Two economists, Keith Chen and Judith Chevalier, summarize their research on the costs of medical school in the Atlantic. They conclude that it might make more financial sense for women to become physician assistants (PAs), rather than doctors.
The training to become a PA is much cheaper than medical school. In addition, they begin to earn money earlier than doctors, who have many years of low paid internships after school. Money earned earlier in life is worth more than money earned later in life, because of returns on investment. In order to pay off that education and training investment, doctors need to work harder and earn more money later.
Focusing on the financial repercussions of these career choices, we use a tool common for analyzing investment called a net-present-value (NPV) calculation. An NPV calculation adds up the costs of obtaining a degree, and all of the earnings received over the career that degree enables, taking into account the fact that money earned later is not as valuable as money earned earlier (due to interest), summarizing a career decision in a single number. This captures the insight that in order for an investment in the high up-front cost medical degree to overcome the lower up-front cost of a PA degree, not only do a doctor's wages have to significantly exceed those of the PA, but the doctor needs to be willing to work enough hours to make those wages pay off.
For men, this investment pays off. They work 60 to 70 hours per week in highly paid subfields of medicine. Female doctors, on the other hand, work much fewer hours and in less lucrative areas of medicine. They do not earn enough to justify the training to be a doctor. A PA degree might make more financial sense.
There's no doubt that I would be in be better financial shape, if I became a secretary after college, instead of investing in a PhD. I lost ten years of income and retirement savings. (I worked nearly full time while in grad school, but at a lower rate than a secretary.) Unlike an MD, academics cannot stop and start up their career. There are also no real opportunties for part time work. Once you stop working at full speed, you're done.
I'm not sure what to think about this research and my own observations. I want women in the top levels of medicine and business, but it isn't fair that they should lose money in order to purse that goal. Perhaps, the solution isn't to tell women to aim lower, but to make the investment costs lower. Cheaper medical programs and shorter time in grad school.
Apt. 11d 
Could be good for men, too. Last time we were in the ER we had a male PA.
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Keith Chen wrote an article about how Southern Europeans were more lazy and profligate than Northern Europeans because most Germanic languages (except English!) do not have morphologically marked future tense, unlike Romance languages. I am going to take anything he writes with a grain of salt the size of a salt flat.
I also agree that telling bright, ambitious women to be secretaries and PAs rather than doctors or professors seems to straight out of the 1950s (I can feel my 2nd wave grandmother spinning in her grave). I think that gender maps on to, but is not essential to, larger problems in medicine, like the over crowding of lucrative specialities and the relative lack of GPs and pediatricians due to this exact reason.
In terms of your thoughts, I wonder how you’d feel if you’d actually became a secretary, and I imagine at this point you’d be fantasizing about grad school, and thinking that your modest financial security couldn’t make up for general dissatisfaction. My grandmother, a very bright and ambitious person, was a full time secretary and office manager for over 40 years. She was great at her job but absolutely hated it. She took a boring job because the salary, benefits, and pension were good, and at times she was the sole breadwinner of the family, and in the 50s career options for women trained as secretaries were few. However, the fact she worked her way into the middle class and retired in comfort couldn’t make up for almost 90 years of bitterness and regret over her lack of expression for her intellectual abilities and stunted life options carried literally to her deathbed. The psychic cost she suffered outweighed the financial gain, even though it was considerable.
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Apologies for the tortured sentences! The last part means that she carried her regrets and bitterness to her deathbed.
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Unless she was very long-lived, apparently her bitterness started before she was working.
(Also, a PA is a job for the bright and the ambitious, at least as far as these things go in the population of college-bound USians.)
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The concept of this article makes my blood boil. First, I’d question whether the economic evaluation is correct. How did they enhance the value of early earnings, for example? If they assumed a real rate of return, that’s not accurately reflecting rates of return in the last decade. There are a multitude of fudges that could go into that calculation that could change life time earnings calculations quite substantially (including, for example, taking into account the risks of changing professional requirements, changing compensation, changing entry into the profession). Second, even if the economic analysis was correct, it has nothing to do with women. The analysis would be questioning whether an MD is valuable if one is going to take a less well compensated specialty within the medical spectrum. In effect, the analysis questions whether one should invest the high cost of medical training for a general practice/internship. The analysis could be relevant to a person (male or female) who knows that they are going to want to work part time in a low paid medical profession when they apply for their specialty degree.
It’s a prime example of “stepping back” before you have to to prepare for a choice you are going to make at 33 when you have your first child (and, for most, you’re making this decision before you’ve even married or decided you’re starting a family). The PA choice cuts off the option of being a surgeon or a radiologist. If you know you’re not going for the higher paid positions, absolutely know it, cutting off your options might make sense. But it’s not a choice I’d counsel for my children.
And, if you are sure that you want a less intensive (and less well compensated career) you already have the option in our current system. You can chose the PA track (rather than the MD). You can choose the masters/teach high school track (rather than the Ph.D.). You can chose the paralegal track (rather than the JD). If we believe the economic analysis, maybe it’s worth considering your likely end choices before investing in the degree, but you loose the upside gain in return for the economic value.
For example, a Ph.D. might have ended up better off if she were a secretary (though I doubt it economically as a family, unless the secretarial position was very solid), but with the Ph.D., she could also have ended up as a tenured professor somewhere with a decent salary (if all the ducks lined up).
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Clearly the article made my blood boil, ‘causing me to violate the rule of not having comments longer than the post! Probably have a bunch of zombie pronouns in there, too.
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MH
Ha, that is poorly phrased. Though, she started working at 9 and died 80 years later… I guess it was really more like 70 years of bitterness when the disappointment started to set in after high school graduation.
I don’t think there’s anything wrong with being a PA, but I don’t think women who could be and want to be doctors should be steered into being PAs instead based on their gender.
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“(Also, a PA is a job for the bright and the ambitious, at least as far as these things go in the population of college-bound USians.)”
Yeah, it’s not exactly a consolation prize to earn a $100k a year, which is what they make if I’m not mistaken.
(To go a little off topic, it sometimes seems like EVERYBODY is trying to get into nursing right now, which worries me 1) from the point of view of quality control and 2) whether it is realistic to expect medical salaries to continue to be so fat indefinitely. One of my relatives who teaches community college sees it as an important part of his mission to prevent the less promising specimens from getting into nursing. That sounds nasty, but think how disconcerting it would be to find yourself in the local hospital being cared for by somebody that you know cut half of your classes and has no number sense at all.)
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it sometimes seems like EVERYBODY is trying to get into nursing right now
There might soon be a glut in the lower-level nursing professions (medical assistant, LPN) but I think the demand for highly skilled, specialized nurses will continue to grow. Nurse practitioners, like physician assistants, function like doctors. It’s an “easier” path to take than med school and probably a good option for both men and women who want to be paid well while still working on a reasonable schedule.
Nurse anesthetists seem to have it made in that make good money and can demand practically any schedule they want. I’ve seen jobs at hospitals with full benefits, $80k a year, and 20 hours a week.
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Also, the issue I see with jobs where you’re not at the peak is the lack of control. The NY Times had an article about short maternity leaves, and a notable characteristic of the women who took short leaves was that they were making the choices about when and how they worked.
I don’t know enough about the job of PA to know how much control they have over their work out comes, but I suspect for that some, it would be galling to have to check in with the physician to sign off on a decision. For others, it might not be a big deal. And, if we get to the point that a PA doesn’t need anyone to sign off, we’re basically replacing the MD general practice profession with the PA. My guess is the replacement will occur in underserved areas first, so being a PA in charge will mean working with an underserved population (urban or rural).
So, there’s lots of balancing to do.
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An executive secretary in Manhattan makes way more than a tenured faculty in the humanities or the social sciences, even if you don’t figure in the ten years of wasted income in grad school. Pharmacists also do really well. I know a woman with an AA in medical technology who reads EKG machines. She makes 6 figures. I don’t know. I don’t think we should be snobby about these things. It might be a better feminist decision to bank all that money and read EKG machines, than to become a doctor who is a slave to insurance forms.
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” It might be a better feminist decision to bank all that money and read EKG machines, than to become a doctor who is a slave to insurance forms.”
If it’s a good financia/social capital decision, then men would do it.
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If it’s a good financia/social capital decision, then men would do it.
This. Also, as someone said above, it’s not like anyone is steering women away from these jobs in the first place. If a woman wants to do these jobs, that’s great and she should do them. If she wants to be a doctor or a professor and realistically has a chance, then she should be encouraged in that. I doubt anyone goes into academia for the money, so I’m not sure how being told a job you’re not interested in makes more money than the career path you’ve chosen is all that relevant.
Also, to reiterate, Keith Chen is a total crank, so I’m not sure why we should listen to anything he says.
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“Pharmacists also do really well.”
Here’s a word of caution on that. I have two relatives who are pharmacists who have sold out of their business and are in the process of retiring. Their old pharmacy now has a pill-counting robot that costs in the low six figures. I’m not sure to what extent the pill-counting robot can replace actual people, but it bears watching.
“If it’s a good financia/social capital decision, then men would do it.”
A lot of women are becoming MDs these days. Does that mean that that’s a bad idea? (That’s not a rhetorical question.)
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My sister is a pharmacist in a hospital. The pill-counting robots aren’t replacing the pharmacists but the techs.
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Being a doctor is an extremely low-status and poorly paid profession in Russia — where the majority of doctors are women. I’m trying to think of other examples of careers that started out male, but then became largely female, and as a result dropped in status and pay. I’m sure there are others — I just can’t think of any right now. Also, wondering if it works the opposite way as well — as more men become nurses, do wages rise along with the prestige? Are there actually anymore jobs out there anymore that are considered male or female?
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(To go a little off topic, it sometimes seems like EVERYBODY is trying to get into nursing right now, which worries me 1) from the point of view of quality control and 2) whether it is realistic to expect medical salaries to continue to be so fat indefinitely.
Nursing is screwy for a number of reasons:
1. Nurses can make lots of money at hospitals with a good base salary, plus shift differentials for night work, plus readily available overtime. Administrative positions and teaching positions may (or may not) have a higher base salary, but there is no overnight teaching shift, and no overtime, so accepting a “promotion” often involves accepting a real substantial pay cut. Many nurses try it out and then “demote” themselves.
2. There are lots of things that only a nurse can do, but there are even more things that a nurse can do that can also be done by a nursing assistant, or an aide, or a phlebotomist, or the housekeeping staff. Sometimes, management has the brilliant idea: “We’ll only have the nurse do stuff that we need a nurse for, and she can take care of six patients, and there will be a bunch of lesser paid assistants to do all of the other stuff like draw blood and empty bedpans. We will save money that way!” And sometimes, management has the brilliant idea, “We can make the nurses do everything. They’ll only have 2 or 3 patients, but then we won’t need all of those aides and stuff, and we can save a lot of money that way!” I have no idea which way actually saves money, but you tend to switch back and forth a lot, and can end up with either a nursing shortage or a nursing glut with the exact same number of nurses.
3. Because of the problems in convincing nurses to teach nurses described in #1, unlike almost every other advanced degree career (like lawyers or PhDs), there is not a glut of graduates who cannot find jobs, but rather a glut of applicants who cannot get in to nursing schools and become nurses because there aren’t enough programs with qualified teachers to train them, because the available teachers are making more money working an overnight double shift.
4. Nursing and PAs are probably good careers if you think healthcare spending can’t go up forever, because one of the easiest ways to save money is to cut the doctor out of the equation altogether.
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Louisa said:
“Being a doctor is an extremely low-status and poorly paid profession in Russia — where the majority of doctors are women.”
I don’t know if things have changed with the rise of private medicine in Russia, but at least in the 90s, it was 1) low-paid 2) overwhelmingly female 3) much faster to qualify for than in the US (you’d go to Medical Institute straight out of high school) but 3) for all that surprisingly prestigious. The students who went to Medical Institute were very bright–I had two silver medalists from among my students that were planning to go to the Medical Institute. I expect that things have changed since my day, because back then, Russian doctors could barely afford to eat on their salaries–you can only go so long with that combination of miserable pay and high academic standards.
Here’s a piece on increasing numbers of young women doctors in Europe (64% of physicians under 35 in Spain are women):
Ragtime said:
“Nursing and PAs are probably good careers if you think healthcare spending can’t go up forever, because one of the easiest ways to save money is to cut the doctor out of the equation altogether.”
Good point.
Since Laura’s home birth post, I’ve been reading Amy Tuteur’s blog at skepticalob.blogspot.com and I’m not very excited at the thought of replacing OBs with cheaper personnel.
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