because someone else will just swoop in and do the work for them...

Back when I was an intern, I was basically acting as an assistant for laparoscopic procedures—if you've ever actually performed one or even watched one, you know exactly what kind of chaos that implies—mostly because the clinic where I was working was drowning in staffing issues. They had plenty of people on paper who were supposed to be there, but in reality, they were just ghosts protected by bureaucracy... luckily enough, I was "thrown into the fire" in surgery, so I kept myself busy and, hey, everyone survived... 😉

It's the salary, the benefits, and all the other overhead costs the hospital incurs to support a resident during their training, plus a little extra penalty fee, and that's pretty much it...

When you factor in the cost of living and everything else, plus actual tuition and professor fees—just looking at a medical school like Johns Hopkins, it costs roughly $350k-$400k $0.00 per student at today's rates, and on top of that, the student isn't even getting a paycheck; naturally, a portion is covered by the student or their family, while the government picks up the rest, but still...

That's wonderful! 👍
I honestly doubt they’d actually know what to do with that information if they ever found out! 🤣

I am seriously dying of curiosity here—I just have to know, how much is that actually going to run me?
My daughter would definitely have to pay back more than that if she used it for her PhD, but that's still a long way off! Honestly, the scholarship is such a fantastic opportunity, even though the cost of living over there is absolutely sky-high.
But what about here in the States?

State-funded care + being one of the top students in class.

jadesailor14 said:Unless we're talking about plastic surgery, it’s going to be a tough climb! 😁

That's wonderful! 👍
I honestly doubt they’d actually know what to do with that information if they ever found out! 🤣

I am seriously dying of curiosity here—I just have to know, how much is that actually going to run me?
My daughter would definitely have to pay back more than that if she used it for her PhD, but that's still a long way off! Honestly, the scholarship is such a fantastic opportunity, even though the cost of living over there is absolutely sky-high.
But what about here in the States?

🤣 It’s definitely possible, and even though my current patients in the ER—who I’m basically just patching up as I go—are absolutely thrilled with the results, I actually know how to stitch a wound now so the scarring stays minimal... honestly, I spent way too much time hanging out with plastic surgeons back in the day, so they ended up teaching me their ways... 🤣

jadesailor14 said:Unless we're talking about plastic surgery, it’s going to be a tough climb! 😁

That's wonderful! 👍
I honestly doubt they’d actually know what to do with that information if they ever found out! 🤣

I am seriously dying of curiosity here—I just have to know, how much is that actually going to run me?
My daughter would definitely have to pay back more than that if she used it for her PhD, but that's still a long way off! Honestly, the scholarship is such a fantastic opportunity, even though the cost of living over there is absolutely sky-high.
But what about here in the States?

Sent you a PM.

jadesailor14 said:Unless we're talking about plastic surgery, it’s going to be a tough climb! 😁

That's wonderful! 👍
I honestly doubt they’d actually know what to do with that information if they ever found out! 🤣

I am seriously dying of curiosity here—I just have to know, how much is that actually going to run me?
My daughter would definitely have to pay back more than that if she used it for her PhD, but that's still a long way off! Honestly, the scholarship is such a fantastic opportunity, even though the cost of living over there is absolutely sky-high.
But what about here in the States?

I can't even begin to tell you how much of a headache this whole debt calculation thing is—it’s honestly infuriating. Look, I know it’s all supposedly laid out in the contract, but let me tell you, "laid out" doesn't mean "clear." I actually sat down with an independent lawyer to try and make sense of the math, and even she was left scratching her head! If a professional can't give me a straight answer on how they arrived at these numbers, how am I supposed to trust anything? It just feels like a total mess.

Kate Collins67 said:I can't even begin to tell you how much of a headache this whole debt calculation thing is—it’s honestly infuriating. Look, I know it’s all supposedly laid out in the contract, but let me tell you, "laid out" doesn't mean "clear." I actually sat down with an independent lawyer to try and make sense of the math, and even she was left scratching her head! If a professional can't give me a straight answer on how they arrived at these numbers, how am I supposed to trust anything? It just feels like a total mess.

And they really lock you in for 10 years? That feels like a bit much!
But hey, knowledge is expensive, and everywhere you go, people get tied down when there's a huge investment involved.

At least you'll have the chance to make some extra cash on the side
if our Secretary's wild idea to scrap this actually happens.
I'm really not a fan of that plan!
And honestly, those on-call shifts are just awful—it's totally not right.

Brandon Newman95 said:Look, the only thing I’ll agree on is that doctors are underpaid. There are plenty of other ways to make money, but I'm not going to get into that on this forum.
It isn't even about the years of school. They should be teaching basic stuff at medical school: how to actually deal with patients, the doctor-patient relationship, how to communicate properly. Because if I ask, "Hey, does this med have side effects?" I expect an actual answer from a doctor. Not some "no, there are no side effects" nonsense—unless they want me stumbling around my house like a drunk. And then, suddenly, someone remembers, "Oh, by the way, this drug has a ton of side effects until your body adjusts, and don't take it on an empty stomach." Great. Just great.
In every profession, people need to learn things—it just depends on the individual.

I would personally introduce Russian language and literature, basic shipbuilding, and perhaps logic and reasoning. That would solve everything. Like I said before, there isn't much need for "communication studies." A patient tells me what hurts and what their issue is; I provide a diagnosis, recommend therapy, or refer them out. Why would a kid in med school need communication skills? We aren't running therapy sessions. If a patient is boring or rambles about nonsense, I'll send them to psychiatry or dump them on a colleague. (That was sarcasm). A doctor won't tell you about drug side effects. I certainly wouldn't. That's what pharmacologists are for. Maybe if they swapped communication classes for more pharmacology, it would work. For anything else, go talk to a pharmacist.😁

bluehawk37 said:I would personally introduce Russian language and literature, basic shipbuilding, and perhaps logic and reasoning. That would solve everything. Like I said before, there isn't much need for "communication studies." A patient tells me what hurts and what their issue is; I provide a diagnosis, recommend therapy, or refer them out. Why would a kid in med school need communication skills? We aren't running therapy sessions. If a patient is boring or rambles about nonsense, I'll send them to psychiatry or dump them on a colleague. (That was sarcasm). A doctor won't tell you about drug side effects. I certainly wouldn't. That's what pharmacologists are for. Maybe if they swapped communication classes for more pharmacology, it would work. For anything else, go talk to a pharmacist.😁

The next time you notice people are suddenly going dead silent around you, you really need to ask yourself if the situation described above is playing out—because, let me tell you, that tactic is used way more often than you'd think.

bluehawk37 said:I would personally introduce Russian language and literature, basic shipbuilding, and perhaps logic and reasoning. That would solve everything. Like I said before, there isn't much need for "communication studies." A patient tells me what hurts and what their issue is; I provide a diagnosis, recommend therapy, or refer them out. Why would a kid in med school need communication skills? We aren't running therapy sessions. If a patient is boring or rambles about nonsense, I'll send them to psychiatry or dump them on a colleague. (That was sarcasm). A doctor won't tell you about drug side effects. I certainly wouldn't. That's what pharmacologists are for. Maybe if they swapped communication classes for more pharmacology, it would work. For anything else, go talk to a pharmacist.😁

Look, I'm talking specifically about antidepressants, not every other pill out there. Like, take Zoloft—it doesn't leave me stumbling around the house like a drunk. But what happens when you find yourself caught in this massive psychological-neurological-psychiatric showdown? (Not that anyone actually cares, since everyone seems to be pro-psychiatry anyway 😉). I’d also say—if we're being technical—they should probably be taken on a full stomach, unlike something like Heffterol. And the whole pharmacist thing is such an old story... whenever I’ve asked them anything, they haven't had a clue, unless they're strictly following some script from the doctor they're tied to.
As for "communication studies"—maybe just try being a little more decent to patients.

Brandon Newman95 said:Look, I'm talking specifically about antidepressants, not every other pill out there. Like, take Zoloft—it doesn't leave me stumbling around the house like a drunk. But what happens when you find yourself caught in this massive psychological-neurological-psychiatric showdown? (Not that anyone actually cares, since everyone seems to be pro-psychiatry anyway 😉). I’d also say—if we're being technical—they should probably be taken on a full stomach, unlike something like Heffterol. And the whole pharmacist thing is such an old story... whenever I’ve asked them anything, they haven't had a clue, unless they're strictly following some script from the doctor they're tied to.
As for "communication studies"—maybe just try being a little more decent to patients.

A pharmacist's job description includes giving advice; if they don't do that, it's their own fault.
Yet, nobody blames them.

Kindness is always extended to a kind patient. But there is nothing in the manual
stating I have to kiss the feet of a patient who is arrogant or rude.
As my namesake colleague would put it: arrogance must be earned. 😁

bluehawk37 said:A pharmacist's job description includes giving advice; if they don't do that, it's their own fault.
Yet, nobody blames them.

Kindness is always extended to a kind patient. But there is nothing in the manual
stating I have to kiss the feet of a patient who is arrogant or rude.
As my namesake colleague would put it: arrogance must be earned. 😁

I don't care about the "who, what, where, or how"—if they're wrong, I'm judging them. Look, if a patient is being an arrogant jerk, that's one thing—but in my own little journey here, I've been nothing but fair and professional with everyone, just like they were with me.
Especially since I'm such a unique medical case myself.

Brandon Newman95 said:I don't care about the "who, what, where, or how"—if they're wrong, I'm judging them. Look, if a patient is being an arrogant jerk, that's one thing—but in my own little journey here, I've been nothing but fair and professional with everyone, just like they were with me.
Especially since I'm such a unique medical case myself.

We always welcome pilgrims and maintain a professional relationship with anyone who acts professionally. 😁

Kate Collins67 said:Look, I expect a salary that actually reflects my level of education, but as for a medal? You can have it, or give it to someone else if they want it.
In other fields, people don't undergo the same kind of mandatory, continuous specialization required in medicine—and I'm not even talking about the extra certifications, because those exist everywhere, not just in the medical field.
Was your college degree paid for by the government or out of your own pocket? Since specialization is essentially just an extension of medical school—and you literally cannot practice without it in any reasonable timeframe (actually, in most cases, you can't even start without it)—who exactly is supposed to foot the bill? Me? Or the government/company I work for?

Exactly!
That’s honestly what I was getting at when I brought this up a few pages back... It's pretty rare to find a profession where you spend so many years constantly studying, mastering new techniques, and keeping up with the latest research like doctors do, so they definitely deserve the financial reward for it—which is just a fancy way of saying a high salary...

From what I’ve gathered so far, they’re moving toward making specialization mandatory, if they haven't already decided... This even applies to those "general practitioners" who are required to specialize in family medicine, so soon enough, they won't even be called general practitioners anymore because everyone will officially be a specialist in family medicine... I feel like the term "general practitioner" is basically becoming obsolete on paper, and if it still exists, it probably won't in a few years...

And unfortunately, up until now, the standard has mostly been paying for those specializations out of your own damn pocket...

bluehawk37 said:A pharmacist's job description includes giving advice; if they don't do that, it's their own fault.
Yet, nobody blames them.

Kindness is always extended to a kind patient. But there is nothing in the manual
stating I have to kiss the feet of a patient who is arrogant or rude.
As my namesake colleague would put it: arrogance must be earned. 😁

Look, House—I'm honestly getting tired of typing out how much I agree with you...😁

What you said is spot on... 👍

bluehawk37 said:A pharmacist's job description includes giving advice; if they don't do that, it's their own fault.
Yet, nobody blames them.

Kindness is always extended to a kind patient. But there is nothing in the manual
stating I have to kiss the feet of a patient who is arrogant or rude.
As my namesake colleague would put it: arrogance must be earned. 😁

Pure nonsense!
I refuse to let some snobby, ill-mannered, arrogant person drag me down to their level. This is about professional standards. In a doctor-patient relationship, nothing should be "earned"—neither kindness nor rudeness. It's all about basic decency and maintaining a professional distance from your personal feelings.

jadesailor14 said:And they really lock you in for 10 years? That feels like a bit much!
But hey, knowledge is expensive, and everywhere you go, people get tied down when there's a huge investment involved.

At least you'll have the chance to make some extra cash on the side
if our Secretary's wild idea to scrap this actually happens.
I'm really not a fan of that plan!
And honestly, those on-call shifts are just awful—it's totally not right.

It makes sense that they tie you down for 10 years. A hospital paying for a resident's pension, health insurance, salary, and tuition—all while they're training for 3, 4, or 5 years—is a huge commitment. Most of the time, the hospital doesn't even see much benefit from that doctor during residency because specialists are usually working outside their home institution anyway.
Once training is done, there’s a contract where the doctor agrees to work for the institution that funded them for twice the length of their training. If they break it, they have to pay back the tuition plus penalties. They don't have to pay back salaries or benefits. For most specialties, we're talking about $30,000 to $50,000, though that amount decreases proportionally for every year served.
Even then, if a doctor decides to walk away early, they just negotiate a 7 or 10-year repayment plan with the hospital, interest-free, jump over to private practice, and pay back an interest-free loan of maybe $250-$300$1000 a month.
These contracts should actually have much higher penalties and longer repayment terms.

Kate Collins67 said:You know what true professionalism would look like for about 60-70% of the patients walking into an ER? It would be saying: "You can leave now, and you'll be notified in the morning regarding the official legal proceedings being initiated against you for obstructing emergency medical services." Now *that* would be pure professionalism.

The reality is that these high-ranking officials often hold those positions because the rude, bottom-tier staff handle both their work and the work of those above them—leaving the higher-ups plenty of time to focus on "science" and "advancement" at everyone else's expense. Go to a major teaching hospital and look at the surnames of the veteran doctors versus the names of the newcomers. The young ones whose names you see associated with the older generation will likely be professors and PhDs in a few years; the other group? They'll just become more arrogant doctors. Just so you know how the game is played.

Ugh, honestly, I’d say it’s actually the exact opposite, at least based on my own experience (and not even as a patient)...