What is a bigger problem: Too few docs *OR* Too many mediocre docs?

[zut212]

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In the USA, we have an acute shortage of physicians, especially doing primary care work. Routinely, patients have to wait a long time to get elective treatment. Moreover, the costs are very much outrageous in this country for medical care.

The AMA restricts the number of medical graduates per year, and as a consequence, there have been few medical schools opened since the '80s. The AMA's reasoning is that they only want the best of the best to practice medicine. To be fair to the AMA, we have excellent MDs in the USA.

However, I believe that a greater problem is that we don't have enough MDs to begin with, and this is a bigger problem than having some lesser quality MDs dilute the quality of the MD pool.

So here is my question to you: Which of these two situations is a bigger problem?

A. Our current situation in the USA, where we have too few, but excellent, physicians who don't have the time to tend to patients and drive the cost of healthcare, and hence, prevent a lot of people from getting treated?

B. A situation where, instead of 18,000 MDs matriculating a year, we allow many more to graduate - let's say 24,000 - 36,000 MDs are allowed to graduate each year. The patient has shorter wait times, and their costs would be significantly lower, but their average quality of care is slightly diminished.

 

[VoiceofReason]

the AMA is a group of ******s, the motivation behind restricting the number of seats is a diseased institution of selfish greed and nothing more. We could double the number of acceptances and not dilute the quality of our physician work force.

 

[zut212]

the AMA is a group of ******s, the motivation behind restricting the number of seats is a diseased institution of selfish greed and nothing more. We could double the number of acceptances and not dilute the quality of our physician work force.

I agree with you, VoR. I think that the quality would not go down by a statistically *SIGNIFICANT* amount. Moreover, a person who graduated from a lousy medical college with a mediocre MCAT and GPA would do just as good of a job diagnosing a patient's health and making recommendations for that patient as a person from Washington University with a 35 on his MCAT and 3.8 GPA.

My analogy is this: If all of a sudden, the DMV only wanted college graduates with 3.0 and better GPAs to obtain licenses to drive, for sure, I would think that the rate of accidents would diminish slightly (let's ignore the fact that traffic would be 85% gone, and it's more difficult to get into an accident). However, the greater problem, if this situation were to ever arise, is NOT that the drivers are not good enough, but that there not enough drivers. By relaxing the standards on who gets a license, the productivity and costs go DOWN, and sure, the accident rate is slightly higher. Never forget, a person from MIT is not a better driver than a high school drop out.

 

[CyclistOK]

I agree with you, VoR. I think that the quality would not go down by a statistically *SIGNIFICANT* amount. Moreover, a person who graduated from a lousy medical college with a mediocre MCAT and GPA would do just as good of a job diagnosing a patient's health and making recommendations for that patient as a person from Washington University with a 35 on his MCAT and 3.8 GPA.

My analogy is this: If all of a sudden, the DMV only wanted college graduates with 3.0 and better GPAs to obtain licenses to drive, for sure, I would think that the rate of accidents would diminish slightly (let's ignore the fact that traffic would be 85% gone, and it's more difficult to get into an accident). However, the greater problem, if this situation were to ever arise, is NOT that the drivers are not good enough, but that there not enough drivers. By relaxing the standards on who gets a license, the productivity and costs go DOWN, and sure, the accident rate is slightly higher. Never forget, a person from MIT is not a better driver than a high school drop out.

Wow, what a terrible analogy. Driving a car is nothing like practicing medicine, nor is the training for driving a car anything like the training for medicine.

 

[bronx43]

Too few physicians is far from the reason the US has such high health care costs.

While I agree that you don't need to be anything near brilliant to be a competent physician, the more lax you make medical school entrance criteria, the more likely you are of letting in an entirely incompetent individual. And obviously, it would be a continuum - at some point health care would receive a statistically significant blow to its quality.

 

[MOHS_01]

the AMA is a group of ******s, the motivation behind restricting the number of seats is a diseased institution of selfish greed and nothing more. We could double the number of acceptances and not dilute the quality of our physician work force.

BS -- complete, total, utter, uninformed, ignorant BS. We graduate people year in and year out who are hardly competent providers. Look at our pass/fail rates and compare that with those of other professions. Once one has their foot in the door they are virtually guaranteed of walking out the other side as a state sanctioned physician -- whether they are truly capable of meeting the standards set by their more capable peers or not.

The only way your argument has a snowball's chance of being factually accurate is if you assume (or determine) that the bottom x% of those who do get in are actually significantly less capable than a sizable portion who do not get in....

 

[VA Hopeful Dr]

The AMA restricts the number of medical graduates per year, and as a consequence, there have been few medical schools opened since the '80s. The AMA's reasoning is that they only want the best of the best to practice medicine. To be fair to the AMA, we have excellent MDs in the USA.

Completely untrue. The AMA has nothing to do with new med schools. The AAMC and LCME do that for allopathic schools. I don't know who deals with DO schools.

 

[zut212]

Completely untrue. The AMA has nothing to do with new med schools. The AAMC and LCME do that for allopathic schools. I don't know who deals with DO schools.

The AMA may not have anything to do with new medical schools, but don't they have a lot to do with how many MDs matriculate each year?

I also read that Congress may (or has) limited the number of residency positions to 100,000. Keep in mind, that US graduates ~18,000 people a year in MD programs. If each MD is in residency for 4 years, this means that we have, on average, 72,000 residency positions filled. Given that 10% of our doctors are DOs, then this means that about 79,200 are filled up.

Therefore, we have a surplus of residency positions, but a shortage of MD graduates.

Therefore, the number of MDs seem to be on the onus of the AMA and not Congress.

Please clarify.

 

[deepdish83]

Completely untrue. The AMA has nothing to do with new med schools. The AAMC and LCME do that for allopathic schools. I don't know who deals with DO schools.

Yeah because the AMA has absolutely no influence over the AAMC and the LCME. I mean its not as if they heavily fund them, or have significant oversight over their boards and bureaucratic processes.

 

[avatarftw]

WHAT?!! Pre-med was a cake walk compared to this. I'm only an MS1 but its a LOT more work than doing the pre-med requirements and MCAT. And it will get a lot harder.

Umm.. I'm quite sure there's a lot of mediocre doctors in the US. It's hard to enter med school, but it's relatively hard to fail yourself out either. There's probably a handful of students in every classroom that got so tired of studing like crazy as in their premed years and just do the bare minimum to pass in med school knowing that even if it's a family medicine residency slot in rural Utah, they will still get into *something*.

In Mexico it's easy to get into med school, but it's also easy to fail yourself out too. If you don't gain 80% class entrance rates in 4 subjects, BAM! you're out of med school at my university no matter how good your grades are because you can't enter final exams and thus fail the course. If you fail 4 subjects at once you're automatically evicted forever at that school. You'll be lucky if another university accepts your credits since every university has different curricula. I've met people that had personal problems or health issues that didn't let them go to class and were forced to drop themselves out before final exams started in order to save themselves from being evicted from the career. Better retake 1 semester than 4 years of school.

Also, being a good test taker doesn't make you a good doctor. I know a lot of people with great school scores that actually cheated on every exam to get where they are. Other people were honest and good test takers but hate the actual job to death and med school doesn't exactly teach you that 50% of your job as a doctor is paperwork. In fact you are rarely if ever in a code blue at the real job. I was in a code blue at the most twice a month in a hospital setting and that's actually a lot. You're most likely begging that lab tech guy to print you another copy of lab results for your rounds in 1 hour because you lost the originals and the attending is going to kill you if everything isn't complete. Has little to do with being a good test taker, a lot to do with being organized.

You'll see great doctors from subpar schools and crappy doctors from top tier schools. I come from a top tier school and I know a lot of people that have no talents for medicine whatsoever and I've met people from schools everybody loves to laugh at that are excellent doctors. The problem with the US isn't that there isn't enough MD graduates each year, it's that there isn't more residency slots being opened. The day will come where there's more MD graduates than residency slots and unlike in Mexico you can't practice medicine with an MD degree unless you do 1 year of internship (In Mexico internship is just another year in med school education so the requirement is already set for everyone that graduates).

 

[hurdlepup]

WHAT?!! Pre-med was a cake walk compared to this. I'm only an MS1 but its a LOT more work than doing the pre-med requirements and MCAT. And it will get a lot harder.

Don't worry. This poster, vasca, lives in Mexico. Based on prior posts, its questionable if he or she has ever set foot in the U.S. for more than a short vacation.

 

[Charles_Carmichael]

Yeah because the AMA has absolutely no influence over the AAMC and the LCME. I mean its not as if they heavily fund them, or have significant oversight over their boards and bureaucratic processes.

It doesn't matter how many new med schools open if the number of residency spots (the majority of which are funded through Medicare) remain stagnant. Unless a graduating medical student goes through a minimum of 1 year of residency training (and even this is very rare these days. The vast majority go through a minimum of 3 years of residency training), they cannot practice medicine. So, what's the point of rapidly increasing med schools or med school seats if residency spots aren't increasing. It's not a good thing to have unemployed MDs/DOs who have tons of debt.

 

[ReineAshe]

Umm.. I'm quite sure there's a lot of mediocre doctors in the US. It's hard to enter med school, but it's relatively hard to fail yourself out either. There's probably a handful of students in every classroom that got so tired of studing like crazy as in their premed years and just do the bare minimum to pass in med school knowing that even if it's a family medicine residency slot in rural Utah, they will still get into *something*.

Er, then what are transfer students for?

Sure, you may not fail grade-wise. But "mental health" is the new way to "fail yourself out."

You'll see great doctors from subpar schools and crappy doctors from top tier schools. I come from a top tier school and I know a lot of people that have no talents for medicine whatsoever and I've met people from schools everybody loves to laugh at that are excellent doctors.

Agreed. Grades are a terribly flawed metric. 🙁

 

[countingdays]

the AMA is a group of ******s, the motivation behind restricting the number of seats is a diseased institution of selfish greed and nothing more. We could double the number of acceptances and not dilute the quality of our physician work force.

You are right about the AMA being a group of ******s, well of course they aren't actually ******ed, they are just complete sell-outs who back-stab the majority of US physicians to provide short term financial gains to their base, PCPs, and to keep their own gravy train, CPT codes, flowing.

The AMA is a terrible organization that unfortunately is wrongly thought to represent the interests and views of doctors.

 

[honker23]

The AMA is a terrible organization that unfortunately is wrongly thought to represent the interests and views of doctors.[/QUOTE]

Sounds like congress!

 

[FutureCTDoc]

The way to cut cost is to cut the amount of healthcare that is delivered. Fewer physicians would cut cost, I don't think most people would find it palatable.

 

[lipomas]

What do you mean by "mediocre"? Does "mediocre" mean poor/borderline incompetent? I think you are confusing "average" with "mediocre." The great majority of physicians are competent. Very few are mediocre. In many contexts the word "average" tends to refer to someone who is middling or borderline passable. But in medicine to be average is not an insult.

And are you sure that increasing training spots will lead to an increase in poor physicians?

 

[MOHS_01]

...

And are you sure that increasing training spots will lead to an increase in poor physicians?

Unless the quality of the applicant pool not currently getting in is significantly better than the "poor" candidates who are making it through the process -- the answer is yes.

 

[filter07]

Umm, on some years, the acceptance rate for medical school approaches 50%. If you double the acceptances, that is close to 100%. I've worked with a lot of people who just don't belong in medical school. Medicine might not be rocket science but sadly there are a lot of people who can't cut it intellectually. Not only that but medicine takes a lot of sacrifice, persistence, and diligence, and far more people fail that standard.

To answer the original question, I think the biggest problem is too many mediocre docs, but more specifically the problem is the reimbursement system that rewards doctors for consulting away responsibility and generally profiting from being *******es.

 

[MOHS_01]

Umm, on some years, the acceptance rate for medical school approaches 50%. If you double the acceptances, that is close to 100%. I've worked with a lot of people who just don't belong in medical school. Medicine might not be rocket science but sadly there are a lot of people who can't cut it intellectually. Not only that but medicine takes a lot of sacrifice, persistence, and diligence, and far more people fail that standard.

To answer the original question, I think the biggest problem is too many mediocre docs, but more specifically the problem is the reimbursement system that rewards doctors for consulting away responsibility and generally profiting from being *******es.

Yep, it is much easier to "call a doctor" than it is "to be one".

 

[zut212]

Umm, on some years, the acceptance rate for medical school approaches 50%. If you double the acceptances, that is close to 100%.

You're absolutely wrong in this. If the chances of getting into all MD school is 33%, and you apply to 3 of them, this does *NOT* mean that your chances of getting accepted is 100%. It's actually less than 70.3%.

 

[filter07]

You're absolutely wrong in this. If the chances of getting into all MD school is 33%, and you apply to 3 of them, this does *NOT* mean that your chances of getting accepted is 100%. It's actually less than 70.3%.

You are talking about the chances for one individual applying to many programs. VoiceofReason was talking about doubling the spots nationwide, which would in effect supply enough spots for every applicant on some years. So please make sure you understand what the adults are talking about before you say someone is "absolutely wrong".

 

[zut212]

Umm, on some years, the acceptance rate for medical school approaches 50%. If you double the acceptances, that is close to 100%. I've worked with a lot of people who just don't belong in medical school. Medicine might not be rocket science but sadly there are a lot of people who can't cut it intellectually. Not only that but medicine takes a lot of sacrifice, persistence, and diligence, and far more people fail that standard.

To answer the original question, I think the biggest problem is too many mediocre docs, but more specifically the problem is the reimbursement system that rewards doctors for consulting away responsibility and generally profiting from being *******es.

If an institution/system has 10 positions available, and there are 20 applicants, the acceptance rate is 50%. If there are now 20 positions, then the acceptance rate is around 100%. You were right.