Why aren't there more accredited US Medical Schools?

[loren646]

There definitely seems a demand for it. Are there just not enough jobs out there? I figured we would need more doctors not fewer.

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[evoviiigsr]

The AMA has every interest to keep the supply of doctors as low as possible, ensuring high salaries for doctors...ah politics

 

[phospho]

The AMA has every interest to keep the supply of doctors as low as possible, ensuring high salaries for doctors...ah politics

it's not just "politics" - they're looking out for your ass and mine...

look what happened in law - there's a law school on every corner now... try getting a decent job as a lawyer without going to a top 50 school...

 

[funkymunkytoes]

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Thank you, AMA.

 

[evoviiigsr]

it's not just "politics" - they're looking out for your ass and mine...

look what happened in law - there's a law school on every corner now... try getting a decent job as a lawyer without going to a top 50 school...

it is just politics..it just so happens that it helps us out..i'm not complaining here..

 

[Siverhideo1985]

Do they (AMA or whoever) actually actively control the number of medical schools?

Are there new schools that try to open but are rejected on the basis of the argument of supply and demand?

 

[FrickenhugeMD]

Easy answer, there wouldn't be enough residency spots to be able to place every graduating senior. Its hard enough to get a good spot for competitive ones now. The best are still going to be the best......


You either weed people out now, or later. One of these options saves a whole lot of people a butt load of debt and years of their life they will never get back.

 

[Handy388]

after looking at what happened in law, I feel like choosing a school based on its ranking may have merit.

Right now, you could graduate from a very local oriented school and still get jobs all over the country. But what would happen when supply outstrips demands? What if when there is a massive oversupply of medical schools? Less well known schools' graduate will definitely suffer.

I hope it'll never come to that, however.

Medicine is a very demanding occupation, and selective admission insures that only the best gets into the system.

Also, once in med school, low enrollment of USMD ensured cooperation at large instead of competition for top 10%

Law school, which have massively overaccepted, have brutal competition, and many people still end up without a job and massive debt.

 

[Law2Doc]

after looking at what happened in law, I feel like choosing a school based on its ranking may have merit.

Right now, you could graduate from a very local oriented school and still get jobs all over the country. But what would happen when supply outstrips demands? What if when there is a massive oversupply of medical schools? Less well known schools' graduate will definitely suffer.

I hope it'll never come to that, however.

Medicine is a very demanding occupation, and selective admission insures that only the best gets into the system.

Also, once in med school, low enrollment of USMD ensured cooperation at large instead of competition for top 10%

Law school, which have massively overaccepted, have brutal competition, and many people still end up without a job and massive debt.

Bear in mind that supply in medicine is not based on med school graduates, it's based on residency slots. So you could double the number of med schools and still not have any more practicing doctors unless/until you increased residency slots. Which costs big money, and so people aren't going to be quick to do it.

Right now there is arguably a shortage of doctors (in certain regions and specialties), due, almost entirely, to the large and long living baby boomer generation. However the generation behind that one is substantially smaller, so it would be extremely short-sighted to increase the number of doctors now to meet a demand that won't be there in a decade or two.

 

[evoviiigsr]

Easy answer, there wouldn't be enough residency spots to be able to place every graduating senior. Its hard enough to get a good spot for competitive ones now. The best are still going to be the best......


You either weed people out now, or later. One of these options saves a whole lot of people a butt load of debt and years of their life they will never get back.

I just don't think that is true...if you doubled the amount of people granted MDs, you don't think there would be room to accomodate this in the healthcare system? Demand is what creates supply (not the other way around) and we are definately in the shortage zone..

As for weeding people out, I honestly think that even with double the amount of MDs the distribution of board scores would stay about the same...that means there are people who never get into medical school who would score in the top and of course those that who disappoint as you said...you are assuming that the quantity of physicians determined by the AMA is some sort of optimum and any deviation from that will result in lower quality...so many people get rejected even though they would make spectacular doctors..why do you think there are hundreds of applicants with identical stats that compete for the same spot and it comes down to who comes up with the best answer for "why medicine?"

 

[Depakote]

http://en.wikipedia.org/wiki/Flexner_report

 

[bluesmd]

after looking at what happened in law, I feel like choosing a school based on its ranking may have merit.

Right now, you could graduate from a very local oriented school and still get jobs all over the country. But what would happen when supply outstrips demands? What if when there is a massive oversupply of medical schools? Less well known schools' graduate will definitely suffer.

I hope it'll never come to that, however.

Medicine is a very demanding occupation, and selective admission insures that only the best gets into the system.

Also, once in med school, low enrollment of USMD ensured cooperation at large instead of competition for top 10%

Law school, which have massively overaccepted, have brutal competition, and many people still end up without a job and massive debt.

i doubt that medicine will never come to that.

other factors include:
the cost of educating a medical student. yes we pay a lot of money to go to medical school but it also costs the schools a lot of money to educate us. almost all of them (correct me if i'm wrong) get gov funding. a lot more resources are needed than say law school

you can't just set up a school overnight, a lot of planning is involved.

i forgot my thrid one

 

[Danbo1957]

Right now there is arguably a shortage of doctors (in certain regions and specialties), due, almost entirely, to the large and long living baby boomer generation. However the generation behind that one is substantially smaller, so it would be extremely short-sighted to increase the number of doctors now to meet a demand that won't be there in a decade or two.

There is a massive shortage of American doctors. Look at any physician roster at any large city hospital (Houston, Miami, etc.) and you see hundreds of doctors trained at med-schools outside the US. There will also be a large group of Baby-Boomer doctors retiring over the next twenty years.

 

[Handy388]

I did realize that law school is A LOT easier to open and much more profitable to operate (law2doc can chime in here with all his/her wisdom)

Think about it, you got a student body of 300 that pays 20k+ per year for tuition, but you don't really need any expensive equipment, a lot less professors, and probably no capital investment needed for a teaching hospital. Plus, you can't just have a teaching hospital out of nowhere.

I feel that new medical school may be limited by the amount of teaching hospitals, correct me if I am wrong.

 

[mmmcdowe]

I just don't think that is true...if you doubled the amount of people granted MDs, you don't think there would be room to accomodate this in the healthcare system? Demand is what creates supply (not the other way around) and we are definately in the shortage zone..

As for weeding people out, I honestly think that even with double the amount of MDs the distribution of board scores would stay about the same...that means there are people who never get into medical school who would score in the top and of course those that who disappoint as you said...you are assuming that the quantity of physicians determined by the AMA is some sort of optimum and any deviation from that will result in lower quality...so many people get rejected even though they would make spectacular doctors..why do you think there are hundreds of applicants with identical stats that compete for the same spot and it comes down to who comes up with the best answer for "why medicine?"

Because stats aren't the only thing that makes a good doctor. Unless more capable applicants decide to apply, doubling the number of acceptances is crazy talk. That means about 80% of applicants would be accepted to medical school. Since the average MCAT of those who apply is, I believe, a 28, that would mean that we would be getting regular acceptances of students with 20 or lower on the MCAT, which is at the moment a rare exception. MD schools could accept maybe another 5-10% of applicants without much noticible decline in average scores, perhaps. Besides, you are also making an assumption that all of those new students would be able to pass the boards. The whole reason why med schools have become more strict on admissions is because they don't want ANYONE to fail out who is admitted. Students who don't become doctors are a waste of money for the government and medical schools.

 

[Law2Doc]

There is a massive shortage of American doctors. Look at any physician roster at any large city hospital (Houston, Miami, etc.) and you see hundreds of doctors trained at med-schools outside the US. There will also be a large group of Baby-Boomer doctors retiring over the next twenty years.

The number of doctors is dictated by residency spots. To the extent there's a shortfall between US graduates and residency spots, FMG/IMGs are given spots. That is not a new thing. And having non-US trained people working as doctors does not equate to a shortage of doctors. These folks are doctors, and fill a current need. The enrollment in US schools is increasing now so you will see a larger percentage of US to non-US folks in the next few matches. However it would be shortsighted to increase the number of residencies for a baby boomer generation that is self-limited, and is being followed by a much much smaller generation. It's better to have a shortage for a few years then a glut a few years later. The retiring baby boomers are not as much of a concern, because thanks to the bad economy, most are delaying retirement to a much later date, and again, since the number of residency slots has been fairly constant, there are an equivalent number of new doctors coming into practice each year to replace those who retire. Residency numbers are fixed, they are not proportionate to the generation/population.

 

[airca12]

I think a pretty sensible point is made here - http://www.kevinmd.com/blog/2009/02/more-coverage-requires-more-doctors-my.html

if more people become covered under the new administration, there should be more doctors, right?

 

[Law2Doc]

I think a pretty sensible point is made here - http://www.kevinmd.com/blog/2009/02/more-coverage-requires-more-doctors-my.html

if more people become covered under the new administration, there should be more doctors, right?

Nah. More likely it will mean (1) longer hours for the current doctors, and (2) more PAs and NPs -- they work cheaper.

 

[Pinkertinkle]

Whyse no one listening to Law2Doc, its graduate medical education that controls the number of doctors. To train additional doctors the federal government has to increase graduate medical education funding and thus residency spots.

Opening more medical schools reduces the number of foriegn doctors "imported" but does not increase the overall number of doctors.

 

[Danbo1957]

Those "imported doctors" are doing their residencies here in the US.

Those foreign med-school graduated doctors are taking US residencies because there are not enough US med-school graduated doctors competitive enough to take those residencies. In other words, US med-schools are only graduating 80% of the doctors needed.

Damn sad, really.

 

[chessknt]

Nah. More likely it will mean (1) longer hours for the current doctors, and (2) more PAs and NPs -- they work cheaper.

Until people start dying due to misdiagnoses and the media figures out that the reason for that is because NPs and PAs =/= doctors.

 

[BluntSurgeon]

Until people start dying due to misdiagnoses and the media figures out that the reason for that is because NPs and PAs =/= doctors.

I heard somewhere that replacing a doctor with a well-trained PA doesn't really change clinical outcomes all that much. And that negligible drop in mortality (or whatever metric) is probably worth the huge savings, especially for hospitals/private practices/whatevers in this economy.

 

[chessknt]

I heard somewhere that replacing a doctor with a well-trained PA doesn't really change clinical outcomes all that much. And that negligible drop in mortality (or whatever metric) is probably worth the huge savings, especially for hospitals/private practices/whatevers in this economy.

So you are suggesting that the extensive training we are about to undertake has little impact on the people we end up serving? Thats nice.

 

[PeepshowJohnny]

I approve increasing the number of American medical graduates, because it's silly where the bottle-neck is placed in the system.

The first big "step" is when all the premeds entering college give up/change their mind (I've heard big variation in numbers) but this is not only people giving up because they can't handle it, but also those who discover medicine is for them. I don't think this should change much.

However, I think it's kinda silly the admission standards for medical schools is currently "the gatekeeper" of what keeps people from preparing medical studies, when really, undergraduate classes and MCAT are very poor predictors of who will be a successful physician. If we increase the number of medical school slots, that gives people more of a place "in the dance" and shifts some of the burden to:

Residency slots, which would remain unchanged. Now, it's true the majority of these newly created slots would require students to take noncompetitive slots that are largely filled by FMG's: Internal medicine, family medicine, etc. But, I'd prefer to have more robust competition for residnecy slots if it takes the pressure off medical school admissions. Several people in the upper quartile of my class were reapplicants to medical school, they're very skilled and will make great doctors, I've known to great clinicians who had to go to Carib because they couldn't get into an AMG because of low GPA or whatever. It makes me sad to think we probably lose some great clinicians because the medical school application process can be so competitive and can be so poorly predictive of aptitude in medical school.

 

[Siverhideo1985]

I approve increasing the number of American medical graduates, because it's silly where the bottle-neck is placed in the system.

The first big "step" is when all the premeds entering college give up/change their mind (I've heard big variation in numbers) but this is not only people giving up because they can't handle it, but also those who discover medicine is for them. I don't think this should change much.

However, I think it's kinda silly the admission standards for medical schools is currently "the gatekeeper" of what keeps people from preparing medical studies, when really, undergraduate classes and MCAT are very poor predictors of who will be a successful physician. If we increase the number of medical school slots, that gives people more of a place "in the dance" and shifts some of the burden to:

Residency slots, which would remain unchanged. Now, it's true the majority of these newly created slots would require students to take noncompetitive slots that are largely filled by FMG's: Internal medicine, family medicine, etc. But, I'd prefer to have more robust competition for residnecy slots if it takes the pressure off medical school admissions. Several people in the upper quartile of my class were reapplicants to medical school, they're very skilled and will make great doctors, I've known to great clinicians who had to go to Carib because they couldn't get into an AMG because of low GPA or whatever. It makes me sad to think we probably lose some great clinicians because the medical school application process can be so competitive and can be so poorly predictive of aptitude in medical school.

I'd rather have the bottle-neck before people start taking on debt in the range of a quarter million. But that's just my opinion.

 

[fizzle]

I approve increasing the number of American medical graduates, because it's silly where the bottle-neck is placed in the system.

The first big "step" is when all the premeds entering college give up/change their mind (I've heard big variation in numbers) but this is not only people giving up because they can't handle it, but also those who discover medicine is for them. I don't think this should change much.

However, I think it's kinda silly the admission standards for medical schools is currently "the gatekeeper" of what keeps people from preparing medical studies, when really, undergraduate classes and MCAT are very poor predictors of who will be a successful physician. If we increase the number of medical school slots, that gives people more of a place "in the dance" and shifts some of the burden to:

Residency slots, which would remain unchanged. Now, it's true the majority of these newly created slots would require students to take noncompetitive slots that are largely filled by FMG's: Internal medicine, family medicine, etc. But, I'd prefer to have more robust competition for residnecy slots if it takes the pressure off medical school admissions. Several people in the upper quartile of my class were reapplicants to medical school, they're very skilled and will make great doctors, I've known to great clinicians who had to go to Carib because they couldn't get into an AMG because of low GPA or whatever. It makes me sad to think we probably lose some great clinicians because the medical school application process can be so competitive and can be so poorly predictive of aptitude in medical school.

Better to have the gatekeepers guard the entrance to medical education than to have many more people dropping out in the middle of their education having wasted years of work and being neck-deep in debt with nothing to show for it...

Gatekeepers aren't there just to keep the unqualified out; they are also there to keep out the uncommitted, who otherwise wouldn't realize that the medical field isn't for them until too late.

 

[btricycle]

Better to have the gatekeepers guard the entrance to medical education than to have many more people dropping out in the middle of their education having wasted years of work and being neck-deep in debt with nothing to show for it...

Gatekeepers aren't there just to keep the unqualified out; they are also there to keep out the uncommitted, who otherwise wouldn't realize that the medical field isn't for them until too late.

I'd rather have it the other way around, granted my low undergrad GPA is justification for that statement. Let me in and I'll show you what I'm made of, rather than some no-personality bookworm that would be better suited for a lab environment.

 

[niranjan162]

I'd rather have the bottle-neck before people start taking on debt in the range of a quarter million. But that's just my opinion.

damn right. Alotta people who wouldve considered switching fields midway through dont because of this reason.

 

[niranjan162]

The AMA has every interest to keep the supply of doctors as low as possible, ensuring high salaries for doctors...ah politics

Supply and demand is not politics, its economics. Also its VERY expensive to train people in medicine (both med school and residency)

Also you cant apply simple supply and demand economics because when it comes to wanting to live, there is infinite demand, yet only so much that can be supplied.

 

[fizzle]

Let me in and I'll show you what I'm made of, rather than some no-personality bookworm that would be better suited for a lab environment.

Oh come on, there are so many people with both great numbers and great personalities. Do you really think that many no-personality bookworms are going to survive a process that includes so many subjective factors that would trip them up (letters of recommendation, essays, interviews)?

There is an odd misconception that most people with great numbers must simply be the most boring and lifeless people around.

 

[Law2Doc]

Those "imported doctors" are doing their residencies here in the US.

Those foreign med-school graduated doctors are taking US residencies because there are not enough US med-school graduated doctors competitive enough to take those residencies. In other words, US med-schools are only graduating 80% of the doctors needed.

Damn sad, really.

Sure. But foreign doctors don't equal a shortage of doctors (in terms of serving the public). The OP wasn't talking US vs foreign, he was talking about a need for more physicians generally.

And no, US med schools aren't graduating even close to 80% of the doctors needed. There are 15,000 US graduates for 22,000 residency slots. That's only 68%. The AAMC has indicated that US grads should be increased to fill US needs. Starting about 2 years ago, medical schools were asked to voluntarily increase their enrollment by 10-15% over the next few years. At the same time a few new schools were (and are being) added. The ultimate goal is to eventually graduate the 22,000 US grads to fill the 22,000 seats, and not have to resort to importing physicians. The concern over imports is that the LCME has no control over the standards and quality of the education (particularly from caribbean schools) and so while no specific issues with these grads were cited, the sentiment was that if you can't control quality, standards won't meet US expectations.

The downside in all this is that the more US students graduate, the more US people are going to get pushed down to some of the less desirable specialties/geographic locations that were previously snagged by offshore folks.

 

[Handy388]

just a couple of things.

I been lurking on the caribeaan board a lot, and realized the following about those schools.

- they are basically a big ole camp kaplan.

all of them advertise how much they teach toward the boards, and many students feel that they don't learn much except things necessary for the boards.

I feel like a physician with no access to opportunity for research like US schools may not have as much of a success for academic positions

 

[Handy388]

I approve increasing the number of American medical graduates, because it's silly where the bottle-neck is placed in the system.

The first big "step" is when all the premeds entering college give up/change their mind (I've heard big variation in numbers) but this is not only people giving up because they can't handle it, but also those who discover medicine is for them. I don't think this should change much.

However, I think it's kinda silly the admission standards for medical schools is currently "the gatekeeper" of what keeps people from preparing medical studies, when really, undergraduate classes and MCAT are very poor predictors of who will be a successful physician. If we increase the number of medical school slots, that gives people more of a place "in the dance" and shifts some of the burden to:

Residency slots, which would remain unchanged. Now, it's true the majority of these newly created slots would require students to take noncompetitive slots that are largely filled by FMG's: Internal medicine, family medicine, etc. But, I'd prefer to have more robust competition for residnecy slots if it takes the pressure off medical school admissions. Several people in the upper quartile of my class were reapplicants to medical school, they're very skilled and will make great doctors, I've known to great clinicians who had to go to Carib because they couldn't get into an AMG because of low GPA or whatever. It makes me sad to think we probably lose some great clinicians because the medical school application process can be so competitive and can be so poorly predictive of aptitude in medical school.

we need more physicians, but there is a fine line of more and too much.

let's look at law school.

since years ago, lawyer supply is no longer controlled by admission. law school used to fail people out to control the amount of graduates, but they stopped doing that because each grad brings in money, and because of how much tuition there is.

in the end, massive unempolyment occured with lawyers who aren't well trained. basically, anyone rank less than top 10% and made law review have a hard time finding a good job that'll allow them to pay back their loan.

Imagine what would happen if 600 LCME school opened up and pumped out massive amount of grads.

residency competition will become so insane that outside of top 20 med schools, you need to be the top 10% on boards and/or AOA to even get a mediocore residency. most people won;'t be able to pay back their crushing debt and leave medicine all together.

worse of all, while you can argue law degree open doors in other professions, medicine is a specialized skill and years would be wasted obtaining that skill

 

[airca12]

The downside in all this is that the more US students graduate, the more US people are going to get pushed down to some of the less desirable specialties/geographic locations that were previously snagged by offshore folks.

Elaborate on this if you don't mind.

Wouldn't you rather have more U.S. students getting in and graduating, even if it means taking the less desirable specialties, than giving them to students who haven't attended a U.S. med school? I'd say the U.S. students who aren't being accepted would agree that they'd rather take anything than nothing. I don't understand your point though, I guess.

 

[dannyboy1]

Sure. But foreign doctors don't equal a shortage of doctors (in terms of serving the public). The OP wasn't talking US vs foreign, he was talking about a need for more physicians generally.

And no, US med schools aren't graduating even close to 80% of the doctors needed. There are 15,000 US graduates for 22,000 residency slots. That's only 68%. The AAMC has indicated that US grads should be increased to fill US needs. Starting about 2 years ago, medical schools were asked to voluntarily increase their enrollment by 10-15% over the next few years. At the same time a few new schools were (and are being) added. The ultimate goal is to eventually graduate the 22,000 US grads to fill the 22,000 seats, and not have to resort to importing physicians. The concern over imports is that the LCME has no control over the standards and quality of the education (particularly from caribbean schools) and so while no specific issues with these grads were cited, the sentiment was that if you can't control quality, standards won't meet US expectations.

The downside in all this is that the more US students graduate, the more US people are going to get pushed down to some of the less desirable specialties/geographic locations that were previously snagged by offshore folks.

there are more than 15,000. you are not counting all of the DO graduates

 

[Handy388]

I feel like if most people REALLY want to be a physician and researched it hard enough, a career of physician is really within their reach.

low grades of freshmen year? no problem, do another year in undergrad, postbac, or DO

low MCAT? practice test taking skill and take again, or DO

if all fails, there's the big 4 caribean schools. Hell, Saba doesn't even REQUIRE MCAT.

I feel like a lot of people can't get into USMD because they aren't willing to go for DO/IMG status due to percieved fact that they'll be shoved to less desirable residencies/locations.

I personally would go for all routes if I am not good enough for USMD.

 

[Law2Doc]

Elaborate on this if you don't mind.

Wouldn't you rather have more U.S. students getting in and graduating, even if it means taking the less desirable specialties, than giving them to students who haven't attended a U.S. med school? I'd say the U.S. students who aren't being accepted would agree that they'd rather take anything than nothing. I don't understand your point though, I guess.

Sure -- I'll elaborate. But, you have to realize that it's not the students who aren't currently being accepted who necessarily would emerge as the bottom feeders of their med school curve. Things get shaken up in med school, and what works in college often doesn't in med school. And 3rd and 4th year of med school are nothing like college courses, so it's hard to assume that people who did well in college are necessarilly better equipped for these than the next tier.

In med school, you see some folks who got nothing but A's in college end up in the bottom half of the med school class. That's just the nature of the beast when thanks to admissions standards, the grouping is so tight. The folks who never had to work for their great college grades sometimes can find themselves ill equipped in a situation where everybody has to work insanely hard to stay afloat in med school. It happens. It's actually interesting, from an anthropology-like viewpoint, after the first set of exams to see how some people who never got a bad grade before suddenly deal with being at the low end of the curve. People cry, drink, doubt their abilities, question whether they are on the right path, or redouble their efforts and move into the library. Everybody has their own way to deal. So to the extent your post suggests that the folks who aren't getting in now are going to be the ones who end up with the crummy residencies at the end of the road, I don't know if that's going to be universally true. It will be true for some, but not of others.

But my point is that people go to a US med school expecting to have choices. They aren't going just to be a doctor, anywhere, in any specialty, under any terms. They expect to figure out what they like and choose it. And when you get to the bottom of the residency slots, there are some malignant programs in undesirable locales that wouldn't really be high on anybodies choice list. People cast them aside to the IMG/FMG crowd now because nobody who can get anything better wants them. So it will be rough when suddenly the bottom grad in US allo has to smile and take these positions seriously. Right now the IMGs/FMGs serve as a nice buffer between a less desirable path and an undesirable one. Remove that, and somebody from the US gets the ugly stepsister. That's all I'm saying.

Now, you can say that's better for patients to get someone whose training was accredited and overseen by the LCME, and I'd agree with this. But from the selfish viewpoint of someone hoping for a choice of residencies, this wouldn't be so hot.

 

[airca12]

Ok, I get what you're saying. But I still think 7,000 extra residency slots is quite a bit. Instead of having 15,000 U.S. grads they should narrow the margin more.... to like 18,000 grads, with 4,000 leftover residency positions. Right now, 1/3 of these are going to non U.S. medical students while about 50% get rejected from medical school here! That's just really distorted, and kinda seems wrong. But I understand your point.

 

[Law2Doc]

Ok, I get what you're saying. But I still think 7,000 extra residency slots is quite a bit. Instead of having 15,000 U.S. grads they should narrow the margin more.... to like 18,000 grads, with 4,000 leftover residency positions. Right now, 1/3 of these are going to non U.S. medical students while about 50% get rejected from medical school here! That's just really distorted, and kinda seems wrong. But I understand your point.

The AAMC agrees with you. It remains to be seen whether this gets remedied over time (at the expense of offshore programs). The theory is that if done gradually enough, you won't see a big drop-off in credentials as you add more seats. So far that seems to be working, as seats have gone up but matriculant numbers haven't gone down.

 

[PeepshowJohnny]

we need more physicians, but there is a fine line of more and too much.

let's look at law school.

since years ago, lawyer supply is no longer controlled by admission. law school used to fail people out to control the amount of graduates, but they stopped doing that because each grad brings in money, and because of how much tuition there is.

in the end, massive unempolyment occured with lawyers who aren't well trained. basically, anyone rank less than top 10% and made law review have a hard time finding a good job that'll allow them to pay back their loan.

Imagine what would happen if 600 LCME school opened up and pumped out massive amount of grads.

residency competition will become so insane that outside of top 20 med schools, you need to be the top 10% on boards and/or AOA to even get a mediocore residency. most people won;'t be able to pay back their crushing debt and leave medicine all together.

worse of all, while you can argue law degree open doors in other professions, medicine is a specialized skill and years would be wasted obtaining that skill

I'm not saying just throw the floodgates open, but look at the matching data, there are so many residency openings that have to be filled because there are just not enough American medical school graduates. In 2007, there were almost 1000 extra family medicine positions, almost 2000 internal medicine, and 500 pediatric slots filled by non AMG MD's. We have plenty of ceiling where we can increase admissions, and as long as its done gradually increased class size and opened new, high quality sights, I don't think we have to worry about falling into the problems law schools have.

As for competition, there will be more, absolutely. But, there is no evidence that prestige of med school would become such big factor (still have the Step 1 for the leveler). Pretty much all people WILL be able to get a residency (we aren't going to increase above the level current resident levels can accept). Will competition be difficult? Probably, but I believe this is a more "equitable" solution: The competition that matters is now medical school, not undergraduate and the nebulous network of EC's and shadowing and recommendation and research. And also, currently people don't simply drop out because they don't get derm or ENT.

And as for people worrying about people being accepted and not being able to hack it: Again, the standards would not just be thrown out the window, the % of "suitable" applicants accepted would be increased. And based on my experience, med school applicants does such a poor job (in general) of discriminating who will do a good job as a medical student and who will struggle (again, numerous "reapplicants" doing excellent, some "stars" struggle), that I don't think there is any great danger of letting unwashed masses flood the system. The new applicants accepted would probably perform on an equal level to those admitted.

 

[ButImLETired]

I'm not saying just throw the floodgates open, but look at the matching data, there are so many residency openings that have to be filled because there are just not enough American medical school graduates. In 2007, there were almost 1000 extra family medicine positions, almost 2000 internal medicine, and 500 pediatric slots filled by non AMG MD's. We have plenty of ceiling where we can increase admissions, and as long as its done gradually increased class size and opened new, high quality sights, I don't think we have to worry about falling into the problems law schools have.

As for competition, there will be more, absolutely. But, there is no evidence that prestige of med school would become such big factor (still have the Step 1 for the leveler). Pretty much all people WILL be able to get a residency (we aren't going to increase above the level current resident levels can accept). Will competition be difficult? Probably, but I believe this is a more "equitable" solution: The competition that matters is now medical school, not undergraduate and the nebulous network of EC's and shadowing and recommendation and research. And also, currently people don't simply drop out because they don't get derm or ENT.

And as for people worrying about people being accepted and not being able to hack it: Again, the standards would not just be thrown out the window, the % of "suitable" applicants accepted would be increased. And based on my experience, med school applicants does such a poor job (in general) of discriminating who will do a good job as a medical student and who will struggle (again, numerous "reapplicants" doing excellent, some "stars" struggle), that I don't think there is any great danger of letting unwashed masses flood the system. The new applicants accepted would probably perform on an equal level to those admitted.

I wonder though if that would really be a solution. You can make a pretty good argument that first and second years of med school are ultimately mostly useless, and that the best students in those years aren't necessarily the best in third year, or the best doctors. A lot of schools, too, are moving toward a pass/fail curriculum purposefully, to disencourage (is that a word?) competition and make students focus on the big picture, useful info.

So if the competition is not during first and second year, is it during third year only? Ok, well, as far as I've heard there is enough gunnerish behavior third year even without making competition more fierce. When your ENTIRE future (including being stuck in the most unpleasant locations of residency fields you are not interested in at all) is based on your performance third year (I'm discounting Step I for the purpose of this discussion, since that wouldn't change with more people being accepted), I suspect that it would become a minefield.

As Law2Doc said, I look forward to having choices when I get to med school. I know I don't want to go into primary care. I know I'll work hard to not have to be in a malicious program. And I know that it will be fairly easy for me to avoid primary care fields and nightmarish programs because thankfully, IMG's will be taking those off my hands. I have no idea how good I'll be in med school, but I'm going to a pass/fail school so as far as years 1 and 2 are concerned, I'm not worried about competition. If all of this were to change-- if I had to suddenly deal with an uber-competitive student body (I imagine schools would have to move away from pass/fail) in order to avoid being stuck in an evil program in a field I'm not interested in...well, that'd be pretty depressing.

 

[Handy388]

I wonder though if that would really be a solution. You can make a pretty good argument that first and second years of med school are ultimately mostly useless, and that the best students in those years aren't necessarily the best in third year, or the best doctors. A lot of schools, too, are moving toward a pass/fail curriculum purposefully, to disencourage (is that a word?) competition and make students focus on the big picture, useful info.

So if the competition is not during first and second year, is it during third year only? Ok, well, as far as I've heard there is enough gunnerish behavior third year even without making competition more fierce. When your ENTIRE future (including being stuck in the most unpleasant locations of residency fields you are not interested in at all) is based on your performance third year (I'm discounting Step I for the purpose of this discussion, since that wouldn't change with more people being accepted), I suspect that it would become a minefield.

As Law2Doc said, I look forward to having choices when I get to med school. I know I don't want to go into primary care. I know I'll work hard to not have to be in a malicious program. And I know that it will be fairly easy for me to avoid primary care fields and nightmarish programs because thankfully, IMG's will be taking those off my hands. I have no idea how good I'll be in med school, but I'm going to a pass/fail school so as far as years 1 and 2 are concerned, I'm not worried about competition. If all of this were to change-- if I had to suddenly deal with an uber-competitive student body (I imagine schools would have to move away from pass/fail) in order to avoid being stuck in an evil program in a field I'm not interested in...well, that'd be pretty depressing.

seconded. I feel that medicine is a feel that requires cooperation and team spirit. bitter competition such as what we have now in law school can only decreases the quality of education.

plus, I don't feel that IMGs are necessarily less educated.

 

[Law2Doc]

...
plus, I don't feel that IMGs are necessarily less educated.

It's not that the are less educated. It's just that the LCME doesn't get to set standards for them or have any oversight. So there's no quality control. Many of the offshore schools will admit anyone with a working credit card, on the theory that if they fail out, they fail out.

 

[PeepshowJohnny]

I wonder though if that would really be a solution. You can make a pretty good argument that first and second years of med school are ultimately mostly useless, and that the best students in those years aren't necessarily the best in third year, or the best doctors. A lot of schools, too, are moving toward a pass/fail curriculum purposefully, to disencourage (is that a word?) competition and make students focus on the big picture, useful info.

First year being useless is argued, I don't think you can make that argument for second year (at most traditionally structured schools). While pathology and pharmacology can be bogged down with low yield stuff, the stuff you learn second year is the fundamental knowledge that you learn to put into practice third year. Also, I think that while those who excel first and second year are not GUARANTEED to perform well in third year, they almost overwhelmingly seem to do so. It is far more common to see an "average" first and second year student start succeed third year, but (in my limited experience) there is very little (if any) slippage by those on top.


[/quote] So if the competition is not during first and second year, is it during third year only? Ok, well, as far as I've heard there is enough gunnerish behavior third year even without making competition more fierce. When your ENTIRE future (including being stuck in the most unpleasant locations of residency fields you are not interested in at all) is based on your performance third year (I'm discounting Step I for the purpose of this discussion, since that wouldn't change with more people being accepted), I suspect that it would become a minefield. [/quote]

Maybe my experiences are colored by going to a medical school where gunner-ism just does not work. Do people try it? Yeah, a few do every year, but it doesn't lead to better grades or better recommendations because residents and attendings see through it. I could go on with actual examples, but this is anecdotal and an n=1, so I'll stop.

As Law2Doc said, I look forward to having choices when I get to med school. I know I don't want to go into primary care. I know I'll work hard to not have to be in a malicious program. And I know that it will be fairly easy for me to avoid primary care fields and nightmarish programs because thankfully, IMG's will be taking those off my hands. I have no idea how good I'll be in med school, but I'm going to a pass/fail school so as far as years 1 and 2 are concerned, I'm not worried about competition. If all of this were to change-- if I had to suddenly deal with an uber-competitive student body (I imagine schools would have to move away from pass/fail) in order to avoid being stuck in an evil program in a field I'm not interested in...well, that'd be pretty depressing.

The thing is, competition can take a lot of forms in medical schools. I'll be a braggart for a second and say right now that I was a damn competitive applicant (in radiology too, so I'm right there with you about not wanting to do primary care) but I never felt like I was batting heads with anyone in my medical school. I was competing against myself to be the best student I could be. I would have worked just as hard on Step 1 regardless if my dream was Derm in Calfornia or PM&R in Arkansas. I got good third year grades by trying to be hardworking and helpful, but within reason. When I found out about a research opportunity, I shared the options I'd discovered with other classmates.

Am I saying I'm a saint? No, I only share this to say I'M NOT THAT UNCOMMON. The top of my class are the nicest freaking people in the world. The people I meet on the interview trail, 9/10, you can tell within 5 minutes of meeting them that they're cool, down to earth people.

But again, these are anecdotal, I can give no objective evidence that increasing medical school enrollment isn't going to turn this thing into Thunderdome if I had my way.

Listen, this is a philosophical difference, and as such, there is no real right or wrong answer. The system we have no isn't "wrongbad" nor is mine. I will readily admit my system would probably increase competitiveness of medical students, but I think it would be minor compared to what some people are expecting.

I will say that I think this increased competiveness is more equitable now. I mean, for individual students, it's advantageous to have the system the way it is now. But I think it's less advantageous to the healthcare system and the USA as general. We're in a self-perpetuating cycle now: Nobody (who are AMG MD's, anyway) wants to go into primary care for all its problems, nobody CARES about primary care because nobody goes into it, nobody wants to go into primary care because nobody seems to care to fix it (Except for the politicians, who are probably going to screw it up anyway).

But again, philosophical difference. I don't like the system we have now, because I've seen so much evidence about how wrong admission committees can get it, but others experiences may point them in a different direction.

 

[badasshairday]

I wonder though if that would really be a solution. You can make a pretty good argument that first and second years of med school are ultimately mostly useless, and that the best students in those years aren't necessarily the best in third year, or the best doctors. A lot of schools, too, are moving toward a pass/fail curriculum purposefully, to disencourage (is that a word?) competition and make students focus on the big picture, useful info.

I don't mean to be rude, but please refrain from making these assumptions before even starting medical school. First year, you can make an argument, but second year is pretty important. At the same time first year is important because it sets you up into understand the path and pharm for 2nd year.

 

[ButImLETired]

Sorry, I didn't express myself well. I'm not arguing that the knowledge you gain in first and second year is useless, merely that the grades aren't all that important. As far as I've seen in those "residency criteria" lists, 1st and 2nd year grades are way below 3rd year scores and step 1s, as well as LORs, research, etc. Please correct me if I'm wrong, but this is what I've seen and heard multiple times. It seems that as long as you know enough to do well on Step 1, and as long as you've at least passed all your classes, you're fine. This appears to be supported by the fact that med schools are moving toward pass/fail for first and second years: why do that if grades are really relevant?

All I'm saying is, with med schools themselves moving in the direction of "the first two years, just know enough to pass and study for Step 1 on your own", it seems a bit backwards to me to suddenly make those two years more competitive.

However, as peepshowjohnny said, it's definitely a matter of opinion. There is no "wrong" way to do it- the competition has to be SOMEwhere. From my humble opinion as a lowly, ignorant little premed, I'd rather the bottleneck be here at the application level and have as pleasant a med school experience as I can, than be competing against my classmates while trying to sip from the proverbial waterhose.

 

[farrago]

There simply aren't enough sufficiently intelligent students to dramatically increase medical school enrollment. If you look at MCAT averages for all schools, we start at about 27 and end up at about 35. There is no surplus of super-qualified students to fill 10 extra med school classes. And, if we look at the medical students accepted, some significant portion will get mediocre scores on the boards (a few percent won't pass at all!), will get into mediocre residencies, and end up accomplishing nothing of particular significance - apparently, many people who do get in aren't particularly qualified either. What good is having 5000 more of these sorts of students around?

Medicine competes with academia and other lucrative career paths for top students, and there are only so many to go around. On top of that, there are personality factors that affect one's inclination to go into medicine, and one's success as a physician - so, some portion of the available pool of good students is simply unsuited for a medical career.

As for competition in medical school - I don't understand what the problem is as long as there are objective grading standards (no ass slurping). If someone wants to study 10 hours a day and memorize all of Robbins, and then is rewarded for it with an Honors, while you only get a Pass because you studied for 3 hours, good for them. You have to study for the boards anyway, no?

 

[PeepshowJohnny]

As for competition in medical school - I don't understand what the problem is as long as there are objective grading standards (no ass slurping). If someone wants to study 10 hours a day and memorize all of Robbins, and then is rewarded for it with an Honors, while you only get a Pass because you studied for 3 hours, good for them. You have to study for the boards anyway, no?

Objective Grading + Clinical Rotations = DOES NOT COMPUTE.

 

[Lokhtar]

Bear in mind that supply in medicine is not based on med school graduates, it's based on residency slots. So you could double the number of med schools and still not have any more practicing doctors unless/until you increased residency slots. Which costs big money, and so people aren't going to be quick to do it.

Right now there is arguably a shortage of doctors (in certain regions and specialties), due, almost entirely, to the large and long living baby boomer generation. However the generation behind that one is substantially smaller, so it would be extremely short-sighted to increase the number of doctors now to meet a demand that won't be there in a decade or two.

That's not quite true. The projected population of the US will indeed go down after the baby boomers, but only slightly, and only for a few years before it goes that way.

In addition, if you look at the number of foreign graduates in US residency (not US students who go outside), it's sad that we have to deny US students the opportunity to get those spots. Why couldn't that spot go to a US student?

 

[HPSPpayissues]

I wonder though if that would really be a solution. You can make a pretty good argument that first and second years of med school are ultimately mostly useless, and that the best students in those years aren't necessarily the best in third year, or the best doctors. A lot of schools, too, are moving toward a pass/fail curriculum purposefully, to disencourage (is that a word?) competition and make students focus on the big picture, useful info.

So if the competition is not during first and second year, is it during third year only? Ok, well, as far as I've heard there is enough gunnerish behavior third year even without making competition more fierce. When your ENTIRE future (including being stuck in the most unpleasant locations of residency fields you are not interested in at all) is based on your performance third year (I'm discounting Step I for the purpose of this discussion, since that wouldn't change with more people being accepted), I suspect that it would become a minefield.

As Law2Doc said, I look forward to having choices when I get to med school. I know I don't want to go into primary care. I know I'll work hard to not have to be in a malicious program. And I know that it will be fairly easy for me to avoid primary care fields and nightmarish programs because thankfully, IMG's will be taking those off my hands. I have no idea how good I'll be in med school, but I'm going to a pass/fail school so as far as years 1 and 2 are concerned, I'm not worried about competition. If all of this were to change-- if I had to suddenly deal with an uber-competitive student body (I imagine schools would have to move away from pass/fail) in order to avoid being stuck in an evil program in a field I'm not interested in...well, that'd be pretty depressing.

Actually, people that do well the first two years and get higher step 1 scores, tend to do better on the wards than the bottom feeders. During your third year, you still have to take the shelf exams and be able to answer all the questions that attendings ask. If you can't answer them, because you slacked off the first two years, you will look stupid and get bad marks. If you can interview decent enough to get accepted to med school, such minor interactions with attendings shouldn't be a problem.
All in all, you have to excel first two years to have a chance to do well the third year. It is hard to run, if you have never walked before, you know...
We are not nurses: we don't get graded on how well we know stupid CPR, put IV's in someone's vein, do jaw-thrust manuever, etc. Yes, some bookworms suck at those, but those are not at all graded. If you want hands-on career like that, go be an EMT or nurse - well, surgery is different but...