Flip The Standardized Single Payer System

American physicians feel entitled to a big salary. It can't just be the time in school that gives us this expectation, since graduate school averages 6.5 years, followed by a four to five year post-doc before getting a "real job". Unlike attaining a PhD in the biomedical field, where students generally get paid, medical students will be paying a quarter of a million dollars of debt to get their degrees. There are no guarantees of getting through medical school or even a residency spot, so this cost of a medical education at hundreds of dollars per day is prohibitive — especially to students from lower incomes, which impede efforts to diversify medicine.

What if we had a single source funding medical education, and it was free to students? The talk of a single payer system fixing the dilapidated American healthcare system is focused on the wrong end of the spectrum, since over 40% of a doctor's office bill goes to the doctor's salary. Imagine if one actually made money throughout medical school — that would make it easier to take a smaller salary after residency. How do we know? Evidence shows that the level of medical school debt inversely correlates with desire to do academic medicine, which is not as high paying as private practice.

How do we make medical school free or even pay medical students? Flip the focus of Medicare to paying doctors earlier while they are in medical school so they don't get their souls crushed by a growing mountain of debt and a resulting entitled mindset for higher salaries once they dug their way out of that mountain. It is possible. Medicare/Medicaid paid US physicians $64 billion dollars in 2012. If they annually paid $50,000 for medical school for all 20,000 US medical students, but then reimbursed 10% less later, they would come out on top. A rough breakdown of the math would be $64 billion per year x 10% less = $6.4 billion in gross annual savings. Subtract the cost of education to students ($50,000 per year per medical student x 20,000 students = $1 billion) and the eventual net annual savings for Medicare/Medicaid is $5.4 billion dollars. A fraction of that could go to more residencies to address the physician shortage, hospitals in underserved communities, or even research.

Let's flip the single payer system and pay doctors from day one of medical school.