Money & Politics

So the other day I attended a speech at my medical school entitled "The State of the Medical School Address." I was one of a handful of senior medical students in attendance. The majority of the crowd was a mix of underclassmen--present despite the absence of free food; professors--who looked almost human with their absence of papers and folders and textbooks tucked under their arms; and administrators--eager to be absent from another boring weekday noon meeting.

Overall it was an illuminating presentation. The slides were presented in Prezi, which can make anything look like a Ted Talk, and our school's newly inaugurated Dean, Dr. Tomkoviak, is a psychiatrist so he possessed the appropriate vocabulary and ethos to motivationally interview everyone in attendance--further adding to the Ted Talk vibe. It was nice to hear where our school was going in a suspiciously positive light. But I tried to temper my suspicions with my generally optimistic attitude. It kind of worked, although my cynicism wouldn't completely shut off. Chicago has many highly ranked medical schools and despite being The Chicago Medical School it is hard to stand out and be exceptional. We were also placed on probation by the LCME, as well. Another insult and another reason to wonder if this speech wasn't just a publicity stunt filled with half-truths and full lies.

Our dean talked about what he would be doing as our leader. Essentially he vowed to help everyone work together, allowing the staff and the students to work towards a similar vision of excellence. At times it almost sounded as though he would start telling us that we were "poised to shift paradigms by synergizing our individual strengths" -- it was one of those kind of talks that seemed displaced from the 1980s. I tried not to roll my eyes or laugh. I stayed optimistic.

Finally he mentioned some highlights of the work our administrators were doing for the good of the students, important additions to our school's plan: the creation of more residency programs affiliated with our school and the creation of a 5th year program for those students who fail to match, two wonderful additions for future graduates. He also talked about finding more clinical opportunities for students. All wonderful things. This part of the talk I didn't roll my eyes, I didn't scoff. I was in awe. I was grateful.

But in the end I found two things deeply upsetting. The first was the almost complete omission of our outrageous tuition. At almost 60k a year it's no wonder our school has struggled with diversifying our student population in recent years, a problem which the LCME noticed and used to place us on probation, along with the high debt among graduating students. Our tuition is the most expensive in Illinois--even more than Northwestern's medical school, whose students purportedly are given rental cars to commute to clinical rotations lest they lack a car of their own. A diverse student population is something our school has always been committed to, even from its start in 1912. Something that no other medical school still standing in Illinois today can claim. But how can we ask people--even the most driven among them--to jump into nearly a quarter of a million dollars in debt? That's insane. This shouldn't be happening. And even though, sadly, escalating student debt is not a unique problem to Chicago Medical School, I think students of our school should know exactly why our tuition is so high. What are we paying for? If it's the renovated and lovely cafeteria that closes absurdly early at 2 PM, I hate to say this... but I think we could have made do without. As somebody who's been well briefed about the political corruption in the City of Chicago, I can't believe that any entity with 'Chicago' in its title is free of any monetary mismanagement. Where's our money going? Understandably to hospitals and professors--for our education. For standardized patients and to purchasing online scholarly journals--also for our education. But I can't believe with a class size of almost 200 students (and at 60k a year that's roughly 12 million dollars in revenue), all that money is being used wisely. Where's the waste? What can we do about it?

Which leads me to the way the speech ended and the second thing that ticked me off. During the talk, the dean mentioned a new twitter campaign and offered a prize to a randomly drawn tweeter using the hashtag #CMSPLEDGE. Social  media at its finest! The winner was a medical student. The dean proudly handed her a gift bag and asked her to open it. She pulled out an IPAD mini. To help her with her studies in the evolving world of medical education. A nice symbolic gesture. And a nice gift. Almost as an aside he mentioned: "And to all of you students wondering, I didn't use any of your tuition money to buy this. I paid for that myself." A comment that garnered many laughs. Yet I was outraged. Sure our tuition money didn't go directly into buying gifts. That would be--and the only course I ever failed was accounting so I'm sure I'll mess this up but--that would be some form of money laundering, right? Regardless, it has been proposed that one of the causes for the ever increasing cost of higher education is the money paid to top administrators. Like deans. Like CEOs. Like non-essential and inept staff who don't respond to your emails on time and who belittle you once they finally respond to your originally non-urgent but now emergent requests because it was sitting, neglected, in an inbox for three weeks. Okay, so not so much that last one. But that's an inefficiency all the same. And if the CEO of our university is making $500,000 dollars a year for essentially being a figurehead, I've got to ask if that money would be better used to give eight to ten medical students 100% tuition assistance.

I'm not claiming to know anything about business models or how to run a university. But I do know that in some small way my peers and I helped pay for that IPAD mini and I would much rather have had assistance paying for any number of the many additional fees of medical school few people tell you about.

I love my school. The students represent--in my personal and likely biased opinion--some of the most hardworking and honest medical students you can find in Chicago. And whether or not it was motivated by being placed on probation, I like the way our school keeps thinking up innovative changes to the curricula. Our school has emphasized liberal arts to the long term benefit of every one of its graduates. And I appreciate that. I truly due. But the fact that tuition wasn't addressed heavily tells me that either it was too difficult or too depressing of a topic to put into a motivating speech or that nobody at the top cares about this specific problem. And if tuition isn't seriously addressed, I fear that the quality of the CMS graduate will decline not because of any weaknesses in the school's academics, but because it will be admitting only those students who can look at a quarter million dollar pricetag and not flinch.

Hospital Billing and Insurance

The prompt for this next clinical reflection meeting at school was the following: To what extent are physicians' values and decisions responsible for the cost of health care, and what responsibility do we have to control costs? How cost-conscious have the physicians you have worked with been, and what rolled does financial stewardship have in the professional responsibilities of physicians? 

But like so many other things, I was still angry about dropping $175 at Walgreens the other day for 3 vials of lantus and two boxes of test strips, so I had trouble focusing:

I think it is fundamentally irresponsible to be a physician unaware of the costs of medicine and health care services. That being said, a lot of physicians don't want to worry themselves with the details. Have I ever worked with a physician who seemed to understand how much things cost for patients? Not really. No. But consider this: how many physicians actually have chronic illnesses? How many doctors are on a ton of prescriptions at any one time?