It’s that time of the year again, the time when you find unlimited countdowns and the “best of” for the year. Why not have a best of Med School Hell? I’ll go ahead and list the most well-received and/or controversial posts of 2007 with a bit of commentary.

If you missed anything from 2007 and are too lazy to click on the Archives link, here ya go. Let’s start with the obvious.

January
January was kind of a dry month. There were only two posts that graced the binary digits of the MSH database this month. I was probably still recovering from my New Year’s eve hangover, but the best post of the month has to be the one I wrote about my vascular surgery attending. Yes, vascular surgery still sucks.

• My Vascular Surgery Attending

February
Ahh, the month of love. February of 2007 was also the month I scrapped the lame Blogger blog and migrated to my domain. Activity picked up this month, and here are some of the highlights:

• Five Ways to Slack Off and Still Do Well In Medical School
• Pharmaceutical Marketing is Good and Here’s Why
• Five Things I Learned From Medical School

March
March is the month that topped the post count for any month in 2007 at MSH. I might have been on too much coffee at the time or not playing WoW as much — I honestly don’t remember.

• Percent Change of U.S. Medical School Graduates Filling Residency Positions in Various Specialties
• Five First Year Mistakes To Avoid
• Quotes From Physicians That Make You Go Hmm…
• Why It’s Not A Sign Of Weakness

April
April produced a few winners, and maybe a few losers as well. I had a blast with Fun With Numbers. The real winner of the month is probably 101 Things You Wish You Knew Before Starting Medical School.

• Ten Reasons Why Residency Is Prison
• Fun With Numbers
• 101 Things You Wish You Knew Before Starting Medical School

May
Moving right along into May, we started to see a greater frequency of guest posts.

• A Primer for Applying
• What People With a Net Worth of $5M+ Do That Other People Don’t
• Medical School Requirements
• When Did I Realize Medicine Wasn’t For Me?

June
Post frequency dropped a bit in June, probably due to more time spent doing outdoor activities. At least a single decent post was produced:

• Can’t Match Derm? Try Derm Path Instead

July
Guest posts rule the roost during this month:

• Cherokee’s Treatise on Medical School
• Why be an MD when you can be an NP

August
Free pharma lunches and student loan debt is among us.

• For Every Free Lunch You Don’t Eat, I’ll Eat Three
• 7 Tips For Managing Your Student Loan Debt

September
September was kind of a “blah” month for MSH. A couple of posts are worth mentioning:

• Opportunity Costs & Why Lifestyle Specialties Are So Popular
• Is It Time To Rethink Your Pre-Med Major?

October
A single lonely post was written in October. Fortunately, it was mildly popular:

• The Medicine Work Ethic

November
November was probably the crappiest month for new content at MSH. Let’s try not to have too many months like that rolling into 2008.

• An Existential Perspective on Medicine: Part 1

December
Here we are, just about over the holiday hump and gearing up for a busy (or not so busy, depending on what you’re doing) 2008. December started off with the first post in the ‘Freedom’ series of posts, Finding Freedom In The Middle of War — Mindset. I have more posts in this series lined up and ready to go for the new year. Another notable post is:

• Everybody’s In It For The Money

Onwards to 2008

Thanks to all who have contributed quality content and commented at MSH. I appreciate the fact that I have a nice base of regulars and look forward to new subscribers over the coming months.

Have a safe and happy new year. Oh, and try not to get too shitty.

The amount of money that you earn in life depends on managing your opportunity costs. In principle, this is somewhat simple: Focus your time where returns are the greatest.

Choosing a medical specialty is difficult for many students, since there are numerous factors that come into play.

First you’ll need to evaluate your commitments: How long is the residency? How much time do I have to work each week? What’s the call schedule like?

It’s also important to try and get an idea of your returns for completing residency: What’s the average salary? How much vacation time do I get? Are there bonuses for patient, case, or specimen volume?

Let’s step out of the residency realm for a bit. Did you know that you could earn $1 Million by not watching TV?

A recent study found that it would take $1 million for someone to be willing to give up TV for the rest of their lives. People rarely consider the cost of watching TV, and when they do, they usually focus on the cost of their monthly cable bill. The truth is that there are a wide variety of costs associated directly and indirectly with having a TV.

The costs associated with watching TV go far beyond the cost of the television and cable. Additions such as pay-per-view, DVD players, gaming consoles, entertainment cabinets, movie rentals, and games help to run up the bill.

More importantly are the opportunity costs associated with not watching TV and the hidden costs of commercials.

Another cost often overlooked when considering the price of watching TV is the opportunities forfeited when you choose viewing over something else. Assuming that your time is worth at least the minimum wage of $5.85 per hour, your opportunity cost is $737 a month if you view the average amount of TV.

In 2005, Nielsen Media Research reported that the average person watched approximately 4.5 hours of TV a day, or 31.5 hours a week. At $200 in extra spending for each hour watched, that means that the average person spends an extra $6,300 a year due to TV commercials that they wouldn’t have spent if they didn’t watch TV.

You Need To Measure The Opportunity Costs For Medical Training

This case study on TV looks at costs many people have never thought of. You need to take the same approach when selecting a specialty in medicine.

It basically boils down to this: Where can you make the most amount of money with equal time and monetary commitments?

Here are some things to consider:

• Are increased costs associated with a “prestigious” residency or medical school worth it in the long run?
• Will you dilute your time value of money with more hours worked on the job?
• If you plan to go into private practice, is it really necessary to train at an academic center?
• Could you do something now that surpasses your future earning potential as a physician?
• Is a 5-year residency financially sound when you could potentially match those earnings in a three or four year specialty?

Lifestyle specialties are so popular because either the commitments, returns, or both are favorable. Similarly, the opportunity cost of not choosing a lifestyle specialty is extremely high.

Honestly, why work 60 hour weeks for $120,000 per year if you can work the same amount of time and pull in $300,000?

It’s something to think about.

Are you concerned about educational debt? Have you stopped to ponder how exactly that debt will get repaid? What type of salary do you need to support your family’s current and future lifestyle?

Average educational debt

• $130,571 – According to the Association of American Medical Colleges, the average educational debt of indebted graduates of the class of 2006 (including pre-med borrowing). The average debt of graduating medical students increased in 2006 by 8.5 percent over the previous year.
• 72 percent of graduates have debt of at least $100,000
• 86.6 percent of graduating medical students carry outstanding loans
• 40.2 percent of 2006 graduates have non-educational debt, averaging $16,689

3-5 years of residency with a salary in the $40,000 per year range means 3-5 years of lost earning potential. Loan forbearance during residency multiplies the interest you owe on your loan. Student loan interest rates are on the rise.

7 Tips For Managing Your Student Loan Debt

1. Just because you can borrow more doesn’t mean you should.
   Lenders will provide you with money to burn. Borrow smart and only borrow what you need now. Your actual repayment amount is going to be much higher once interest is calculated. Don’t assume that you’re paying back exactly what you’re borrowing. You need to budget and stick with it. Treat yourself, but not excessively. Play it smart.
2. I still say buy versus rent.
   Even with the housing slump and record foreclosures, I am still an advocate for purchasing a home versus renting while in medical school. If you’re going to school in a large “college city”, there will always be buyers for your home. I purchased a town home when I began medical school and sold it for a huge 40.3% profit when I finished. I had no trouble selling the home, and I marketed it to incoming medical students. At the same time, my classmates were dumping $600-$700 per month in rent with nothing to show for it when they moved away.
3. Max out your subsidized loan borrowing power first.
   Federal student loans typically come in two flavors: Subsidized and unsubsidized. Subsidized loans are loans where the government subsidizes the interest on the loan for the duration of your education. On the other hand, unsubsidized loan interest begins accumulating immediately. To save yourself some money in the long run, max out your subsidized loan borrowing power first. Most students need both types of loans.
4. Pay interest on your unsubsidized loans if you can.
   If you find yourself with extra money every month and are able to pay your unsubsidized loan interest payments comfortably, go ahead and do it. You’ll find yourself facing lower loan payments when it comes time to repay your principle loan balance.
5. Avoid private loans if possible.
   If it’s within your means, try to avoid private loans. While federal student loans are eligible for forbearance during residency, most private loans are not. This means you’ll be hit with loan payments on a $40,000 per year residency salary. If you are forced to take out private loans, borrow the least amount possible and pay off the balance of these loans first. For example, if you have the option of paying your unsubsidized loan interest or making payments on a private loan, pick the private loan payment.
6. Get those credit cards paid off.
   Many students come into medical school with a fair amount of credit card debt. As you already know, interest rates on these cards are often times extremely high. If you’re making the minimum payment or something close to it, interest accumulation will make paying off your balance very difficult. If you have additional borrowing power on a federal student loan, borrow the extra amount to pay off your credit card in full. Do this only once. The benefits are obvious — you’re using a lower interest rate loan to pay off a higher interest rate loan. You have to be dedicated to yourself and your budget to not carry a balance on your cards in the future. Always budget and always pay off your credit card in full. If you can’t afford to pay off the balance in full every month, you do not need what you are buying and you need to take a closer look at your budget.
7. Consolidate your loans while you’re still in school. – Thanks HalfMD for this tip.
   Students who come from undergraduate programs with multiple loans should consolidate their loans at the beginning of medical school to lower future payments. Also, having all of the bills come from one lender makes record keeping a lot easier.

Happy borrowing!

I never really understood why some physicians wouldn’t take the free pharma lunches that were offered at the office or hospital. I even asked a few of them why they weren’t eating and they babbled off something about ethics and free lunches as they are related to drugs.

What’s The Main Argument?

The main argument is that the free lunches, pens, and prescription pads increase the cost of the drug to the consumer. This is absolute nonsense and emphasizes the average physician’s lack of understanding of basic business principles.

Now I won’t deny that the cost of marketing new drugs is factored into the cost of the drug. This cost is passed to the consumer. However, you aren’t doing your patients a disservice for sitting in on a free lunch. In other words, the price of the drug will not change. Let me explain.

If money isn’t allocated towards free physician lunches in a company’s marketing budget, they will allocate that money into marketing elsewhere. For example, if all direct physician marketing was banned, drug companies would simply shift that money into another advertising vertical such as print, television, or radio ads.

Let’s talk about that.

Economics 101

Let’s look at this from a business standpoint. Each product that is produced and sold has what is known as an optimum price point. This is the price that will produce both optimum revenues and sales volume. It looks like this:

As you can clearly see, if you drop the price volume will increase but revenues will drop. Conversely, if you increase the price your volume will decrease. If you adjust the price too high or low on either side, you will also begin to decrease your revenues no matter which way you are moving your price. At this point you are at sub optimum levels.

So What About Marketing Expenses?

As stated earlier, the argument is that eliminating the drug rep lunches and free pens will decrease the cost of the drug to the consumer.

Marketing directly to physicians is extremely effective and most likely offers drug companies the most bang for their advertising dollar. If they are banned from marketing directly to physicians through free lunches, they’ll simply shift those marketing dollars into other areas in order to maintain optimum volume.

Get off your ethics soapbox and spend some drug company money. Who gives a shit, they’re going to spend it anyway.

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