Agree - one sensible start would be to at least hybridize the European model where students are a whole lot closer to getting there medical degree as an undergraduate.
In most countries that do this training is longer which that total training time is only 1-2 years shorter.
So you’re doing a few things.
1. Moving more training from cheaper colleges to more expensive medical schools.
2. Moving the filter from undergrad to medical school
3. There is no national curriculum in US high schools, so essentially the first 2 years is getting everyone on the same footing. Removing this without changing high school, puts students at poor high schools at an even greater disadvantage.
Many of the programs you listed don’t cut any time off. They’re just a special pipeline program that can help you get into med school.
Of the ones that do save time, most cut 1 year off not 2. And they do it by having students take more than a full time load during undergrad.
It’s essentially the same thing as taking an extra class or 2 every semester so you can finish undergrad in 3 years instead of 4.
I randomly sample 15 of the programs listed there and 14 were 8 year programs. Only 1 had an optional 7 year program (if you were willing to take more than full time load or go to school in summmer). And there were no 6 year programs.
While not perhaps the best argument is the private equity provides liquidity for founders that want to exit. If you started business X, you’ve grown it for 20-40 years and you want to retire, selling is typically the answer. Let’s say the business makes $1m/yr after tax cash flow, PE might buy for $10m, besides PE there aren’t a bunch of likely buyers for your business (of course maybe there is a big competitor, and maybe you could sell it to an employee (but they probably don’t have the money and would need you to seller finance etc)). So for entrepreneurs with a successful small business (say $2-5m+ of ebitda) selling to private equity is the clearest path to a liquidity event for them.
I feel like medical practices should be like law firms where effectively non-lawyers can’t own equity and equity owners have to comply with ethics and code of conduct rules…
Most doctors don't want to be business owners. It used to be that they were kind of forced to operate in partnerships but now most choose to become employees. This might be worse for patients but for better or worse there's no going back.
Also, I don't think they're particularly opposed to owning their practice. I can understand them not wanting to manage a business. But for that problem, they can hire professional managers. Which is basically how hospitals work; if the doctors all want the CEO replaced, he gets fired. There's a physicians board and the trustees tend to listen to it.
So you're proposing to create a privileged class of investors with MD degrees who are protected from competition and will be able to earn above-market returns on their equity? Why would we want provider organizations to have a higher cost of capital? Makes no sense at all.
Yes they will earn above market return on a lower capital base with medical shares in medical practice trading closer to book value - and the economics are the profit share not equity value of the firm. Earning $250k/yr on a $1m capital contribution requires a whole lot less rent seeking than earning the same $250k on a $5m share purchase.
If you want to look at it that way there's already a much worse problem; a "privileged class" of service providers has a government-enforced total monopoly on the market for medical practice!
Can you cite - antidotally the only doctors I know that would rather be an employee work for big hospital chains or already sold their practice for a pile and are happy with less responsibility.
A former employer owned a combined cycle power plant -when they were having issues (not huge ones, but weird issues or gauge readings) they’d call this old timer and he’d come in walking around ask the operators to make some settings changes and be listening the whole time. And he’d come back and be like “hey the second stage compressor is out of balance” there were all sorts of telematics and manuals, but he could tell what was wrong just by listening…that was invaluable
The diagnostic/service steps you have to write to preclude any requirement of skill/experience make it stupid proof waste a lot of labor in the process. Cheaper to have the guy with the skill/experience show up and listen to the thing.
TD bank has branches but that's not super helpful if you're at the airport. the helpful thing is having a "relationship manager", someone you can call or email directly - you can get that at a big bank or a small one, and you don't need tons of assets, a lot of banks its having your direct deposit with them is enough to qualify for some special relationship.
Online banks typically offer much more competitive financial products. I have some HYSA accounts at 4% APY, that’s not achievable with a CU or traditional bank.
The solution is the same solution as any financial risk: diversification. I have many accounts at many banks. If any one of them goes down, I’m fine. If multiple go down, I’m still fine in the interim.
I moved over to Fastmail a maybe five years ago and it was pretty painless. The actual mechanics I did in an hour or so while half watching a movie.
The hardest bit, which you just have to do slowly over the course of 2-6 months is update your new email in services and accounts (banks, insurance, airlines, etc) but with a password manager, you just do it as you use them and it’s pretty easy.
The best thing for me was that I’ve had my Gmail for 20+ years, so thinning out the list of companies that have my email is nice - now my Gmail is mostly marketing emails from companies I don’t care about. I go into it occasionally to see if there is anything I need and then just delete in bulk.
11-13yr payback on something that is going to degrade ~3-4%/yr for 10 years (and limited terminal value) doesn't seem like the greatest investment unless you think the arb is going to widen a ton.
Alternative systems are closer to 5 years payback if you have access to off peak energy. 3-4%/year degradation is very high, battery packs available in the UK from Fogstar are rated at 8,000 cycles with a 95% depth of discharge.
FWIW my high voltage battery pack has almost 365 cycles and is still at 100% state of health.
And any arbitrage is also trivially exploited by the electricity company, who has a much greater financial incentive and scale, so there's really no reason to think that it's going to widen in the future either.
Until grid-scale batteries are more established, you're helping the electric company, and that's why they're exposing the arbitrage. They're providing the incentives to nudge demand, so a home battery is doing exactly what they want (use more at time X, use less at time Y). Otherwise they'd just have the 24/7 price be whatever it currently costs when the supply and demand curves are tightest for them (when demand is highest and/or supply is lowest).
You could exploit it yourself, but only if you have several million to invest, less than that and it isn't worth the bother for the electric company to talk to you. Even at ten million invested you really need to have this is round one in your proposal with the understanding you intend to invest a lot more when it proves in the real world to work like you expect.
Add in that my freezer probably contains over $500 of food (and the fridge has less, but not none.)
Usually you can buy ice, but when I had a ~36 hour outage a couple years ago, I couldn't. Most stuff was fine for that long, but 2-3 days would've meant tossing pretty much the entire contents.
(Plus, I don't have cell service where I live, so being able to power my router is pretty useful.)
This is probably a bad move if you live in a city. It makes more sense in rural areas.
Let's assume the calculation is correct and you actually earn back in 11-13 years. You are better off investing the money in something like the S&P 500 where you'd double your investment in about a decade without the hassle.
Things will start to get interesting where €1600 don't buy you 5kWh but double or triple the amount.
I can imagine most people are better off either investing like I said or in insulation.
Yeah - I was in the nostalgia boat, until you said this and remembered all the times I was in the country going to a friend's house that I've never been to before, its night time, nothings open, your low on gas, an your looking for a dirt road with a red snow plow reflector that was after the old white house on the left… yeah don’t miss that too much.
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