The major reason why getting into medical school is so Hard

[medgator]

Before you go jumping to conclusions, look at the proportion of total costs that phyiscian compensation represents. If you really want to cut the cost of healthcare in this country, address the prescription drug nightmare and outrageous administrative costs. Why should our European/Canadian counterparts (and even the VA health system) pay 25-60% less than the American public/American HMOs for a gamut of prescription drugs?? It is because they (and their governments) negotiate for their citizens/clients. That idea had been thrown around in this administration and was successfully blocked (by a powerful pharmaceutical lobby).... and they even considered halting the importation of Rx drugs from Canada by US citizens "because of quality assurance concerns". Physician reimbursements have been dropping every year while the percentage of GDP (greater than 15% last I remember) devoted to healthcare goes up. Do the math... its not the physicians making a killing.

HMO/PPO/Hospital CEO salaries range all the way into the tens of millions.... and thats when their companies are putting the major squeeze on doctors and still not turning a hefty profit for shareholders. Its as bad as professional sports (NY Yankees?)

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[medgator]

Hey i know a PA who does cardiothoracic surgery

That PA is probably first assisting at the most.... definitely NOT leading the case (thats just scary otherwise.... I mean cmon CT surgeons go through 7-8 years of graduate medical training--gen surg plus fellowship).

 

[Ross434]

That PA is probably first assisting at the most.... definitely NOT leading the case (thats just scary otherwise.... I mean cmon CT surgeons go through 7-8 years of graduate medical training--gen surg plus fellowship).

why not just hire an RN to first assist?? I think in this case the PA does like 60% of the surgery , with the doc coming in to do the difficult parts.

 

[medgator]

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[medgator]

PAs can fill the roles of residents.... RNs do not. Whether they can or cannot , I really can't say. That general paradigm would seem to fit with what we've seen medicine. PAs can see patients independently in clinic (and have their note signed off like a resident). With respect to the surgery, I think its a case by case basis.... PAs probably become pretty good in that speciality and with time, get some free reign from the surgeon, although they certainly could not independently lead the surgery-- the surgeon could (note I said lead, not perform... many of the surgeries will require 2 people).

 

[little_late_MD]

Employers are tired of paying for ever growing health insurance premiums. Workers are tired of seeing their share of premiums go up every year. They are disgusted to see a physician bill $$$$ for a 10 minute consultation. So there is pressure to reduce costs.

The insurance companies have put pressure on professionals to do more with less $ by pressuring service providers to accept low reimbursement for services. If the reimbursement is low enough, the docs don't want the work and they are happy to delegate the low paying scut (like well baby visits) to allied health professionals. Everybody's happy.

I'm not sure that I can agree with your conclusions here. While people are tired of paying for huge increases in premiums, I'm not sure that this increase can be attributed to rising physician salaries. The mean salary for a FP/IM doctor has stayed fairly level over the past decade when adjusted for inflation. Do a google search, and you can see that. The huge increases can be blamed on several facets of our broken system.

1. Increasing amounts of "designer diagnosis," where patients are demanding unnecessary tests just to be sure. Along with this are doctors who order every test under the sun to protect themselves from any hint of liability, which brings us to....
2. The vast amounts of malpractice and malfeasance cases clogging the courts. I believe I read somewhere that the average MD is sued at least 6 times in his/her career. THis leads to
3. Higher insurance premiums. When there are people jumping ship from certain specialties due to the astronomically high insurance rates, there is a problem. This leads us to...
4. Insane amounts of specialization. People are leaving FP, IM, etc in droves for the more lucrative fields of surgery, sports medicine, etc, etc, etc. Primary care becomes more expensive when there are less primary care physicians. Unfortunately for most of us, these are the only doctors we ever really need to see. Even more unfortunate for them is...
5. The fact that it costs an arm and a leg to pay for a medical education. Even if we were not experiencing a shortage of physicians in this country, the ones that do enter the profession are forced to charge exorbident amounts to pay for both insane overhead costs, as well as their student loan repayments.
6. Pharmaceuticals. Do I even have to go into how this industry has created modern civilization's largest money pit?
7. Finally, the biggest cost driver in the industry are the managed care systems themselves. While encouraging doctors to "do more with less" they have still yet to find an efficient way to delegate caseloads/referrals/etc. Any efficiency savings they might create are lost in the demand to create shareholder wealth. They get rich, and healthcare gets more expensive.

 

[DrBowtie]

3. High malpractice doesn't lead to 4. insane amounts of specialization.

Specialists pay the highest rates so if anything more people would be going into PC fields.

 

[little_late_MD]

3. High malpractice doesn't lead to 4. insane amounts of specialization.

Specialists pay the highest rates so if anything more people would be going into PC fields.

Really? I would think it's a pretty safe bet that if field A has a much higher premium for malpractice than field B, field A is going to have less practitioners than field B. What do you know? Iinternal medicine has one the most expensive malpractice premiums.

Also, while certain specialties are paid higher than FP/IM not all are, and there are many other benefits to IM. For one, there is a well-documented kick-back system in place in regards to specialists and drug companies vis-a-vis the referring doctor.

Did you not notice that I said "leads us to?" Meaning we're moving on. It's called a transitional phrase. Learn it, live it, love it. You might have done better to realize that all the factors were to be taken as a whole. However, since your MO seems to be trolling these forums, I shouldn't expect any better.

 

[GoodEats]

They pay the highest rates but they are also paid more, so the net benefit is greater, right?

Just read an interesting interview in the latest Discover. Some high points:
- We spend the most per capita for health care (~6000/year), but we're near the bottom of the barrel for the top 23 spenders when it comes to healthy life expectancy (life expect. - yrs illness)
- When getting a physical, a patient is 67% likely to talk about cholesterol levels, but they're less than half as likely to discuss lifestyle choices (diet, exercise, no smoking)
- Reliability of drug trials are going down while advertising is going up
(1991: 80% trials done in universities, 2000: 34%;
commercial studies are 5.3 times more likely to favor the drug;
no requirement to release all data when publishing, and many times all authors
aren't with access to all of the data)
- Number of med students choosing FP is down 50% in last 8 years, number of specialists going up
- Ironically, more specialists in a state per capita is correlated with quality rank of medical care inthe state, and the higher the cost

 

[DrBowtie]

However, since your MO seems to be trolling these forums, I shouldn't expect any better.

I will just let that absurd comment speak for itself. 2000+ posts don't come from trolling.


OB/GYN and Surgical Specialties have the highest rates. If I was an gambling man I would venture to say a greater % of income is paid to malpractice for OBGYN than FP.

If you wanted to list your points fine but when one point leads to another it is an implicit connection.

 

[little_late_MD]

OB/GYN and Surgical Specialties have the highest rates. If I was an gambling man I would venture to say a greater % of income is paid to malpractice for OBGYN than FP.

And OB-GYN is losing specialists faster than FP. Ask your wife/girlfriend/mother how hard it is to find an OB-GYN these days. I'll give you a personal anecdote. My girlfriend recently changes insurances. The earliest appt she could get with any OB-GYN was one and a half months after the day she called.

If you wanted to list your points fine but when one point leads to another it is an implicit connection.

You assumed a connection. There's a difference. I feel that the points that were causal were clearly written as such.

 

[DrBowtie]

And OB-GYN is losing specialists faster than FP. Ask your wife/girlfriend/mother how hard it is to find an OB-GYN these days. I'll give you a personal anecdote. My girlfriend recently changes insurances. The earliest appt she could get with any OB-GYN was one and a half months after the day she called.



You assumed a connection. There's a difference. I feel that the points that were causal were clearly written as such.

I agree that all of the points you make are good ones and I agree there are many wrongs with the system like OB's quitting. There isn't a debate with the facts.

My point is that the AMA has protected its doctors salaries and benefits which is the organizations purpose. You can say that it has affected medicine for the people adversely fine, but when I become a doctor I sure want them fighting for me.

 

[NandroloneDecanoate]

if you open more schools, you create more doctors. when there is more labor available, the compensation drops. it's obvious supply and demand. why would the medical industry (at least from the doc. side) want to dig its own grave? the flip side to the doctor shortage is what microsoft is planning to do this year - fire 18,000 workers and then bring H1B visa workers from india. you will see an influx of docs. from around the globe to fill the shortage - at least to a degree or if/when some new fad takes over in the 2040s and up such as new legislation or more seats or whatever they come up with. society always evolves. just a little over 100 years ago, you and i on these message boards would have been working as 10 year olds in garment factories in new york city, sleeping in grates slumped over after having come home from sniffing soot or cloth material in a loom. a commoner would never ever dream about medical school or the profession.

the excuse i keep reading above of how med. schools can't open up due to budgeting is laughable. obviously they can. they just don't want to. i don't know why people like to lie to themselves or try to be politically correct. you are not fooling anyone, and certainly not kids with brains. this isn't a profession for a blue collar layman driving trucks or moving furniture.