Robert C.G. Foam, MD, brings up some interesting points in her editorial “Emergency Medicine Needs a New Approach Too”. (EMC… 2021; 43: 2; https://bit.ly/3ju2WFA.) From the point of view of an EM resident, who is drowning in debt and pays less than a technician who monitors the vital functions of his patients, his point of view is understandable. The devil’s advocate on wages and loans will look at the big picture of the financial picture.
The argument for current local wages is the assumption that low-wage work is a form of payment for education provided, not very different from postdocs in other fields of science. A career as an emergency doctor involves a three- or four-year residency, paid at $ 22 an hour, in exchange for education, experience, certification, and a path to a lucrative career.
Assuming an average EM salary of $ 350,000 per annum with a 3% annual increase, an EM career would be worth over $ 21 million after 35 years. Compare this to the average lifetime earnings of other vocationally trained people of about $ 3.7 million, or the average American income of $ 1.7 million. (Georgetown University Education and Workforce Center, May 7, 2020; https://bit.ly/3B735VN.) An investment over three or four years that will generate between $ 195,000 and $ 260,000 over that time period will be huge returns.
Several reforms are under way to pay off student loans. These include income-based payments, loan forgiveness after 20 or 25 years, and interest limits based on the 10-year Treasury rate. Excluding three or four years of residence and associated income, the average student loan repayment of US $ 200,000 at 5% over 10 years is US $ 2,100 per month at the average salary of an EM attendant.
Some rough calculations show how the proposed student loan reform will affect this situation. ExCEL Law (https://bit.ly/2UQF5Wp) and the Law on PROSPER (https://bit.ly/3B1Sag9) require monthly payments of 15 percent of discretionary income for $ 4,100 per month payable in less than five years. Supreme Purpose Act (https://bit.ly/3z2ogGJ) reduces that portion of the salary to 10 percent of discretionary income, which would translate to $ 2,700 per month payable seven years later. Even the five percent idea outlined by President Biden would result in a payout of $ 1,400 a month, payable in about 18 years. (Forbes… May 24, 2021; https://bit.ly/3wI5SkS.) All of these repayment terms will be less than the 20 or 25 year limit leading to the loan forgiveness. None of the ongoing reforms will affect the average emerging market provider’s loan repayment prospects and could potentially force it to pay more per month than some would feel comfortable with if they were instructed to participate.
When we talk about a $ 10,000 or $ 50,000 loan forgiveness, it will be the American taxpayer who splits the bill. Is it reasonable for 80 percent of American adults without this debt to pay for 20 percent of those who bear the burden of student loans? (EducationData. June 30, 2021; https://bit.ly/3z1Y4vL.) Is it wise for the average American to pay on a student loan for an EP provider that will earn more than 12 times what they do in their entire life, putting it at or near one percent? (Don’t quit your day job. April 6, 2021; https://bit.ly/3xMS35Z.)
Neil Young, M.D.