Doctors are keeping premeds down

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Mutterkuchen

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A fundamental problem for premedical students is the issue of collusion within the AAMC and other medical organizations to regulate the number of doctors in the US. Simply put there should be more medical student positions in the United States if a large number of students want to be doctors. I am not suggesting getting rid of admission standards, but right now they are too high given the number of people that apply to medical school.

If people were able to get in in a less competitive environment in the 1970s and 1980s and still made good doctors adding more medical student positions will still create a high level of doctor compentency.

The problem is that current doctors want to regulate the number of new students to keep a slight doctor shortage. This keeps salaries up. Case in point. . . Radiology. If Radiology is so competitive because of its high salary and good lifestyle, why not have more radiology residencies? If so many people want to do it, we should let them. If it drives salaries down so be it.

But this will not happen because current radiologists will not let it. They want their high salaries.

We need more medical school positions in the nation. If qualified people want to be doctors we should let them.
 
Ah, but then being a doctor would be like being a lawyer - yes there are tons of them, but they are NOT guaranteed a decent job unless they attend a top school. (of course health insurance plays a large role in this also)

One of the beautiful things about being a doctor, in terms of career choices, is that a doctor will never be involuntarily unemployed.
 
Pardon me if I am mistaken, but the reason medical school requirements have remained so stringent in the past ten years is because we remain in a doctor surplus. There are too many doctors right now. While this is a point of contention, the data (collected at my undergrad university over the last 20 years) show that while the number of applicants has fluctuated, the number of matriculants remains the same. This is due to a steady need for doctors, but no more, and maybe less than the 15K-16K a year that are produced. While there remains a shortage of primary care physicians (caused by the need for an increasing number of them by HMO/PPO healthcare and underserved areas), there remains a glut of specialists. My point is that not only is there a prestige factor here pointed out by Ybee, but more importantly there is an economic factor. There is already a high supply of doctors, and an equally high demand. Unless demand goes up, we will not see a call for more physicians (ie, less stringest requirements to get more people into medical school). As it is there are more than 2 applicants for every spot in medical school. If less people apply it might be easier, but there have been studies that at the low point of recession, applications to medical school go up. Now is probably the best time to apply in the last 5 years. I would predict that the number of applicants will start to rise again soon, making admission even harder. In the '70's less people applied, so it was easier to pick 15K-16K from a pool of 20K than from the present 35K.
 
I think doctors will always have jobs available for them. People will ALWAYS be getting sick, being born, and dying. A machine can't do this stuff, doctors do. And as far as having too many doctors: there are shortages of them right now in tons of areas, so I don't think we'll have a surplus anytime soon.

(oh and as long as the ones who dish out pain meds like candy keep getting caught, it opens up spaces for the moral ones to practice)
 
sure there's a shortage -- but in poor neighborhoods and in the country. otherwise, there are just enough doctors around. and imo, there are just enough med school/residency positions

ybee makes a good point about lawyers. you know how tough it is to get a job if you didn't go to very very good law school?

the same thing can be said for dentists -- for example, in the los angeles area, there's a huge oversupply of dentists. you practically have to beg for patients.
 
Let's assume that their is a slight surplus (I don't necessarily agree). What difference does it make? If there are too many dentists in LA, then some of them should move elsewhere. I fail to see the reason that if you are are qualifed to go to medical school and are willing to make the sacrifices to be a doctor, you should not be permitted to do so.

And what makes derm and rad such highly paid doctor specialities? If qualified applicants want to do it, why not let them. If the salary goes down accordingly, so be it.

Regarding the "surplus" of doctors. . . Does anyone know of a doctor that is unemployed, or has spent a significant amount of time unemployes? I don't know any doctor without a job.
 
JBJ, I am not an expert on the subject, so I turned to the AAMC for help. The following is a newsletter Q and A between AAMC and School of Medicine deans. It sheds some light on our exact question.
The question presented:
Should the number of U.S. medical students be increased?

No. We are suffering from a misdistribution of physicians, not an undersupply. Increasing the absolute number of physicians is unlikely to improve matters, and may actually be bad for the profession. We should be taking better care of the physicians currently in practice (less paperwork, greater job satisfaction, etc.) and rewarding those willing to work in underserved areas with better pay and improved lifestyles.

Richard Rathe, M.D.
Associate Dean for Information Technology
University of Florida College of Medicine

Yes, for two reasons: to increase diversity among the student population, and to increase the number of U.S. citizens in the internship and residency pools of teaching hospitals and/or academic health centers.

Thomas E. Smith, Ph.D.
Professor, Biochemistry and Molecular Biology
Howard University College of Medicine

No. The physician surplus is real. Surplus causes dilution of talent. We need to better design our physician manpower training so that we produce the physicians we need.

Joseph E. Scherger, M.D., M.P.H.
Associate Dean for Primary Care
University of California, Irvine College of Medicine

We are failing to educate general practitioners who can effectively deal with the simple, common problems of all organ systems in patients of all ages. Enlarging the pool of today's graduates will only continue to fractionalize care and perpetuate high costs.

Eric Radin, M.D.
Professor of Orthopedic Surgery
Tufts University School of Medicine

I just returned from a visit to my alma mater in Canada, where a projected surplus of physicians has translated into a shortage. My advice is to try to learn some lessons from the experiences of our neighbors to the north.

John R. Wright, M.D.
Dean, School of Medicine and Biomedical Sciences
State University of New York at Buffalo
Increasing the output of U.S. medical schools will not solve distribution inequities. The supply problem is not caused by the number of physicians, but by where and what they practice. Since the 1970s, there have been attempts to change the criteria for the selection and admission of medical students to attract those that might be more likely to work in underserved communities. However, the distribution of physicians continues to be based on personal amenities and life choices, rather than need or demand. In addition, the high cost of medical education has deterred physicians from primary care practice, particularly in underserved areas.

Lewis Lefkowitz Jr., M.D.
Vanderbilt University School of Medicine

Definitely not, unless we can find a new way of financing medical education and a new pool of applicants. I believe that we are stretching the entrance criteria at some schools already, and financing issues for both undergraduate and post-graduate medical education are growing by the day.

Allen B. Rawitch, Ph.D.
Vice Chancellor, Academic Affairs Dean, Graduate Affairs University of Kansas Medical Center

As it has been for many years, it is more the distribution than the numbers, too many "fat cat" cardiologists and orthopedists and too few primary care doctors. I suggest we limit the number of residency slots and fellowships, as is done in England, and give tuition reimbursement to doctors who settle in underserved areas.

Gordon Walbroehl, M.D.
Professor, Family Medicine
Wright State University

Increasing the number of students in our medical schools would help fill U.S. residencies with U.S. graduates, thereby increasing the opportunity in medicine for U.S. citizens. Since medical education is so heavily subsidized by taxpayers, maximizing the opportunity in medicine for their children only seems right. It would also help stem the drain of top talent from the developing world to U.S. residencies and practice, potentially helping those countries improve their health care systems.

Mark Albanese, Ph.D.
Professor, Preventive Medicine
University of Wisconsin Medical School

Next month's question: Is the decline in medical school applicants cause for concern?

Please send your responses (75 words or fewer) to [email protected] or fax to (202) 828-1123. Responses must be received by October 13 for consideration, and may be edited for length and clarity. Also, please include your title, institution, and any academic degrees. Select answers will be printed in the September edition of the AAMC Reporter.

So now you can see both sides of the argument from 'experts'.

It can be found at this website:
<a href="http://www.aamc.org/newsroom/reporter/oct2000/respond.htm" target="_blank">http://www.aamc.org/newsroom/reporter/oct2000/respond.htm</a>
 
It seems interesting to me that the MDs in this study seem to say that they do not support increasing the number of med student slots and the non-MDs (Ph.D.s) seem to support producing more doctors.
 
A lot of long term forcasts are seeing that we may indead not have enough physicians.

I think the real problem is that we train about 25,000 residents a year and about 17,000 medical students in the U.S. We could easily increase the medical school slots by thousands to meet the current demand for residents and that would mean more US grads would have to do Medicine, more primary care to meet the demand. This won't happen though, it's extremely expensive and time consuming to open up a medical school although I hear there are a couple more DO schools opening up.

I don't think it's that competitive though. There's about 17000 slots for 35000 applicants this year so you have a 50% shot of getting in. That's not too bad. Even in 1996 when there were 46000 applicants the odds aren't terrible. It's stressful and of course half won't get in, I think it should be that competitive.

As for increasing the number of Radiology slots. Believe me, Program Directors would love to do it. The problem is the funding. It's expensive to train a resident and Medicare is enforcing their quotas on a particular training hospital. This means that a certain hospital gets funding for say 140 new residents a year. So in order to train more radiologists, you'd have to cut back on another specialty or the alternative is that the hospital could fund the additional resident themselves without any funding from Medicare and with the financial status of most hospitals currently, this doesn't happen. A lot of residency programs have been approved to train more residents, many more but there is no funding for them. Also, who do you think the hospital would rather have, an internal medicine resident that fills the beds in the hospital or a radiology resident that...hmm, do they generate any income for the hospital? Nope.

I think we need more physicians as well and we'll probably need many more as the population ages, more technology comes into play.
 
here are my two questions: if there are enough doctors in primary care in the suburbs...then why can't i get a physical without waiting like 2 months. and if there are too many specialists...then why are they paid so much? you mean specialists surplus compared to primary care shortage? i'm confused.
also, the more we know about the body, aren't specialists in more and more demand? also aren't specialists the ones that do a good amount of the research that trickles down to people seeing primary care physicians. i mean, how many primary care people do research? i don't think alot. i could be wrong. enlighten me!
 
Just wanted to make a comment on the radiology issue. About 3-4 years ago, there were over 1000 radiology spots. However, with the conventional wisdom being that there were too many radiologists out there, no one was applying. The number of positions was cut to the current number, which is around 900. So, its not radiologists limiting these spots. By the way, the number is increasing and is said to be about 940 per year as opposed to 890 this year. There is now additional funding and I predict even more residency postitions in the future.

In addition to all of this, the vast majority of current radiologists have absolutely no input on the number of residents. The only people that do are those at academic centers, where the income is 1/3 of private practice and has barely increased at all despite the recent boom.

So, please do not make comments without actual information to back them up JBJ.
 
I think increasing the absolute numbers of physicians WILL solve the distribution inequities. Assuming there is a relatively constant demand for medical services, then a surplus of doctors in the suburbs or well-serviced areas will lead to lower average incomes for physicians in these areas. Doctors who wish to maintain a high income level will then be forced, by economic factors, to practice in underserviced areas. So increasing the physician supply will exacerbate the surplus initially, but evetually even out the distribution when income-conscious physicians discover more lucrative practices are possible in underserviced areas. Therefore the cynical view of why these doctors oppose increasing the supply of doctors is so that they can continue to work in "good" areas like the suburbs while maintaining a high level of income.
 
There is obviously a disconnect between medical education and graduate medical education (GME i.e. residencies).

We decline thousands of qualified applicants to med school, and instead take in thousands of foreign grads.

FMGs initially do go to underserved areas for their residencies to get a foothold in the US. However, after that initial residency training, they are just as likely to go off to the big city to get the "cushier" physician jobs.

Residency slots are a cash cow for hospitals. Medicare funds each resident position at $100,000 per year, which is more than enough to cover the hospital's cost for training residents. Most hospitals use the surplus gained from these funds to support indigent patients and other activities which have no direct link to resident education costs. It is in the hospital's best interest financially to beg Medicare and the other oversight authorities to grant funding for more residency slots. Thats why residency slots have increased at a MUCH higher rate than the population growth, with most of this growth occurring in the early 80s to the mid 90s.

At this point in time, the data is inconclusive regarding doctor surplus as a whole. Clearly there are rural areas which have always been underserved and probably always will be unless there is some sort of nationalized scheme which removes residency choice from the equation. FMGs have obviously not solved the problem. The FMG population has increased by over 170% the last 30 years yet the population still regarded as underserved has increased, even when adjusted for population growth. Of course, opening more med schools probably wont help, at least initially.

I agree with one of the people on the list who said that there should be more incentives given to people to relocate to underserved areas.
 
I'd just like to add something..I'm unsure if it's even relevant to this long discussion about a surplus/grade correlation..whatever..

Just because you have superior grades does not make a physician. Great physicians are made that way not because they had perfect undergrad grades, but because they applied themselves to their craft with a kindness and sensitivity. (Yes, HMO's aren't an excuse to be a jerk, no matter how you look at it.) I think many forget sick people are in a very weak position and we must be kind.

I have met many physicians in my time. The one that stood out was not the cardiac surgeon or anyone else. It was the kind doctor who treated me with respect, kindness and empathy. HE was a great doctor. THAT is who the patients remember...and that is who I will always admire.

Patients do not care about undergrad grades..they care how they are treated, not medically, but emotionally. (FWIW, they don't choose a physician on basis of where they went to school either. They don't so "Wow, that guy went to School XXX. I'm going to him." )

I think medical schools should stick interviewees in a room with some other people, maybe the disabled, some children etc. with a hidden camera. Choose by who has the most sympathy and caring for them. Those would be the ones accepted..not some bookworm with perfect grades.

Onto the doctor surplus..I don't know.
 
I have a question about the "oversupply" of doctors - why don't doctors cut their own supply? I know most doctors work 60 hours a week or so, why not cut this to 40? Personally, I think a lot of doctors work to many hours and not enjoy some of the fine things in life. Once a person is a physician, there is more to life than being a physician......
 
dukeblue01 said:
Pardon me if I am mistaken, but the reason medical school requirements have remained so stringent in the past ten years is because we remain in a doctor surplus. There are too many doctors right now. While this is a point of contention, the data (collected at my undergrad university over the last 20 years) show that while the number of applicants has fluctuated, the number of matriculants remains the same. This is due to a steady need for doctors, but no more, and maybe less than the 15K-16K a year that are produced. While there remains a shortage of primary care physicians (caused by the need for an increasing number of them by HMO/PPO healthcare and underserved areas), there remains a glut of specialists. My point is that not only is there a prestige factor here pointed out by Ybee, but more importantly there is an economic factor. There is already a high supply of doctors, and an equally high demand. Unless demand goes up, we will not see a call for more physicians (ie, less stringest requirements to get more people into medical school). As it is there are more than 2 applicants for every spot in medical school. If less people apply it might be easier, but there have been studies that at the low point of recession, applications to medical school go up. Now is probably the best time to apply in the last 5 years. I would predict that the number of applicants will start to rise again soon, making admission even harder. In the '70's less people applied, so it was easier to pick 15K-16K from a pool of 20K than from the present 35K.
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If we have a surplus of doctors, they why are we accepting so many foriegn meds for residency and then jobs?

Much like anything else, it is about supply and demand. If there are too many docs for demand, then salaries and jobs will be lost.

And working less hours with more docs doesnt solve the problem since the distribution of doctors is skewed and a doc has to cover for their patients on rotation.
 
the only way to fix the misdistribution is to make being a primary care/underserved physician more lucrative, and maybe the fat cat jobs a little less lucrative. any other remedy won't work. but of course, with our healthcare system, that will never happen.
 
Mutterkuchen said:
A fundamental problem for premedical students is the issue of collusion within the AAMC and other medical organizations to regulate the number of doctors in the US.
Click to expand...

Oh ho, wrong wrong wrong, wrong wrong, wrong wrong wrong wrong wrong.

The fact that the AAMC can work with congress to regulate the number of residency positions that are funded (and hence indirectly regulate the number of medical school positions) is perhaps one of the nicer aspects of a career in medicine. Name another field in which you can control your numbers so effectively.

You claim that it promotes job security and keeps salaries from dropping? Well...yeah! I think you're right. And I think we should keep doing it because it promotes job security and keeps salaries high.

Furthermore we have to do it this way. Residency programs are expensive and the taxpayers foot the bill. Hence, its only fair that congress approve the number of positions funded, and its only fair that the AAMC not overestimate the demand for physicians.

I don't know why you would oppose a policy that gives physicians such great job security and is so fiscally responsible for the American taxpayer...but I guess it's stressful not knowing if you're going to get in this year! This fall when you start as an M1, I predict your position will promptly reverse 😉 Good luck!
 
Mutterkuchen said:
Regarding the "surplus" of doctors. . . Does anyone know of a doctor that is unemployed, or has spent a significant amount of time unemployes? I don't know any doctor without a job.
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I know, the AAMC do a good job don't they?
 
velo said:
...but I guess it's stressful not knowing if you're going to get in this year! This fall when you start as an M1, I predict your position will promptly reverse 😉 Good luck!
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My thoughts exactly. Just wait until all those student loans build up. You will be dependent on that job security and high salary.
 
snowballz said:
I'd just like to add something..I'm unsure if it's even relevant to this long discussion about a surplus/grade correlation..whatever..

Just because you have superior grades does not make a physician. Great physicians are made that way not because they had perfect undergrad grades, but because they applied themselves to their craft with a kindness and sensitivity. (Yes, HMO's aren't an excuse to be a jerk, no matter how you look at it.) I think many forget sick people are in a very weak position and we must be kind.

I have met many physicians in my time. The one that stood out was not the cardiac surgeon or anyone else. It was the kind doctor who treated me with respect, kindness and empathy. HE was a great doctor. THAT is who the patients remember...and that is who I will always admire.
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so you would rather have a compassionate idiot diagnose your illnesses rather than a stoic but proficient expert?
 
snowballz said:
Just because you have superior grades does not make a physician. Great physicians are made that way not because they had perfect undergrad grades, but because they applied themselves to their craft with a kindness and sensitivity. .
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Compassion is an excellent trait in a physician, but it certainly does not excuse poor performance in school. If I want someone compassionate to diagnose my illnesses, I'll go talk to my mom, or maybe my barber. I want someone who knows what they're talking about, and reducing the academic requirements for medical school is definitely not the way to manufacture such physicians.
 
_ian said:
Compassion is an excellent trait in a physician, but it certainly does not excuse poor performance in school. If I want someone compassionate to diagnose my illnesses, I'll go talk to my mom, or maybe my barber. I want someone who knows what they're talking about, and reducing the academic requirements for medical school is definitely not the way to manufacture such physicians.
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i totally agree. when you are a patient in a pretty desperate situation, it's nice if your doctor treats you as a person, but you care a whole lot more about whether or not he/she will be able to heal you. obviously kindness and compassion are nice, but competency is much more impt.

anyway, as far as i can tell, med schools take the whole "compassion" thing into account. just because it's harder to get into med schools doesn't mean that only the mean people with great stats will get in. i know a lot of ppl w/ lower stats who will evidently make great doctors who were accepted to schools over a$$holes with higher numbers. scores can be pretty important indicators sometimes, but they're definitely not the only factors med schools appear to use to assess prospective students' future performances as doctors.
 
Duchess742 said:
i totally agree. when you are a patient in a pretty desperate situation, it's nice if your doctor treats you as a person, but you care a whole lot more about whether or not he/she will be able to heal you. obviously kindness and compassion are nice, but competency is much more impt.
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House, MD suckahs.
 
Duchess742 said:
i totally agree. when you are a patient in a pretty desperate situation, it's nice if your doctor treats you as a person, but you care a whole lot more about whether or not he/she will be able to heal you. obviously kindness and compassion are nice, but competency is much more impt.
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Its tempting to think that, but polls actually show the opposite. There was a article on CNN a few months ago and the results were basically that while patients like to watch House, they don't want a House-like doctor taking care of them.

Every older doc who's been around for a while has told me, basically, the same thing. Patient's will rank you on the three A's. Availablity, Affability, and Ability...in that order. They want to be able to see their doctor when they need to, they want him to be agreeable, and they want him to be competent.

You can argue, as I would, that reason #3 (ability) would rank higher if admissions standards were lowered. In general, most physicians are perfectly competent, and differences in sheer ability will be too subtle for a patient to pick up on unless its a very hard diagnosis, complicated case, or complex surgery. Thus the patients judge more on convenience and personality. If standards were lowered the the point that competency became an issue, I'm sure patient's would pay a bit more attention to #3.
 
There is a definite shortage of doctors.

1) We have more residencies than graduating medical students.

This is of questionable ethics for two reasons. One, we deny many qualified applicants from entering a medical school that are grown in the US. Two, it's a brain drain on other countries. While I appreciate many people from India, China, Russia, Southeast Asia, Europe and elsewhere would like to work in the USA, I'm pretty sure that there are many people, especially in the 3rd world, that would prefer to have their doctors stay in their country to serve their populations instead of going to the US. I am not sure how we can uphold ourselves as healers if our actions to heal our own population leads to further sickness and injury elsewhere in the world.

2) Demand in the US is increasing due to the increasing number of uninsured people and the looming retirement of the baby boomer generation.

The USA has nearly 40 million uninsured Americans and an increasing elder population. As they fail to get preventative health care in time, in part due to a lower number of doctors, the costs to our government and society grow exponentially. Untreated diabetes then becomes leg amputations and blindess.
 
I have a great idea to make the distribution of doctors even in all areas. The "higher ups" should make all the residency spots everywhere even. Meaning the same number everywhere. They could force the med students to take certain specialties. Then, to top it all off, make everyone's salary the same, say 200k a year. After that's done, everything will be the same and noone can complain about unfairness. Sometimes, I even amaze myself. 😀
 
MirrorTodd said:
I have a great idea to make the distribution of doctors even in all areas. The "higher ups" should make all the residency spots everywhere even. Meaning the same number everywhere. They could force the med students to take certain specialties. Then, to top it all off, make everyone's salary the same, say 200k a year. After that's done, everything will be the same and noone can complain about unfairness. Sometimes, I even amaze myself. 😀
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I like the current system. As others have said it's a distribution and not a quantity problem.
 
velo said:
Oh ho, wrong wrong wrong, wrong wrong, wrong wrong wrong wrong wrong.

The fact that the AAMC can work with congress to regulate the number of residency positions that are funded (and hence indirectly regulate the number of medical school positions) is perhaps one of the nicer aspects of a career in medicine. Name another field in which you can control your numbers so effectively.

You claim that it promotes job security and keeps salaries from dropping? Well...yeah! I think you're right. And I think we should keep doing it because it promotes job security and keeps salaries high.

Furthermore we have to do it this way. Residency programs are expensive and the taxpayers foot the bill. Hence, its only fair that congress approve the number of positions funded, and its only fair that the AAMC not overestimate the demand for physicians.

I don't know why you would oppose a policy that gives physicians such great job security and is so fiscally responsible for the American taxpayer...but I guess it's stressful not knowing if you're going to get in this year! This fall when you start as an M1, I predict your position will promptly reverse 😉 Good luck!
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The voice of reason speaks... I agree with you Velo.
 
hmmm..."manufacture such physicians"..sounds like doctors are like mass-produced robots that need the proper parts assembled....
 
Mutterkuchen said:
A fundamental problem for premedical students is the issue of collusion within the AAMC and other medical organizations to regulate the number of doctors in the US. Simply put there should be more medical student positions in the United States if a large number of students want to be doctors. I am not suggesting getting rid of admission standards, but right now they are too high given the number of people that apply to medical school.

If people were able to get in in a less competitive environment in the 1970s and 1980s and still made good doctors adding more medical student positions will still create a high level of doctor compentency.

The problem is that current doctors want to regulate the number of new students to keep a slight doctor shortage. This keeps salaries up. Case in point. . . Radiology. If Radiology is so competitive because of its high salary and good lifestyle, why not have more radiology residencies? If so many people want to do it, we should let them. If it drives salaries down so be it.

But this will not happen because current radiologists will not let it. They want their high salaries.

We need more medical school positions in the nation. If qualified people want to be doctors we should let them.
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Be thankful that you're in America. It's 10x harder for Canadians to get in.
 
Anyone that thinks that an increase in U.S. med students will prevent IMGs/FMGs from trying to get residencies here is ignorant. And if said IMGs/FMGs are better qualified for the residency spots than this new influx of med students, what are you going to do then? Your problem still exists.
 
leviathan said:
Be thankful that you're in America. It's 10x harder for Canadians to get in.
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Sadly this is so true 🙁

Especially if you're from Ontario like me! People here talk about how California is bad, I tell them, look at Ontario's GPA.....
 
BlazerMed said:
Anyone that thinks that an increase in U.S. med students will prevent IMGs/FMGs from trying to get residencies here is ignorant. And if said IMGs/FMGs are better qualified for the residency spots than this new influx of med students, what are you going to do then? Your problem still exists.
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Also keep in mind that FMG's can be U.S. citizens (probably a small percentage), too, but for one reason or another, had to go to med school in a foreign institution.
 
BlazerMed said:
Anyone that thinks that an increase in U.S. med students will prevent IMGs/FMGs from trying to get residencies here is ignorant.
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It wouldn't prevent them from trying, but it would certainly make it more difficult. Not that I care, I'm just pointing out that almost ALL programs take US grads over FMGs.

As far as this whole issue goes, I really HOPE we hit a shortage at some point soon. Reimbursements are declining while the patient population is increasing, insurances are ruling with an iron fist, and graduating physicians are going any direction they can other than primary care. So let's create a situation where people say, "Hold on, this isn't right" and for once are willing to stick up for doctors rather than their pocketbooks. Let's see what happens when getting in with your PCP is as difficult as getting in with your dermatologist.
 
socuteMD said:
As far as this whole issue goes, I really HOPE we hit a shortage at some point soon. Reimbursements are declining while the patient population is increasing, insurances are ruling with an iron fist, and graduating physicians are going any direction they can other than primary care. So let's create a situation where people say, "Hold on, this isn't right" and for once are willing to stick up for doctors rather than their pocketbooks. Let's see what happens when getting in with your PCP is as difficult as getting in with your dermatologist.
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I wouldn't go so far as to hope for a shortage, that's unfair to the patient population... it's not their fault that medicare and insurance companies are dropping reimbursement rates. Of course, I know of no other way to get the point across.

As far as US grads over FMGs, you can say that now, but would it remain the same if the expansion of med schools leads to inferior residency applicants?
 
MirrorTodd said:
I have a great idea to make the distribution of doctors even in all areas. The "higher ups" should make all the residency spots everywhere even. Meaning the same number everywhere. They could force the med students to take certain specialties. Then, to top it all off, make everyone's salary the same, say 200k a year. After that's done, everything will be the same and noone can complain about unfairness. Sometimes, I even amaze myself. 😀
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Hey jackass, "your" idea sucks!!!!! It's called communism. This is a free market economy. America is a great place because our government doesn't pull $hit like this. If you want this wonderful idea of yours to go into effect, go on line, buy a time machine like uncle Rico and take yourself back to the U.S.S.R. circa '82. Hopefully you can get your oh-so-fair position for the same salary as everyone else somewhere in in east Siberia. Then you won't be able to to "complain about unfairness."
 
Residencies get funded. Lose residency lose money. Much of the graduate medical system is a bureaucracy. Can you think of a department in a medical shcool or residency that people say, "We have some money left over in our budget this year, lets save it". No, they are encouraged to spend and hire more people. Can you imagine doing that with your private business or personal budget? Also, they must fill slots to maintain a work force. So less attactive residencies get FMGs to fill slots.

Do you really want to compete to get in to medical school and then be told that the classic medical education process of train, choose, match, and work is no good. Its primary care or nothing for you. Primary care is great, but our system has not evolved to work that way.

Considering all that, wouldn't it be better to just meet the standards for admission instead of changing the entire system for your personal gain? 😉
 
drvechman said:
Hey jackass, "your" idea sucks!!!!! It's called communism. This is a free market economy. America is a great place because our government doesn't pull $hit like this. If you want this wonderful idea of yours to go into effect, go on line, buy a time machine like uncle Rico and take yourself back to the U.S.S.R. circa '82. Hopefully you can get your oh-so-fair position for the same salary as everyone else somewhere in in east Siberia. Then you won't be able to to "complain about unfairness."
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It was sarcasm, Bro. Calm down. You could not have honestly believed that I thought that idea up myself. BTW who's Uncle Rico?
 
Lotta good stuff on this thread, and an excellent topic for discussion. Don't turn it into a fight that the moderators have to shut down.

I'm not well educated on Dr. shortages vs. surpluses. If we do have a surplus, I think that it's pretty cool to be in a field where everyone is still more or less guaranteed to make 6 figures... A friend of mine who is a CRNA is always talking about the looming surplus of Anesthesiologists, meanwhile the gas docs he works with are buying new Beemers and vacationing in the South of France.

The problem with just increasing spots has been hinted at. The real shortage is in rural areas. Magically increasing the number of doctors doesn't magically make those Drs all want to be Family Practioners/Internists/Pediatricians out in Western North Dakota. You admit some kid from college who writes a PS about wanting to serve the underserved population then he decides that Ortho is really sweet and he'd rather do total knees in a big city than manage BP out on the farm. These types of things happen, and no offense meant to Ortho, it's a sweet field.

I know that some people have to wait a while to see a doc but I would guess that even in small cities this is pretty rare (data anyone?)...
 
velo said:
You claim that it promotes job security and keeps salaries from dropping? Well...yeah! I think you're right. And I think we should keep doing it because it promotes job security and keeps salaries high.
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👍 👍 👍
 
Mutterkuchen said:
A fundamental problem for premedical students is the issue of collusion within the AAMC and other medical organizations to regulate the number of doctors in the US. Simply put there should be more medical student positions in the United States if a large number of students want to be doctors. I am not suggesting getting rid of admission standards, but right now they are too high given the number of people that apply to medical school.

If people were able to get in in a less competitive environment in the 1970s and 1980s and still made good doctors adding more medical student positions will still create a high level of doctor compentency.

.
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I disagree with a couple of notions in your post. First, you suggest that the doctors of the 70s and 80s were good, but perhaps this level of adequacy is not the ideal to strive for. There have been huge changes in medicine and medical school admissions (particularly the move away from the traditional student Bio major cookie cutter admittee), and these changes don't appear to be going anywhere anytime soon, suggesting that they have been positively received. Second, you seem to think that you can just admit thousands more applicants and they can be absorbed someplace. The training in the 70's and 80's was actually less diluted than it is now, where there are more medical schools and bigger classes. Most med schools do not have the infrastructure to take in more than another 10-20 students at most -- classroom size, number of professors, number of cadavers, etc. are huge limiting factors. An overcrowded medical school is a bad medical school. And that is not to mention the fact that residency slots would have to be adjusted and funded accordingly too.
As to the poster who suggested a surplus of physicians, it should be noted that if this were truly the case, then no caribbean trained physicians would ever get residencies. That is not the case. Thus US trained physicians do not meet US needs, hence a shortage by definition. But bear in mind that certain parts of the country face gluts as lots of people don't want to go to the underserved communities where a lot of these offshore trained physicians find slots.
 
Yaaaay 2002. Let's hear it for invading Afghanistan and declaring the Axis of Evil!...Who thinks Iraq is gonna be next? And how about that Enron mess, molesting Catholic priests, and sniper attacks?! Jeez what a whack year. 🙄

But seriously this thread is from 2002, guys...two thousand two...just listen to how nicely that rolls off the tongue. Congrats to whoever managed to dig this sucker out of the grave...It makes me feel like an archaeologist! *cue Indiana Jones theme*
 
Really?!?! Holy crap he's right. Goddamn you Orbital Bebop! what's your problem?!?!



<--------sucker
 
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