AAMC limit on new doctors?

[craig1212]

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1. Is it true that the AAMC have a limit on the amount of new medical schools that can be opened each year ? is there a limit on the amount of medical degree's conferred each year? (could you please share links that'll back up your statements)
2. if medical services are so expensive wouldn't the theory of "supply and demand" bring the prices down by now?

 

[NickNaylor]

The AAMC can only offer recommendations to its members. As far as I know it can't do jack **** with respect to requiring schools to do anything.

This looks like it's going to be a promising healthcare discussion.

 

[DoctwoB]

1. Is it true that the AAMC have a limit on the amount of new medical schools that can be opened each year ? is there a limit on the amount of medical degree's conferred each year? (could you please share links that'll back up your statements)
2. if medical services are so expensive wouldn't the theory of "supply and demand" bring the prices down by now?

1. No. LCME accredits medical schools, and has strict standards, but no set limit on new schools or degrees.

2. No. Demand is inelastic, patients don't see the cost of services, there is inequality of information so supply effects demand, there are monopolies and monopsonies, etc. Basically medicine is a mess of market failures and normal economic rules of free markets don't mean jack.

 

[Beta Cell]

1. No. LCME accredits medical schools, and has strict standards, but no set limit on new schools or degrees.

2. No. Demand is inelastic, patients don't see the cost of services, there is inequality of information so supply effects demand, there are monopolies and monopsonies, etc. Basically medicine is a mess of market failures and normal economic rules of free markets don't mean jack.

Are you sure about that? Why is the max medical school class I've ever seen 170 and not ~500 like some law schools or MBA programs? I've always thought physician salaries were preserved at the medical school entrance level. The standards to start a medical school are understandably rigid and difficult which explains why there are so few medical schools, but it does not explain why there aren't huge classes.

P.S. I haven't looked up the statistics, so if anyone has seen a medical school class of 200, let's call that irrelevant. A U.S. M.D. class of 300+ is certainly something noteworthy. As is only logical, we're counting entering classes, not record graduating classes. This is important to distinguish because some classes have significant portions of their students taking 5 years or more to finish while others do not, creating an artificially large graduating class.

 

[235788]

Yeah to prevent to many doctors. A doctor shortage is needed so people don't have to work in crapholes like rural north dakota and can work by their families.


God forbid medicine becomes like law and only 60% of graduates find jobs.

 

[NickNaylor]

Are you sure about that? Why is the max medical school class I've ever seen 170 and not ~500 like some law schools or MBA programs? I've always thought physician salaries were preserved at the medical school entrance level. The standards to start a medical school are understandably rigid and difficult which explains why there are so few medical schools, but it does not explain why there aren't huge classes.

P.S. I haven't looked up the statistics, so if anyone has seen a medical school class of 200, let's call that irrelevant. A U.S. M.D. class of 300+ is certainly something noteworthy. As is only logical, we're counting entering classes, not record graduating classes. This is important to distinguish because some classes have significant portions of their students taking 5 years or more to finish while others do not, creating an artificially large graduating class.

Salaries are controlled at the residency "gate." A person with a MD but no residency training isn't qualified to do much other than practice medicine... maybe teach and do research, but that's pretty much it.

 

[aerodoc]

Are you sure about that? Why is the max medical school class I've ever seen 170 and not ~500 like some law schools or MBA programs? I've always thought physician salaries were preserved at the medical school entrance level. The standards to start a medical school are understandably rigid and difficult which explains why there are so few medical schools, but it does not explain why there aren't huge classes.

P.S. I haven't looked up the statistics, so if anyone has seen a medical school class of 200, let's call that irrelevant. A U.S. M.D. class of 300+ is certainly something noteworthy. As is only logical, we're counting entering classes, not record graduating classes. This is important to distinguish because some classes have significant portions of their students taking 5 years or more to finish while others do not, creating an artificially large graduating class.

I would imagine one of, if not the most important factor in medical school class size is the amount of resources available for training. In law school your number of students is only limited by how many papers you can grade, but in medical school, you need to provide placements for each of those students in a teaching hospital during their clinical rotations. As you might imagine, with many schools having access to a limited amount of healthcare facilities for training, they also will then have a limit on how many students they can train.

FYI Wayne State University in Detroit has around 300 students in each class, but if you note how many hospitals it has access to for training that might explain how they are able to do that. Many other schools with high numbers of students have to spread those students out across multiple sites during their clinical rotations. Michigan State University is an example of this model.

 

[Beta Cell]

Salaries are controlled at the residency "gate." A person with a MD but no residency training isn't qualified to do much other than practice medicine... maybe teach and do research, but that's pretty much it.

I don't know about that either. Most people can't afford to finish medical school, have $150-250k in debt, and not complete a residency. I don't know the rates, but the students who choose not to complete a residency have to be an incredible minority. Everyone wants to be a doctor, very few get into medical school; nearly all MDs complete a residency.

Here's a thought test: Which scenario would you guess would lead to lower salaries?

Fewer residency positions
Increased seats in all medical schools and an increased number of US MD schools

Fewer residency would seem to drive up salaries while the second situation would decrease them.

 

[aerodoc]

I don't know about that either. Most people can't afford to finish medical school, have $150-250k in debt, and not complete a residency. I don't know the rates, but the students who choose not to complete a residency have to be an incredible minority. Everyone wants to be a doctor, very few get into medical school; nearly all MDs complete a residency.

There are plenty of MDs that don't complete a residency, they just aren't coming from American Universities.......

 

[RogueUnicorn]

Are you sure about that? Why is the max medical school class I've ever seen 170 and not ~500 like some law schools or MBA programs? I've always thought physician salaries were preserved at the medical school entrance level. The standards to start a medical school are understandably rigid and difficult which explains why there are so few medical schools, but it does not explain why there aren't huge classes.

P.S. I haven't looked up the statistics, so if anyone has seen a medical school class of 200, let's call that irrelevant. A U.S. M.D. class of 300+ is certainly something noteworthy. As is only logical, we're counting entering classes, not record graduating classes. This is important to distinguish because some classes have significant portions of their students taking 5 years or more to finish while others do not, creating an artificially large graduating class.

because law students don't need to rotate through law firms during the school year to learn law. you can cram 2000 students into lecture halls. you can't cram them into a single hospital system without serious logistical and educational issues

I don't know about that either. Most people can't afford to finish medical school, have $150-250k in debt, and not complete a residency. I don't know the rates, but the students who choose not to complete a residency have to be an incredible minority. Everyone wants to be a doctor, very few get into medical school; nearly all MDs complete a residency.

you missed the point, which was that an MD without a residency is not a practicing physician. thus the true bottleneck is the residency. it's not about what one can afford

 

[eli20]

Free market/capitalism.

Healthcare.

America.

Subscribing for the lolz.

 

[NickNaylor]

I don't know about that either. Most people can't afford to finish medical school, have $150-250k in debt, and not complete a residency. I don't know the rates, but the students who choose not to complete a residency have to be an incredible minority. Everyone wants to be a doctor, very few get into medical school; nearly all MDs complete a residency.

Here's a thought test: Which scenario would you guess would lead to lower salaries?

Fewer residency positions
Increased seats in all medical schools and an increased number of US MD schools

Fewer residency would seem to drive up salaries while the second situation would decrease them.

Not if there isn't a corresponding increase in residency slots in order to train them. Otherwise we're just training a whole lot more MDs that can't do anything meaningful in the field.

 

[TheMightySmiter]

Pretty sure that the real problem here is the number of residency slots, which is determined by Congress because they are mostly funded by Medicare.

 

[craig1212]

So, it seems to me that the problem is limited residency slots. Upon further research I found several links that indicated that more medical schools will be opening within the next few years. (so maybe the theory of "supply and demand" also holds true in the medical field since more hospitals aren't being opened to meet demand).

Medical schools that will be opened in the next few years:

http://www.nytimes.com/2010/02/15/ed...edschools.html

http://www.thelancet.com/journals/la...329-7/fulltext

 

[Longshanks]

P.S. I haven't looked up the statistics, so if anyone has seen a medical school class of 200, let's call that irrelevant. A U.S. M.D. class of 300+ is certainly something noteworthy. As is only logical, we're counting entering classes, not record graduating classes. This is important to distinguish because some classes have significant portions of their students taking 5 years or more to finish while others do not, creating an artificially large graduating class.

I think you are right that the average class size is 170. However, this can be as small at 60 at Dartmouth or as large as 250 at Drexel. This is more do to with the individual school and their philosophy, desires, finances, and core rotations sites rather than what the AAMC tells them to do. Even if every school modestly increased their enrollment today, there would still be available residency positions needing to be filled by US DO grads, IMGs, and FMGs.

 

[Longshanks]

So, it seems to me that the problem is limited residency slots. Upon further research I found several links that indicated that more medical schools will be opening within the next few years. (so maybe the theory of "supply and demand" also holds true in the medical field since more hospitals aren't being opened to meet demand).

Medical schools that will be opened in the next few years:

http://www.nytimes.com/2010/02/15/ed...edschools.html

http://www.thelancet.com/journals/la...329-7/fulltext

"Supply and demand" doesn't relate to health care as it does in other markets/industries.

Residency positions are limited by Medicare funding. And yes, this is the bottleneck point for those entering the field as practicing physicians. Increasing US medical school enrollment will not change the number of residency positions without Congress allocating more funding, all it will do is squeeze out IMGs and FMGs.

 

[aSagacious]

So, it seems to me that the problem is limited residency slots.

Correct. Follow the money and you'll see how this comes to be.

Undergrad --> students pay the school to learn (if they are subsidized by federal loans along the way, they pay back the loans with interest)
MD school --> students pay the school to learn (same as above, yes I know that a good chunk of the funding comes from elsewhere... but this is a simplification)
Residency --> hospitals pay you to be trained

... see the problem? Who's going to fund the increased residency positions? (rhetorical question)

 

[bkprodigy]

Correct. Follow the money and you'll see how this comes to be.

Undergrad --> students pay the school to learn (if they are subsidized by federal loans along the way, they pay back the loans with interest)
MD school --> students pay the school to learn (same as above, yes I know that a good chunk of the funding comes from elsewhere... but this is a simplification)
Residency --> hospitals pay you to be trained

... see the problem? Who's going to fund the increased residency positions? (rhetorical question)

Not to mention hospitals spend much more than measly resident salaries to train residents.

 

[Beta Cell]

because law students don't need to rotate through law firms during the school year to learn law. you can cram 2000 students into lecture halls. you can't cram them into a single hospital system without serious logistical and educational issues



you missed the point, which was that an MD without a residency is not a practicing physician. thus the true bottleneck is the residency. it's not about what one can afford

Harvard has a bunch of hospitals associated with it and only 165 students per year. They could most definitely increase the size of their class, yet they don't. They also have the largest endowment of any medical school and I'm certain could handle the "logistical and educational issues" associated with doubling their class size, for instance. It just has always seemed like this has been regulated.

I don't see what you're saying in the second point. You can practice with an intern year under your belt, you don't necessarily need to complete the entire residency to actually be able to see patients. An MD opens you up to the ability to consult (some grads go to McKinsey or other endeavors, though rarely) as well.

Most importantly, however, you don't seem to understand the definition of a bottleneck. A bottleneck is a decrease in the capacity of an entire system caused by a limited number of resources. The match statistics are in the 90% region for most specialties and lower, but still much higher than 50%, for specialties like dermatology. You go from 45,000 applicants to 18,000 matriculants just in the medical school application process each year, not to mention the 45,000 number is probably 1/100th of the amount of students that actually wanted to be doctors when they began college. Residency isn't a bottleneck, it's just an extension of medical school essentially. As a US MD student, the only thing stopping you from completing a residency is yourself. The same cannot be said for the med school application process.

Overall physician salaries are protected, from what I can see, at the med school level. The fact is that if there were 10x as many medical students as usual tomorrow, we would eventually see an overall decrease in the price people were willing to pay physicians.

 

[Beta Cell]

Not if there isn't a corresponding increase in residency slots in order to train them. Otherwise we're just training a whole lot more MDs that can't do anything meaningful in the field.

Good point, I had made that assumption in my head. I was in a net result state of mind and just realizing the effects of increased physicians in the marketplace.

 

[RogueUnicorn]

Harvard has a bunch of hospitals associated with it and only 165 students per year. They could most definitely increase the size of their class, yet they don't. They also have the largest endowment of any medical school and I'm certain could handle the "logistical and educational issues" associated with doubling their class size, for instance. It just has always seemed like this has been regulated.

I don't see what you're saying in the second point. You can practice with an intern year under your belt, you don't necessarily need to complete the entire residency to actually be able to see patients. An MD opens you up to the ability to consult (some grads go to McKinsey or other endeavors, though rarely) as well.

Most importantly, however, you don't seem to understand the definition of a bottleneck. A bottleneck is a decrease in the capacity of an entire system caused by a limited number of resources. The match statistics are in the 90% region for most specialties and lower, but still much higher than 50%, for specialties like dermatology. You go from 45,000 applicants to 18,000 matriculants just in the medical school application process each year, not to mention the 45,000 number is probably 1/100th of the amount of students that actually wanted to be doctors when they began college. Residency isn't a bottleneck, it's just an extension of medical school essentially. As a US MD student, the only thing stopping you from completing a residency is yourself. The same cannot be said for the med school application process.

Overall physician salaries are protected, from what I can see, at the med school level. The fact is that if there were 10x as many medical students as usual tomorrow, we would eventually see an overall decrease in the price people were willing to pay physicians.

do you understand the meaning of a bottleneck? or how the american medical system works? residency is the bottleneck. if we enrolled 10x more medical students tomorrow, the net result will be the exact same amount of physicians, and thus salary, except we'll have a lot of unemployed people with MDs. you also assume the only supply of residents are american schools, which is false. medical schools do not produce physicians. they produce people who can train to be physicians. your school acceptance vs. residency match % is completely ignoring the fact that medical schools are smart enough to not accept so many students as to oversupply the residencies. finally, that you can practice with only an internship is merely true de jure, not de facto.

your consulting point is totally irrelevant to the discussion, we're talking about physicians.

 

[Wolfman89]

God forbid medicine becomes like law and only 60% of graduates find jobs.

Amen. I have several friends who changed their minds about going into law because of that fact.

Can you imagine what that would do to the gunner mentality out there?

 

[kautionwirez]

Yeah to prevent to many doctors. A doctor shortage is needed so people don't have to work in crapholes like rural north dakota and can work by their families.


God forbid medicine becomes like law and only 60% of graduates find jobs.

is that true for CT surgeons?

 

[boobelle]

Not only does the AAMC not control the number of med schools or seats (and can only advise), they've been heavily pushing to INCREASE the size of medical school classes to increase the number of US MD grads.