Beware of lies regarding a so-called "doctor shortage"

[Socrates25]

As the number of med schools inflates beyond 30% increase over the last few years, we have been hearing a lot of nonsense about how there's a so-called projected physician shortage in the next few years. Stories like the one below illustrate why thats all BS: http://www.nytimes.com/2010/02/14/health/14robot.html?hpw If urologists were in shortage, they wouldnt be forced to cater to patients by offering robotic surgery. The fact that the traditional surgeons are at a competitive disadvantage proves that there is no urologist shortage. If there were, patients would be forced to pick whatever urologist was available instead of doctor shopping for the robot guys. There are dozen other stories just like this about doctors having to shop for patients. Pretty soon we'll be just like chiroprators--offering free chicken to people who stop by our booths at walmart for a "health screen." By 2015, the number of MDs graduating from medical schools will be 35% higher than it was in 2002. The USA does not have a doctor shortage--in fact we have a surplus which is part of the reason why healthcare costs are so high.

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[ChiDO]

Many people mis-interpret the doctor shortage as you are. The urban centers (ie. Big cities) are becoming over-saturated with doctors, while the REAL SHORTAGE is happening in rural areas. Thus, many of these areas over very good compensation, low cost of living, to attract doctors to come to these smaller cities.

I think a student who comes from a smaller town (<50-150k) who would like to go back to their hometown is at a clear advantage in their lifelong earning potential vs. someone who wants to go the the big name hospital in the city. I'm from a major city and I am contemplating on eventually choosing to live/practice in a smaller area due to the reasons mentioned above.

In summary, doctor shortage in cities = not going to happen, doctor shortage in rural areas/smaller cities = happening.

 

[Doctor D]

If you look at the research rural doctors tend to work more hours for a little less money than their suburban or urban counterparts. With that said, there is an enormous shortage and the rural lifestyle can be attractive...

 

[RedAnesthesia]

Many people mis-interpret the doctor shortage as you are. The urban centers (ie. Big cities) are becoming over-saturated with doctors, while the REAL SHORTAGE is happening in rural areas. Thus, many of these areas over very good compensation, low cost of living, to attract doctors to come to these smaller cities.

I think a student who comes from a smaller town (<50-150k) who would like to go back to their hometown is at a clear advantage in their lifelong earning potential vs. someone who wants to go the the big name hospital in the city. I'm from a major city and I am contemplating on eventually choosing to live/practice in a smaller area due to the reasons mentioned above.

In summary, doctor shortage in cities = not going to happen, doctor shortage in rural areas/smaller cities = happening.

I agree. In addition, I think the doctor shortage is coming in the next 10 years as we see many older physicians retire especially if reimbursement is cut with Obama healthcare. Time will tell.

 

[NotAProgDirector]

Also an increase in US medical grads will not increase the physician supply. That is set by the number of residency slots. Without an increase in residency slots, more US grads will simply displace foreign grads. Whether or not this is a good thing depends upon your perspective.

 

[medicinesux]

let's not forget to mention the absolute explosion of doctorate in nursing degrees being doled out like candy

 

[Excelsius]

Also an increase in US medical grads will not increase the physician supply. That is set by the number of residency slots. Without an increase in residency slots, more US grads will simply displace foreign grads. Whether or not this is a good thing depends upon your perspective.

Exactly. And residency spots have been barely increasing. The increase in medschool enrollment is more like a shift in specialties and USMG/IMG ratios than an increase in doctor supply.

 

[Excelsius]

If you look at the research rural doctors tend to work more hours for a little less money than their suburban or urban counterparts. With that said, there is an enormous shortage and the rural lifestyle can be attractive...

I have seen the opposite: the shortage in rural doctors actually drives up the salaries vs highly concentrated areas like NY to make it more appealing for the doctors to practice. On top of that you can have loan forgiveness programs and a much lower cost of living and lower taxes.

 

[jl lin]

It was my understanding that the projected (or even current) shortage of physicians was/is in primary care, particularly in the more remote or rural areas.

 

[Law2Doc]

I have seen the opposite: the shortage in rural doctors actually drives up the salaries vs highly concentrated areas like NY to make it more appealing for the doctors to practice.

This only works for the very short term, because at the heart of it, the money a practice generates is based on insurance reimbursements and these aren't really going to be any better in rural areas. So there is only so high a practice is able to pay it's salaried employees and still make a profit, unless it forces them to work absurd hours.

The OP misunderstands the concept of shortage. You can have a glut in cities or in specialties and still have a massive shortage nationally. In fact, this is exactly what we have. There is no shortage of urologists in major coastal cities, but try to find an internist or pediatrician in some of the rural areas and you will see the other extreme. This will only get worse as the baby boomers age (as older people get sicker) but love longer, and also look to it coming to a head as physicians die off and retire (more doctors are working longer now so the constant of new doctors and retirees no longer exists, now we have a combo of retirees and doctors who will die on the job, and in higher numbers. This will get worse before it gets better. And already is pretty bad in most of the country, just not in the region and specialty that OP chose to focus on, naively.

 

[mlw47]

Some reading material on the subject:


Physician Workforce Crisis? Wrong Diagnosis, Wrong Prescription
http://content.nejm.org/cgi/content/full/358/16/1658


Does Having More Physicians Lead to Better Health System Performance?
http://jama.ama-assn.org/cgi/content/extract/299/3/335

 

[PhakeDoc]

Also an increase in US medical grads will not increase the physician supply. That is set by the number of residency slots. Without an increase in residency slots, more US grads will simply displace foreign grads. Whether or not this is a good thing depends upon your perspective.

Looks like there's danger up ahead:

http://www.nytimes.com/2010/02/15/education/15medschools.html?partner=rss&emc=rss

Not much, if any, mentioning of the creation of additional residency spots.

 

[Eta Carinae]

Also an increase in US medical grads will not increase the physician supply. That is set by the number of residency slots. Without an increase in residency slots, more US grads will simply displace foreign grads. Whether or not this is a good thing depends upon your perspective.

Definitely a good thing in my opinion.

Culture-wise and in several other aspects. The benefits of foreign grads are simply exaggerated.

 

[dragonfly99]

There may not be an overall physician shortage in all specialties, but there is DEFINITELY a physician distribution problem. Having lived in the Midwest and South, there just isn't much of an oversupply of docs (even in most of the medium and larger cities). There is a shortage of docs (not just primary care but most specialists too) just about everywhere there other than large cities. Now that I'm out West, it appears that it's hard to get a job in the city, but still pretty easy if you are willing to go somewhere rural, or even places I wouldn't exactly consider rural (smaller cities but that are several hours from the famous/really big cities).

 

[unimaginative]

As the number of med schools inflates beyond 30% increase over the last few years, we have been hearing a lot of nonsense about how there's a so-called projected physician shortage in the next few years. Stories like the one below illustrate why thats all BS: http://www.nytimes.com/2010/02/14/health/14robot.html?hpw If urologists were in shortage, they wouldnt be forced to cater to patients by offering robotic surgery. The fact that the traditional surgeons are at a competitive disadvantage proves that there is no urologist shortage. If there were, patients would be forced to pick whatever urologist was available instead of doctor shopping for the robot guys. There are dozen other stories just like this about doctors having to shop for patients. Pretty soon we'll be just like chiroprators--offering free chicken to people who stop by our booths at walmart for a "health screen." By 2015, the number of MDs graduating from medical schools will be 35% higher than it was in 2002. The USA does not have a doctor shortage--in fact we have a surplus which is part of the reason why healthcare costs are so high.

Your name and critical thinking skills don't jibe, my friend.

 

[kash_711]

sure some IMG's that complete residency go back to their respective countries but an increase in US grads won't fix the current physician shortage/physician distribution problem if the number of residency positions, or the specialties that indebted medical students choose does not change. You may argue that there may not really be a shortage, but your reasoning is nonsensical. BTW there is not a 30% increase in medical schools, but rather a projected 30% increase in graduates from newly opened medical schools and increased enrollments in current medical schools.

As the number of med schools inflates beyond 30% increase over the last few years, we have been hearing a lot of nonsense about how there's a so-called projected physician shortage in the next few years. Stories like the one below illustrate why thats all BS: http://www.nytimes.com/2010/02/14/health/14robot.html?hpw If urologists were in shortage, they wouldnt be forced to cater to patients by offering robotic surgery. The fact that the traditional surgeons are at a competitive disadvantage proves that there is no urologist shortage. If there were, patients would be forced to pick whatever urologist was available instead of doctor shopping for the robot guys. There are dozen other stories just like this about doctors having to shop for patients. Pretty soon we'll be just like chiroprators--offering free chicken to people who stop by our booths at walmart for a "health screen." By 2015, the number of MDs graduating from medical schools will be 35% higher than it was in 2002. The USA does not have a doctor shortage--in fact we have a surplus which is part of the reason why healthcare costs are so high.

 

[LawNonTrad]

BTW there is not a 30% increase in medical schools, but rather a projected 30% increase in graduates from newly opened medical schools and increased enrollments in current medical schools.

Maybe I suck at math but what's the practical difference? Or are you agreeing with me that there isn't one?

If you say that there are 100 people on average per graduating medical school class and there are currently 100 schools (just to keep the math as simple as possible, these are not accurate #'s), then you have 10,000 medical graduates a year. Increasing the number of graduates by 30% means that there will now be 13,000 medical graduates per year.

In the other scenario, using the same numbers (100 schools X 100 graduates/school), you end up with 10,000 again. Increasing the number of medical schools by 30%, assuming that the new medical schools have equivalent enrollment, would mean that there would be 130 schools X 100 graduates/school = 13,000.

It doesn't matter how they accomplish it, the principal effect of this will be to push IMGs/FMGs out of the match as more MDs get pushed down into primary care residencies.

 

[kash_711]

Maybe I suck at math but what's the practical difference? Or are you agreeing with me that there isn't one?

If you say that there are 100 people on average per graduating medical school class and there are currently 100 schools (just to keep the math as simple as possible, these are not accurate #'s), then you have 10,000 medical graduates a year. Increasing the number of graduates by 30% means that there will now be 13,000 medical graduates per year.

In the other scenario, using the same numbers (100 schools X 100 graduates/school), you end up with 10,000 again. Increasing the number of medical schools by 30%, assuming that the new medical schools have equivalent enrollment, would mean that there would be 130 schools X 100 graduates/school = 13,000.

It doesn't matter how they accomplish it, the principal effect of this will be to push IMGs/FMGs out of the match as more MDs get pushed down into primary care residencies.

there wouldn't be a significant difference in the math over time. Most inaugural medical school classes are significantly smaller, I just read about one school in New York that was accepting 50 students their first year. Just didn't want anyone to be confused and think that the number of US medical schools would jump from 130 to 160 or 170 because that is what the OP clearly stated.

 

[Socrates25]

Here's a list of new med schools from an old thread. Its already out of date, there are at least 2-3 more new schools that are in planning that have yet to be added.



NEW MEDICAL SCHOOLS/BRANCH CAMPUSES THAT HAVE OFFICIALLY OPENED

MD - University of Hawaii-Kakaako - 2006
DO - Touro/Las Vegas - 2005
DO - PCOM/Atlanta - 2005
MD - University of Miami/FAU joint program - 2004
MD - Cleveland Clinic/Lerner - 2004
DO - LECOM/Bradenton - 2004
MD - Florida State University - 2002
DO - VCOM - 2002
DO - Rocky Vista University COM - 2008 (first class being accepted now)

NEW MEDICAL SCHOOLS THAT WILL OPEN SOON

MD - Florida International Univ - 2008
MD - Univ Central Florida - 2008
MD - Touro/NJ - 2008
DO - Touro (Harlem NY) - 2008
DO - Pacific Northwest (Yakima WA) - 2007
MD - Michigan State University (Grand Rapids MI) - 2008
MD - University of Arizona (Phoenix AZ) - 2007
DO - AT Still University (Mesa AZ) - 2007
DO - Lincoln Memorial/Debusk (Harrogate TN) - 2007
DO - William Carey Univ (Hattiesburg, MS, http://www.wmcarey.edu/asp/viewpr.asp?item=430) - 2009
MD - Commonwealth/Scranton (Scranton, PA, http://physiciansnews.com/spotlight/1006.html)
MD - MCG-UGA/Athens (http://www.uga.edu/news/artman/publi...Building.shtml)


NEW MEDICAL SCHOOLS/BRANCH CAMPUSES THAT ARE IN PLANNING

MD - University of Cal Merced (Merced CA)
MD - University of Cal Riverside (Riverside CA)
MD - Texas Tech - El Paso (El Paso TX)
MD - OHSU (Eugene OR)
DO - MSUCOM (Detroit MI)
DO - Barry University (Miami FL)
MD - CUNY/Hunter College (NY, NY)
MD - Virginia Tech/Carilion (private, Roanoke VA) http://www.carilion.com/ContentStore...%20Release.pdf
MD/DO - Central Michigan University (http://www.mlive.com/news/sanews/ind...660.xml&coll=9)
MD - Oakland University (Michigan) http://www4.oakland.edu/view_news.aspx?sid=34&id=3803
MD/DO - St Thomas (St Paul MN) http://www.stthomas.edu/bulletin/new...ool5_11_07.cfm
MD - Touro New Jersey http://passaicnews.wordpress.com/200...in-2009-touro/
MD - Hofstra Univ (http://www.hofstra.edu/home/News/Pre...medschool.html)
MD - Mercer/Savannah (http://www2.mercer.edu/News/Articles...hMedSchool.htm)
DO - WesternU COM/Lebanon OR (http://www.gazettetimes.com/articles...1_hospital.txt)
MD - Univ Washington/Spokane (http://depts.washington.edu/mediarel/spokane1.html)
DO - LECOM, Greenburg PA, Seton Hill Univ (http://www.osteopathic.org/index.cfm?PageID=acc_predoc)
DO - MSUCOM, Clinton Township MI, Macomb College (http://www.osteopathic.org/index.cfm?PageID=acc_predoc)


Edit (6/05/06): BarryU in Miami recently announced plans for a new DO school
Edit (9/14/06): AT Still announced plans to join AOA application cycle
Edit (9/14/06): Lincoln/Debusk announced plans to join AOA application cycle
Edit (9/30/06): CUNY/Hunter announces plans for a new med school in next 5 years
Edit (1/07/07): VT/Carilion announce plans for first privately operated MD school, scheduled for 2010
Edit (04/22/07): CMU announces an initial exploration for a new med school
Edit (07/25/07): ST Thomas announces plans for new med school
Edit (07/28/07): Oakland Univ announces plans for new MD program
Edit (11/17/07): Touro announces plans for new DO program in NJ
Edit (11/27/07): William Carey Univ announces new DO program in MS
Edit (11/28/07): Hofstra Univ announces plans for new MD school (2010 projected start date)
Edit (11/29/07): Commonwealth/Scranton program added, accepting applicants in 2009
Edit (02/08/08): Mercer announces plans for new medical school branch in Savannah
Edit (02/09/08): Western COM announces plans for new DO school in Lebanon, Oregon
Edit (02/09/08): Univ Washington announces plans for new branch campus in Spokane
Edit (02/10/08): MCG and Univ of Georgia announces plans for a new MCG branch campus in Athens.
Edit (05/06/08): 2 new DO campus expansions in planning stages (LECOM Greenburg, MSUCOM Clinton)

Total count of new/expanding programs: 39
Estimated increase in number of graduates per year: 5500
% Increase in new grads per year above 2002 levels: 35%

 

[Socrates25]

Whenever you read these NY Times articles about med schools, notice how they ignore DO programs like they dont exist.

Its an outright falsehood that there were "no new medical schools in 25 years" according to the NY Times. DO programs have been expanding like wildfire since the 1970s. Even though there was a long period of no new MD programs, DO programs have doubled in the same time span.

 

[dragonfly99]

Overall, I think the expansion of medical schools (and med school positions) is a good thing. Before (and currently...) what we have is a system where we import thousands of foreign-trained docs every year just to fill up our residency positions. And we have a lot of qualified people who still get denied med school admission every year, not because all of them aren't qualified (some ARE) but because there just aren't enough spots in med school. It's relatively insane. Few (or no?) other country would do this. I'm not saying many of the foreign docs aren't good... a lot of them are super smart, or they wouldn't be able to pass USMLE in what (for many) isn't evey their native language. I'm just saying that from a public policy standpoint, what we have had in the past isn't a logical way of doing things. It is far more logical for us to train enough docs to fill up our residency positions (or at least nearly do so). And even if some of those US grads are "forced" into primary care, if the choice is between NEVER becoming a doctor, and doing a specialty that might not have been their first choice, I think that most would rather take a shot at being a doc. It's still a good occupation. I think about people I knew who couldn't get into med school (several years ago) and it makes me sad because I know that some would have made good physicians, as good as any of the foreign citizens we've been importing to fill up our residencies in IM, etc. for many years.

As long as these new schools are of good quality, I see nothing manacing (and in fact only good) coming from training some more docs in the US. I feel sure the AAMC isn't going to allow med schools to expand willy-nilly to produce a number of grad > number of internship positions available each year. I guess a potential problem could be if the DO schools expanded too rapidly, without enough attention paid to making sure all those grads have a residency to go to when they finish.

I also think that it would likely be prudent if we had a few more residency positions...it's always hard to do these calculations, but my general sense is that residents of today don't want to work the crazy hours that physicians in the 1960's-1980's worked. They/we don't mind hard work but also want time for family, etc. and many of the male docs now (as opposed to in the past) will have spouses who work and thus won't necessarily have a wife at home to take care of 98% of the domestic chores and child rearing. We might need a few more docs (per proportion of US population) than we did in the past due to that, plus our aging population.

 

[Gentle]

Definitely a good thing in my opinion.

Culture-wise and in several other aspects. The benefits of foreign grads are simply exaggerated.

What do you mean??

 

[thedrjojo]

Here's a list of new med schools from an old thread. Its already out of date, there are at least 2-3 more new schools that are in planning that have yet to be added.



NEW MEDICAL SCHOOLS/BRANCH CAMPUSES THAT HAVE OFFICIALLY OPENED

MD - University of Hawaii-Kakaako - 2006
DO - Touro/Las Vegas - 2005
DO - PCOM/Atlanta - 2005
MD - University of Miami/FAU joint program - 2004
MD - Cleveland Clinic/Lerner - 2004
DO - LECOM/Bradenton - 2004
MD - Florida State University - 2002
DO - VCOM - 2002
DO - Rocky Vista University COM - 2008 (first class being accepted now)

NEW MEDICAL SCHOOLS THAT WILL OPEN SOON

MD - Florida International Univ - 2008
MD - Univ Central Florida - 2008
MD - Touro/NJ - 2008
DO - Touro (Harlem NY) - 2008
DO - Pacific Northwest (Yakima WA) - 2007
MD - Michigan State University (Grand Rapids MI) - 2008
MD - University of Arizona (Phoenix AZ) - 2007
DO - AT Still University (Mesa AZ) - 2007
DO - Lincoln Memorial/Debusk (Harrogate TN) - 2007
DO - William Carey Univ (Hattiesburg, MS, http://www.wmcarey.edu/asp/viewpr.asp?item=430) - 2009
MD - Commonwealth/Scranton (Scranton, PA, http://physiciansnews.com/spotlight/1006.html)
MD - MCG-UGA/Athens (http://www.uga.edu/news/artman/publi...Building.shtml)


NEW MEDICAL SCHOOLS/BRANCH CAMPUSES THAT ARE IN PLANNING

MD - University of Cal Merced (Merced CA)
MD - University of Cal Riverside (Riverside CA)
MD - Texas Tech - El Paso (El Paso TX)
MD - OHSU (Eugene OR)
DO - MSUCOM (Detroit MI)
DO - Barry University (Miami FL)
MD - CUNY/Hunter College (NY, NY)
MD - Virginia Tech/Carilion (private, Roanoke VA) http://www.carilion.com/ContentStore...%20Release.pdf
MD/DO - Central Michigan University (http://www.mlive.com/news/sanews/ind...660.xml&coll=9)
MD - Oakland University (Michigan) http://www4.oakland.edu/view_news.aspx?sid=34&id=3803
MD/DO - St Thomas (St Paul MN) http://www.stthomas.edu/bulletin/new...ool5_11_07.cfm
MD - Touro New Jersey http://passaicnews.wordpress.com/200...in-2009-touro/
MD - Hofstra Univ (http://www.hofstra.edu/home/News/Pre...medschool.html)
MD - Mercer/Savannah (http://www2.mercer.edu/News/Articles...hMedSchool.htm)
DO - WesternU COM/Lebanon OR (http://www.gazettetimes.com/articles...1_hospital.txt)
MD - Univ Washington/Spokane (http://depts.washington.edu/mediarel/spokane1.html)
DO - LECOM, Greenburg PA, Seton Hill Univ (http://www.osteopathic.org/index.cfm?PageID=acc_predoc)
DO - MSUCOM, Clinton Township MI, Macomb College (http://www.osteopathic.org/index.cfm?PageID=acc_predoc)


Edit (6/05/06): BarryU in Miami recently announced plans for a new DO school
Edit (9/14/06): AT Still announced plans to join AOA application cycle
Edit (9/14/06): Lincoln/Debusk announced plans to join AOA application cycle
Edit (9/30/06): CUNY/Hunter announces plans for a new med school in next 5 years
Edit (1/07/07): VT/Carilion announce plans for first privately operated MD school, scheduled for 2010
Edit (04/22/07): CMU announces an initial exploration for a new med school
Edit (07/25/07): ST Thomas announces plans for new med school
Edit (07/28/07): Oakland Univ announces plans for new MD program
Edit (11/17/07): Touro announces plans for new DO program in NJ
Edit (11/27/07): William Carey Univ announces new DO program in MS
Edit (11/28/07): Hofstra Univ announces plans for new MD school (2010 projected start date)
Edit (11/29/07): Commonwealth/Scranton program added, accepting applicants in 2009
Edit (02/08/08): Mercer announces plans for new medical school branch in Savannah
Edit (02/09/08): Western COM announces plans for new DO school in Lebanon, Oregon
Edit (02/09/08): Univ Washington announces plans for new branch campus in Spokane
Edit (02/10/08): MCG and Univ of Georgia announces plans for a new MCG branch campus in Athens.
Edit (05/06/08): 2 new DO campus expansions in planning stages (LECOM Greenburg, MSUCOM Clinton)

Total count of new/expanding programs: 39
Estimated increase in number of graduates per year: 5500
% Increase in new grads per year above 2002 levels: 35%

Touro New Jersey is, I believe, officially dead. Rowan University in NJ is in the works for making a medical school in new jersey, and this time actually working with, instead of stealing administrators from, UMDNJ, so might actually get off the ground.