Why aren't existing schools expanding their facilities to accommodate more students?

[TheBiologist]

or are they?

When you look at acceptance data for med school, something like 10-15% of people with 517+ MCAT are not accepted to medical school in a given year. That is crazy, isn't it?

So they are building new schools, sure, but that takes a long time and as "unestablished schools" I'd guess they'd take even more time to become accredited, get research funding etc.

So why don't existing schools from Harvard to ECU take measures to let more qualified students in, like buying more resources, expanding buildings, hiring more professors or whatever it takes

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[Matthew9Thirtyfive]

Go onto Top Law Schools - Index page and do some reading about how expanding law school classes and adding new schools has destroyed the job market.

 

[TheBiologist]

Go onto Top Law Schools - Index page and do some reading about how expanding law school classes and adding new schools has destroyed the job market.

But isn't there enough of a shortage of doctors such that some expansion (and perhaps even a lot) would be fine?

 

[EasyEveryoneWouldDoIt]

Residency Caps: What Medical Students Should Know | Student Doctor Network
mentions that even if there were more medical student slots. residency slots have not kept up for various reason which has turned in a bottleneck effect

 

[Matthew9Thirtyfive]

But isn't there enough of a shortage of doctors such that some expansion (and perhaps even a lot) would be fine?

I won’t pretend to know the ins and outs, but whether it would be or not, I’m guessing ensuring the physician job market doesn’t turn into the law job market is part of the issue (not to mention that more med students without an equal expansion of residency spots just means more med students going unmatched; more med school grads won’t fix the shortage—you need them to be residency trained too).

 

[JeSuisUnDoc]

There is not enough funding to increase residency slots. Increasing the number of medical students will only decrease matching rates and we’ll have a bunch of unemployed graduates.


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[ciestar]

But isn't there enough of a shortage of doctors such that some expansion (and perhaps even a lot) would be fine?

Means nothing if the number of residency slots don’t increase. DO schools are doing this. People go unmatched. That is bad.

 

[ChiDO]

We also have a physician distribution problem. Rural areas need physicians,. Unfortunately, most graduates end up going a major metro area and they become the 10,000th ortho surgeon competing for the same knee scope.

 

[premeddestiny]

An interesting document from the AAMC on debunking the myths involving residency slot funding and Medicare:

https://www.aamc.org/download/386376/data/07252014.pdf

 

[Goro]

But isn't there enough of a shortage of doctors such that some expansion (and perhaps even a lot) would be fine?

There is not a shortage of doctors in the US. There is a maldistribution, especially for Primary Care.

It's one thing for a med schools to physcially add seats, but they also have to increase rotation slots/sites, and then the big bottleneck comes with residency positions. Med schools have an obligation to get all of their graduates jobs. if they don't, the accreditors come around, with axes.

 

[LizzyM]

Beyond the concern about residency spots, a medical school needs clerkship and elective spots for the clinical training portion of medical school and preceptors for hands-on training that takes place earlier in students' medial school education. There are only so many outpatients, inpatients, pregnant women, newborn babies, etc in a given area. An increase in the number of students with no increase in the number of patients will not work and could threaten a school's accreditation.

 

[deleted804295]

As many have said, the less seats the better for now. You don't want to be earning $50k for 11+ years of education + training now do you?

 

[Ms Procrastinator]

There is not enough funding to increase residency slots. Increasing the number of medical students will only decrease matching rates and we’ll have a bunch of unemployed graduates.


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And nobody wants to be unemployed with 250,000+ in debt

 

[gyngyn]

It's easy (and cheap) to increase capacity for "pre-clinical" education." Increasing quality clinical experience is extraordinarily difficult.

 

[LizzyM]

It's easy (and cheap) to increase capacity for "pre-clinical" education." Increasing quality clinical experience is extraordinarily difficult.

But we already have M1 students bitching and moaning about having preceptors who are not within three blocks of their lecture hall so increasing capacity in "pre-clinical" is difficult, too.

 

[gyngyn]

But we already have M1 students bitching and moaning about having preceptors who are not within three blocks of their lecture hall so increasing capacity in "pre-clinical" is difficult, too.

Yes, all clinical supervision is hard to come by. I got the impression that OP thought medical school was like college. Just adding more seats in the classroom is easy. Adding skilled preceptors who can afford the time away from practice is very, very difficult.

 

[Obnoxious Dad]

Means nothing if the number of residency slots don’t increase. DO schools are doing this. People go unmatched. That is bad.

Forgive me for repeating myself from an earlier thread but there is no shortage of residency slots. The presence of foreign nationals occupying U.S. residency slots demonstrates that there are more residency slots than there are Americans to fill them.

In the 2016-2017 academic year there were 29,826 residents entering ACGME "pipeline" residency slots.
https://www.acgme.org/About-Us/Publ...tion/GraduateMedicalEducationDataResourceBook
See pages 79 and 80. Please also note the growth of ACGME slots over the past 10 years.
There were an additional 2,600 osteopathic slots not including traditional rotating year slots. 2017 Summary by Program Type
That brings the total slots leading to board certification to approximately 32,400 slots.
In the fall of 2017 21,338 people enrolled as MS1s at US Md schools: https://www.aamc.org/download/321442/data/factstablea1.pdf
In the fall of 2017 7,630 people entered osteopathic schools:
https://www.aacom.org/docs/default-...-profile-summary-report.pdf?sfvrsn=4f072597_8
Therefore, there were 3,400 more residency slots leading to board certification than there were people entering US Medical schools. This does not account for the usual attrition of about 5% (approximately 1,100 students) nor does it account for the growth in ACGME slots. I realize that some AOA residencies will not make the ACGME grade, but I would bet that most will and the growth of ACGME slots will more than cover any losses.

Check this out from medpage today:
The Myth of the Residency Shortage
"According to data analysis published by The New England Journal of Medicine, the number of medical graduates has indeed begun catching up with the number of available residency positions, but the gap is narrowing very slowly. The report examined recent and projected U.S. medical school enrollment alongside the rate of increase in residency program positions, concluding that in 2024 the inventory of available residency slots will still exceed the number of U.S. medical school graduates by around 4,500."

But we already have M1 students bitching and moaning about having preceptors who are not within three blocks of their lecture hall so increasing capacity in "pre-clinical" is difficult, too.

It doesn't matter if they complain. Let them complain

 

[RogueUnicorn]

if anything, medical schools are too easy to get into. a blasphemous opinion in these parts, but come at me bro.

 

[puahate]

if anything, medical schools are too easy to get into. a blasphemous opinion in these parts, but come at me bro.

yeah pretty blasphemous.

 

[On_The_Way_Up]

if anything, medical schools are too easy to get into. a blasphemous opinion in these parts, but come at me bro.

You must be real special.

 

[aldol16]

"According to data analysis published by The New England Journal of Medicine, the number of medical graduates has indeed begun catching up with the number of available residency positions, but the gap is narrowing very slowly. The report examined recent and projected U.S. medical school enrollment alongside the rate of increase in residency program positions, concluding that in 2024 the inventory of available residency slots will still exceed the number of U.S. medical school graduates by around 4,500."

But isn't there a problem to lumping all residencies together? More people go unmatched in competitive specialties than those in non-competitive specialties. IMGs go into the less desirable specialties - if you were to increase a med school class in the U.S., you're not increasing only just those people who want to go into the less desirable specialties. You're increasing competition across the board and that competition is much worse in the competitive fields.

 

[Goro]

1) why do make the assumption that academic metrics are the only thing that matters in medical admissions nor make someone a good physician? Sheldon from Bing Bang Theory is brilliant but I damn well wouldnt want his as my doctor
2) The limiting factor in expanding medical school class is creating clinical rotations. While medical schools are often associated with hospitals, they are not the same institution. Not only do you need sufficient staff for the training, you need sufficient beds/patients for the training to occur. One of the issues is how many students are too many for available staff and patients.
3) Even so, US MD schools will have increased first year enrollment by about 30% from 16,540 in 2003-4 to an expected 21,300 by 2019-20
4) US DO schools have increased from 3,300 in 2003 to a projected 8,300 in 2019
5) overall, the increase in MD and DO first year enrollment form 2003 to 2019 is nearly 50% from 19,840 to 29,600 students
6) The residency bottleneck suffers from similar as medical students but has 2 additional issues. First is that school/institution must go through the effort, expense, and hiring to develop a new program or expand an existing one. Second, and more importantly, is while the educational training of a resident is "owned" by a school/institution, the hospitals owns the actual job slots and pay the residents. These slots are funded by the federal govt via Medicare and it is a struggle to get any increase in that from congress.
7) one of the reasons that the ACGME and AOA merger did go forward is many of the traditional Osteopathic residency slots, which are owned by the hospitals, is were not being filled. That could be about 1,000 additional slots which will eventually be allocated as the merger progress moves forward.
8) residency pipeline slots went from 24,300 in 2003 to 29,826 in 2016, the last year I have data. So, we have had about 6,000 increase in residency slots but 10,000 increase in first year enrollment.

This is the firebell in the night. The rate at which new grads are being turned out (and this isn't even including the IMGs) is greater than that for residency slots being made. I trust someone with decent graphing skills can graph this data for us.

Also worth mentioning is that the attrition rate of 5% quoted above does NOT mean med schools lose 5% of their students, it means that the majority of these simply do not graduate on time. Most of these are doing teaching or research fellowships.

At least my school is developing new residencies, but I'm not seeing any of the other COMs doing this.

 

[DrStephenStrange]

First of all, residency slots aren't stagnant (they grow by at least 1% every year). They just haven't been growing at the same pace as the growing number of medical students. Second, according to this study, even with the growing number of medical students, we'll have enough residency slots for graduates till 2026 (or beyond depending on how they continue to grow).

Source: Ten Year Projections for US Residency Positions: Will There be Enough Positions to Accommodate the Growing Number of U.S. Medical School Graduates? - PubMed - NCBI

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[DrStephenStrange]

At least my school is developing new residencies, but I'm not seeing any of the other COMs doing this.

Though not many COMs are doing this, other COMs are also doing the same thing. From the top of my head, CUSOM is a great example. My school, ARCOM, also has been working hard in partnership with Mercy and Sparks health system in the region. My hope is that they have the same success CUSOM had in NC.


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[DameJulie]

1) why do make the assumption that academic metrics are the only thing that matters in medical admissions nor make someone a good physician? Sheldon from Bing Bang Theory is brilliant but I damn well wouldnt want his as my doctor

Speaking of TBBT, anyone thinks Penny's personality would be a great primary care physician?

 

[ChymeofPassion]

Speaking of TBBT, anyone thinks Penny's personality would be a great primary care physician?

Ditsy and sarcastic?

 

[Obnoxious Dad]

But isn't there a problem to lumping all residencies together? More people go unmatched in competitive specialties than those in non-competitive specialties. IMGs go into the less desirable specialties - if you were to increase a med school class in the U.S., you're not increasing only just those people who want to go into the less desirable specialties. You're increasing competition across the board and that competition is much worse in the competitive fields.

That is probably true. However, I would rather see an American get rejected by all orthopedics programs and still get into internal medicine than not get into the medical school at all.

 

[Lucca]

if anything, medical schools are too easy to get into. a blasphemous opinion in these parts, but come at me bro.

Was this just for the lols or do you really think this. Interested in the opinion tbh.

 

[Matthew9Thirtyfive]

The issue isnt covering enough residency slots for US grads. That low growth rate of residencies is the limiting factor on creating new physicians. Perversely, not having slots helps increase the profitability of for-profit schools. There is less need to adequately prepare students to enter residency as many will never get slots and therefore allows to grow their classes even larger Ross is trying to build up to 1800 entering students a year. SGU may be reaching past its current 1200 a year

And they will market that as a selling point to gullible premeds who will not realize that the larger their class is, the lower their chance of matching.

 

[Obnoxious Dad]

But isn't there a problem to lumping all residencies together? More people go unmatched in competitive specialties than those in non-competitive specialties. IMGs go into the less desirable specialties - if you were to increase a med school class in the U.S., you're not increasing only just those people who want to go into the less desirable specialties. You're increasing competition across the board and that competition is much worse in the competitive fields.

So what?

 

[Obnoxious Dad]

I don't buy this absence of potential clinical rotations because the number of medical school seats in each state is not proportional to each state's share of the U.S. population. California is a perfect example. California has approximately 12% of the U.S. population but only has about 8% of the country's medical school seats and that includes the seats at the for profit school, Riverside and the new school to be opened by Kaiser. The number of seats in the Los Angeles metro area is ridiculously low. Michigan on the other hand has clinical rotations all over the state and vastly more than its share of medical school seats.

 

[Med Ed]

I don't buy this absence of potential clinical rotations because the number of medical school seats in each state is not proportional to each state's share of the U.S. population. California is a perfect example. California has approximately 12% of the U.S. population but only has about 8% of the country's medical school seats and that includes the seats at the for profit school, Riverside and the new school to be opened by Kaiser. The number of seats in the Los Angeles metro area is ridiculously low. Michigan on the other hand has clinical rotations all over the state and vastly more than its share of medical school seats.

Opening new frontiers for clerkships is not easy, and population is only one factor. To open quality new inpatient rotations need to find a hospital that is (1) willing to decrease clinical productivity, (2) has a medical staff that is on board with being or becoming an academic or semi-academic hospital, (3) ideally has GME programs, (4) is a reasonable distance from your main campus, (5) isn't going to charge exorbitant fees to the medical school, and (6) hasn't already been overrun with students from other medical schools, including Caribbean and DO schools, which is unlikely if criteria 1-5 are met.

We can certainly stick students into any old hospital or clinic that will take them, but without a commitment to teaching those rotations often end up as mildly glorified shadowing.

 

[Goro]

Opening new frontiers for clerkships is not easy, and population is only one factor. To open quality new inpatient rotations need to find a hospital that is (1) willing to decrease clinical productivity, (2) has a medical staff that is on board with being or becoming an academic or semi-academic hospital, (3) ideally has GME programs, (4) is a reasonable distance from your main campus, (5) isn't going to charge exorbitant fees to the medical school, and (6) hasn't already been overrun with students from other medical schools, including Caribbean and DO schools, which is unlikely if criteria 1-5 are met.

We can certainly stick students into any old hospital or clinic that will take them, but without a commitment to teaching those rotations often end up as mildly glorified shadowing.

And this is one of the issues that DO schools have, especially the newest ones, which makes it harder for their grads to be competitive candidates, because they come to residency with limited clinical skills.

 

[Obnoxious Dad]

Opening new frontiers for clerkships is not easy, and population is only one factor. To open quality new inpatient rotations need to find a hospital that is (1) willing to decrease clinical productivity, (2) has a medical staff that is on board with being or becoming an academic or semi-academic hospital, (3) ideally has GME programs, (4) is a reasonable distance from your main campus, (5) isn't going to charge exorbitant fees to the medical school, and (6) hasn't already been overrun with students from other medical schools, including Caribbean and DO schools, which is unlikely if criteria 1-5 are met.

We can certainly stick students into any old hospital or clinic that will take them, but without a commitment to teaching those rotations often end up as mildly glorified shadowing.

Oh gee, people would actually have to make an effort.

The Commonwealth medical school was created from scratch between 2007 and 2009. It was based at community hospitals in Scranton, Wilkes-Barre and Williamsport. In the entire area there was a single, small residency program. For financial stability reasons it is now part of Geisinger. Here is a link to the most recent match list for Geisinger Commonwealth SOM.
Residency Match
If a school can be started from scratch in Northeast Pennsylvania and eventually produce this sort of match list, it ought to be obvious that it isn't impossible in other places.

 

[mwsapphire]

Undergrad humanities still remain even so!

(This is a joke, I have a degree in a humanities field...)

250k+ in debt though? When is UGrad debt that high?

 

[Goro]

Oh gee, people would actually have to make an effort.

The Commonwealth medical school was created from scratch between 2007 and 2009. It was based at community hospitals in Scranton, Wilkes-Barre and Williamsport. In the entire area there was a single, small residency program. For financial stability reasons it is now part of Geisinger. Here is a link to the most recent match list for Geisinger Commonwealth SOM.
Residency Match
If a school can be started from scratch in Northeast Pennsylvania and eventually produce this sort of match list, it ought to be obvious that it isn't impossible in other places.

Of course it's not impossible...the relevant question is: is it rational to do so? Seton Hall tried essentially the same thing (with a longer prep time) and ran into so much trouble that, as you glibly mention, "for financial stability reasons" it's now being run by Hackensack Medical Center.

And as most COMs learn the hard way, when you don't have your own teaching hospital, and you have to send your students all over the state (like SOMA, for one), you can't adequately supervise their clinical education.

 

[Select All That Apply]

@Goro The merger between Hacksensack and Meridian in 2016 and Hackensack-Meridian with JFK in 2018 along with Robert Wood Johnson with Barnabas Health in 2016 were major mergers that occurred within the span of... 2 years. Internal talk is that Hacksensack-Merdidian-JFK is at a hospital cap in NJ and either needs approval to acquire more hospitals or will convert one or two community hospitals into long term care facilities in order to go restart acquisitions. My impression since the transition phase around late 2016 to 2017 was that Hacksensack-Meridian was going to take control of the medical school with Seton Hall retaining minimal interest. There were lots of talks from Hackensack-Meridian that this was going to be "their" flagship medical school inside the network and at least a year before official press release. Also, I've heard that Touro COM was squeezed out of a couple of clinical rotations with the advent of the new medical school.

 

[futureDocDD]

This sounds so great! Try that with Law/MBA schools...which cost similarly (per-year) but no such training(residency)/job security after graduated with huge debt. No wonder they said Law/MBA schools can expand their classes easily with bigger lecture hall...but their graduates suffer the expansion consequence.

Med schools have an obligation to get all of their graduates jobs.

 

[Goro]

This sounds so great! Try that with Law/MBA schools...which cost similarly (per-year) but no such training(residency)/job security after graduated with huge debt. No wonder they said Law/MBA schools can expand their classes easily with bigger lecture hall...but their graduates suffer the expansion consequence.

The big difference between the professions is that the ABA doesn't care whether law grads go unemployed. It's different for Medicine (but not at the AOA or AMA levels) as both LCME and COCA stipulate that schools that have too many unemployed grads will get sanctioned. I surmise the first thing would be their getting put on probation, and if that doesn't work, they'd be forced to cull seats. Worst case scenario? Close doors.

The Pharmacy people suspended admissions for two years at one of the east coast Pharm schools when they have had a really high attrition rate, so accreditors do have teeth, at least in one profession!

 

[RogueUnicorn]

Was this just for the lols or do you really think this. Interested in the opinion tbh.

Porque no los dos? I really think this. What does it take to get into med school? Get good grades (not hard at most colleges), get average (for matriculant) MCAT (harder but last I checked about 30% of test takers fall here), and check a few boxes (braindead). At no stage are you being actually evaluated or tested for the qualities necessary (or beneficial) to be a physician. We're pumping out thousands of low quality automatons who've sailed through being career box-checkers and will perform algorithmic cookbook medicine to the unsuspecting masses.

Getting into medical school is easy. It might be hard for you (generic you) based on your individual circumstance, but the actual process itself is extremely simple.

 

[aldol16]

That is probably true. However, I would rather see an American get rejected by all orthopedics programs and still get into internal medicine than not get into the medical school at all.

Well then you just have people who may not be happy with their job. I think there's a trade-off between people wanting to be doctors and people wanting to be a specific kind of doctor. A pre-med will always love having more medical school spots but what if you told them that it means they have less of a chance (statistically) of getting the specialty they want? Would they still want more med school spots or would they rather the selection happen at the med school stage?

 

[Obnoxious Dad]

Well then you just have people who may not be happy with their job. I think there's a trade-off between people wanting to be doctors and people wanting to be a specific kind of doctor. A pre-med will always love having more medical school spots but what if you told them that it means they have less of a chance (statistically) of getting the specialty they want? Would they still want more med school spots or would they rather the selection happen at the med school stage?

I am sure that there are a few medical school applicants, who have a 520 and a 3.95, who would not like to see growth in the number of medical school seats. However, the vast majority of medical school aspirants in the U.S. would like to see enough spots for everyone who is qualified to go to medical school.

 

[Med Ed]

Oh gee, people would actually have to make an effort.

You do not seem to understand the reality of the situation. Medical schools do expend a great deal of effort finding, securing, and defending clinical rotations sites. These sites do not grow on trees, and there are no vast untapped fields of rotation sites that go unused solely because medical schools can't be bothered to approach them. New York City is ground zero for this phenomenon, and you can read all about it in Med Students Squeezed Amid Wider Competition for Rotation Space.

In 2013 the Texas medical schools and the Texas Medical Association successfully lobbied the state legislature to prevent Caribbean medical students from doing clinical rotations in Texas sites. Other states have considered or passed similar measures. They didn't do it to be mean, they did it because quality clinical rotations represent the single most valuable asset a medical school can possess. And this is to say nothing of the domestic MD-MD MD-DO DO-DO warfare over these assets.

The Commonwealth medical school was created from scratch between 2007 and 2009. It was based at community hospitals in Scranton, Wilkes-Barre and Williamsport. In the entire area there was a single, small residency program. For financial stability reasons it is now part of Geisinger. Here is a link to the most recent match list for Geisinger Commonwealth SOM.
Residency Match
If a school can be started from scratch in Northeast Pennsylvania and eventually produce this sort of match list, it ought to be obvious that it isn't impossible in other places.

The Commonwealth Medical College? The place that hemorrhaged money and faculty, had a revolving door in the dean's office, and went on probation before its first class graduated? The place that had 14% of its charter class not match or SOAP? The place the constructed a longitudinal clerkship model that had their M3s driving all over central PA on a daily basis? The place that couldn't get U of Scranton to buy it because it was such a financial morass, and got within a hair of being the first allopathic school to collapse since Oral Roberts? That place that likely only exists now because the nearest substantial health system took on its debt and bought the infrastructure for pennies on the dollar?

TCMC's early years were an object lesson in many ways, few of them positive. It did demonstrate the intrinsic value of a domestic MD degree, and that if you have achieved any level of LCME accreditation you can find a buyer. I consider them a model of what's possible with medical education in the same way that I consider Dean Corll a model of what's possible with plywood.

 

[sunshinefl]

I am sure that there are a few medical school applicants, who have a 520 and a 3.95, who would not like to see growth in the number of medical school seats. However, the vast majority of medical school aspirants in the U.S. would like to see enough spots for everyone who is qualified to go to medical school.

This is false. We don’t want the pool of physicians diluted so that not matching, not getting the specialty of your choice, not getting a job, and depressed wages are common. See pharmacy.

 

[Goro]

This is false. We don’t want the pool of physicians diluted so that not matching, not getting the specialty of your choice, not getting a job, and depressed wages are common. See pharmacy.

or Law.

In addition, there are a lot of people who want to go to med school. Whether they're qualified is a different story.

 

[Obnoxious Dad]

This is false. We don’t want the pool of physicians diluted so that not matching, not getting the specialty of your choice, not getting a job, and depressed wages are common. See pharmacy.

I would bet a large sum of money you weren't singing this tune when you were a sophomore in college. Furthermore, your attitude reflects a union mentality. You want to keep people out of medicine to enrich yourself. You ought to be ashamed.

 

[Goro]

I would bet a large sum of money you weren't singing this tune when you were a sophomore in college. Furthermore, your attitude reflects a union mentality. You want to keep people out of medicine to enrich yourself. You ought to be ashamed.

We want to keep people out of Medicine who have no business being in Medicine, and for those that do, we want them to be employable, and employed.

After all, look how well Law is doing for its graduates these days.

 

[aldol16]

I am sure that there are a few medical school applicants, who have a 520 and a 3.95, who would not like to see growth in the number of medical school seats. However, the vast majority of medical school aspirants in the U.S. would like to see enough spots for everyone who is qualified to go to medical school.

I don't think that's the case. I don't think you can presume to speak for the "vast majority of medical school aspirants" either. I don't think people would want to make med school a riskier endeavor where you spend $250k plus to go into a specialty you don't like.

 

[AnatomyGrey12]

However, the vast majority of medical school aspirants in the U.S. would like to see enough spots for everyone who is qualified to go to medical school.

Wrong.