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This was one of the most poorly researched articles I've ever read in a major newspaper. LA Times has really become a dumpster fire of a newspaper with all the cuts. Not many major players left that still write with journalistic integrity.

Actual quotes from the article:
"I wasn’t even aware of this issue until I stopped by a CVS MinuteClinic the other day to get my annual flu shot" (no experience, no expertise on topic)
"Many medical issues don’t require the expertise of a physician." (No citation, dangerous platitude)

There aren't many outlets that cover health news well. NPR (nationally, not the local stations as much) is particularly atrocious. At least the LA Times has guys like Matt Pearce who's a great national reporter for other current events.
 
Where the hell is our national public campaign ?
 
Even in cities with medical schools the wait time for a physical can be as long as 8 or 9 months. Try to see a dermatologist. The medical establishment of the U.S. has succeeded admirably in creating an artificial shortage of physicians and now the rest of society is looking for alternatives. The use of NPs to diagnose people is a perfect example.

All of you know talented people who didn't get medical school for B.S. reasons like insufficient volunteering, a ticket for minor in possession or some other nonsense. Others didn't get in because they were residents of states like New Hampshire or Rhode Island which give medical education zero support. There were others who got in but didn't want to go $600,000 in debt at Tufts, BU or Michigan State (as a non-resident). Others didn't want to wait until their mid 30s to have kids. Others didn't know what a D.O. is.

Medical education could and should be much cheaper. The first two years are largely rote memorization and students rely on power points, outlines and streaming video to pass standardized tests. Why are 170 medical schools reinventing these wheels every year? Why are medical students subsidizing policy analysts, care for the indigent and unfunded researchers? Why are medical students paying dozens of people, with content free education degrees, for reading personal statements in admissions offices when the folks at BU couldn't figure out who would be the Craigslist killer? Why are almost all pediatric fellowships three years long? Why doesn't anybody know how to design an efficient residency program and why doesn't anyone know what that costs after adjusting for the slave labor supplied by residents?

You can carp about the AANP but the real culprits are the AMA, the AAMC, the LCME, the AOA, and the ACGME.
 
Even in cities with medical schools the wait time for a physical can be as long as 8 or 9 months. Try to see a dermatologist. The medical establishment of the U.S. has succeeded admirably in creating an artificial shortage of physicians and now the rest of society is looking for alternatives. The use of NPs to diagnose people is a perfect example.

All of you know talented people who didn't get medical school for B.S. reasons like insufficient volunteering, a ticket for minor in possession or some other nonsense. Others didn't get in because they were residents of states like New Hampshire or Rhode Island which give medical education zero support. There were others who got in but didn't want to go $600,000 in debt at Tufts, BU or Michigan State (as a non-resident). Others didn't want to wait until their mid 30s to have kids. Others didn't know what a D.O. is.

Medical education could and should be much cheaper. The first two years are largely rote memorization and students rely on power points, outlines and streaming video to pass standardized tests. Why are 170 medical schools reinventing these wheels every year? Why are medical students subsidizing policy analysts, care for the indigent and unfunded researchers? Why are medical students paying dozens of people, with content free education degrees, for reading personal statements in admissions offices when the folks at BU couldn't figure out who would be the Craigslist killer? Why are almost all pediatric fellowships three years long? Why doesn't anybody know how to design an efficient residency program and why doesn't anyone know what that costs after adjusting for the slave labor supplied by residents?

You can carp about the AANP but the real culprits are the AMA, the AAMC, the LCME, the AOA, and the ACGME.

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┻┳| •.•) the selectivity of US med schools has nothing to do with the number of practicing physicians in the US.
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Hope y'all are ready for NP week coming soon. A great time for celebration :hardy::hardy::hardy:
 
Even in cities with medical schools the wait time for a physical can be as long as 8 or 9 months. Try to see a dermatologist. The medical establishment of the U.S. has succeeded admirably in creating an artificial shortage of physicians and now the rest of society is looking for alternatives. The use of NPs to diagnose people is a perfect example.

All of you know talented people who didn't get medical school for B.S. reasons like insufficient volunteering, a ticket for minor in possession or some other nonsense. Others didn't get in because they were residents of states like New Hampshire or Rhode Island which give medical education zero support. There were others who got in but didn't want to go $600,000 in debt at Tufts, BU or Michigan State (as a non-resident). Others didn't want to wait until their mid 30s to have kids. Others didn't know what a D.O. is.

Medical education could and should be much cheaper. The first two years are largely rote memorization and students rely on power points, outlines and streaming video to pass standardized tests. Why are 170 medical schools reinventing these wheels every year? Why are medical students subsidizing policy analysts, care for the indigent and unfunded researchers? Why are medical students paying dozens of people, with content free education degrees, for reading personal statements in admissions offices when the folks at BU couldn't figure out who would be the Craigslist killer? Why are almost all pediatric fellowships three years long? Why doesn't anybody know how to design an efficient residency program and why doesn't anyone know what that costs after adjusting for the slave labor supplied by residents?

You can carp about the AANP but the real culprits are the AMA, the AAMC, the LCME, the AOA, and the ACGME.

Umm.... wut?
 
Slightly off topic, but Nurse Joy is probably a nurse practitioner and she's doing good for herself 😉
 
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┻┳| •.•) the selectivity of US med schools has nothing to do with the number of practicing physicians in the US.
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Let me see if I can make this clear for the economically delayed. The number of medical school seats and the number of residency slots in the U.S. has been artificially constrained by the policies of various organizations such as the AAMC and the ACGME. This has lead to a physician shortage. This in turn has lead to the employment of nurse practitioners as substitutes for physicians.

Medical school seats should be available at a much lower price for EVERYONE who can handle medical education. There is no reason for charging people $80,000 a year for med school and keeping thousands of qualified people out when all the students are doing in their first two years is cramming information to pass standardized tests. Medical schools are not cranking out sculptors, poets and jazz musicians. They are producing clinicians and the underlying cost does not justify the prices paid by students, donors and taxpayers.

Residency programs should be designed to be efficient. I just spoke with a buddy of mine who is a nationally prominent cardiologist at a prestigious med school. I asked him if he thought that any of the 59 internal medicine programs in New York State shared didactic materials. His answer was "no." It is in fact the number of residency slots that is the key bottleneck but no one knows how to manage them efficiently and that's why the number of slots grows from year to year at a snail's pace.
 
I like NP's, I have friends that are going into NP programs but it is NOT equal care they are providing.

If they provide equal care they should take step exams 1, 2, and 3 and boards for family medicine to prove they're walking in the room with the same amount of knowledge. Otherwise, it's not equal care.

That being said, I don't really have much of an opinion on them being supervised or not. It's the patient's choice if they want to see a NP. But make no mistake, it is not the same level of care, they do not take the same board exams to prove equal competence. It should not be compensated equally.
 
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Even in cities with medical schools the wait time for a physical can be as long as 8 or 9 months. Try to see a dermatologist. The medical establishment of the U.S. has succeeded admirably in creating an artificial shortage of physicians and now the rest of society is looking for alternatives. The use of NPs to diagnose people is a perfect example.

All of you know talented people who didn't get medical school for B.S. reasons like insufficient volunteering, a ticket for minor in possession or some other nonsense. Others didn't get in because they were residents of states like New Hampshire or Rhode Island which give medical education zero support. There were others who got in but didn't want to go $600,000 in debt at Tufts, BU or Michigan State (as a non-resident). Others didn't want to wait until their mid 30s to have kids. Others didn't know what a D.O. is.

Medical education could and should be much cheaper. The first two years are largely rote memorization and students rely on power points, outlines and streaming video to pass standardized tests. Why are 170 medical schools reinventing these wheels every year? Why are medical students subsidizing policy analysts, care for the indigent and unfunded researchers? Why are medical students paying dozens of people, with content free education degrees, for reading personal statements in admissions offices when the folks at BU couldn't figure out who would be the Craigslist killer? Why are almost all pediatric fellowships three years long? Why doesn't anybody know how to design an efficient residency program and why doesn't anyone know what that costs after adjusting for the slave labor supplied by residents?

You can carp about the AANP but the real culprits are the AMA, the AAMC, the LCME, the AOA, and the ACGME.

I think it might be a question of quality vs quantity. The limited student body at medical school probably means more access to cadavers and rotations at hospitals etc. which have a finite capacity to begin with.
 
I think it might be a question of quality vs quantity. The limited student body at medical school probably means more access to cadavers and rotations at hospitals etc. which have a finite capacity to begin with.
Totally agree with this, if schools continued to just expand their class size the quality would surely suffer.
 
Let me see if I can make this clear for the economically delayed. The number of medical school seats and the number of residency slots in the U.S. has been artificially constrained by the policies of various organizations such as the AAMC and the ACGME. This has lead to a physician shortage. This in turn has lead to the employment of nurse practitioners as substitutes for physicians.

Medical school seats should be available at a much lower price for EVERYONE who can handle medical education. There is no reason for charging people $80,000 a year for med school and keeping thousands of qualified people out when all the students are doing in their first two years is cramming information to pass standardized tests. Medical schools are not cranking out sculptors, poets and jazz musicians. They are producing clinicians and the underlying cost does not justify the prices paid by students, donors and taxpayers.

Residency programs should be designed to be efficient. I just spoke with a buddy of mine who is a nationally prominent cardiologist at a prestigious med school. I asked him if he thought that any of the 59 internal medicine programs in New York State shared didactic materials. His answer was "no." It is in fact the number of residency slots that is the key bottleneck but no one knows how to manage them efficiently and that's why the number of slots grows from year to year at a snail's pace.

No, the problem wasn't your lack of clarity. It was because it was a dumb non sequitur.

And re: your last paragraph: You've been making similar rants on these forums for months/years now, and do YOU have actual experience in medical education? ...because you've been a member for 10+ years and your posts are all over the place.
 
All of you know talented people who didn't get medical school for B.S. reasons like insufficient volunteering, a ticket for minor in possession or some other nonsense. There were others who got in but didn't want to go $600,000 in debt at Tufts, BU or Michigan State (as a non-resident). Others didn't want to wait until their mid 30s to have kids.

Wow! So much disinformation, so little time
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First off, Medicine is a service profession, and so we need people to be able to show that they are altruistic, and know what they're getting into.

A misdemeanor or two wont' keep a good candidate out of med school.

Others didn't know what a D.O. is.
Correct on that, or they want the MD not the DO.

Medical education could and should be much cheaper.
I agree...but med schools actually lose money on medical education (DO schools not applicable) and a single academic department can make more money in the indirects on a R01 grant than from a entire class of med students.

The first two years are largely rote memorization and students rely on power points, outlines and streaming video to pass standardized tests. Why are 170 medical schools reinventing these wheels every year?
There's also that other stuff, like, y'know how to take a take physical and history, deliver bad news, do an abdominal exam...the doing of Medicine. Life doesn't begin nor end with Step I. And medical and scientific knowledge are but one of six competencies that med students have to master. The rest are humanistic domains....that's what we faculty spend our time doing.


Why are medical students subsidizing policy analysts, care for the indigent and unfunded researchers?
?????? Maybe the same reasons surgery dep't fund family medicine, or schools of science fund the art school at a college?


Why are medical students paying dozens of people, with content free education degrees, for reading personal statements in admissions offices when the folks at BU couldn't figure out who would be the Craigslist killer?
Please restrain your ignorance of the Admissions process.

Why are almost all pediatric fellowships three years long? Why doesn't anybody know how to design an efficient residency program and why doesn't anyone know what that costs after adjusting for the slave labor supplied by residents?
To make sure pediatricians don't kill children?

You can carp about the AANP but the real culprits are the AMA, the AAMC, the LCME, the AOA, and the ACGME.[/QUOTE]

Let me see if I can make this clear for the economically delayed. The number of medical school seats and the number of residency slots in the U.S. has been artificially constrained by the policies of various organizations such as the AAMC and the ACGME. This has lead to a physician shortage. This in turn has lead to the employment of nurse practitioners as substitutes for physicians.

These organization do no put guns to grads of residencies and make them want to go to big cities and suburbs. Nor do they refuse to let them practice in Kalispell,MT or Jonesboro, AR. These are choices made by doctors. There is no doctor shortage, only a maldistribution.

Medical school seats should be available at a much lower price for EVERYONE who can handle medical education. There is no reason for charging people $80,000 a year for med school and keeping thousands of qualified people out when all the students are doing in their first two years is cramming information to pass standardized tests. Medical schools are not cranking out sculptors, poets and jazz musicians. They are producing clinicians and the underlying cost does not justify the prices paid by students, donors and taxpayers.

Point taken, but we also don't want American Medicine to end up like the American legal profession...glutted out out, do we?
 
All of you know talented people who didn't get medical school for B.S. reasons like insufficient volunteering, a ticket for minor in possession or some other nonsense. There were others who got in but didn't want to go $600,000 in debt at Tufts, BU or Michigan State (as a non-resident). Others didn't want to wait until their mid 30s to have kids.

Wow! So much disinformation, so little time
.
First off, Medicine is a service profession, and so we need people to be able to show that they are altruistic, and know what they're getting into.

A misdemeanor or two wont' keep a good candidate out of med school.

Others didn't know what a D.O. is.
Correct on that, or they want the MD not the DO.

Medical education could and should be much cheaper.
I agree...but med schools actually lose money on medical education (DO schools not applicable) and a single academic department can make more money in the indirects on a R01 grant than from a entire class of med students.

The first two years are largely rote memorization and students rely on power points, outlines and streaming video to pass standardized tests. Why are 170 medical schools reinventing these wheels every year?
There's also that other stuff, like, y'know how to take a take physical and history, deliver bad news, do an abdominal exam...the doing of Medicine. Life doesn't begin nor end with Step I. And medical and scientific knowledge are but one of six competencies that med students have to master. The rest are humanistic domains....that's what we faculty spend our time doing.


Why are medical students subsidizing policy analysts, care for the indigent and unfunded researchers?
?????? Maybe the same reasons surgery dep't fund family medicine, or schools of science fund the art school at a college?


Why are medical students paying dozens of people, with content free education degrees, for reading personal statements in admissions offices when the folks at BU couldn't figure out who would be the Craigslist killer?
Please restrain your ignorance of the Admissions process.

Why are almost all pediatric fellowships three years long? Why doesn't anybody know how to design an efficient residency program and why doesn't anyone know what that costs after adjusting for the slave labor supplied by residents?
To make sure pediatricians don't kill children?

You can carp about the AANP but the real culprits are the AMA, the AAMC, the LCME, the AOA, and the ACGME.

Let me see if I can make this clear for the economically delayed. The number of medical school seats and the number of residency slots in the U.S. has been artificially constrained by the policies of various organizations such as the AAMC and the ACGME. This has lead to a physician shortage. This in turn has lead to the employment of nurse practitioners as substitutes for physicians.

These organization do no put guns to grads of residencies and make them want to go to big cities and suburbs. Nor do they refuse to let them practice in Kalispell,MT or Jonesboro, AR. These are choices made by doctors. There is no doctor shortage, only a maldistribution.

Medical school seats should be available at a much lower price for EVERYONE who can handle medical education. There is no reason for charging people $80,000 a year for med school and keeping thousands of qualified people out when all the students are doing in their first two years is cramming information to pass standardized tests. Medical schools are not cranking out sculptors, poets and jazz musicians. They are producing clinicians and the underlying cost does not justify the prices paid by students, donors and taxpayers.

Point taken, but we also don't want American Medicine to end up like the American legal profession...glutted out out, do we?[/QUOTE]


Interesting, Goro. If I may - are you an attending? What do you think would happen if they loosened FMG, especially non-US, restrictions for residency spots "across the board?" They've denied more than quite a few (maybe n = accepted = 1) 260+ and higher candidates with quite good research (including benchtop), good interpersonal skills, and a strong knowledge of English (w/o strong accent I may add) someplace in some field...- individuals who have gone on to become great physicians, and, perhaps (depending on how you look at "operating") even more remarkable: great surgeons. I would be very, very interested to see what some of those individuals would be able to do with access to our da Vinci, PRN.
 
Point taken, but we also don't want American Medicine to end up like the American legal profession...glutted out out, do we?

Well at least you're honest about it. You want to keep qualified people out of the medical profession, make patients wait forever for appointments and then charge patients an arm and a leg. I'll bet you are the kind of guy who complains about unions without recognizing that you want to mimic their anticompetitive tactics.

In my lifetime I've seen the nation's healthcare burden expand from 5% of the GDP to 18%. Some of this growth has been due to the aging of the population as well as the availability of new medical services. However, it's also due to the anticompetitive practices of all health related professional groups including nurses, dentists, physical therapists, pharmacists and physicians. These groups have all done their best to make training in their fields unavailable to all people who are qualified to pursue that training and then these groups engage in endless battles to keep people with different credentials off their turf. Examples of these behaviors include the termination of hospital based diploma programs for nurses, the extension of the time it takes to train pharmacists and nurse anesthetists, the war dentists have waged to keep dental therapists from practicing and of course the ridiculous time and expense required to be a physician. All of these maneuvers, that had absolutely no empirical justification, drive up the costs of health care and ultimately the burden imposed on the entire country. We can't keep imposing an ever expanding health care burden on this country. At some point we have to be efficient.

I've heard this joke before that medical students are subsidized. That hallucination is simply the product of inefficient medical education and distorted cost accounting. In 2009, when LECOM was in the process of expanding to a third campus and building a dental school, LECOM's total costs amounted to $15,000 per student. LECOM made an enormous "profit" while charging people less than $32,000 per year for tuition. (Don't believe that? Ask your accountant to print off LECOM's 990.) Why was Michigan State's D.O. School charging non-residents $80,000 per year? Perhaps the cost of teaching students to take a physical at MSU was $48,000. Interestingly enough, COCA just blocked LECOM's expansion in Elmira, New York. I wonder if Touro or NYCOM had anything to do with that.

I keep hearing there is a maldistribution rather than a shortage of physicians. You will never see physicians moving in sufficient numbers to Jonesboro, Mukwanago or Plattsburg until the economics of practice in large cities is miserable enough to drive physicians to rural areas. That's how we will fix that problem. This might come as a shock to you but the investments made by the American people in medical research and education weren't made for the benefit of physicians. Nobody owes you a luxurious life style in the city of your choice. Sorry.
 
Point taken, but we also don't want American Medicine to end up like the American legal profession...glutted out out, do we?

Well at least you're honest about it. You want to keep qualified people out of the medical profession, make patients wait forever for appointments and then charge patients an arm and a leg. I'll bet you are the kind of guy who complains about unions without recognizing that you want to mimic their anticompetitive tactics.

In my lifetime I've seen the nation's healthcare burden expand from 5% of the GDP to 18%. Some of this growth has been due to the aging of the population as well as the availability of new medical services. However, it's also due to the anticompetitive practices of all health related professional groups including nurses, dentists, physical therapists, pharmacists and physicians. These groups have all done their best to make training in their fields unavailable to all people who are qualified to pursue that training and then these groups engage in endless battles to keep people with different credentials off their turf. Examples of these behaviors include the termination of hospital based diploma programs for nurses, the extension of the time it takes to train pharmacists and nurse anesthetists, the war dentists have waged to keep dental therapists from practicing and of course the ridiculous time and expense required to be a physician. All of these maneuvers, that had absolutely no empirical justification, drive up the costs of health care and ultimately the burden imposed on the entire country. We can't keep imposing an ever expanding health care burden on this country. At some point we have to be efficient.

I've heard this joke before that medical students are subsidized. That hallucination is simply the product of inefficient medical education and distorted cost accounting. In 2009, when LECOM was in the process of expanding to a third campus and building a dental school, LECOM's total costs amounted to $15,000 per student. LECOM made an enormous "profit" while charging people less than $32,000 per year for tuition. (Don't believe that? Ask your accountant to print off LECOM's 990.) Why was Michigan State's D.O. School charging non-residents $80,000 per year? Perhaps the cost of teaching students to take a physical at MSU was $48,000. Interestingly enough, COCA just blocked LECOM's expansion in Elmira, New York. I wonder if Touro or NYCOM had anything to do with that.

I keep hearing there is a maldistribution rather than a shortage of physicians. You will never see physicians moving in sufficient numbers to Jonesboro, Mukwanago or Plattsburg until the economics of practice in large cities is miserable enough to drive physicians to rural areas. That's how we will fix that problem. This might come as a shock to you but the investments made by the American people in medical research and education weren't made for the benefit of physicians. Nobody owes you a luxurious life style in the city of your choice. Sorry.

Username on point.
 
Interesting, Goro. If I may - are you an attending?

PhD...phony doctor. But medical educator for > 20 years now.


What do you think would happen if they loosened FMG, especially non-US, restrictions for residency spots "across the board?" They've denied more than quite a few (maybe n = accepted = 1) 260+ and higher candidates with quite good research (including benchtop), good interpersonal skills, and a strong knowledge of English (w/o strong accent I may add) someplace in some field...- individuals who have gone on to become great physicians, and, perhaps (depending on how you look at "operating") even more remarkable: great surgeons. I would be very, very interested to see what some of those individuals would be able to do with access to our da Vinci, PRN.

They're the ones actually going to Kalispell, MT and similar places. But with the increase in DO schools, and MD schools soon to be enlarging thier classes, I suspect that more US trained docs will be headed to areas where there are actual physician shortages. What the effect of HMOs and insurance companies desiring to have less expensive NPs in said places will be, I have no idea. The AMA used to be a pretty powerful union, um, professional organization, and maybe they and the AOA can rediscover that lobbying power?
 
Interesting, Goro. If I may - are you an attending?

PhD...phony doctor. But medical educator for > 20 years now.


What do you think would happen if they loosened FMG, especially non-US, restrictions for residency spots "across the board?" They've denied more than quite a few (maybe n = accepted = 1) 260+ and higher candidates with quite good research (including benchtop), good interpersonal skills, and a strong knowledge of English (w/o strong accent I may add) someplace in some field...- individuals who have gone on to become great physicians, and, perhaps (depending on how you look at "operating") even more remarkable: great surgeons. I would be very, very interested to see what some of those individuals would be able to do with access to our da Vinci, PRN.

They're the ones actually going to Kalispell, MT and similar places. But with the increase in DO schools, and MD schools soon to be enlarging thier classes, I suspect that more US trained docs will be headed to areas where there are actual physician shortages. What the effect of HMOs and insurance companies desiring to have less expensive NPs in said places will be, I have no idea. The AMA used to be a pretty powerful union, um, professional organization, and maybe they and the AOA can rediscover that lobbying power?

Another question, do you think that, if true, open merit-based competition was extended to slots in M.D. programs, and even D.O. programs, I suppose (I just can't say much about them - I have worked with D.O. surgeons, but I don't know much about their undergraduate system - although, interestingly, AACOMAS is basically merging with AMCAS, and there will, to my understanding, be no restrictions in being an allopathic grad. and applying to any "D.O.-exclusive" programs that wish to remain certified as providing residency training, by way of the NRMP by year-end, 2020) that many American undergrads would even be able gain a seat in top ~30-40 U.S. medical schools?

To add: No, Sir, you are not a phony doctor. I would argue that perhaps the M.D. is the more phony one much of the time. PhDs have their place even in regular consultation regarding clinical cases. A career in medical education: that deems its own share of respect.
 
Another question, do you think that, if true, open merit-based competition was extended to slots in M.D. programs, and even D.O. programs, I suppose (I just can't say much about them - I have worked with D.O. surgeons, but I don't know much about their undergraduate system - although, interestingly, AACOMAS is basically merging with AMCAS, and there will, to my understanding, be no restrictions in being an allopathic grad. and applying to any "D.O.-exclusive" programs that wish to remain certified as providing residency training, by way of the NRMP by year-end, 2020) that many American undergrads would even be able gain a seat in top ~30-40 U.S. medical schools?

I'm sorry; I'm not following your question. The merger has nothing to do with medical education, only graduate medical education.
 
These groups have all done their best to make training in their fields unavailable to all people who are qualified to pursue that training and then these groups engage in endless battles to keep people with different credentials off their turf.

So instead of limiting positions to only those who are qualified (you're grossly exaggerating the number of "qualified" people who don't gain admission), you suggest we just open the floodgates, let anyone in so they can accrue obscene debt, then let the graduate into a field where they'll be compensated far less than they are now so they can live the rest of their lives trying to dig out of debt? Sounds pretty similar to what happened with federal loans for undergrad education, it's not like there are any problems with that system now...


All of these maneuvers, that had absolutely no empirical justification, drive up the costs of health care and ultimately the burden imposed on the entire country. We can't keep imposing an ever expanding health care burden on this country. At some point we have to be efficient.

I agree, but you're once again grossly exaggerating the portion of that burden that lies with the training or salary of physicians. The proportion of healthcare expenditure on physicians and salary has remained stable since 1975 (~20%), and the cost of procedures has generally remained stable when compared to inflation rates. What has increased, is the incidence and prevalence of chronic diseases, our ability to detect these conditions, as well as the number of people insured and seeking treatment. When there is more disease and more people seeking treatment then the cost is obviously going to go up. Pointing fingers at doctors for increasing medical costs because technology has made identifying a condition easier and more people are seeking treatment is idiotic. You want to make things cheaper, find a way to convince the general public to embrace preventative medicine and actually take care of themselves so we decrease the prevalence of chronic diseases like diabetes, heart disease, and cerebrovascular disease. Do that and not only do you have less actual expenditure, you create a healthier pool of insured/covered and drop premium rates for all (or Medicaid/medicare expenditure).

Also, good job completely ignoring all of the completely legitimate points Goro was making and responding to the one thing you found ethically questionable. I see you've become a master of moving the goalposts.

Another question, do you think that, if true, open merit-based competition was extended to slots in M.D. programs, and even D.O. programs, I suppose (I just can't say much about them - I have worked with D.O. surgeons, but I don't know much about their undergraduate system - although, interestingly, AACOMAS is basically merging with AMCAS, and there will, to my understanding, be no restrictions in being an allopathic grad. and applying to any "D.O.-exclusive" programs that wish to remain certified as providing residency training, by way of the NRMP by year-end, 2020) that many American undergrads would even be able gain a seat in top ~30-40 U.S. medical schools?

No. In 2015, around 60,000 people took the MCAT and around 48,000 applied to medical schools. If we assume the average med school class size is 100 people, that means there are 4,000 slots in the top 40 schools. That's less than 10% of applicants and less than 7% of people taking the MCAT. That does not include people that want to pursue medicine but don't take the MCAT. So no, most American undergrads stand no chance at all getting into a top 30-40 med school, even if they are a far better student than the average UG student.

As to your statement in parentheses, some corrections: AACOMAS is not merging with AMCAS, and neither really have anything to do with much of actual medical education. The AOA match and the ACGME match are merging, however COCA (the licensing body for DO schools) and the LCME (licensing body for MD schools) are remaining completely separate entities as well as AACOMAS and AMCAS. There never were restrictions on being an allopathic grad, as they have always had their match. There's a plethora of reasons floating around about why the merger is occurring, but basically the ACGME said if the AOA didn't want to merge, then AOA grads won't be eligible for ACGME fellowships. This would have been a huge problem for the DO side of things, so the merge was instituted. There are plenty of threads already on this site about the merger, and you can get all the info you could want with the search function.
 
So instead of limiting positions to only those who are qualified (you're grossly exaggerating the number of "qualified" people who don't gain admission), you suggest we just open the floodgates, let anyone in so they can accrue obscene debt, then let the graduate into a field where they'll be compensated far less than they are now so they can live the rest of their lives trying to dig out of debt? Sounds pretty similar to what happened with federal loans for undergrad education, it's not like there are any problems with that system now...




I agree, but you're once again grossly exaggerating the portion of that burden that lies with the training or salary of physicians. The proportion of healthcare expenditure on physicians and salary has remained stable since 1975 (~20%), and the cost of procedures has generally remained stable when compared to inflation rates. What has increased, is the incidence and prevalence of chronic diseases, our ability to detect these conditions, as well as the number of people insured and seeking treatment. When there is more disease and more people seeking treatment then the cost is obviously going to go up. Pointing fingers at doctors for increasing medical costs because technology has made identifying a condition easier and more people are seeking treatment is idiotic. You want to make things cheaper, find a way to convince the general public to embrace preventative medicine and actually take care of themselves so we decrease the prevalence of chronic diseases like diabetes, heart disease, and cerebrovascular disease. Do that and not only do you have less actual expenditure, you create a healthier pool of insured/covered and drop premium rates for all (or Medicaid/medicare expenditure).

Also, good job completely ignoring all of the completely legitimate points Goro was making and responding to the one thing you found ethically questionable. I see you've become a master of moving the goalposts.



No. In 2015, around 60,000 people took the MCAT and around 48,000 applied to medical schools. If we assume the average med school class size is 100 people, that means there are 4,000 slots in the top 40 schools. That's less than 10% of applicants and less than 7% of people taking the MCAT. That does not include people that want to pursue medicine but don't take the MCAT. So no, most American undergrads stand no chance at all getting into a top 30-40 med school, even if they are a far better student than the average UG student.

As to your statement in parentheses, some corrections: AACOMAS is not merging with AMCAS, and neither really have anything to do with much of actual medical education. The AOA match and the ACGME match are merging, however COCA (the licensing body for DO schools) and the LCME (licensing body for MD schools) are remaining completely separate entities as well as AACOMAS and AMCAS. There never were restrictions on being an allopathic grad, as they have always had their match. There's a plethora of reasons floating around about why the merger is occurring, but basically the ACGME said if the AOA didn't want to merge, then AOA grads won't be eligible for ACGME fellowships. This would have been a huge problem for the DO side of things, so the merge was instituted. There are plenty of threads already on this site about the merger, and you can get all the info you could want with the search function.

[Edit: can't tell intent through written text in this case, necessarily] Just goes to show you how much I know about D.O. undergraduate education, or what's involved with their graduates applying to allopathic programs. Not interested in studying that, for now.
 
[Edit: can't tell intent through written text in this case, necessarily] Just goes to show you how much I know about D.O. undergraduate education, or what's involved with their graduates applying to allopathic programs. Not interested in studying that, for now.

Essentially DO education = MD education (in the U.S.). Today, everything about it is essentially exactly the same except DOs in the U.S. also learn OMM. Other than that, we have to go through all the same certifications and standards that MDs do. I realize that the DO degree in Europe is very different than the U.S. and a European "DO" is more akin to chiropractors in the U.S. than it is to actual physicians.
 
Another question, do you think that, if true, open merit-based competition was extended to slots in M.D. programs, and even D.O. programs, I suppose (I just can't say much about them - I have worked with D.O. surgeons, but I don't know much about their undergraduate system - although, interestingly, AACOMAS is basically merging with AMCAS, and there will, to my understanding, be no restrictions in being an allopathic grad. and applying to any "D.O.-exclusive" programs that wish to remain certified as providing residency training, by way of the NRMP by year-end, 2020) that many American undergrads would even be able gain a seat in top ~30-40 U.S. medical schools?

To add: No, Sir, you are not a phony doctor. I would argue that perhaps the M.D. is the more phony one much of the time. PhDs have their place even in regular consultation regarding clinical cases. A career in medical education: that deems its own share of respect.

LOLwut
 
No seriously, @Obnoxious Dad, what's your deal exactly?

You joined this site a decade or so ago to be a helicopter parent for your daughter while she was at Kalamazoo College (?) then have spent the last ten years ranting about your regrets about the educational choices you feel she should have made despite her getting into a perfectly good but not first choice medical school or popping in to make posts on topics that you don't have particular experience in (a quick search posts giving advice on programs from peds, gas, IM...). All of which is pseudo-knowledgable but to those of us who actually are clinicians and faculty, we can smell the bull**** of someone speaking outside their area of expertise. Like, "sharing didactic materials" for efficiency sounds like a great idea, but only to someone who doesn't actually know how didactics in residency actually function.

I mean, if you want to come in here and rant to blow off steam for your mental health or whatever, fine, but I question if you're really contributing as much as you think you are.
 
No seriously, @Obnoxious Dad, what's your deal exactly?

You joined this site a decade or so ago to be a helicopter parent for your daughter while she was at Kalamazoo College (?) then have spent the last ten years ranting about your regrets about the educational choices you feel she should have made despite her getting into a perfectly good but not first choice medical school or popping in to make posts on topics that you don't have particular experience in (a quick search posts giving advice on programs from peds, gas, IM...). All of which is pseudo-knowledgable but to those of us who actually are clinicians and faculty, we can smell the bull**** of someone speaking outside their area of expertise. Like, "sharing didactic materials" for efficiency sounds like a great idea, but only to someone who doesn't actually know how didactics in residency actually function.

I mean, if you want to come in here and rant to blow off steam for your mental health or whatever, fine, but I question if you're really contributing as much as you think you are.

Well I guess I struck a nerve here. It looks like you've read every post I have made on this site. You don't have some kind of obsession do you?

My daughter is doing just fine right now. Thank you very much. I can take a small amount of credit for that because I spent hundreds of hours figuring out a med school admission strategy that she used to overcome the gross misinformation that she was handed by her high school guidance counselor, her pre-med counselor and the idiots in one particular med school admissions office.

You may be a physician but that doesn't mean you know anything about the economics of medicine or the regulation of medicine or medical malpractice. I suspect that you have no formal education in those realms. I on the other hand have multiple professional degrees in law, business and public policy.

Don't like opinions that contradict the usual group think? That's tough. I think that it may be useful for others on this site to hear something other than the usual spiel that the world revolves around physicians and the primary function of American health care is to make physicians happy,
 
gross misinformation that she was handed by her high school guidance counselor, her pre-med counselor and the idiots in one particular med school admissions office.

Seeing as though your posts are dripping in bitterness from events that would have occurred in 2003 thru 2008... yeah, about that obsession. (high school guidance counselor? seriously?)

I mean, you can post all the "unique" opinions on here all you want, but I'm going to make fun of you when you post something dumb.
 
Seeing as though your posts are dripping in bitterness from events that would have occurred in 2003 thru 2008... yeah, about that obsession. (high school guidance counselor? seriously?)

I mean, you can post all the "unique" opinions on here all you want, but I'm going to make fun of you when you post something dumb.
👍👍😍😍😍🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣
 
Well I guess I struck a nerve here. It looks like you've read every post I have made on this site. You don't have some kind of obsession do you?

My daughter is doing just fine right now. Thank you very much. I can take a small amount of credit for that because I spent hundreds of hours figuring out a med school admission strategy that she used to overcome the gross misinformation that she was handed by her high school guidance counselor, her pre-med counselor and the idiots in one particular med school admissions office.

You may be a physician but that doesn't mean you know anything about the economics of medicine or the regulation of medicine or medical malpractice. I suspect that you have no formal education in those realms. I on the other hand have multiple professional degrees in law, business and public policy.

Don't like opinions that contradict the usual group think? That's tough. I think that it may be useful for others on this site to hear something other than the usual spiel that the world revolves around physicians and the primary function of American health care is to make physicians happy,
Wait, you were serious with the original post of yours? Wow. OK, I'll take that on.


Even in cities with medical schools the wait time for a physical can be as long as 8 or 9 months. Try to see a dermatologist. The medical establishment of the U.S. has succeeded admirably in creating an artificial shortage of physicians and now the rest of society is looking for alternatives. The use of NPs to diagnose people is a perfect example.

OK first off, the "medical establishment" has no say in this. Residency slots are governed by 2 things: CMS money and education. The vast majority of residency spots are paid for by the government. That number has not increased much since the mid-90s. In fact, pretty much all increases in spots since then are being paid for by hospitals. Not exactly something the "medical establishment" would do if we were trying to keep things scarce now is it? The other issue is education. Each specialty has rules governing what experiences residents must have to graduate. Most specialties need a tertiary center to get those things. There are only so many sick people to go around. You don't want a surgeon who trained at a 70 bed hospital nor a dermatologist who trained in a town of 10k people.

Second, I can get patients into derm within 7 days. If patients themselves call, it is of course longer. But that's how the system should work.

Third, we have new med schools opening all the time so no shortage there.

All of you know talented people who didn't get medical school for B.S. reasons like insufficient volunteering, a ticket for minor in possession or some other nonsense. Others didn't get in because they were residents of states like New Hampshire or Rhode Island which give medical education zero support. There were others who got in but didn't want to go $600,000 in debt at Tufts, BU or Michigan State (as a non-resident). Others didn't want to wait until their mid 30s to have kids. Others didn't know what a D.O. is.

A basic Google search will tell you that you need volunteer hours. Most tickets won't keep you from med school. It might keep you from Hopkins or Yale, but you can find a school. If you can get into Tufts or BU, you can get into somewhere cheaper. Though I will agree tuition in general is getting insane.

I know lots of people in my class alone who had kids in med school and did fine in residency. Its not easy, but its possible. That way you don't have to wait until your 30s to have kids if you don't want to.

Not knowing what a DO is is absolutely the fault of the applicant.

Medical education could and should be much cheaper. The first two years are largely rote memorization and students rely on power points, outlines and streaming video to pass standardized tests. Why are 170 medical schools reinventing these wheels every year? Why are medical students subsidizing policy analysts, care for the indigent and unfunded researchers? Why are medical students paying dozens of people, with content free education degrees, for reading personal statements in admissions offices when the folks at BU couldn't figure out who would be the Craigslist killer? Why are almost all pediatric fellowships three years long? Why doesn't anybody know how to design an efficient residency program and why doesn't anyone know what that costs after adjusting for the slave labor supplied by residents?

You can carp about the AANP but the real culprits are the AMA, the AAMC, the LCME, the AOA, and the ACGME.

Med students subsidize research PhDs (the teachers for those first 2 years) the same way undergrads do. Its not ideal sure, but the research is important. Not sure what "dozens of people" you're talking about here.

Peds fellowships are very research heavy, that's why.

Many residency programs are efficient. I recall very little wasted time in mine.

Slave labor? Really? Making above median is slave labor now?
 
Wait, you were serious with the original post of yours? Wow. OK, I'll take that on.




OK first off, the "medical establishment" has no say in this. Residency slots are governed by 2 things: CMS money and education. The vast majority of residency spots are paid for by the government. That number has not increased much since the mid-90s. In fact, pretty much all increases in spots since then are being paid for by hospitals. Not exactly something the "medical establishment" would do if we were trying to keep things scarce now is it? The other issue is education. Each specialty has rules governing what experiences residents must have to graduate. Most specialties need a tertiary center to get those things. There are only so many sick people to go around. You don't want a surgeon who trained at a 70 bed hospital nor a dermatologist who trained in a town of 10k people.

Second, I can get patients into derm within 7 days. If patients themselves call, it is of course longer. But that's how the system should work.

Third, we have new med schools opening all the time so no shortage there.



A basic Google search will tell you that you need volunteer hours. Most tickets won't keep you from med school. It might keep you from Hopkins or Yale, but you can find a school. If you can get into Tufts or BU, you can get into somewhere cheaper. Though I will agree tuition in general is getting insane.

I know lots of people in my class alone who had kids in med school and did fine in residency. Its not easy, but its possible. That way you don't have to wait until your 30s to have kids if you don't want to.

Not knowing what a DO is is absolutely the fault of the applicant.



Med students subsidize research PhDs (the teachers for those first 2 years) the same way undergrads do. Its not ideal sure, but the research is important. Not sure what "dozens of people" you're talking about here.

Peds fellowships are very research heavy, that's why.

Many residency programs are efficient. I recall very little wasted time in mine.

Slave labor? Really? Making above median is slave labor now?

This was a good post, but I wanted to add that I called a dermatologist to make an appointment for my daughter and got in the same day. I’ve done that with her general pediatrician several times. Moving to a more rural area changed things slightly. My wife needed an OB appointment and had to wait a week instead of a couple days.
 
Well I guess I struck a nerve here. It looks like you've read every post I have made on this site. You don't have some kind of obsession do you?

My daughter is doing just fine right now. Thank you very much. I can take a small amount of credit for that because I spent hundreds of hours figuring out a med school admission strategy that she used to overcome the gross misinformation that she was handed by her high school guidance counselor, her pre-med counselor and the idiots in one particular med school admissions office.

You may be a physician but that doesn't mean you know anything about the economics of medicine or the regulation of medicine or medical malpractice. I suspect that you have no formal education in those realms. I on the other hand have multiple professional degrees in law, business and public policy.

Don't like opinions that contradict the usual group think? That's tough. I think that it may be useful for others on this site to hear something other than the usual spiel that the world revolves around physicians and the primary function of American health care is to make physicians happy,

Just because you hold degrees in law, business, and public policy doesn't mean you have any formal education in the healthcare issues either (if you even have any of those degrees).

Contradicting opinions are welcome. What isn't welcome with me is when you ask questions that are meant to be rhetorical that actually have very obvious answers, then you act like no one knows what they're talking about when those answers aren't the ones you want to hear.
 
Another question, do you think that, if true, open merit-based competition was extended to slots in M.D. programs, and even D.O. programs, I suppose (I just can't say much about them - I have worked with D.O. surgeons, but I don't know much about their undergraduate system - although, interestingly, AACOMAS is basically merging with AMCAS, and there will, to my understanding, be no restrictions in being an allopathic grad. and applying to any "D.O.-exclusive" programs that wish to remain certified as providing residency training, by way of the NRMP by year-end, 2020) that many American undergrads would even be able gain a seat in top ~30-40 U.S. medical schools?

To add: No, Sir, you are not a phony doctor. I would argue that perhaps the M.D. is the more phony one much of the time. PhDs have their place even in regular consultation regarding clinical cases. A career in medical education: that deems its own share of respect.
TF?
 
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