Are US medical school expanding too fast?

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ATPsynthase123

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So there appears to be a new DO/MD school opening up every year or two. Either that, or we have an established school increasing class size. So if we project the rate of expansion, when can we expect for the number of US-MGs to surpass the number of residency slots? I don't see it happening within the next 4-6 years, but the fact that a new DO school seems to open every year or two and often has a class size of 150-200+ is very worrisome.

The AOA has to know this rate of expansion isn't sustainable in the long term, so why do they allow it? Wouldn't it be better to cap DO school and focus on getting them up to par with MD programs rather than continuously expanding class size and creating more schools?


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ATPsynthase123 said:
So there appears to be a new DO/MD school opening up every year or two. Either that, or we have an established school increasing class size. So if we project the rate of expansion, when can we expect for the number of US-MGs to surpass the number of residency slots? I don't see it happening within the next 4-6 years, but the fact that a new DO school seems to open every year or two and often has a class size of 150-200+ is very worrisome.

The AOA has to know this rate of expansion isn't sustainable in the long term, so why do they allow it? Wouldn't it be better to cap DO school and focus on getting them up to par with MD programs rather than continuously expanding class size and creating more schools?


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The AOA does not care about expansion or meeting standards, they want to proliferate their cancerous philosophies of osteopathy and OMM.
 
Rekt said:
The AOA does not care about expansion or meeting standards, they want to proliferate their cancerous philosophies of osteopathy and OMM.
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I think they are just oblivious/ don't care. I wouldn't necessarily call OMM cancerous when it actually has clinical applications. Ditto for the holistic philosophies of osteopathic schools


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Well, the sky is not falling. Even if ten new schools owned right now, there will still be more residency slots than grads to fill them.

I do agree that the expansion of DO schools is occurring at the expense of quality clinical education (meaning poor rotations ), and this will only end up hurting the profession because it not only fails to live down the sterotypes of DOs as being poorly trained, it will actually live up to them.

Yet the AOA persists in thinking "more DOs good".
 
Goro said:
Well, the sky is not falling. Even if ten new schools owned right now, there will still be more residency slots than grads to fill them.

I do agree that the expansion of DO schools is occurring at the expense of quality clinical education (meaning poor rotations ), and this will only end up hurting the profession because it not only fails to live down the sterotypes of DOs as being poorly trained, it will actually live up to them.

Yet the AOA persists in thinking "more DOs good".
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Do you think they will ever cap the DO expansion? Like obviously there are plenty of DOs. Let's focus on making sure we are adequately prepared for our careers instead of pumping more students into the field.


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Some interesting graphs I'd like to share with you guys with respect to law school enrollment.
1450206675013

1450206750532
 
Found a graph on new law school openings. Only goes up to 2005.
Chart.ABAbyYear1.jpg
 
Sardinia said:
Some interesting graphs I'd like to share with you guys with respect to law school enrollment.
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scary....BUT, i think healthcare field is still safe...theres enough lawyers, but are there enough doctors for everyone? maybe in the cities, but def not in the rural and less populated areas.....scary though!
 
cptnjack said:
scary....BUT, i think healthcare field is still safe...theres enough lawyers, but are there enough doctors for everyone? maybe in the cities, but def not in the rural and less populated areas.....scary though!
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Thank god im Getting in now as opposed to 10 years from now when the doctor bubble bursts and the field is saturated.


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Three factors contributed to the mountain peak decline in enrollment:

(1) If you went to law school and came out of law school, it was very hard to find a job as a lawyer in case you had an inside connection. Firms were contracted and limited, an experience similar to a "DIY medical residency" where you need the experience because school isn't sufficient to teach you the business side of law school.

(2) The scam blog movement broke out. Professor Paul Campos an admissions professor at the law school at University of Colorado Boulder outed himself when he had been blogging anonymously as a law school professor unhappy with the admission policy to accept more students on the basis of increased revenue. Students had a respectable source to base their suspicion that law schools were juking the post-employment stats in various ways and the ABA was complicit.

(3) There are 4 tiers of law schools and no demand for lawyers. Law as an industry doesn't have the same years of training required to medicine. The barrier of entry is low and therefore that contributed to the influx of students getting a JD because they couldn't cut it with a bachelor's degree. Not requiring pre-medical course work, volunteer hours, or direct healthcare experience meant that anyone could float an application. People from Tier 4 schools eroded the value of a T2/T3 school and coined the phrase "T14" as the top 14 law schools that had the most clout. Even so students from a T14 law school struggle to find similar respect in a market that has deemed law students to have little to no value.

These were the three primary factors that has led to the current law market being the most saturated professional degree market there currently is and should provide a key metric for medical schools collectively to avoid making similar mistakes.
 
ATPsynthase123 said:
Thank god im Getting in now as opposed to 10 years from now when the doctor bubble bursts and the field is saturated.


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Here's the difference between law and medicine, if GME doesn't expand, it doesn't matter how many med schools open for putting physicians into the workforce. All there will be is the bad medical students without residencies. Think 50% of the Caribbean students.
 
Let's grab pitchforks and start burning schools down. 🙂 I am also concerned about the rate of new schools opening.
I plan on going rural, and I saw somewhere that North Dakota and perhaps Arkansas had highest physician compensations on average. I imagine because these are less desirable places to go. If DO schools continually open, could it be possible that the compensations for these rural locations begins to drop as DO is producing a lot of primary care graduates? I'm not worried, I just wonder what your opinions are.
 
I don't think this is nearly as applicable.

Compared to medicine, law is:

-substantially easier to get into (everyone and their grandmother can get in, none of this "applying multiple years" stuff)
-substantially easier to finish (I know a few guys who literally spent law school doing nothing but getting high. Try that in med school, see how that works for you.)
-nowhere near as daunting to students as medical school (the vast majority of students just don't have the tolerance for medical workloads)
-far less in demand. It's always been this way. How many lawyers does the country really need? Law is a 40 hour workweek. Meanwhile, doctors have always been in intensely high demand, and even after training is done, a 70 hour workweek is common.

Saturation of the field of law was inevitable. It has a bad combination of low barrier to entry, an appealing lifestyle, and low demand. "If it were easy, everyone would do it!" Spoiler alert: everyone did it.

Meanwhile, we could increase the number of residency positions to 35,000 a year and STILL not make a dent in the need for physicians nationwide. Think about how many baby boomers are getting old now. Some countries have a glut of physicians. Those countries also have populations of ~15 million and no real underserved areas to speak of. Oh yeah, and they also have socialized healthcare, in which the government will often rarely pay for more doctors, even if needed.

You also cannot "dilute" the value of a DO degree without also diluting the value of an MD. Some residency directors and pretentious pre-meds may care about the difference between MD and DO, but literally no one else does. Employers and recruiters do not give half a **** what the letters after your name are, as long as you're making their hospital/clinic/practice money. Patients don't give half a **** what the letters after your name are as long as you can write their xanax prescriptions and make sure their genitals aren't falling off.

DOs still match at rates approaching 100% and this is unlikely to change soon. Quitcher bellyachin'.
 
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ATPsynthase123 said:
So there appears to be a new DO/MD school opening up every year or two. Either that, or we have an established school increasing class size. So if we project the rate of expansion, when can we expect for the number of US-MGs to surpass the number of residency slots? I don't see it happening within the next 4-6 years, but the fact that a new DO school seems to open every year or two and often has a class size of 150-200+ is very worrisome.

The AOA has to know this rate of expansion isn't sustainable in the long term, so why do they allow it? Wouldn't it be better to cap DO school and focus on getting them up to par with MD programs rather than continuously expanding class size and creating more schools?


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Click to expand...
Yes... Number of new MD/DO grads is increasing at a faster pace than new residency slots. I really don't think the COCA has a clue. I guess their strategic plan is to make the DO degree the new nurse practitioner degree. Of course, the investors in all of the new for profit DO schools could not care less about DO placement after graduation. Their return on investment calculation is driven by tuition revenue not DO placement statistics.
 
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Wjldenver said:
Yes... Number of new MD/DO grads is increasing at a faster pace than new residency slots. I really don't think the COCA has a clue. I guess their strategic plan is to make the DO degree the new nurse practitioner degree. Of course, the investors in all of the new for profit DO schools could not care less about DO placement after graduation. Their return on investment calculation is driven by tuition revenue not DO placement statistics.
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DO=NP lol kk


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Very true. My University's Pharm school is hurting in enrollment now.
Sardinia said:
@FourniersGreenGang I feel like the rapid expansion of pharmacy programs is becoming the new medical program equivalent.
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While this is true, it will still take some time to saturate, and Carib IMGs will be the first ones thrown under the bus. The for-profit schools and the chain schools (let's see, Touro, LECOM, PCOM, RVU, CCOM, NYITCOM and VCOM) all know that they have a gravy train, so I doubt that they will put the profession ahead of thier financial interests. Remember, you're dealing with a University system, such as at Midwestern, not merely CCOM.

Wjldenver said:
Yes... Number of new MD/DO grads is increasing at a faster pace than new residency slots. I really don't think the COCA has a clue. I guess their strategic plan is to make the DO degree the new nurse practitioner degree. Of course, the investors in all of the new for profit DO schools could not care less about DO placement after graduation. Their return on investment calculation is driven by tuition revenue not DO placement statistics.
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I do not know. I am hoping that DOs (and MDs) as a collective are smarter and better at long term consequences than the AOA (and LCME). But still, there is too much of a "the sky is falling!" attitude on SDN about stuff like this (and with mid-level creep., esp. in the Allo forum)


ATPsynthase123 said:
Do you think they will ever cap the DO expansion? Like obviously there are plenty of DOs. Let's focus on making sure we are adequately prepared for our careers instead of pumping more students into the field.


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Click to expand...
 
All it does is make things more competitive for the competitive specialties, which could be extremely annoying for those who want those and fields like FM, community IM will have a surplus of spots for a long while.

There will never be an over saturation of physicians though because it's residency that makes physicians, independant of how many med students there are.

I think it is garbage though that these new schools are allowed to rotate through the local hot dog stand and call it clinical education. Also it should be a requirement that you make enough residency spots to accommodate a certain percentage of your graduates. And not just FM spots either.
 
Goro said:
But still, there is too much of a "the sky is falling!" attitude on SDN about stuff like this (and with mid-level creep., esp. in the Allo forum)
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I know your arent exaggerating when you say SDN needs to relax with all the "DOs and
Mid levels are killing medicine!"BS. A month ago, I legit had a guy in the pre-allo forum tell me that I should cancel my apps and apply for NP/PA school. That a DO degree just wasn't worth it and I would have more opportunities as an NP than a DO...

Lol like either that is someone gunning way too hard or this guy has no clue of how the GME system works. I'd like to think that everything will be fine, but if the bubble does burst, then I pray I am on the graduated side of it. I can't imagine being like some pharmD students, graduating to an over-saturated job market and no jobs.


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It's that and the "Primary Care is the 7th Circle of Hell" mentality.


ATPsynthase123 said:
I know your arent exaggerating when you say SDN needs to relax with all the "DOs and
Mid levels are killing medicine!"BS. A month ago, I legit had a guy in the pre-allo forum tell me that I should cancel my apps and apply for NP/PA school. That a DO degree just wasn't worth it and I would have more opportunities as an NP than a DO...

Lol like either that is someone gunning way too hard or this guy has no clue of how the GME system works. I'd like to think that everything will be fine, but if the bubble does burst, then I pray I am on the graduated side of it. I can't imagine being like some pharmD students, graduating to an over-saturated job market and no jobs.


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Peach Newport said:
I love medicine but oh my god are pre-meds some of the most awful people in the world.
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"Bruh. I'm pre-allo only. None of that DO Bullsh*t. I'd rather not go to medical school at all than share a school with the idiot that only has 3 publications and an abysmal B+ in organic 2. When I get into a top ten, I'm going Ortho or bust bruh. While you f*ckin DO plebs are doing measly Family Med in rural Kansas, I'll be making bank as a DO Ortho surgeon. Straight drilling knees and drilling puss while you go home tired to your fat cow of a wife."

Pre-meds are cancerous.


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ATPsynthase123 said:
"Bruh. I'm pre-allo only. None of that DO Bullsh*t. I'd rather not go to medical school at all than share a school with the idiot that only has 3 publications and an abysmal B+ in organic 2. When I get into a top ten, I'm going Ortho or bust bruh. While you f*ckin DO plebs are doing measly Family Med in rural Kansas, I'll be making bank as a DO Ortho surgeon. Straight drilling knees and drilling puss while you go home tired to your fat cow of a wife."

Pre-meds are cancerous.


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They're just pissed because DOs are so much better looking. "Getting ripped for OMM" isn't something that happens at MD schools. :joyful::joyful::joyful:

That being said, there are some pretty terrible DOs too.
 
Goro said:
It's that and the "Primary Care is the 7th Circle of Hell" mentality.
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I don't get the pre-med obsession with surgery, I really don't. Like I'm 99% sure most people want to do Orthopedics because of the pay and "lifestyle", but the surgery lifestyle is straight garbage sometimes. I shadowed a surgeon and it freaking sucked. It was interesting, but your quality of life is abysmal. He straight told me that some weeks he spend more time in the OR than he does with his kids.

That's miserable, even if you don't have a family that would suck. So if you really want a nice paycheck, free time, and a nice lifestyle; then why not do FM or IM? Both make 150k to 180k and require much less time commitment. Sure you take a 100k pay cut, but what is the point in making 250-300k if you never get to use it? Or if you do use it for a trip or something you have to schedule it, and the hospital dumps tons of on-call hours on you.

I'll take the 7 days on 7 off schedule of a hospitalist over a surgeon schedule any day.


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Peach Newport said:
They're just pissed because DOs are so much better looking. "Getting ripped for OMM" isn't something that happens at MD schools. :joyful::joyful::joyful:

That being said, there are some pretty terrible DOs too.
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DOs and deadlifts ftw

I'm going into osteopathic school with 500 lbs deadlift, and I want leave with a 600+ lbs deadlift due to OMT alone lol


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ATPsynthase123 said:
DOs and deadlifts ftw

I'm going into osteopathic school with 500 lbs deadlift, and I want leave with a 600+ lbs deadlift due to OMT alone lol


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Bro just wait til OMT class. You'll probably be able to hit 650 -700 afterward easy. Nothing builds up the hand strength like a little counterstain of the tensor fascia latae
 
What I think most people fail to understand is that you never want your field/profession to even be nearing saturation. You want to remain highly desirable and in-demand. We've already seen numerous professions fall by the waist-side when it comes to this. As soon as you're a dime-a-dozen you're getting into a situation where you are dispensable and the employer has all the power. Rapid medical school expansion, including GME expansion, is undoubtedly a bad thing for physicians, but of course may help others in need of healthcare.
 
Giovanotto said:
What I think most people fail to understand is that you never want your field/profession to even be nearing saturation. You want to remain highly desirable and in-demand. We've already seen numerous professions fall by the waist-side when it comes to this. As soon as you're a dime-a-dozen you're getting into a situation where you are dispensable and the employer has all the power. Rapid medical school expansion, including GME expansion, is undoubtedly a bad thing for physicians, but of course may help others in need of healthcare.
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Totally agree. Look at what happened with labor market saturation in law. For example, the University of Colorado's law school is ranked as the 40th best law school in the country but the median private sector starting salary of it's grads is only $72K per year. With the ACGME residency merger, and the continued rapid expansion of DO schools, there will be a clearer delineation of the have's and have not's in medicine. ...With DO grads facing diminished opportunities and salaries. Maybe some lobbying group of DO school professor's, or current students, should petition the COCA to stop rapid DO school expansion since it will become a detriment to their graduates.
 
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Wjldenver said:
Totally agree. Look at what happened with labor market saturation in law. For example, the University of Colorado's law school is ranked as the 40th best law school in the country but the median private sector starting salary of it's grads is only $72K per year. With the ACGME residency merger, and the continued rapid expansion of DO schools, there will be a clearer delineation of the have's and have not's in medicine. ...With DO grads facing diminished opportunities and salaries. Maybe some lobbying group of DO school professor's, or current students, should petition the COCA to stop rapid DO school expansion since it will become a detriment to their graduates.
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If the field of medicine gets saturated, it's not going to be a DO thing. Medicine is simply too skilled of a profession, and hiring is based on skills, not academic pedigree. This isn't Wall Street, where only a few people get hired per year so they just take the Harvard grads, and this sure as **** isn't law. This is Medicine. MDs and DOs will be in it together.

But it's not going to happen any time soon. There is too high of a barrier to entry, and just as importantly, the growth of demand is exceeding the growth of supply, and will continue to do so for the foreseeable future.

Stop the fear mongering.
 
DO2015CA said:
This mentality is due to pre-meds that grew up comfortably and have never had to work for a living. I'll take outpatient PCP any day of the week if I don't have to go back to busting up concrete for a living
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Same. My dad worked his fingers to the bone and as a result has to have major spinal surgery at 45 because 30 years of tough farm work literally broke him. I'll take being an out patient FM doc or Hospitalist over that any day.


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ATPsynthase123 said:
Same. My dad worked his fingers to the bone and as a result has to have major spinal surgery at 45 because 30 years of tough farm work literally broke him. I'll take being an out patient FM doc or Hospitalist over that any day.


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Exactly. I grew up to a family of farmer's and construction workers. No way I go back to that. I love farming but just seeing the back breaking work is what drove me to get an education
 
Peach Newport said:
the growth of demand is exceeding the growth of supply, and will continue to do so for the foreseeable future.

Stop the fear mongering.
Click to expand...

I don't know that you were referring to this in particular or not, but regardless... A significant amount of this growth in demand is the repeated (ad nauseam) fact that the boomers are getting older and we have an aging population in general. Another source of the demand is increased numbers of people with adequate health insurance.

The issue I take with this is that the primary demand generated by these two groups is in fields that are just not very desirable. You're talking about very high demand for gerontologists and PCPs. Yes, there is spill over demand for specialists to work with these patients, but not to the same extent.

Now, one cause of gerontology and Primary Care being undesirable is low compensation. Let's say that changes somehow due to this huge increase in demand. You are still left with another cause of them being undesirable: a near complete lack of instant gratification. Yes, yes, you build great relationships, etc, etc. But in both fields it is largely managing meds and in gerontology you're just hoping to help them die with a little more dignity (broad brush, I know, but trying to keep this rant short where I can).

So, few years down the line, more doctors forced into fields they didn't really want but they couldn't match in a specialty they did. Well, at least we're closer to solving the physician shortage, even if it is half-assed, right? Are we? Look at states where NPs have full practice rights. A major argument in favor of that was it would ease the shortage in rural areas. Except that's not what is actually happening because they don't want to practice there, either. There is already an oversaturation in desirable locations, and adding more doctors will in all likelihood just exacerbate that issue while rural America continues to be just as underserved.

tl;dr, Until you figure out how to make people want to enter undesirable fields of medicine and how to make undesirable locations more alluring, adding more doctors isn't helping anyone.
 
hurtem&healem said:
I don't know that you were referring to this in particular or not, but regardless... A significant amount of this growth in demand is the repeated (ad nauseam) fact that the boomers are getting older and we have an aging population in general. Another source of the demand is increased numbers of people with adequate health insurance.

The issue I take with this is that the primary demand generated by these two groups is in fields that are just not very desirable. You're talking about very high demand for gerontologists and PCPs. Yes, there is spill over demand for specialists to work with these patients, but not to the same extent.

Now, one cause of gerontology and Primary Care being undesirable is low compensation. Let's say that changes somehow due to this huge increase in demand. You are still left with another cause of them being undesirable: a near complete lack of instant gratification. Yes, yes, you build great relationships, etc, etc. But in both fields it is largely managing meds and in gerontology you're just hoping to help them die with a little more dignity (broad brush, I know, but trying to keep this rant short where I can).

So, few years down the line, more doctors forced into fields they didn't really want but they couldn't match in a specialty they did. Well, at least we're closer to solving the physician shortage, even if it is half-assed, right? Are we? Look at states where NPs have full practice rights. A major argument in favor of that was it would ease the shortage in rural areas. Except that's not what is actually happening because they don't want to practice there, either. There is already an oversaturation in desirable locations, and adding more doctors will in all likelihood just exacerbate that issue while rural America continues to be just as underserved.

tl;dr, Until you figure out how to make people want to enter undesirable fields of medicine and how to make undesirable locations more alluring, adding more doctors isn't helping anyone.
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The issue of how competitive desirable/popular specialties and locations are is an ENTIRELY different issue than the saturation of the medical field, the dilution of the DO degree, and job prospects after graduation.

There's also a big middle between "making $1 m/year in ortho" and "making $150k in FM." The field of medicine is not split into high paying surgical subspecialties and working primary care for peanuts. EM, psych, PM+R and neurology are all fields that, off the top of my head, are going to be in more demand, and have "mid range" compensation.

Oh yeah, and if you work in an underserved area, you can make HUGE money, even in FM, because you're the only doctor around. On my way to my Marian interview, I met an FM doc who lives in Indianapolis and makes $600k a year... Because no one wants to practice in Indiana. Meanwhile, he owns his own airplane and drives an Aston Martin. And the government forgives your loans for practicing in an underserved area. And cost of living is cheaper! It balances out.

But yeah, it's gonna be a bit harder to become a dermatologist.
 
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Peach Newport said:
Oh yeah, and if you work in an underserved area, you can make HUGE money, even in FM, because you're the only doctor around. On my way to my Marian interview, I met an FM doc who lives in Indianapolis and makes $600k a year... Because no one wants to practice in Indiana. Meanwhile, he owns his own airplane and drives an Aston Martin. And the government forgives your loans for practicing in an underserved area. And cost of living is cheaper! It balances out.
.
Click to expand...

That massive increase in pay, loan forgiveness, and the lower CoL have still proven to not be enough of an incentive for physicians to practice in those locations, though. If they were, there wouldn't still be such a massive shortage!

I don't know the solution, but just throwing more physicians at the problem will not solve it. Again, that was the intent of giving NPs full practice rights, but all that has actually done is led to an even greater saturation in desirable markets.
 
hurtem&healem said:
tl;dr, Until you figure out how to make people want to enter undesirable fields of medicine and how to make undesirable locations more alluring, adding more doctors isn't helping anyone.
Click to expand...

Make schools even more
Mission based with contracts. I can't tell you how many people say they're for rural primary care and then once they are accepted their tune is changed to city life. Contracts for the community you planned to serve, not specialty because everything changes.

That and make the MCAT pass fail so we stop getting an ultra competitive stat driven acceptance who tend to be from more well off people from affluent neighborhoods. These people will not be out in the cuts or in the inner city
 
DO2015CA said:
That and make the MCAT pass fail so we stop getting an ultra competitive stat driven acceptance who tend to be from more well off people from affluent neighborhoods. These people will not be out in the cuts or in the inner city
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I don't think people realize how self selecting of a population incoming medical students are. We select for a bunch of type A, usually affluent individuals and then wonder why they want to do plastic surgery in LA. If we want different results then we need to change the input population. It honestly is one thing I think DO schools do so much better than MD schools. They actually accept people that are more likely to go for rural PC when that is the mission of the school.
 
AnatomyGrey12 said:
I don't think people realize how self selecting of a population incoming medical students are. We select for a bunch of type A, usually affluent individuals and then wonder why they want to do plastic surgery in LA. If we want different results then we need to change the input population. It honestly is one thing I think DO schools do so much better than MD schools. They actually accept people that are more likely to go for rural PC when that is the mission of the school.
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Yep my point exactly in not so many words
 
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