Med School admissions is getting too competitive.

[Gandyy]

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If someone works hard during undergrad and has a good personality, it's not *that* hard to get into medical school.

Its still pretty hard lol

 

[Mad Jack]

We owe them $300k and a resume's worth of accolades that weren't necessary for premeds 50-60 years ago and they don't owe us a couple more spots in their school? Oh okay

How does you having it harder mean they owe you anything? Times were different and things change. They don't owe you the exact world they were educated in lol.

 

[avgn]

lol the trolling is real right now

I mean, it's only fitting for this thread

 

[efle]

I agree with both of these points. At the end of the day, if you're honest with yourself, do some genuine reflection about whether medicine is the right career for you, and get as much information as possible given your stage, you will likely be fine. People run into problems when they, for lack of a better phrase, "don't trust their gut" or don't engage in meaningful research into both medicine as a career as well as other possible alternatives. Theoretically the admissions process gets at this process by de facto requiring things like clinical experience, volunteering, etc., but people that approach the admissions process only has a box-checking exercise without reflecting on their experiences or focusing solely on the end-game, for example, are at risk of being unfulfilled by medicine.

To give an example (and hopefully without putting words in his mouth), I think @circulus vitios is a prime example of this. He often talked about medicine as strictly a job that offers a fantastic salary with minimal work beyond getting into the training pathway, yet he dropped out of med school and went on to other things before finishing his first year. I don't mean that in a pejorative sense - I'm not ****ting on him for what he did by any means. But it serves as an example of what can happen if you don't engage in serious reflection on what the process entails, what your overall goals are, and if you think the intrinsic work of being a medical student/resident/doctor will be interesting or fulfilling enough to you to propel you through the arduous training process. If he still checks SDN, maybe he'll pop into this thread and give a more thorough perspective of his experience.

If he dropped out as an M1 though doesn't that indicate problems with the academics more than being unfulfilled by patients?

Dermviser's old signature comes to mind, the quote talking about how everyone comes in ready to change the world and sacrifice, and then ends up resenting patients and praying for the lifestyle specialty match

 

[Gandyy]

IT IS NEVEE TOO LATE! POKEMON = II, per se
You want that, don't you?

ah alas, I dont know if pokemon status will give me a II. MD schools dont like pokemon from what I hear.

 

[avgn]

Its still pretty hard lol

I think that's because the academics are hard for the overwhelming majority of people

 

[avgn]

ah alas, I dont know if pokemon status will give me a II. MD schools dont like pokemon from what I hear.

LIES
BLASPHEMY

We don't want you anymore, hmph

 

[Gandyy]

I think that's because the academics are hard for the overwhelming majority of people

Well I was actually talking about the many 3.7, 30-31 applicants who dont get into a single MD school even with a lot of EC's and applying early June.

 

[Mad Jack]

Don't like 90% of applicants get into a residency? Just going off of what other people have told me/what I've seen.

EDIT: Just checked, 97% of applicants find a residency.

Extra residencies fill with IMGs, which end up being just as good as US trained doctors. Adding more residency slots increases the actual number of doctors in practice. Adding more medical school seats just changes the number of US grads that fill those seats. Soon, however, there will no longer be an excess, and we will have more US graduates than residency positions, in which case US graduates will have nowhere to train.

 

[Gandyy]

Extra residencies fill with IMGs, which end up being just as good as US trained doctors. Adding more residency slots increases the actual number of doctors in practice. Adding more medical school seats just changes the number of US grads that fill those seats. Soon, however, there will no longer be an excess, and we will have more US graduates than residency positions, in which case US graduates will have nowhere to train.

Well if what you say is 100 percent how its going to go down, then DO students will be in the same spot as IMGs and FMGs are right now. That is assuming with the merger coming up of course.

 

[NickNaylor]

If he dropped out as an M1 though doesn't that indicate problems with the academics more than being unfulfilled by patients?

Dermviser's old signature comes to mind, the quote talking about how everyone comes in ready to change the world and sacrifice, and then ends up resenting patients and praying for the lifestyle specialty match

My understanding of his limited telling of events is that he was doing fine academically. He just hated the routine of the pre-clinical years and hated the material. I think he may have seen a little bit of "the light" had he stuck it out, but clearly he didn't think the continued time and financial expense was worth trying to figure it out.

I would consider my past self relatively knowledgable about what I was getting myself into, but even then I had my doubts. I'm glad that I'm a doctor and overall I've enjoyed intern year thus far, but during MS2 there was a period of several months where I seriously questioned on a weekly basis whether I made the right decision. That continued well into MS3 and it really wasn't until I settled on a field that I thought I would really enjoy that those thoughts dissipated. The training is a grind and can be extremely demoralizing. If you're not ready for it or if you're not motivated by what you see as the light at the end of the tunnel, it can happen to you.

 

[steelersfan1243]

Why is no one bringing up the relationship between the economy and number of medical school applicants? I forget who posted it yesterday, but just ten years ago, there were 8000 more residencies available than fourth year medical students. Can't we see this direct increase in "desire" for medicine a result of the recession? We have put more value in job security, taking us away from pursuing a PhD or a job in business?

Say what you want, but I doubt this interest in medicine is only going to increase as the years go on, as the economy gets better, less will want to put the ten years in to get a job that pays as well as something that just took a Bachelor's

EDIT: *embracing for the naive SDNers who say they would have pursued a career in medicine no matter what*

 

[efle]

a job that pays as well as something that just took a Bachelor's

?

 

[deleted480308]

Why is no one bringing up the relationship between the economy and number of medical school applicants? I forget who posted it yesterday, but just ten years ago, there were 8000 more residencies available than fourth year medical students. Can't we see this direct increase in "desire" for medicine a result of the recession? We have put more value in job security, taking us away from pursuing a PhD or a job in business?

Say what you want, but I doubt this interest in medicine is only going to increase as the years go on, as the economy gets better, less will want to put the ten years in to get a job that pays as well as something that just took a Bachelor's

EDIT: *embracing for the naive SDNers who say they would have pursued a career in medicine no matter what*

Economy absolutely effects it....I did the math

 

[ZedsDed]

Next >

Why is no one bringing up the relationship between the economy and number of medical school applicants? I forget who posted it yesterday, but just ten years ago, there were 8000 more residencies available than fourth year medical students. Can't we see this direct increase in "desire" for medicine a result of the recession? We have put more value in job security, taking us away from pursuing a PhD or a job in business?

Say what you want, but I doubt this interest in medicine is only going to increase as the years go on, as the economy gets better, less will want to put the ten years in to get a job that pays as well as something that just took a Bachelor's

EDIT: *embracing for the naive SDNers who say they would have pursued a career in medicine no matter what*

I've heard LizzyM say before that there is always a spike in admissions during economic downturns.

 

[Mad Jack]

Well if what you say is 100 percent how its going to go down, then DO students will be in the same spot as IMGs and FMGs are right now. That is assuming with the merger coming up of course.

It's likely DOs will face some of the brunt of a shortage. But, interestingly, DOs seem to be doing better in the match, while MD match rates are dropping a bit over the past two years as DO and IMG numbers have increased. There's enough solid non-USMD candidates that bottom of the barrel MDs no longer are getting pity positions much of the time. Will the outlook be great for DOs? Probably not. But will it be as bad as current Carib grads? Also probably not.

 

[steelersfan1243]

?

I imagine someone in business in a good economy could have reached the six figure range within ten years of their undergrad, similar pay to a Pediatrician and Family doctor...

 

[ClrkKnt]

Why is no one bringing up the relationship between the economy and number of medical school applicants? I forget who posted it yesterday, but just ten years ago, there were 8000 more residencies available than fourth year medical students. Can't we see this direct increase in "desire" for medicine a result of the recession? We have put more value in job security, taking us away from pursuing a PhD or a job in business?

Say what you want, but I doubt this interest in medicine is only going to increase as the years go on, as the economy gets better, less will want to put the ten years in to get a job that pays as well as something that just took a Bachelor's

EDIT: *embracing for the naive SDNers who say they would have pursued a career in medicine no matter what*

Most medicine careers pay above six figures and some are guaranteed 200k+ type of money for the most part. I agree with you on one part though, lets face it, most of these med school applicants and the ones who get in as well are doing it for prestige, money, family pressure (Asians and Indians), and/or job security. No one wants to point out the elephant in the room but that is the number 1 reason for majority of the people that eventually do get into med school. Obviously they'll convince themselves and others different but that is why most people want to go to med school.

Now there are people out there that genuinely love medicine and want to do it because they care for others along with having a love for the sciences but these people are not the majority.

 

[md-2020]

I imagine someone in business in a good economy could have reached the six figure range within ten years of their undergrad, similar pay to a Pediatrician and Family doctor...

But w/o the stability of medicine.

Most doctors are also not pediatricians and PCPs.

 

[GrapesofRath]

hahahahahahahahahahahahahahahahahahahahahaha

As usual sb247 sums this whole question up so eloquently. There's nothing else to say here; end of thread move along people

 

[Lucca]

While we're here, any thoughts on how we're going to tackle the doctor distribution problem? I.e getting Psychs, Ob/Gyns and FMs into rural and poorer urban settings?

I've felt for a while that the way we select for future medical students (academics + testing + research + altruism) is also unwittingly selecting for "academics + testing + research + altruism" personality types or, in other words, people who want to live in a metropolitan area and specialize. I know for a fact that not everyone wants that type of lifestyle but successful pre-meds seem to fall into that mold pretty easily. Idk, I'm just talking off the top of my head from what I've observed. Thoughts?

 

[deleted480308]

While we're here, any thoughts on how we're going to tackle the doctor distribution problem? I.e getting Psychs, Ob/Gyns and FMs into rural and poorer urban settings?

I've felt for a while that the way we select for future medical students (academics + testing + research + altruism) is also unwittingly selecting for "academics + testing + research + altruism" personality types or, in other words, people who want to live in a metropolitan area and specialize. I know for a fact that not everyone wants that type of lifestyle but successful pre-meds seem to fall into that mold pretty easily. Idk, I'm just talking off the top of my head from what I've observed. Thoughts?

The only answer is to pay them more. They will not move there en masse without it

 

[Lucca]

The only answer is to pay them more. They will not move there en masse without it

Well NHSC scholarships and loan repayment is a thing so there are financial incentives in place to practicing in such a location. Furthermore, are doctors in those areas not more likely to be able to open up private practices and not be associated with the big hospital systems many docs seem to be complaining about? Technically one should be making far more money working as the only Ortho surgeon within 100 miles than one would be as a junior ortho just starting out in LA. I'm not sure financial incentives are the only thing moving people in that direction because at schools where the debt load is smaller (texas schools) a lot more people seem to go into primary care than at more expensive schools. In some sense, negative money seems to influence people more than positive money even though, technically, there is no real difference between the two in spreadsheet terms.

 

[steelersfan1243]

While we're here, any thoughts on how we're going to tackle the doctor distribution problem? I.e getting Psychs, Ob/Gyns and FMs into rural and poorer urban settings?

I've felt for a while that the way we select for future medical students (academics + testing + research + altruism) is also unwittingly selecting for "academics + testing + research + altruism" personality types or, in other words, people who want to live in a metropolitan area and specialize. I know for a fact that not everyone wants that type of lifestyle but successful pre-meds seem to fall into that mold pretty easily. Idk, I'm just talking off the top of my head from what I've observed. Thoughts?

Open up medical schools in these rural areas. TCMC, UC Riverside, Temple's rural campus. I'm sure wherever you go to medical school there is a good chance a portion of your class stays local in residency and practice

 

[Lucca]

Open up medical schools in these rural areas. TCMC, UC Riverside, Temple's rural campus. I'm sure wherever you go to medical school there is a good chance a portion of your class stays local in residency and practice

Don't those schools also select heavily based on their mission? I feel that form of selection is more influential than simply having a campus in a rural area. But I could be wrong, perhaps it is worth looking at the numbers more closely for schools in rural locations.

 

[deleted480308]

Well NHSC scholarships and loan repayment is a thing so there are financial incentives in place to practicing in such a location. Furthermore, are doctors in those areas not more likely to be able to open up private practices and not be associated with the big hospital systems many docs seem to be complaining about? Technically one should be making far more money working as the only Ortho surgeon within 100 miles than one would be as a junior ortho just starting out in LA. I'm not sure financial incentives are the only thing moving people in that direction because at schools where the debt load is smaller (texas schools) a lot more people seem to go into primary care than at more expensive schools. In some sense, negative money seems to influence people more than positive money even though, technically, there is no real difference between the two in spreadsheet terms.

They leave in large numbers once the loan payments stop...and the aca makes running a single doc family practice harder unless you ditch the whole system and go direct cash primary care

 

[medic86]

While we're here, any thoughts on how we're going to tackle the doctor distribution problem? I.e getting Psychs, Ob/Gyns and FMs into rural and poorer urban settings?

I've felt for a while that the way we select for future medical students (academics + testing + research + altruism) is also unwittingly selecting for "academics + testing + research + altruism" personality types or, in other words, people who want to live in a metropolitan area and specialize. I know for a fact that not everyone wants that type of lifestyle but successful pre-meds seem to fall into that mold pretty easily. Idk, I'm just talking off the top of my head from what I've observed. Thoughts?

I've heard that there is a massive shortage of OBs in West Virginia because of particularly poor malpractice laws (i.e., they get the **** sued out of them, more than anywhere else). Don't know how true this is, though.

 

[efle]

@steelersfan1243 you actually think the majority of people who start small business are six figures ten years later? Many are lucky to still be in business

 

[Lucca]

They leave in large numbers once the loan payments stop...and the aca makes running a single doc family practice harder unless you ditch the whole system and go direct cash primary care

How so to the bolded?

According to NHSC retention data 0-10 years after the commitment is up 82% of providers remain in an under-served location and after 10 years 55% stay in that same setting. (numbers from 2012: http://nhsc.hrsa.gov/currentmembers/membersites/retainproviders/retentionbrief.pdf. Long-term retention could be better but I feel those numbers are pretty robust in that one could confidently say that NHSC is selecting under the proper criteria for choosing primary care providers. Shouldn't medical schools adopt a screening process that more closely resembles the NHSC's?

 

[Lucca]

I've heard that there is a massive shortage of OBs in West Virginia because of particularly poor malpractice laws (i.e., they get the **** sued out of them, more than anywhere else). Don't know how true this is, though.

Considering that favorable tort reform has been shown to increase physician retention in my home state of Texas I would agree with that assessment. Adequate legal and financial protection for the physician is probably more important to geographic retention than the actual size of the physician's paycheck.

 

[Nietzschelover]

I agree with both of these points. At the end of the day, if you're honest with yourself, do some genuine reflection about whether medicine is the right career for you, and get as much information as possible given your stage, you will likely be fine. People run into problems when they, for lack of a better phrase, "don't trust their gut" or don't engage in meaningful research into both medicine as a career as well as other possible alternatives. Theoretically the admissions process gets at this process by de facto requiring things like clinical experience, volunteering, etc., but people that approach the admissions process only has a box-checking exercise without reflecting on their experiences or focusing solely on the end-game, for example, are at risk of being unfulfilled by medicine.

To give an example (and hopefully without putting words in his mouth), I think @circulus vitios is a prime example of this. He often talked about medicine as strictly a job that offers a fantastic salary with minimal work beyond getting into the training pathway, yet he dropped out of med school and went on to other things before finishing his first year. I don't mean that in a pejorative sense - I'm not ****ting on him for what he did by any means. But it serves as an example of what can happen if you don't engage in serious reflection on what the process entails, what your overall goals are, and if you think the intrinsic work of being a medical student/resident/doctor will be interesting or fulfilling enough to you to propel you through the arduous training process. If he still checks SDN, maybe he'll pop into this thread and give a more thorough perspective of his experience.

Putting aside the OP's checkered past and current motivations, the topic itself is an interesting one, and perhaps even an important one.

Agreeing up front that no one is entitled to anything and that no one is trying to screw anyone else, there are issues to look at.

Someone suggested physicians nowadays are happier and more fulfilled than 30-40 years ago. Don't think that is true.

Some of the increased competitiveness may be an effect of good, well thought out intentions, but that doesn't mean there aren't unintended effects.

Let's say, as a regular white applicant, you not so long ago needed 3.5/3.5+ and 30-31 with decent ECs and a decent personality to get in a MD school. I think everyone acknowledges the numbers have been climbing every year, and the EC "requirements" also have increased/intensified. Now 3.65 and 31/32 doesn't make you safe. I've noticed that just within the last year many the numbers for many schools have jumped. Some schools with a median of 31 just a year ago are 33, and schools that were 33 are now 35. Those are huge jumps within a year. The pattern is not dissimilar to elite college admissions where we have seen records breaking numbers (in admissions selectivity) for how many years consecutively?

And I think there are a fair amount of unintended effects. We've read that the AAMC wants MD schools to be more forgiving with applicants scoring 500 or better, and yet we see the grim predictions here everyday for those scoring anywhere from 500 to 507/508. Adcoms have basically said here that the AAMC wishes are just a pipe dream. Now a 3.7 is below the median. We want applicants to prove their humanity and so, seemingly reasonably, psych and soc have been added to the MCAT, and we'll see more schools requiring undergrad courses in those areas. The push to have more well-rounded students actually can make it harder to become well-rounded. With even greater course pre-reqs and with the requirements around volunteering (both types), shadowing, research, etc, where is the time to be "well-rounded"? We've heard that med schools love the double major types who major in English, or Philosophy, or Russian studies, but going forward will anyone but the very rarest of candidates be able to do that?

There's a major time compression issue as well. Increasingly, we're seeing that the past norm of applying your senior year to enter med school directly after graduation is becoming less and less doable. At least one gap year is becoming the norm and we see here in the WAMCs how easily candidates are advised to take at least an additional gap year, if not more. Given that the medical school/training process takes 7 to 9-10 years, every extra year needed to be a viable applicant is meaningful (and costly).

I actually very much agree with the bolded part of the post above, in principle, but where is the time for "reflection"? Packing all of that into a compressed period of time with stellar levels of involvement and stellar reflection on top of that while hitting the academic and other social personality targets, and all of that being done with real genuineness, seems unrealistic. Does everyone have to be the equivalent of a top 15% tri-athlete to reasonably expect admission to med school, and has the median for med schools in general become what 25 years ago we would have assumed was only a standard reserved for the HMS's of the world (i.e. those folks that most of us describe as the most brilliant person we've ever met, who doubled majored and aced an Ivy while excelling in a sport, speaking 4 languages, playing an instrument at a near-world class level, and in general knowing more about everything than anyone else in an already pretty smart room).

 

[deleted480308]

How so to the bolded?

According to NHSC retention data 0-10 years after the commitment is up 82% of providers remain in an under-served location and after 10 years 55% stay in that same setting. (numbers from 2012: http://nhsc.hrsa.gov/currentmembers/membersites/retainproviders/retentionbrief.pdf. Long-term retention could be better but I feel those numbers are pretty robust in that one could confidently say that NHSC is selecting under the proper criteria for choosing primary care providers. Shouldn't medical schools adopt a screening process that more closely resembles the NHSC's?

The aca makes it harder because of all the extra service coordination and tracking docs are being pushed to do, they simply can't do it as a single doc shop in most cases.

The job of the nhsc is to get doctors to those places, it is not the job of medical schools to get doctors to those places. Medical school's role is to train the most competant doctor's possible before they go to residency. Where I end up living is none of my school's concern (note: I actually want to be rural)

 

[Nietzschelover]

@steelersfan1243 you actually think the majority of people who start small business are six figures ten years later? Many are lucky to still be in business

Grads from engineering schools are routinely getting 65-80K from companies right out of the gate. What do you think they might be making in 10 years? Or if some of you guys went straight to a biotech or pharmaceutical? How much do you think you might be making in 8-10 years?

 

[hurryskurry]

You're wrong on a few key points here...
Second, why would you expect "that the "genetic" component is randomly distributed throughout the population"? There's a considerable component of intelligence that is heritable and also a significant correlation between intelligence and educational attainment and future economic success. While we might like to think that all are created equal, that really isn't true and there's a significant skew.
.

That's a standard assumption made in genetics, that the alleles in a population are pretty much randomly distributed. Wealth is far less randomly distributed because wealth and knowledge accrue over generations often irrespective of the genetic component. As in, there seems to be a pretty clear disjunction between genetics (and I'd say really we're probably talking about intelligence) and wealth.

Actually in economics at least Hayek showed that the market actually isn't able to evaluate people based on intelligence or virtue. So wealth can't track either. Wealth represents what the market values, which is only secondarily related to intelligence or virtue.

I never said we were "created equal." That would be a terrible straw man, which one could easily reduce to the absurd.

 

[Lucca]

The aca makes it harder because of all the extra service coordination and tracking docs are being pushed to do, they simply can't do it as a single doc shop in most cases.

The job of the nhsc is to get doctors to those places, it is not the job of medical schools to get doctors to those places. Medical school's role is to train the most competant doctor's possible before they go to residency. Where I end up living is none of my school's concern (note: I actually want to be rural)

Well medical schools have professed missions to meet the healthcare needs of the country and to join a medical school is to align yourself with that mission, is it not? And the geographic maldistribution of physicians is a healthcare problem that should be addressed. If not be medical schools then by who? The NHSC can only do so much and even then their reach is limited. There are many locations that may be in dire need of physicians - especially specialists - that do not meet the NHSCs definition of "under served".

 

[deleted480308]

Well medical schools have professed missions to meet the healthcare needs of the country and to join a medical school is to align yourself with that mission, is it not? And the geographic maldistribution of physicians is a healthcare problem that should be addressed. If not be medical schools then by who? The NHSC can only do so much and even then their reach is limited. There are many locations that may be in dire need of physicians - especially specialists - that do not meet the NHSCs definition of "under served".

And those locations need to pay more...some areas are attractive when you add up the variables (pay/weather/economy/schools/tax structure/expense) and some just aren't.

The only one that can be changed with a pen is the pay. You want medicaid patients in a county with no doctor to have a doctor? Offer a cash premium on their rvu...or the county can write a check to the doctor. But this constant handwringing about why we can't emotionally coerce docs to move places they don't want to is silly. People will follow the money

 

[Lucca]

And those locations need to pay more...some areas are attractive when you add up the variables (pay/weather/economy/schools/tax structure/expense) and some just aren't.

The only one that can be changed with a pen is the pay. You want medicaid patients in a county with no doctor to have a doctor? Offer a cash premium on their rvu...or the county can write a check to the doctor. But this constant handwringing about why we can't emotionally coerce docs to move places they don't want to is silly. People will follow the money

I'm not talking about emotional coercion. Docs should go wherever they please. I'm talking about selecting for the right type of person most likely to actually meet the professed mission of certain medical schools. I don't think pay is enough. Docs are moving to urban centers more often and people are vying for the most competitive, often academic positions in these urban centers. This entails more competition and often less compensation. I think the problem is more complicated than just what job pays the most. I really do think it ultimately has to do with the type of people being selected to be physicians.

 

[NotYou20]

IMO getting into medical school doesn't really demonstrate any of that. It's less than half of the minimal length of the overall training pathway. I'm not really sure you can demonstrate an "unwavering commitment" to anything at that stage.

It does weed out people that aren't serious about getting into medical school, but you still aren't likely to know first-hand what patient care is all about until midway through medical school. Even then it's not quite the same.

Off topic question: could you explain how the difference in patient care affects choosing a specialty? Are residents often surprised by what working in their specialty is like?

 

[LizzyM]

I'm not talking about emotional coercion. Docs should go wherever they please. I'm talking about selecting for the right type of person most likely to actually meet the professed mission of certain medical schools. I don't think pay is enough. Docs are moving to urban centers more often and people are vying for the most competitive, often academic positions in these urban centers. This entails more competition and often less compensation. I think the problem is more complicated than just what job pays the most. I really do think it ultimately has to do with the type of people being selected to be physicians.

Oh, but if you choose people who will "fit in" with regard to race, ethnicity, religion, customs, and taste in music, you are going to be accused of being racist and not choosing "the best" for medicine. The "best" for some areas that many consider "undesirable" is someone who would not be viewed as an outsider in that area. That does limit things for some minorities and could make it easier for others. Discuss.

 

[Psai]

if you don't match up, that's on you son

 

[Azete]

Obviously it should be difficult to get into medical school; after all, it's, you know, pretty hard. Taking a more macro perspective though, for a country that has a physician shortage, and a surplus of applicants capable of becoming high quality physicians, it would have made sense for our healthcare overhaul to include some sort of reform to fund more residency positions.

If 10,000 residency spots were added, it wouldn't take long for medical schools to catch up.

Side note: I always believed the MCAT should be a one time "pass-or-fail" test, with the threshold maybe at the 28 range of the previous exam. You either have the skills to enter medical school, or you don't. But with school's reputations (and by consequence financial livelihood) dependent on board performance, there would be no data that parallels future standardized test success; so, alas, it would never happen.

 

[Lucca]

Oh, but if you choose people who will "fit in" with regard to race, ethnicity, religion, customs, and taste in music, you are going to be accused of being racist and not choosing "the best" for medicine. The "best" for some areas that many consider "undesirable" is someone who would not be viewed as an outsider in that area. That does limit things for some minorities and could make it easier for others. Discuss.

Perhaps. Are the NHSCs criteria for handing out their scholarships and admitting people into their program racist? I feel that a professed desire to serve a population is more important than fit. Especially since we are talking about populations who may not have any ObGyn to actually go see and not simply populations that cannot access existing resources in their location. Cultural differences between races, belief systems will never be more important than having access to basic resources to begin with. Take for example the studies done in Haiti with regards to Voodoo beliefs and healthcare outcomes. In spite of believing that illness came from curses and others in stead of bacteria/viruses providing access to care for both voodoo and "rational" populations resulted in equal rates of adherence and proportional outcomes. The most important thing we can do is concern ourselves with baseline access, the rest can be sorted out over time.

 

[steelersfan1243]

@steelersfan1243 you actually think the majority of people who start small business are six figures ten years later? Many are lucky to still be in business

When I say go into business I mean along the lines of an accountant, consultant, or investment bank. Yes, I believe with a good economy, in ten years these people could and depending on their drive, should expect a six figure salary

 

[efle]

Grads from engineering schools are routinely getting 65-80K from companies right out of the gate. What do you think they might be making in 10 years? Or if some of you guys went straight to a biotech or pharmaceutical? How much do you think you might be making in 8-10 years?

10 years of 65-80k vs the remaining 35 years of low 100s instead 350-400+ if you go for the high paying specialties...you do the math. With the average debt as an MD grad, you more than make up the difference as something like an ortho. If certainty of a high income throughout second half of your life is your primary motivation it's the clear winner

 

[efle]

When I say go into business I mean along the lines of an accountant, consultant, or investment bank. Yes, I believe with a good economy, in ten years these people could and depending on their drive, should expect a six figure salary

There's a mix of overestimated salary and overestimated security/certainty here. Accountants aren't rolling in cash. Going after investment baking and even consulting broadly defined is far from the certainty you're looking at with an MD. Not to mention that if you're the type of person motivated by money, there are specialties that will more than make up the initial difference at the ten-years-in mark

 

[MrChance2]

Oh, but if you choose people who will "fit in" with regard to race, ethnicity, religion, customs, and taste in music, you are going to be accused of being racist and not choosing "the best" for medicine. The "best" for some areas that many consider "undesirable" is someone who would not be viewed as an outsider in that area. That does limit things for some minorities and could make it easier for others. Discuss.

The current selection process is pretty good I think. Most people I know that really fit the mold of what most medical students are like have no desire to work in undeserved locations except for the money. The people who grew up in those areas from in my class who may or may not have quite as good stats seem to be more likely to want to go back and be leaders. I'd imagine there are studies on this but I would assume patients are more likely to be compliant with and like a doctor that is from their culture.

I think my only gripe so far is that as a post bacc from when I started taking classes to when I entered medical school was 3 years which is pretty much the fastest route where I took only 8 courses. Other than knowing the names of the functional groups and the physics of fluid through large and small tubes I'm not sure I've used anything other than my bio classes. I'm not sure adding more required premed coursework and trying to test how much people care about others or whatever via standardized testing was a good idea.

 

[RustBeltOnc]

And those locations need to pay more...some areas are attractive when you add up the variables (pay/weather/economy/schools/tax structure/expense) and some just aren't.

The only one that can be changed with a pen is the pay. You want medicaid patients in a county with no doctor to have a doctor? Offer a cash premium on their rvu...or the county can write a check to the doctor. But this constant handwringing about why we can't emotionally coerce docs to move places they don't want to is silly. People will follow the money

Agree 100 % with the above. Admins constantly lament that they "can't get anyone to do primary care here" but then you ask about the numbers, it's obvious it isn't a priority.

Another (related) issue: many patients in out of the way areas that don't already have PCPs aren't searching for one. Hence, admin above doesn't really have the citzenry breathing down his neck to address this "shortage."

 

[Mad Jack]

Well NHSC scholarships and loan repayment is a thing so there are financial incentives in place to practicing in such a location. Furthermore, are doctors in those areas not more likely to be able to open up private practices and not be associated with the big hospital systems many docs seem to be complaining about? Technically one should be making far more money working as the only Ortho surgeon within 100 miles than one would be as a junior ortho just starting out in LA. I'm not sure financial incentives are the only thing moving people in that direction because at schools where the debt load is smaller (texas schools) a lot more people seem to go into primary care than at more expensive schools. In some sense, negative money seems to influence people more than positive money even though, technically, there is no real difference between the two in spreadsheet terms.

Loan forgiveness is in no way equivalent to a competitive salary. They need to actually be paid more, with actual cash, not expiring fringe benefits.

 

[Mad Jack]

Open up medical schools in these rural areas. TCMC, UC Riverside, Temple's rural campus. I'm sure wherever you go to medical school there is a good chance a portion of your class stays local in residency and practice

Where you go to medical school has little effect on where you practice. Where you go to residency, has, however, been shown to correlate well with eventual practice location. The solution is more rural residencies, not more rural schools.

 

[efle]

Even if it paid equivalently wouldn't there still be a huge preference (for culture and family reasons) to practice in nice areas of cities, not ghettos or rural areas?