How would medical school competition change down the road?

[Dr. Spoodermen ND]

From speaking with physicians who went to school 10-20 years ago, some MS3-4s/residents I know, and looking (well, hearing about) at MSAR trends, it seems med school admissions has gotten a lot more competitive over time. This is purely anecdotal though, and I have no data to support it. Just a food-for-thought kind of question.

Do you think medical school admissions will be more competitive, in general, 5-10 years down the road? How about 10-20 years? I personally don’t think ~5 years would be enough to notice a significant difference, but considering how the US population is in decline, maybe way down the road there would be a noticeable decrease in applicant pool size, which would lead to a relative decrease in perceived competition?

Will a few new schools opening up (like Kaiser, NYU Long Island) help “alleviate” the competition? But this is at most a few hundred more seats, which is almost nothing compared to the applicant pool every year.

One of my friends who's a premed was talking about how a PCP shortage in the US coupled with a supposed increase in med school competition willbe disastrous for the US healthcare system, but doesn't that problem have more to do with incentivizing current medical students to pursue a PCP career than to just lower standards and let more but less qualified candidates in?

What do you think? Do you think med school will get more and more competitive until it hits a "critical mass" at some point, or has it/will it be relatively consistent?

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[965978]

I think the following trends will cause more and more people to consider not going into medicine:

-The rise of responsibilities of nurses/PA's, which make them more appealing careers (I read a recent paper about nurses possibly being trained in lumbar punctures (see below))
-The increased stress of going into medicine
-Increasing tuition of medical schools
-The perceived (and/or actual) necessity of taking gap years, not only after undergrad but after medical school
-Unreliable job markets for certain specialties (Rad Onc is undergoing a crisis, apparently)

Here is the link: Expanding RN Scope of Practice to Include Lumbar Puncture. - PubMed - NCBI

There are also innovative nursing/PA fellowships that are available, such as Penn State's Dermatology fellowship for nurses and physician assistants: Advanced Practice Clinician Dermatology Fellowship – Penn State College of Medicine Residencies and Fellowships

I don't think that more med schools really help because the number of people applying increases also due to the fact that more and more people are taking gap years

Having said all that, I will still put my heart and soul into becoming a doctor. No matter what.

 

[puahate]

No one knows.

 

[Shammyguy3]

Multiple physicians i have worked for, these ones being in their 50s and 60s, have mentioned how they dont know how anybody makes it into med school nowadays and if it was this competitive in the 70s/80s they probably would be doing something else with their careers

 

[deleted804295]

Medicine really isn't super competitive if we also account for DOs. I was looking at their averages and some DO schools have median MCATs around 502-505.

As for MD schools state schools might get a bit harder to get into but this might be offset by primary care shortages.

I think medicine is following the projectory it should in terms of competitiveness if we account for differences in materials/prep/curriculum 5, 10, 15 years ago.

Are things objectively harder now? No doubt about it. But we're also growing up in a world with better technology, better information, and better opportunities.

 

[907914]

In the in mid1970s/early 1980s medical acceptance rates were considerably lower then they are today. Acceptance rates were in from about ranged from about 36% (1 in 3) to as low as 28% (nearly 1 in 4). This was due in mostly to college age demographics (larger applicant pool) and studies speculated an over abundace of doctors. These trends led directly to the rise of Carribean schools.

It wasnt until about the late 1980s that acceptance rates began to rise, again due to college age demographics (smaller applicant pool) and the attraction of technology and business over premed. Here acceptance rates were about 50%

This changed about 2000, again with a large growth in applicant pool that exceeded the growth in medical school seats across both MD and DO

In short, the flux in competition for medical school seats s primarily affected by college age demographics and economic trends rather than any trend in medicine

See link for graphs
https://www.aamc.org/download/153708/data/

In contrast to your last comment about applicant rate exceeding seats, we have seen a rash of medical schools opening up in the last decade (24 of the 141 allopathic medical schools have been opened just since 2008). This doesn't seem like a trend that is likely to slow (as evident by Kaiser and NYU Long island).

Do you think the applicant pool will continue to rise? If so, what in the undergraduate system is leading to current increased trends in application rates?

 

[Shammyguy3]

In the in mid1970s/early 1980s medical acceptance rates were considerably lower then they are today. Acceptance rates were in from about ranged from about 36% (1 in 3) to as low as 28% (nearly 1 in 4). This was due in mostly to college age demographics (larger applicant pool) and studies speculated an over abundace of doctors. These trends led directly to the rise of Carribean schools.

It wasnt until about the late 1980s that acceptance rates began to rise, again due to college age demographics (smaller applicant pool) and the attraction of technology and business over premed. Here acceptance rates were about 50%

This changed about 2000, again with a large growth in applicant pool that exceeded the growth in medical school seats across both MD and DO

In short, the flux in competition for medical school seats s primarily affected by college age demographics and economic trends rather than any trend in medicine

See link for graphs
https://www.aamc.org/download/153708/data/

Perhaps their thought process entailed "quality of individual applicants and total applicant pool" versus number of applicants per number of seats?

 

[lalalallala]

The gist from older physicians that I have talked to is that the training was extremely difficult in their day and age but that admissions was more straight up based on academics - less on hooks, diversity, interesting extra curricular activities. I wasn't there obviously this is just what many older physicians have voiced. So what I'm saying is that maybe getting accepted was a different kind of hard.

I think getting into top/mid schools will continue to be very very challenging with single digit acceptance rates, but I think the overall course of the demand of the profession will depend in part on how the healthcare system changes over time. Relative incomes for some physicians (meaning like what their salary can buy them) have gone down (physicians are no longer automatically wealthy by nature of being a physician). If this trend intensifies I think other professions will be attractive to smart applicants (tech for ex)

 

[Goro]

In contrast to your last comment about applicant rate exceeding seats, we have seen a rash of medical schools opening up in the last decade (24 of the 141 allopathic medical schools have been opened just since 2008). This doesn't seem like a trend that is likely to slow (as evident by Kaiser and NYU Long island).

Do you think the applicant pool will continue to rise? If so, what in the undergraduate system is leading to current increased trends in application rates?

I guarantee you the applicant pool will rise when we get to the next recession

 

[907914]

I guarantee you the applicant pool will rise when we get to the next recession

You think it will RISE when we get to the next recession? Why would an economically disadvantageous situation lead to an INCREASE in applicants?

 

[Goro]

You think it will RISE when we get to the next recession? Why would an economically disadvantageous situation lead to an INCREASE in applicants?

When it's hard to find a job medicine looks like a very good career. Can you touch of the past two recessions that I have live through as a faculty member, we have seen a massive bolus in the number of applications we get. When the economy improves the number of applications goes down

 

[907914]

When it's hard to find a job medicine looks like a very good career. Can you touch of the past two recessions that I have live through as a faculty member, we have seen a massive bolus in the number of applications we get. When the economy improves the number of applications goes down

Interesting. I suppose I was looking at it through the lens of an economically disadvantaged individual - if we were in a recession I wouldn't have been able to save for the application. But, I guess, with medicine tending to attract already higher income individuals/backgrounds, the prospects of just saving for the application don't necessarily matter as much.

Also, good use of the word bolus - don't get to read that on the daily.

 

[AsianPersuasion]

I think med school will continue to rise but I don't think it will be the level of competition as say PA school right now. Every college senior who always had their eyes on that Grey's Anatomy life style are dropping it all for PA. Strutting around in their Fig scrubs, instagram and colored pens.

 

[Dr. Spoodermen ND]

I think med school will continue to rise but I don't think it will be the level of competition as say PA school right now. Every college senior who always had their eyes on that Grey's Anatomy life style are dropping it all for PA. Strutting around in their Fig scrubs, instagram and colored pens.

Oh yeah, I'm seeing a crazy amount of love for PA right now. Less debt, less school, still get to work in a clinical setting, a decent amount of responsibility without the associated risk that comes with being a physician...

A PA who goes to my gym did say "I regret not going to medical school," and he has 10+ years experience. I wonder what % of PA's feel that way.

 

[lalalallala]

Oh yeah, I'm seeing a crazy amount of love for PA right now. Less debt, less school, still get to work in a clinical setting, a decent amount of responsibility without the associated risk that comes with being a physician...

A PA who goes to my gym did say "I regret not going to medical school," and he has 10+ years experience. I wonder what % of PA's feel that way.

I know a lot of NPs who regret their choice but I don't know any PAs. The NPs I know work in various ICUs and say they feel like they're stuck in perpetual residency

 

[AsianPersuasion]

Oh yeah, I'm seeing a crazy amount of love for PA right now. Less debt, less school, still get to work in a clinical setting, a decent amount of responsibility without the associated risk that comes with being a physician...

A PA who goes to my gym did say "I regret not going to medical school," and he has 10+ years experience. I wonder what % of PA's feel that way.

Honestly, if it wasn't for the ceiling affect and limited role, I'd be all about PA school too. But I would never be satisfied being first assist and not a surgeon. My best friend has some regrets but I think he found something that allows him to be in a diverse role.

The sad part is you won't truly know until you get there whether or not you'll be truly satisfied.

It's all a lie but they say that PA works less. Hell, in surgery where I will be doing residency, they make them go see the patient first and work collaboratively with doctors and constantly refer for any concerns.

 

[_TheStruggl3_]

yo TBH I expect a decrease in med school applications and a rise in PA/NP applicants. Medicine has always been glorified, but pretty sure with social media, now all the terrible challenges that come with it are also coming into light, which look especially dark in comparison to the fast track/fast money/flexible lifestyle of PAs

 

[puahate]

PAs will be saturated. Theres already projections of it.

 

[aldol16]

One of my friends who's a premed was talking about how a PCP shortage in the US coupled with a supposed increase in med school competition willbe disastrous for the US healthcare system, but doesn't that problem have more to do with incentivizing current medical students to pursue a PCP career than to just lower standards and let more but less qualified candidates in?

I think it's been well characterized that the US doesn't have a shortage problem as much as a distribution problem. The physician market is saturated and even super-saturated in some of the bigger, more desirable cities in the US. The problem isn't that we don't have enough doctors but that we don't have enough doctors who want to live in Nebraska after spending all of their lives in school and training. They're making money for the first time (for most) in their lives and they want to be able to spend some of that money (and use the rest to pay back the loans). While some people may in fact want to go live in Nebraska, I think most don't. So you have this problem where physicians end up concentrating on the coasts, specifically East Coast + California.

So the solution isn't going to be encouraging students to pursue primary care careers but rather to incentivize primary care providers to live and practice in Nebraska.

With respect to your general question, medicine is also a tightly regulated field - and for good reason. You have people who spend 4+ years of their lives in medical school, racking up hundred(s) of thousands of dollars in debt (plus undergraduate debt) and you want to be able to move them all on to the next phase of their training. Because at the end of medical school, you've basically made a huge investment and only have a piece of paper that doesn't mean a whole lot in the world to show for it. If you increase the number of medical school seats without increasing residency positions, you're gonna end up with an increasing number of people who are MDs on paper only. And that's a bigger problem than the perceived "shortage" of physicians we have.

 

[Lucca]

I think the main things to consider are how good are the perceived opportunities in medicine vs. I’m literally anything else. Recession? Medicine looks better. Boom in some other field? Less competition.

I expect residency competition to be more affected in the future than med school competition. With the growth of med schools outpacing the growth of residency slots, it will be more challenging for people to match into the most competitive spots. Will that mean more go into primary care as a result? Maybe, I hope so personally.

 

[stairway2seven]

The competitiveness of getting into med school is more than X number of applicants and Y number of spots. It seems to me that premeds have increasingly strong applications and are more prepared than ever (in certain aspects) to start medical school.

While I admittedly don't have numbers to back it up, I feel that matriculants are starting school with higher GPA, more clinical experience, volunteer hours, research publications, etc than ever before. This is the vibe I've gotten from speaking to docs and former/current adcom members.

The % of students that get accepted is high (somewhere in the 40s I believe) but thousands of very qualified applicants don't get in unfortunately.

 

[Faha]

It will be much easier to get into medical schools 10 years from now assuming the applicant pool remains stable. There have been 14 new MD schools that have/will open in the 2015 to 2020 time frame with a few more in the pipeline. Also 14 new DO schools in the same time frame with additional ones planned. Compared to 2015 there will be 3,000 more MD students in each entering class and 4,000 more for each DO class. That will be 33,000 to 34,000 first year students. First time applicants for MD and DO schools are currently approximately 44,000 so if this number is stable over 75% of applicants will receive an acceptance in the future. If you look at the GPA-MCAT grid this means that any applicant with a GPA of 3.0 and and MCAT of 507 will be accepted or a GPA of 3.3 and a MCAT of 500. The danger with the large increase in medical schools and enrollment is that applicant levels could drop to 28,000 which is what they were in the late 1980's. Unlikely to happen but it could occur.

 

[907914]

It will be much easier to get into medical schools 10 years from now assuming the applicant pool remains stable. There have been 14 new MD schools that have/will open in the 2015 to 2020 time frame with a few more in the pipeline. Also 14 new DO schools in the same time frame with additional ones planned. Compared to 2015 there will be 3,000 more MD students in each entering class and 4,000 more for each DO class. That will be 33,000 to 34,000 first year students. First time applicants for MD and DO schools are currently approximately 44,000 so if this number is stable over 75% of applicants will receive an acceptance in the future. If you look at the GPA-MCAT grid this means that any applicant with a GPA of 3.0 and and MCAT of 507 will be accepted or a GPA of 3.3 and a MCAT of 500. The danger with the large increase in medical schools and enrollment is that applicant levels could drop to 28,000 which is what they were in the late 1980's. Unlikely to happen but it could occur.

Your “first time applicant” number doesn’t account for the number of re-applicants, which make up a significant portion of the applicant pool.

 

[Shammyguy3]

Your “first time applicant” number doesn’t account for the number of re-applicants, which make up a significant portion of the applicant pool.

But if say that first year reapplying the vast majority of those reapps get in, the following cycle will have very few reapps

 

[907914]

But if say that first year reapplying the vast majority of those reapps get in, the following cycle will have very few reapps

True. But then the whole system collapses 4 years later when 34,000 medical students try to match in to 30,000 residency slots....

 

[Faha]

Your “first time applicant” number doesn’t account for the number of re-applicants, which make up a significant portion of the applicant pool.

Qualified reapplicants will not exist in the future since they will be accepted on their first application. Basically, reapplicants will be those with sub 3.0 GPA's and sub 500 MCAT scores.

 

[NITRAS]

When it's hard to find a job medicine looks like a very good career. Can you touch of the past two recessions that I have live through as a faculty member, we have seen a massive bolus in the number of applications we get. When the economy improves the number of applications goes down

While I don't argue that medicine is relatively recession resistant, the cost of becoming and MD or DO has been trending up, and the average salary has been largely stable or negative, and is tied to some very politically polarizing things. The autonomy of physicians is very different than it used to be. The societal respect of being a doctor is going down.

There is a lot of uncertainty out there, and I don't think anyone really has a good grasp of what it will look like in 10 or 15 years. I think people are starting to really look at the absurdity of student loans that people are taking out.

I love medicine and think that most people can make good money doing it, but if your average doc is making low six figures, the applicant pool will become a lot less competitive.

 

[Shammyguy3]

True. But then the whole system collapses 4 years later when 34,000 medical students try to match in to 30,000 residency slots....

That is definitely a concern

 

[Faha]

True. But then the whole system collapses 4 years later when 34,000 medical students try to match in to 30,000 residency slots....

There were over 32,000 PGY1 positions in the 2019 match. There will be 34,000 in 10 years. Those who do not match will be the foreign IMG and the few US IMG that are still attending Caribbean schools. There will be some graduates that will be forced to choose primary care though even though that is not their preference.

 

[puahate]

There were over 32,000 PGY1 positions in the 2019 match. There will be 34,000 in 10 years. Those who do not match will be the foreign IMG and the few US IMG that are still attending Caribbean schools. There will be some graduates that will be forced to choose primary care though even though that is not their preference.

does that include prelim spots?

 

[glassesvar]

When it's hard to find a job medicine looks like a very good career. Can you touch of the past two recessions that I have live through as a faculty member, we have seen a massive bolus in the number of applications we get. When the economy improves the number of applications goes down

Isn’t the economy basically the best it’s been in 10 years though? And applicant numbers continue to rise?

 

[907914]

Isn’t the economy basically the best it’s been in 10 years though? And applicant numbers continue to rise?

I am just hoping the coming recession waits at least another 7 months so there isn't a balloon of applicants to compete with (by Goro's statement).

 

[Goro]

Isn’t the economy basically the best it’s been in 10 years though? And applicant numbers continue to rise?

Recessions occur roughly every 10 years. Do not count upon the economy staying good forever

 

[glassesvar]

Recessions occur roughly every 10 years. Do not count upon the economy staying good forever

Right but if I’m not mistaken, you said app numbers go down when the economy is better, but as the economy has gotten better app numbers have continued to rise right?

 

[glassesvar]

I am just hoping the coming recession waits at least another 7 months so there isn't a balloon of applicants to compete with (by Goro's statement).

I mean even if there were a recession that hits tomorrow it’s not like a bunch of new people are going to be ready to apply immediately. It would probably take a few years to see that rise after a recession.

 

[Goro]

Right but if I’m not mistaken, you said app numbers go down when the economy is better, but as the economy has gotten better app numbers have continued to rise right?

My school and others have seen a fall off in numbers. This not only has to do with the economy, but also demographics.

 

[Angus Avagadro]

I think soon we will see a drop off in applications irrespective of the economy. As physician autonomy continues to be eroded by corporate entities and practice managers, physician satisfaction will continue to drop. Mid level encroachment on their practice will continue to diminish physician value. It won't be long until the risk/reward of going to med school will be in such imbalance that people will opt out and go into fields with better lifestyles and compensation.

 

[Goro]

I think soon we will see a drop off in applications irrespective of the economy. As physician autonomy continues to be eroded by corporate entities and practice managers, physician satisfaction will continue to drop. Mid level encroachment on their practice will continue to diminish physician value. It won't be long until the risk/reward of going to med school will be in such imbalance that people will opt out and go into fields with better lifestyles and compensation.

I disagree, as Tiger Parents and premends have no idea what midlevels are!

I believe that the only thing that will stop the popularity of Medicine as a career is if it becomes like Law or Pharmacy and becomes saturated. Keep in mind that COCA and LCME have sanctions for schools that will not be able to find jobs for students.

 

[Angus Avagadro]

Probably true about the tiger parents. My son came from a 2 physician family and still went into FM despite FULL disclosure. I believe medicine will saturate faster with the explosion of midlevels and expanding practice parameters of midlevels. Pharm, PT, CRNAs are all going to 6 yr PhD programs where they expect to diagnose and treat, easing physician maldistribution across the country. Or at least that is the party line.

 

[Faha]

does that include prelim spots?

Yes but it does not include the 3,000 PGY2 positions that many of those will eventually advance to.

 

[glassesvar]

Probably true about the tiger parents. My son came from a 2 physician family and still went into FM despite FULL disclosure. I believe medicine will saturate faster with the explosion of midlevels and expanding practice parameters of midlevels. Pharm, PT, CRNAs are all going to 6 yr PhD programs where they expect to diagnose and treat, easing physician maldistribution across the country. Or at least that is the party line.

6 years including undergrad?

 

[lalalallala]

My school and others have seen a fall off in numbers. This not only has to do with the economy, but also demographics.

what do you mean by demographics

 

[Goro]

what do you mean by demographics

dem·o·graph·ics
/ˌdeməˈɡrafiks/
noun

1. statistical data relating to the population and particular groups within it.
   "the demographics of book buyers"

Specifically, I'm referring to the entire pool of college age kids. Where seeing the declining slope of the pig inside the snake, so to speak.

 

[Angus Avagadro]

6 years including undergrad?

YES, I think PT and Pharm are 6 yrs, the others may not be. The fact all the groups I mentioned are moving to PhD degrees is accurate and the salient point. Thank you for pointing that out

 

[907914]

YES, I think PT and Pharm are 6 yrs, the others may not be. The fact all the groups I mentioned are moving to PhD degrees is accurate and the salient point. Thank you for pointing that out

Even at non-provider levels they are migrating away from lower levels of education towards bachelors degrees (See Nurses, lab techs, rad techs, RT). Do you think the increased level of education across healthcare will/could lead to increased scope of care for non-physicians/decreased scope of care for physicians?

 

[Angus Avagadro]

Even at non-provider levels they are migrating away from lower levels of education towards bachelors degrees (See Nurses, lab techs, rad techs, RT). Do you think the increased level of education across healthcare will/could lead to increased scope of care for non-physicians/decreased scope of care for physicians?

Not decreased scope of care for physicians, but decreased demand, then decreased compensation. If demand goes down, what happens to cost? It goes down. This is why I said earlier that the cost/ benefit of going to med school will reduce competition for enrollment in the future.

 

[Walter Raleigh]

When it's hard to find a job medicine looks like a very good career. Can you touch of the past two recessions that I have live through as a faculty member, we have seen a massive bolus in the number of applications we get. When the economy improves the number of applications goes down

I wonder whether this holds true at every selectivity level: does Harvard Medical School get a bolus the same as the state MD schools? Is it marginal candidates selecting medicine more, or people going from management consulting to medical school?