How do you feel about this?

PreMedHopeful

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    The ups and downs
    of doctor supply and demand

    • The U.S. will have about 750,000 doctors by 2025, about 159,000 fewer than it needs, according to the Association of American Medical Colleges.

    • The U.S. population is expected to increase from 300 million in 2006 to 350 million in 2025, and a larger proportion will be older, thus more likely to need doctor care.

    • 42,231 people applied to U.S. medical schools in 2008, and 18,036 enrolled.

    • Four new medical schools are to accept students this year: Texas Tech University in El Paso, Florida International University in Miami, University of Central Florida in Orlando, and Commonwealth Medical College in Scranton, Pa.

    • Five schools are seeking accreditation and aim to begin classes in 2010 or 2011: Virginia Tech in Roanoke; Scripps School of Medicine in La Jolla, Calif.; Oakland University in Royal Oak, Mich.; Touro University in Hasbrouck Heights, N.J.; and Hofstra University in Hempstead, N.Y.

    Source: http://blog.cleveland.com/medical/2009/03/medical_schools_health_just_fi.html
     

    Hoody

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      Scripps would be pretty cool. Nice place.



      And on a side note, I feel like there is too much focus on specialties. Basically we have a bunch of overpaid and underworked docs running around crapping on FP docs when they know nothing about family medicine and its complexity. Salary caps on specialties need to happen, money needs to start going to FP, and more resident spots need to become available. All graduating students should have to do a mandatory year of FP for their first year of residency. Don't like that? Awwww, too bad, don't be a doctor then (and quite preaching that you're in it because you "love to help people"). Hospitals, etc. need to stop making it seem OKAY for Patients to use, and continue to use, an ER doc in place of a PC doc. For obvious reasons. end rant.:beat:


      I'm bored at work. Can you tell? I almost wish someone would code. Ohhhh, did I just say that out loud? :uhno:
       
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      TexasTriathlete

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        Scripps would be pretty cool. Nice place.



        And on a side note, I feel like there is too much focus on specialties. Basically we have a bunch of overpaid and underworked docs running around crapping on FP docs when they know nothing about family medicine and its complexity. Salary caps on specialties need to happen, money needs to start going to FP, and more resident spots need to become available. All graduating students should have to do a mandatory year of FP for their first year of residency. Don't like that? Awwww, too bad, don't be a doctor then (and quite preaching that you're in it because you "love to help people"). Hospitals, etc. need to stop making it seem OKAY for Patients to use, and continue to use, an ER doc in place of a PC doc. For obvious reasons. end rant.:beat:



        Nobody likes these ER frequent flyers less than the people who work there, but they can't turn people away. And a lot of the people who use it for this purpose are people who are extremely sick. Lots of homeless people with AIDS, ESRD, psych problems, or combinations of the above. At Grady, we dialyze patients in the ED all the time. It isn't ideal, but there isn't a better option.

        So do we just start turning them away? Aside from the obvious moral implications, do you see a problem with sending a bunch of AIDS patients with things like TB out into the general population, un-treated, to infect everyone? Or turn loose some psych patients without their meds?

        It is a ****ty situation. I don't have the answer.
         

        TexasTriathlete

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          Also, the problem isn't that specialists make too much. Its that FP docs make too little_ and they don't have a very interesting job anymore. They used to deliver babies, set broken bones, etc.. Today, they are mostly a prescription-writing referral factory. Who the hell wants to go to med school and then residency to do a job that, realistically, a good RN could do most of the time? If there was more money in it, to pay back the ******ed loans that we're all going to owe, then it might be a little better.

          And the osteopathic schools, which pride themselves on being primary-care-centric, are mostly a bunch of ridiculously expensive private schools. So they're not turning out the PC docs that they used to either. I know I won't be going into primary care. I can't even justify considering it with the debt i'll be in
           

          Hoody

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            Nobody likes these ER frequent flyers less than the people who work there, but they can't turn people away.
            Who said to turn them away? I sure didn't. I said not to encourage them to use the ER in place of PCP
            And a lot of the people who use it for this purpose are people who are extremely sick.
            Not likely to get much better visiting the ER twice a week or once a month. Would be much better off just checking in the hospital and being seen by and IM....or better yet, establish care with a PCP who can adequately track the Patient through multiple settings and over a sigifigat duration of time. (gee, there's a thought - a doctor who establishes baselines and then treats the WHOLE patient, not just the acute problem at hand).
            Lots of homeless people with AIDS, ESRD, psych problems, or combinations of the above. At Grady, we dialyze patients in the ED all the time. It isn't ideal, but there isn't a better option.
            Right. This is why Family Medicine needs a significant boost.
            So do we just start turning them away? Aside from the obvious moral implications, do you see a problem with sending a bunch of AIDS patients with things like TB out into the general population, un-treated, to infect everyone? Or turn loose some psych patients without their meds?
            Again, I didn't say not to treat them. However, I believe unless a Patient meets specific criteria, they shouldn't be treated in the ER. They should be refereed to a PCP, just a like a PCP would refer a Patient to a specialist if thats what was truly needed. You wouldn't admit a person who did not meet criteria to be admitted, so don't treat people that can legitimately be seen by a PCP.
            It is a ****ty situation. I don't have the answer.
            Me either. But its worth fighting for. :thumbup: They need our help, and bad. FPPs went through the crappy undergrad classes, survived the MCAT and the application cycle, went to med school and passed the boards. They are real doctors too, just like you or any other doctor. Family Medicine is a specialty and it needs to be recognized for what its worth. Doctors in other specialties have an obligation, in my opinion, to try and hep alleviate this mess by supporting PCPs and their fight for equality.
            Also, the problem isn't that specialists make too much.
            Disagreed. And I really don't care what you (they) *think* your worth. Let the neurosurgeon try to manage a patient with several different morbidities, that is on 20 different meds and is generally non complaint with things like exercise, nutrition, etc, then tell me that the PCP, who handles these types of Patients day in and day out is not as worthy as the neurosurgeon. Forget operating on the brain, the Patient has to survive otherwise, beyond just that one procedure and the neruosurgeon sure as hell aint gonna sit down and do a full workup of the Patients other problems. You cant live without specialists and you cant live without PCPs. They are a TEAM. And they should be treated and supported as such.
            Its that FP docs make too little
            They do. Funding needs to be significantly increased. Some PCPs are seeing some 30+ Pts a day. Now imagine doing a FULL workup and FULL follow up on these people (not just a work up on the acute problem, and not just a follow up of the acute problem). They are working their ass's off just to be told things like:
            they don't have a very interesting job anymore. They used to deliver babies, set broken bones, etc..
            and
            Today, they are mostly a prescription-writing referral factory.
            Gee, way to support your colleagues :rolleyes:. And just for the record, they still do some of the things you mentioned, especially in rural areas. And if they refer you a Patient for maternity/delivery or something else that they have trained to handle, you should be thankful cause THEY just made YOU money.
            Who the hell wants to go to med school and then residency to do a job that
            People that are really in it to help people and do a little mix of everything, not people who are in it for the money. And yes, those people actually exist...and they should be fostered vs. the money/glory seekers.
            realistically, a good RN could do most of the time? If there was more money in it, to pay back the ******ed loans that we're all going to owe, then it might be a little better.
            :laugh:. No seriously. :laugh:

            Im an RN. And I consider myself damn good. There is NO way in HELL that I could even come close to proving primary care. Just FYI, some nurses only have TWO year degrees from local CC's. I suppose I should be happy that you think so highly of nurses, but um, I'm more saddened that you give such little credit to Family Medicine Physicians. What was I saying about specialist not comprehending the complexity of family medicine again....? Oh yeah, take a FULL panel of Patient's for a few months or so then get back to me. ;)



            I really, really don't want to get into a debate or flame war about this because I know a bunch of ER/Specialist are gonna blow me up for *only* being a pre-med and giving away the money that I haven't even earned yet and and blah, blah, blah. Basically I just wanted to reply to the OP, however my response was a little unrelated (sorry, it was late, and I was bored at work, it just sorta spewed out, kinda like this post :oops:). And just for the record, not that it matters any, but I plan to specialize (yay research pathology!), so I'm not fighting for myself here, I'm fighting for what I believe is right and fighting against what I see happening in my ER day in and day out. :thumbdown:
             

            austinap

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              Scripps would be pretty cool. Nice place.



              And on a side note, I feel like there is too much focus on specialties. Basically we have a bunch of overpaid and underworked docs running around crapping on FP docs when they know nothing about family medicine and its complexity. Salary caps on specialties need to happen, money needs to start going to FP, and more resident spots need to become available. All graduating students should have to do a mandatory year of FP for their first year of residency. Don't like that? Awwww, too bad, don't be a doctor then (and quite preaching that you're in it because you "love to help people"). Hospitals, etc. need to stop making it seem OKAY for Patients to use, and continue to use, an ER doc in place of a PC doc. For obvious reasons. end rant.:beat:


              I'm bored at work. Can you tell? I almost wish someone would code. Ohhhh, did I just say that out loud? :uhno:


              I second that Scripps would be cool.

              However, I don't think you're right about the cause for why people aren't going into primary care. The person that immediately applied to you seems to have it right: it's about job satisfaction, etc.

              In my view, one of the main problems is in what is selected for in med school applications. The best schools want high GPA, research experience, and great MCAT scores. In short, they want smart people that have the potential to become good scientists. The number one way to frustrate people with that type of personality is to make them feel bored.

              You could make family practice pay the exact same as neurosurgery right now, and still the only way that I would consider doing it would be if it was part time with a significant amount of research on the side. Why? Because FP isn't technically challenging. It's challenging in other ways, and I'm not saying it's an easy job, but it doesn't present the same technical challenges as other specialties do, and I need interesting problems otherwise I feel bored. You need to fix that problem.

              IMO, making specialties pay less will only make the best applicants look into other carreers, it won't do anything to increase the quality of primary care physicians.
               

              Kaustikos

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                Also, the problem isn't that specialists make too much. Its that FP docs make too little_ and they don't have a very interesting job anymore. They used to deliver babies, set broken bones, etc.. Today, they are mostly a prescription-writing referral factory. Who the hell wants to go to med school and then residency to do a job that, realistically, a good RN could do most of the time? If there was more money in it, to pay back the ******ed loans that we're all going to owe, then it might be a little better.

                And the osteopathic schools, which pride themselves on being primary-care-centric, are mostly a bunch of ridiculously expensive private schools. So they're not turning out the PC docs that they used to either. I know I won't be going into primary care. I can't even justify considering it with the debt i'll be in
                I wouldn't go into primary care because they're basically a filtering/screening system.
                "yes, you're sick. Let me send you to someone who specializes in this."
                "Here are some antibiotics and a lollipop. get better."
                 

                Disinence2

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                  I think you are making the incorrect assumption that what you do should be somehow be tied to how much you make.

                  This holds true for many fields outside of medicine. Sometimes the person working the hardest isn't getting paid the most.

                  That being said, medicine is a skill. Not everyone can do it. In my opinion its a service, and it deserves some compensation in scale to what is being offered. The neurosurgeon deserves to make more money than a family practice doc. They spent longer in training learning how to do things that no other specialty can.

                  Supply and Demand.
                   

                  Hoody

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                    That being said, medicine is a skill. Not everyone can do it. In my opinion its a service, and it deserves some compensation in scale to what is being offered. The neurosurgeon deserves to make more money than a family practice doc. They spent longer in training learning how to do things that no other specialty can.
                    Um, no, the PCP cannot operate on the brain. But how well could the Neurosurgeon manage a Patient with failing kidneys, HTN, diabetes, COPD and extensive edema? Or manage a pregnant lady with gestational diabetes and htn? Not very well. PCPs also do things that no other specialties do...like managing Patients with multiple morbidities across a continuum. Again, this gets back to the basic understanding of how complex Family Medicine truly is, yet rarely gets credited for.

                    How often have you needed a Neurosurgeon? How often have you needed you a PCP?

                    So....how can you say that Neurosurgeon is superior to Family Medicine?

                    Regarding the training, I personally have always found it far more difficult in school to learn a large amount of broad material versus a large amount of a single subject. To say that Neurosurgery, or any other specialty is harder than Primary Care is only your opinion. It may be much much harder to get into Neurosurgery, but it may not be harder to learn and use in everyday practice, just different.

                    Salaries don't need to be equal, but do they really need to be so lopsided? And cant all doctors stand on the same pedestal? We're all just trying to save lives/promote health here.


                    Again, just a pre med, so I really probably know nothing
                    . :(
                     
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                    greatnt249

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                      Hoody, it would do you well to not take every comment that doesn't worship the almighty PCP as a personal affront. To each their own; just because you're gung-ho about primary care doesn't mean you have to win over everyone else who isn't planning on primary care as a specialty, especially when you aren't even in the field yet.
                       

                      Hoody

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                        Hoody, it would do you well to not take every comment that doesn't worship the almighty PCP as a personal affront. To each their own; just because you're gung-ho about primary care doesn't mean you have to win over everyone else who isn't planning on primary care as a specialty, especially when you aren't even in the field yet.
                        I'm just gung ho on supporting them. Sorta like fight for basic human rights thing. I don't expect everyone to understand. People have brought up very valid points, and I respect their opinions completely, sorry if it comes across otherwise.


                        And, I'll repeat, no Family Medicine for me...I want pathology, clinical, research, both, NIH....anything path :biglove:.
                         

                        fried rice

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                          Who said to turn them away? I sure didn't. I said not to encourage them to use the ER in place of PCP

                          And how are you going to enforce that? It isn't the ER staff that's encouraging patients to seek treatment there. EMTALA demands that they pay each patient due diligence.


                          Again, I didn't say not to treat them. However, I believe unless a Patient meets specific criteria, they shouldn't be treated in the ER. They should be refereed to a PCP, just a like a PCP would refer a Patient to a specialist if thats what was truly needed. You wouldn't admit a person who did not meet criteria to be admitted, so don't treat people that can legitimately be seen by a PCP.

                          Take it up with EMTALA.
                           

                          Hoody

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                            Take it up with EMTALA.
                            Why? Is EMTALA going to add more FP residency spots? or promote loan reimbursement/help for FP? or increase FP salaries?

                            I'm not blaming ERs for the situation they are in. I'm saying FP needs to be made more lucrative so that more people are interested in it to begin with and more students take the time to understand what it really is (or is not for that matter).

                            There's still a whole other side to this. Just because you have a bunch of PCPs running around doesn't necessarily mean that people would utilize them and quit utilizing ERs if they still could not afford the health care. I don't even know how to begin to fix that. :scared:
                             

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                                in the end life goes on, and it doesn't matter what the current state of health care is and what's going to happen, you just gotta do what you love....


                                Finally, after about 20 winded posts fighting endless, useless battles, somebody finds some sort of truth.

                                Good work Premedhopeful.:)
                                 
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