Chicagolive

Indebtedness of US Medical Graduates

I am working on updating US medical school articles about the current state of student debt, I appreciate any help that could be offered.

Unlike many other countries, US medical students finance their education with personal debt. In 1992, the average debt of a medical doctor after residency, for those graduating with debt, was $25,000. Currently, the average debt of a medical student is $154,067 and is trending upwards at a rate of 5-6% each year. The current rate of increase has held for the past decade[13].

Medical schools do not have accounting transparency, so it is difficult to pin-point the root cause of tuition increases[14]. Medical education is still based on the 2 + 2 model posited by the 100 year old Flexner report. Some have suggested that the medical education role of medical schools has been subordinated to the patient care and research missions of the academic health center[15][16].

A current economic theory suggests that increasing borrowing limits have been the cause of the increased tuition. As medical students are allowed to borrow more, medical schools raise tuition prices to maximally increase revenue. Studies show that schools raise prices 97 cents for each one dollar increase in borrowing capacity[17].

There is no consensus on whether the level of debt carried by medical students has a strong effect on their choice of medical specialty. Dr. Herbert Pardes and others have suggested that medical school debt has been a direct cause of the US primary care shortage[18]. Some research suggests that to a sub-set of medical students that care about debt, this is certainly the case. For the larger population, the effect may more derive from the sense of entitlement that doctors feel after overcoming tuition, length and rigor of training and debt. Whatever the cause may be, the 2008 Residency match filled only 42% of available slots with US graduates, down from the 1984 level of 98%.

Cleveland Clinic's Departed Faculty

Three well-known faculty members and researchers have recently departed from the Cleveland Clinic. Jay Yadav, an interventional cardiologist, was fired in 2006 for improper disclosure of conflicts of interest. Dr. Yadav filed a lawsuit against the Cleveland Clinic in 2007 based on the circumstances surrounding his departure.

The Cleveland Clinic removed former chief academic officer and provost of Lerner Medical School, Dr. Eric Topol, from his position in 2007 for the purpose of streamlining the administration . At the time Dr. Topol was leading a committee examining conflicts of interest for top officials of the clinic. Dr. Topol has published articles examining physician connections to the investment industry and investigator conflicts of interest.

Dr. Andrea Natale, former medical director of the Center for Atrial Fibrillation and section head of pacing and electrophysiology was not reappointed in 2007, allegedly for performing procedures outside of Cleveland Clinic without permission.

Wikipedia and Online Health

I am a medical student who uses Wikipedia quite a bit. I am interested in learning how best to help the community and meeting other people that edit health and medicine articles. I have only recently begun making my own contributions, so I hope a more senior member might take the lead!

Seems like Wikipedia is interested also: [[1]]

Coronary Angioplasty and Stenting

A section on controversy in coronary stents is not complete without discussing four trials: MASS, COURAGE, RAVEL, and SIRIUSThese trials are large multicenter, randomized trials published in core medical journals. MASS and COURAGE find that stenting does not provide better outcomes over medical therapy in terms of all-cause death. In other words, patients do not live any longer. Comparisons generally note marginally better outcomes with respect to angina and exercise tolerance, but it has been long established that treatments for angina demonstrate a strong placebo effect. RAVEL and SIRIUS find that DES do not improve survival curves over BMS.

Two conclusions that should be shared here

1) Medical therapy is an alternative therapy to stenting and should be mentioned in the section on controversy. The best quality evidence to date, MASS and COURAGE, does not suggest better outcomes for myocardial infarction, death, and revascularization.

2) It should also be mentioned in the controversy section that evidence does not suggest better survival outcomes for DES over BMS. Although, it should also not that there is a moderate reduction in restenosis for DES.

The article reads with a heavy bias for the SYNTAX trial. I wonder if the investigators created the posting because it is hard to believe that someone would include such a detailed explanation of SYNTAX without bothering to mention the other seminal research studies. Chicagolive (talk) 15:22, 10 July 2009 (UTC)

Articles for deletion nomination of Jay Yadav

I have nominated Jay Yadav, an article that you created, for deletion. I do not think that this article satisfies Wikipedia's criteria for inclusion, and have explained why at Wikipedia:Articles for deletion/Jay Yadav. Your opinions on the matter are welcome at that same discussion page; also, you are welcome to edit the article to address these concerns. Thank you for your time.

Please contact me if you're unsure why you received this message. ukexpat (talk) 18:08, 8 September 2009 (UTC)