The major reason why getting into medical school is so Hard

[AHappyCalBear]

Agree, Disagree, Discuss - The reason why getting into medical school is so difficult is because the number of MD granting programs in the USA is kept artificially low. There hasn’t been a significant increase in the number of medical schools established in the USA in the last 20-30 years even though the population has grown tremendously. The number of spots needed to fill residencies and satisfy the demand for doctors in the USA is 6,000 more than the number of people attending US MD programs. Many equate becoming a doctor with getting into an MD school but there are DO schools, as well as foreign schools, that fill the 6,000 residency discrepancy. If a US granted MD was the only degree that allowed you to practice medicine in the USA, and supply for MD education had kept up with demand, we on SDN wouldn’t be going crazy trying to maintain 3.6 GPA and 32 on the MCAT.

Point of caution, if any of the following stats are off, like its not exactly 6,000 or it was 15 years instead of 20-30 the overall point still remains.

Veritas

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[Sicilian]

I would've thought the reason getting into med school is such a pain is because of the enormous cost of training a doctor. If this cost were to come down, then med schools could train way more doctors, and medicine would just be another profession (minus the mystique associated with it). That said, US med schools are the best in the world because they contain the latest in state of the art technology. It makes sense that those not trained in the usage of such technology (non-US MD's) not practice in US hospitals.

 

[AHappyCalBear]

I would've thought the reason getting into med school is such a pain is because of the enormous cost of training a doctor. If this cost were to come down, then med schools could train way more doctors, and medicine would just be another profession (minus the mystique associated with it). That said, US med schools are the best in the world because they contain the latest in state of the art technology. It makes sense that those not trained in the usage of such technology (non-US MD's) not practice in US hospitals.

Interesting points but those who study abroad can come back to the US to practice medicine, all they have to do is pass an extra test and get a residency position. Secondly, the cost of tuition for law school on average is higher than that of a physician and we have plenty of lawyers in this country. Comments?

 

[little_late_MD]

During the late 80s/early 90s the AMA successfully lobbied Congress to both cap the level of funding granted to hospitals for residency programs and cap the number of medical schools opened in the US. They believed that there would be a huge surplus of physicians in the early part of the 21st century which would create unemployment and lower salaries in the medical field. Turns out they were highly mistaken. However, 5 years of Republican dominated federal government have made any reversal on this front nearly impossible. There is a reason that FSU is the only new medical school to open since 1982.

Also, it costs substantially more to train a doctor than a lawyer. While med school/law school tuitions are equitable, law school is only 3 three years and med school 4. Also there is no "residency" in the legal profession, and the prospect of 5-9 years of training keeps many people out of the medical professions. This hidden cost adds the extra $$$ to training a doctor.

 

[-Goose-]

Interesting points but those who study abroad can come back to the US to practice medicine, all they have to do is pass an extra test and get a residency position. Secondly, the cost of tuition for law school on average is higher than that of a physician and we have plenty of lawyers in this country. Comments?

"all they have to do is... get a residency position"

By completing a usmd residency, they are, in fact, US trained docs, eh?

BTW, we have more than "plenty" lawyers.

 

[gujuDoc]

I would've thought the reason getting into med school is such a pain is because of the enormous cost of training a doctor. If this cost were to come down, then med schools could train way more doctors, and medicine would just be another profession (minus the mystique associated with it). That said, US med schools are the best in the world because they contain the latest in state of the art technology. It makes sense that those not trained in the usage of such technology (non-US MD's) not practice in US hospitals.

I agree with the above quoted. If there are toooooooo many med schools, it will the costs of running the med schools will be high, and a surplus of doctors will be created.

Secondly, a few points I'd like to add:

1. admissions is also competitive because you want the most competent and best applicants possible. You don't want just anyone getting into medical school, because you are going to have another person's life in your hands some day.

2. problems with our healthcare are not solely with lack of ability to train sufficient amount of doctors but the lack of distribution of the doctors that we already have.

For instance, a rich city like Sarasota seems to have a ton of doctors, but if you go to more rural parts of northern florida or Alabama/Georgia, etc. there are often less doctors in the area and people have to travel quite a bit away to get to a doctor.

Then there's the issue of malpractice which also causes doctors to leave different areas. Florida, for instance, has some serious malpractice issues leading to doctors like OB/GYN's etc, leaving the state or causing them to stop performing certain procedures.

Again, I don't think opening up more medical schools would be the answer to the problems.

 

[Sicilian]

Interesting points but those who study abroad can come back to the US to practice medicine, all they have to do is pass an extra test and get a residency position. Secondly, the cost of tuition for law school on average is higher than that of a physician and we have plenty of lawyers in this country. Comments?

Well, they have to go through licensing/examination procedures. And that "extra test" you mention just happens to be the USMLE. Imagine the difficulty of studying overseas somewhere and then having to pass an examination designed on the basis of a very different form of preparation. Med students in the Caribb, on average, tend to score lower than US medical students on the USMLE; you could only attribute that to a difference in rigor. Its costly to train a lawyer probably because of the time involved. I guess its costly to train in general; isn't that why buisnesses have employees attend so-called "seminars" as opposed to going through exhaustive personalized training? There are more lawyers than doctors because law does not carry with it the burden of a high mortality rate.

 

[Shredder]

Agree, Disagree, Discuss - The reason why getting into medical school is so difficult is because the number of MD granting programs in the USA is kept artificially low. There hasn’t been a significant increase in the number of medical schools established in the USA in the last 20-30 years even though the population has grown tremendously. The number of spots needed to fill residencies and satisfy the demand for doctors in the USA is 6,000 more than the number of people attending US MD programs. Many equate becoming a doctor with getting into an MD school but there are DO schools, as well as foreign schools, that fill the 6,000 residency discrepancy. If a US granted MD was the only degree that allowed you to practice medicine in the USA, and supply for MD education had kept up with demand, we on SDN wouldn’t be going crazy trying to maintain 3.6 GPA and 32 on the MCAT.

Point of caution, if any of the following stats are off, like its not exactly 6,000 or it was 15 years instead of 20-30 the overall point still remains.

Veritas

medicine/healthcare isnt like other sectors of the economy where the free market dictates who enters which profession and its up to people themselves what career track they want to choose, regardless of job availability. thats why you never hear of drs who are unemployed and seeking work, and the job security of medicine is so highly touted. job security bc theres a perpetual, artificial shortage.

DO school helps fill the shortage but not enough. the med admissions process is way too long and convoluted, much more than any other professional schools. many of the best minds, or even mediocre minds, get turned away due to the needless hassles of applying to med and even the steps beyond applying

 

[MrTee]

.....
Also, it costs substantially more to train a doctor than a lawyer. While med school/law school tuitions are equitable, law school is only 3 three years and med school 4. Also there is no "residency" in the legal profession, and the prospect of 5-9 years of training keeps many people out of the medical professions. This hidden cost adds the extra $$$ to training a doctor.

It's important to note that tuition of medical school does not cover the entire cost to train a medical student. Medical schools must put in money to make up this difference. I don't know if that's the case with law school, but it is for medical school.

 

[bsteves4]

i feel (i could be wrong) that the main reason is simply that you dont want any fool becoming a doctor. the standards set by adcoms (at least as far as academics) is the only standard way to at least partially ensure that these people that are taking lives into thier own hands can read properly

 

[Wiggy73]

Med school is hard to get into because way more people want to get in than there are spots. In other words, there's a shortage of spots. So, let's crank up the econ. You get rid of a shortage by increasing quantity supplied or decreasing quantity demanded (or both). Increasing quantity supplied would entail opening new medical schools and/or expanding existing ones. But there are barriers - institutional and economic (because of the huge initial investment involved in setting up a medical school). Also, marginal costs of training extra doctors by existing medical schools will go up steeply because current facilities are already being used near capacity. This means the supply curve at this point is pretty inelastic. So we're stuck with supply.

How about demand? Well, however much premeds hate to admit it, going into medicine is an economic decision - there will be a cost at which it is not "worth it." We obviously have a surplus of people willing to pay $200K for a medical education (I won't go into residency for simplicity's sake). So a bunch, but not all, of them would be willing to pay even more than that. Take the price up high enough and the quantity demanded will decrease enough so that we reach equilibrium. Is that fair to poor students? Heck no. Will some of the people who bail be the smartest, bestest future doctors (whose opprtunity costs are probably the highest)? Yep. But admissions will be easier! (Another option to decrease demand is to lower physician salaries, which wouldn't necessitate raising tuition so would be easier on poor students, but has the same problem of running off talented people. However, if you just want very committed, dedicated physicians, lowering salaries would be a fairer way than hiking tuition to achieve that.)

In a normal market situation, supply and demand would adjust on their own. Unfortunately the med school market is royally screwed up (in economic terms). Barriers to entry keep supply from expanding, and fairness considerations keep tuition from rising in response to market pressures.

My vote is to use subsidies to overcome the economic barriers to entry, those freakishly high startup costs. This is justified because of the externalities associated with having enough physicians - benefits that aren't felt by the people paying the costs of training them (ie the med schools). The high marginal costs at this point come from the enormous fixed costs of opening new schools. Once you get past that, marginal costs settle back down. So tuition can stay more or less where it is, and I think it would take more new schools than we're ever likely to see to deplete the talent pool to where unqualified people are getting in. I'm only advocating this to a point, because beyond that you will have talent issues with admissions and eventually salaries for doctors will go down, which will further discourage talented people from choosing medicine and make those of us already committed to medical careers unhappy. Considering the condition of most state budgets, I don't think there's much government money around to subsidize new med schools. Which makes my proposal pretty unlikely to ever happen, unless...Bill Gates, are you listening?

If you're still reading you have too much time on your hands. Clearly, so do I. And yes, I was an econ minor. Why do you ask?

 

[ms1finally]

It's important to note that tuition of medical school does not cover the entire cost to train a medical student. Medical schools must put in money to make up this difference. I don't know if that's the case with law school, but it is for medical school.

This actually holds true for almost every type of higher education. My college tuition covered 60% of the cost of my attendance, and my parents paid 30K a year (a few years ago...it's more now!).

 

[little_late_MD]

Med school is hard to get into because way more people want to get in than .....

While I appreciate you analysis, it misses the forest for the trees. The med school "market" is kept in disequillibrium by an arbitrary ceiling kept on enrollments by limitations put on federal dollars spent for medical training. The main limitation in place in terms of medical training is that public hospitals cannot afford to pay for more residents. I believe the yearly quota for funding is set somewhere around the neighborhood of 80,000 residents total. Anytime there is an artificial limit (production, price, etc) on any product, shortages will occur. If funding levels were allowed to move to the population inflated/adjusted levels of the 1970s you would see a solution that is far more akin to what the demand calls for. In real dollars, federal and state dollars for medical training have fallen every year since 1992. That is very scary, seeing how all the baby boom MDs are set to retire in the very near term.

 

[DrBowtie]

While I appreciate you analysis, it misses the forest for the trees. The med school "market" is kept in disequillibrium by an arbitrary ceiling kept on enrollments by limitations put on federal dollars spent for medical training. The main limitation in place in terms of medical training is that public hospitals cannot afford to pay for more residents. I believe the yearly quota for funding is set somewhere around the neighborhood of 80,000 residents total. Anytime there is an artificial limit (production, price, etc) on any product, shortages will occur. If funding levels were allowed to move to the population inflated/adjusted levels of the 1970s you would see a solution that is far more akin to what the demand calls for. In real dollars, federal and state dollars for medical training have fallen every year since 1992. That is very scary, seeing how all the baby boom MDs are set to retire in the very near term.

I think you are missing one major factor. It isn't hard to get into a medical school. It is hard to get into a US medical school. The residency issue doesn't relate to the difficulty of getting in because there are more residency spots than US grads.

 

[little_late_MD]

I think you are missing one major factor. It isn't hard to get into a medical school. It is hard to get into a US medical school. The residency issue doesn't relate to the difficulty of getting in because there are more residency spots than US grads.

Most US residencies are done in US teaching hospitals, which are 98% of the time affiliated in some way with a medical school. I don't know where your information on residencies comes from, but in the most recent article I have read on the subject (which I believe came out in April; I have it at work), the number of open positions in any one year is now just barely ahead of the number of graduates. And for the high demand specialties, the number of open spots is decidely less. Take these two factors, and throw in the fact that a medical school who cannot place its graduates into interships and residencies will have decidely fewer applicants the next cycle, and you have the determinant factor in the number of applicants accepted to any given school. Also, don't forget that medical schools recieve large federal dollars for operational costs as well, and those have not been increasing proportionally either.

 

[DrBowtie]

The open spots are declining b/c programs are forced to take IMG due to lack of US MD grads. If you want data I will find it but it is common knowledge that many spots go unfilled or are taken by non-us students. US schools are the only competitive ones to get into. (not including foreign schools who put out grads for their own country)

 

[DrBowtie]

www.nrmp.org
2005
~24000 slots ~16000 US MD grads ~2000 unfilled

 

[little_late_MD]

The open spots are declining b/c programs are forced to take IMG due to lack of US MD grads. If you want data I will find it but it is common knowledge that many spots go unfilled or are taken by non-us students. US schools are the only competitive ones to get into. (not including foreign schools who put out grads for their own country)

I did a quick google search, and came up with these numbers:

(From a USAToday article)
The government spends about $11 billion annually on 100,000 medical residents, or roughly $110,000 per resident. The number of residents has hovered at this level for the past decade, according to the Accreditation Council for Graduate Medical Education.

In 1997, to save money and prevent a doctor glut, Congress capped the number of residents that Medicare will pay for at about 80,000 a year. Another 20,000 residents are financed by the Veterans Administration and Medicaid, the state-federal health care program for the poor.

Now if the government is paying for all these residents, and they haven't increased the funding in ten years, then I would say that is the impass. I understand what you're trying to point out here, that there are residencies left unfilled. However, these are not exceptions that disprove the rule.

Let's look at it from the med schools point of view. If their goal as an institution is to increase or maintain both their prestige and revenues(which I think we can agree it is), then creating more qualified alumni would certainly be to their advantage. We can all see from anecdotal evidence that plenty of worthy candidates are rejected on seemingly arbitrary grounds. Finding said qualified candidates doesn't seem to be the issue. Why then would they not seek to maximize enrollments? Some outside force seems to be at play here. This rejection of qualified applicants would seem to be counter-intuitive to the rational actor model of a medical school.

 

[little_late_MD]

www.nrmp.org
2005
~24000 slots ~16000 US MD grads ~2000 unfilled

Not unfilled, just unmatched. Many of the unmatched residencies are filled post-match. I don't know who would track the aggregate number of vacancies from year to year.

 

[Wiggy73]

As Brett said, the bottleneck is at the US med schools, not residencies. Most of my post discussed the artificial limits on both supply and price, and I argued that more funding was needed to open new schools. I think the forest (which is amply represented in my post) is making you miss the trees.

Besides, trees are good. They're pretty.

 

[DrBowtie]

Let's debate the word unfilled.

The fact of the matter is that the competitiveness comes from getting a spot in a US medical school that has double the applicants to spots.

Residency costs and placements don't matter until they need to be increased.
BTW 921 US seniors went unmatched. I would say 2000 unfilled spots are enough to scramble into.

 

[AHappyCalBear]

As Brett said, the bottleneck is at the US med schools, not residencies. Most of my post discussed the artificial limits on both supply and price, and I argued that more funding was needed to open new schools.

And we come full circle. My point was that it is hard to get into medical school because of the "artificial" limits. Meaning that we purposely put barriers in place to limit who can go to a US MD school. Wiggy you're right barriers to entry are difficult to overcome but obviously the initial start-up money to make a medical school were there 100 years ago, but in the past we were willing to spend to make more schools, today we are not.

I also think Med Schools like to be selective (we take so and so... bla bla bla), think about it, if every residency post was filled by a US MD school then we'd increase the number of MD Schools in the US and the crazy MCAT and GPA scores would decrease. Eh, am I right?

As for the, oh we need competent doctors argument, I think thats a bit misunderstood because we get people from DO's and foreign schools who didnt make the US Med School MD cut and still end up practicing, not to mention I believe they are just as competent as anyone.

 

[DrBowtie]

And we come full circle. My point was that it is hard to get into medical school because of the "artificial" limits. Meaning that we purposely put barriers in place to limit who can go to a US MD school. Wiggy you're right barriers to entry are difficult to overcome but obviously the initial start-up money to make a medical school were there 100 years ago, but in the past we were willing to spend to make more schools, today we are not.

I also think Med Schools like to be selective (we take so and so... bla bla bla), think about it, if every residency post was filled by a US MD school then we'd increase the number of MD Schools in the US and the crazy MCAT and GPA scores would decrease. Eh, am I right?

As for the, oh we need competent doctors argument, I think thats a bit misunderstood because we get people from DO's and foreign schools who didnt make the US Med School MD cut and still end up practicing, not to mention I believe they are just as competent as anyone.

The cost of adding more students is expensive. Hence the carribean schools fill the niche of accepting the overflow of applicants. Now the real issue is the quality of the education in the Carribean and whether is translates into US MD status.

Having a surplus of doctors would lead to trouble finding jobs. No one is going to take on 150K debt to know that they might not find a job to pay it off. So with the way it is, if you are accepted, you are pretty much guarenteed a job. Not too bad IMO.

 

[little_late_MD]

Having a surplus of doctors would lead to trouble finding jobs. No one is going to take on 150K debt to know that they might not find a job to pay it off. So with the way it is, if you are accepted, you are pretty much guarenteed a job. Not too bad IMO.

That's exactly what the AMA said during the early 90s when they lobbied successfully to prevent the construction and chartering of new medical schools. I don't, and never did, see any physicians on the corner with "Will diagnose for food" signs.

The question we as a nation need to ask is this: Are the needs of our populous being served adequately by the current system of healthcare in this country? I would say no. Waiting in a doctor's office for three hours before recieving a cursory once-over should be unacceptable. Nurses who are forced to carry much of the burden of treatment should be unacceptable. Residents who work 90- some hours a week should be unacceptable. Specialists who only work from 9-5 should be unacceptable. Doctors who cannot be bothered to remember, or even learn, their patient's names should be unacceptable. Doctors coming out of 7-12 years of education $200K in the hole should be unacceptable. And this doesn't even begin to take into consideration the insurance/malpractice/deregulation problems that exist. While this may be a good system for those fortunate enough to be on the practicing end, it is nowhere near adequate for a world power with a rapidly aging populous.

 

[Wiggy73]

Response to CalBear (quote trouble, sorry):

In the past it was easier to set up medical schools. If you're building a university and a big hospital already in a relatively unsaturated market with low prices for capital, it's not too much more trouble to set up the med school.

I'm not sure I buy your second point. US grads have no trouble landing residency spots, which makes me think (based on revealed preference) that if there were more of them they'd be able to fill the "excess" residency slots that currently go to foreign grads (I'm speaking numerically here, not to denigrate some of the excellent foreign-trained doctors doing residency Stateside). Yet we're not increasing US MD schools even with a surplus of residency spots for their graduates, and there must be a reason for that. On top of that, the crazy stats would not decrease because there would still be intense competition to get into the top schools - there are a gazillion colleges and the number keeps growing, but college admissions gets wilder every year because of competition to be at the top. Even if there were a larger number of med school spots, there are so many qualified people who don't get in that it would take a very large increase in spots before people were accepted who didn't meet "selective" criteria.

 

[DrBowtie]

That's exactly what the AMA said during the early 90s when they lobbied successfully to prevent the construction and chartering of new medical schools. I don't, and never did, see any physicians on the corner with "Will diagnose for food signs."

Exactly. Lets hope it remains that way. They are protecting the people they lobby for.

The question we as a nation need to ask is this: Are the needs of our populous being served adequately by the current system of healthcare in this country? I would say no. Waiting in a doctor's office for three hours before recieving a cursory once-over should be unacceptable. Nurses who are forced to carry much of the burden of treatment should be unacceptable. Residents who work 90- some hours a week should be unacceptable. Specialists who only work from 9-5 should be unacceptable. Doctors who cannot be bothered to remember, or even learn, their patient's names should be unacceptable. Doctors coming out of 7-12 years of education $200K in the hole should be unacceptable. And this doesn't even begin to take into consideration the insurance/malpractice/deregulation problems that exist. While this may be a good system for those fortunate enough to be on the practicing end, it is nowhere near adequate for a world power with a rapidly aging populous.

There are no doubt problems with the medical system but I don't see how they really relate to the competitiveness of getting into med school. As long as docs are well compensated and respected, people will flock to apply.

 

[Wiggy73]

I don't, and never did, see any physicians on the corner with "Will diagnose for food signs."

I'd have to be really hard up before I resorted to selling my diagnostic skills for a food sign.

 

[little_late_MD]

Exactly. Lets hope it remains that way. They are protecting the people they lobby for.



There are no doubt problems with the medical system but I don't see how they really relate to the competitiveness of getting into med school. As long as docs are well compensated and respected, people will flock to apply.

It's not the competitiveness that is the problem. It's the fact that the absolute number of physicians in this country has not been increasing. Right now the number of doctors who are retiring is about equal to those who are entering. What is going to happen when the baby-boomers start to both retire from the medical field, as well as get sick? Who will care for them? Who will care for you? From a consumer's point of view, why should you pay more for a physician who both makes you wait, and treats you like a number?

This attitude you seem to have about medicine, that it is a business above all else, is exactly the mindset that has gotten our system to the place it is at today. The poor cannot afford quality healthcare, and the middle class are slowly being squeezed out as well. Medicine should never be commodititzed. There are certain things that all people have an inalienable right to. I would hope that we are advanced enough to see healthcare as one of them.

 

[little_late_MD]

I'd have to be really hard up before I resorted to selling my diagnostic skills for a food sign.

lol. edited.
you bastard

 

[DrBowtie]

You have valid points but they don't relate to "The major reason why getting into medical school is so hard" hence why I am dismissing them. If you want to discuss issues in healthcare start a new one or search and revive an old one.

 

[Wiggy73]

It's not the competitiveness that is the problem. It's the fact that the absolute number of physicians in this country has not been increasing. Right now the number of doctors who are retiring is about equal to those who are entering. What is going to happen when the baby-boomers start to both retire from the medical field, as well as get sick? Who will care for them? Who will care for you? From a consumer's point of view, why should you pay more for a physician who both makes you wait, and treats you like a number?

This attitude you seem to have about medicine, that it is a business above all else, is exactly the mindset that has gotten our system to the place it is at today. The poor cannot afford quality healthcare, and the middle class are slowly being squeezed out as well. Medicine should never be commodititzed. There are certain things that all people have an inalienable right to. I would hope that we are advanced enough to see healthcare as one of them.

The attitude that Brett has is that this thread is about the competitiveness of getting into med school. If you want to critique the state of the American healthcare system, feel free, but please don't hijack the discussion here.

ETA: Brett, we seem to be in telepathic contact.

 

[DrBowtie]

The attitude that Brett has is that this thread is about the competitiveness of getting into med school. If you want to critique the state of the American healthcare system, feel free, but please don't hijack the discussion here.

Exactly. Thanks, Wiggy.

 

[medgator]

It's important to note that tuition of medical school does not cover the entire cost to train a medical student. Medical schools must put in money to make up this difference. I don't know if that's the case with law school, but it is for medical school.

States and the US Government will also invest a significant amount into a medical student (in many cases matching the dollar amount of tuition the student pays each year).

 

[little_late_MD]

The attitude that Brett has is that this thread is about the competitiveness of getting into med school. If you want to critique the state of the American healthcare system, feel free, but please don't hijack the discussion here.

ETA: Brett, we seem to be in telepathic contact.

Ummm...I believe that every problem I mentioned could be solved by having more doctors around. I also believe this is directly related to the med school admissions in this country. I don't see the thread as being hijacked at all.

 

[Wiggy73]

lol. edited.
you bastard

Being a girl, that one's a first.

Thanks, Wiggy.

Any time.

 

[Shredder]

Being a girl, that one's a first.

a girl economist, thats a first in my books. goo free market!

 

[ASDIC]

all this really comes down to money and this has been posted by the previous SDNers....

1) many medical schools have very tight budgets, and squeezing more students wud only hurt the enrolled students...this was the problem with Temple before....they accepted too many students and reduced financial aid for other students thus temporarily lost accredition

2) with the rising malpractice litigation, the medical schools want the best trained doctors and therefore become very selective

3) the AAMC and the AMA want to keep the standards of physician quality high, therefore they refuse to dilute the stream of physicians graduating medical school

 

[Rendar5]

Ummm...I believe that every problem I mentioned could be solved by having more doctors around. I also believe this is directly related to the med school admissions in this country. I don't see the thread as being hijacked at all.

If that's all there is to it (having more docs around), then looking at the allopathic bottleneck alone is not the right area since there are also DOs and FMGs who are just as competent as us allopaths. If we want more docs, then we would need an overall expansion and merger of osteopathic and allopathic schools and an increase in residency spots. Difficulty of getting into allopathic schools alone is not at issue because of other pathways to become a doc (i.e., go to a DO school to become a doctor, or go to a foreign school with a fairly high fail rate)

 

[Shredder]

If that's all there is to it (having more docs around), then looking at the allopathic bottleneck alone is not the right area since there are also DOs and FMGs who are just as competent as us allopaths. If we want more docs, then we would need an overall expansion and merger of osteopathic and allopathic schools and an increase in residency spots. Difficulty of getting into allopathic schools alone is not at issue because of other pathways to become a doc (i.e., go to a DO school to become a doctor, or go to a foreign school with a fairly high fail rate)

healthcare industry has problems due to shortage of docs. the screening tests are too stringent, the standards should be loosened. maybe language requirement--toefl--should be lifted too. its better to have substandard docs than no docs at all. if there were an abundance of docs, competition would bring healthcare costs down from what they currently are. every other industry has decreasing costs over time, with the exception of healthcare--its embarassing

 

[little_late_MD]

If that's all there is to it (having more docs around), then looking at the allopathic bottleneck alone is not the right area since there are also DOs and FMGs who are just as competent as us allopaths. If we want more docs, then we would need an overall expansion and merger of osteopathic and allopathic schools and an increase in residency spots. Difficulty of getting into allopathic schools alone is not at issue because of other pathways to become a doc (i.e., go to a DO school to become a doctor, or go to a foreign school with a fairly high fail rate)

I'm not really sure where this post is coming from. First, it was never said that the shortage is in MDs alone. There is an all over medical-staffing shortage. Currently Osteopaths account for less than one percent of the US aggregate advanced degree healthcare workers. While I know there is an an inherent xenophobia of foreign workers, the influx of foreign doctors still makes up a small percentage of the total US workforce.

As to this point that many on these boards bring up quite often; that of going to a foreign country to get a medical degree and then coming back to practice medicine, I find that suggestion lacks understanding of the reality of the situation. It is extremely difficult to be trained in a foreign country, and then both pass the boards in the US and find a residency somewhere. There is a substantial population of foreign doctors in the US who are working outside of their field because they couldn't make it in this system. Also, think about it for a minute. Would you really want to move to a foreign country, practice medicine there for a while, then pull up all your roots and come back to the US to try make it here? Both moving to another country and then moving back require radical lifestyle shifts, and keep this option a nonstarter for most.

To bring this back to the original topic, the reason it is so hard to get into US medical schools has little to do with the colleges wishing to keep quality stratospherically high, malpractice increases, or the AMA wishing to maintain standards. As with most political issues, it comes down to money. You can look this up for yourself, but I will once again repeat it. During the past decades the AMA has launched and maintained a successful campaign to limit medical school enrollements as well as funding for med schools and teaching hospitals. They originally began this sortie in order to keep a "surplus" of doctors from lowering salaries and increasing entropy in the labor market. They have effected an artificial shortage, and the medical schools are powerless to correct this unless more $$$ are freed up.

 

[Casey James]

Agree, Disagree, Discuss - The reason why getting into medical school is so difficult is because the number of MD granting programs in the USA is kept artificially low. There hasn’t been a significant increase in the number of medical schools established in the USA in the last 20-30 years even though the population has grown tremendously. The number of spots needed to fill residencies and satisfy the demand for doctors in the USA is 6,000 more than the number of people attending US MD programs. Many equate becoming a doctor with getting into an MD school but there are DO schools, as well as foreign schools, that fill the 6,000 residency discrepancy. If a US granted MD was the only degree that allowed you to practice medicine in the USA, and supply for MD education had kept up with demand, we on SDN wouldn’t be going crazy trying to maintain 3.6 GPA and 32 on the MCAT.

Point of caution, if any of the following stats are off, like its not exactly 6,000 or it was 15 years instead of 20-30 the overall point still remains.

Veritas

It's just plain ol' supply and demand. Keep jumin' through them hoops.

-Casey

 

[medgator]

healthcare industry has problems due to shortage of docs. the screening tests are too stringent, the standards should be loosened. maybe language requirement--toefl--should be lifted too. its better to have substandard docs than no docs at all. if there were an abundance of docs, competition would bring healthcare costs down from what they currently are. every other industry has decreasing costs over time, with the exception of healthcare--its embarassing

Are you kidding? In this day and age of malpractice, the average patient holds a doctor up to impossibly high standards. While the malpractice situation in this country is clearly out of control, it is still rooted in the idea of maintaining a pool of high quality, competent physicians. So in that respect, I would definitely say that it's probably not better to have a lot of substandard docs. Rather, there should be efforts to streamline our current system.

No one wants to do primary care now. If you look at US grad IM residents in ths country (and probably all IM residents in this country), well over 50% of them are going into specialties. Family Practice has one of the worst fill rates of all specialties in the country after the match. It is not out of the realm of possiblity that in the future, PAs and NPs will start to pick up some of the PCP (primary care provider) slack (doing screenings and well check-ups, managing hypertension, diabetes, lipids etc.) It is already happening now-- FPs and IM docs hiring PA's and allowing them to see patients independently.

 

[LizzyM]

Current schools could increase enrollment but don't. Why not? Because the real bottleneck is in clerkship slots. A medical school can just build a bigger lecture hall but it can't easily find places for clinical training of its students. Although America is aging and there is going to be increased demand for services related to the ravages of old age, the length of hospital stay is shorter and shorter such that we are doing more with fewer hospital beds. In the 1950s, the annual births per year was about the same as it is now but length of stay for a vaginal delivery was 5 days, now it is 2 days. So, there are fewer days of care for the same put-through.

Meanwhile, there are twice as many applicants to medical school as there are seats. Some of the applicants are clearly substandard and don't merit admission to any medical school. Some are adequate, or even very good, but don't catch a break. Many of them re-apply and are admitted. Some choose to go abroad.

As for the poor scores among students at Carribean schools. Is it that the teaching is substandard or is it that the students, in comparison to students at US schools, are not as strong - as a group- as those admitted to US schools? The quality that goes in determines, in part, the quality that comes out.

 

[AHappyCalBear]

Finally, a discussion on SDN that simply debates the merits or dismerits of medicine today. Beautiful... ::tear::

 

[Jon Davis]

To bring this back to the original topic, the reason it is so hard to get into US medical schools has little to do with the colleges wishing to keep quality stratospherically high, malpractice increases, or the AMA wishing to maintain standards. As with most political issues, it comes down to money. You can look this up for yourself, but I will once again repeat it. During the past decades the AMA has launched and maintained a successful campaign to limit medical school enrollements as well as funding for med schools and teaching hospitals. They originally began this sortie in order to keep a "surplus" of doctors from lowering salaries and increasing entropy in the labor market. They have effected an artificial shortage, and the medical schools are powerless to correct this unless more $$$ are freed up.

I agree with this thesis. It is clearly a case of supply and demand. Does anyone actually think the AMA is dumb enough not to see the increasing shortage in the future, even as far back as a decade ago? I believe they have always known this would happen but argued otherwise to keep up a shortage. More demand, more money or atleast keep their comfy salaries. I think the question is, have the docs actually hurt themselves by not creating more spots for U.S. students? As someone mentioned above, other professionals are taking over what docs used to do. Will there be a total class of professionals that take up these duties permanently? (probably at a much cheaper price) With the situation of this era, that might be a plausible solution. Also, there are a HUGE amount of residency spots not being filled each year and the AMA doesnt remedy the situation by increasing matriculants. I am not sure how long this has been happening for. I am sure there are thousands of qualified applicants that just get passed up. Kinda sad. I think there is enough money to go around for docs even by increasing the number of matriculants.

 

[medgator]

PAs and NPs can take some of the primary care burden away. But in the realm of specialties, I think its a "professional degree" only scenario.... I have never heard of PAs reading CT scans or doing bronchoscopies.

If we assume this along with the overall drain of physicians away from primary care and towards all specialties.... things may stay in equilibrium for now.

 

[Ross434]

PAs and NPs can take some of the primary care burden away. But in the realm of specialties, I think its a "professional degree" only scenario.... I have never heard of PAs reading CT scans or doing bronchoscopies.

If we assume this along with the overall drain of physicians away from primary care and towards all specialties.... things may stay in equilibrium for now.

Hey i know a PA who does cardiothoracic surgery

 

[Anastasis]

Hey i know a PA who does cardiothoracic surgery

Do they have their MD or DO as well?

If not I want to go to that PA school.

 

[DrMojorisin]

I agree with the theory that the AMA has intentionally created a shortage of doctors in order to keep salaries high, just like a union. This seems to be the simplest explanation for why med school is so competitive. If some plumbing lobby managed to get the gvmt. to only allow 1000 plumbers to exist in the U.S., then plumbers would make 500K or more per year. We'd have highly competitive plumbing schools and the plumbers would keep reminding us... "if somebody messes up your plumbing, then you'll have s**t all over the place. we need to only take the best plumbing candidates" Someone explained this more succinctly by mentioning price caps earlier...

DOs, NPs, PAs, and other allied health professions have now built powerful lobbies that can potentially neuter the AMA if they can garner expanded health care service privileges (thus filling the enormous demand for reasonably priced health care). The AMA is now pressuring US schools to open more spots in an effort to correct this problem, but I think it is too late. I predict that the allied health professions will gain most of the service allowances that remain exclusive to M.D.'s. I further predict this will happen within 10 years because of the looming medicare crisis.

 

[LizzyM]

Employers are tired of paying for ever growing health insurance premiums. Workers are tired of seeing their share of premiums go up every year. They are disgusted to see a physician bill $$$$ for a 10 minute consultation. So there is pressure to reduce costs.

The insurance companies have put pressure on professionals to do more with less $ by pressuring service providers to accept low reimbursement for services. If the reimbursement is low enough, the docs don't want the work and they are happy to delegate the low paying scut (like well baby visits) to allied health professionals. Everybody's happy.

Except the below-average applicants who think that there aren't enough medical school slots to get them into the game.

The mention of plumbers reminds me of the joke about the urologist who calls the plumber to his house. The plumber presents a bill for $500 for just a few minutes work. The urologist is outraged. "I'm a urologist and I don't bill this high for a few minutes work."

"Neither did I when I was a urologist!" relied the plumber.