Why don't US med schools increase spots???

[jms2002]

This might not be the right forum for this but I figure it relates somewhat to int'l...

If US med schools are approx. 120,000 tuition over 4 years (give or take several thousand) why don't they just increase class size to make the extra $$$ - since their are so many people with great gpa's and mcat scores that do not get into US med schools???

I don't expect an absolute answer, just something to ponder...

---

Members don't see this ad.

 

[Skip Intro]

At least people are talking about it...

Given these data, Dr. Mullan is now advocating increasing the number of U.S. medical schools and/or medical school graduates by 4000-5000/year as a way of filling our residency programs rather than taking off-shore graduates or participating in the brain drain from other countries.

http://www.nyas.org/books/medicaled/gme05fei.htm

This won't happen. The AMA is notoriously protectionist. They don't want the "profession" of medicine in the U.S. to go the way of "civil service", as it has in the U.K. Besides, it costs a lot of money to train a doctor in the U.S., even at public schools.

Docs make a boatload of money. Currently, the AMA, Congress, and the U.S. Health System are all happy to turn a blind-eye to all of the IMGs coming ashore as well as to those planning and opening of several new Osteopathy schools - towards whom the effort will be fully focused on pushing both into primary care - while protecting the more prestigious residencies and lucrative specialties for the U.S. grads.

Just my random speculations...

-Skip

 

[Stephen Ewen]

A few years ago, Florida Atlantic University had taken significant steps to open a med school program with the University of Miami SOM. Students would have applied to FAU-SOM where they would do basic sciences, after which they would continue on in the program as FAU-SOM students but amidst UM-SOM students for their clinicals. The program died because Florida's Governor (Bush) refused to sign on to the plan with state money. Florida got two state-funded law schools instead, one at Florida International University, and another at Florida A & M. Under Chiles some years before, the PIMs program won < 50 extra state-funded med school seats in the state. All the while, Florida still remains one of the most competitive states to gain entrance into a state med school due to state applicant/slot ratios.

A new Osteopathic Medical College has been trying to get going in central Florida since receiving a charter in the mid-1990s.

 

[BellKicker]

Yeah, I've been wondering about the same thing myself.

The real question should be: Why don't pre-medical students unite and demand more spots. You've got all these off-shore schools making millions off the situation and pre-meds seem almost content with it.

Or alternatively, weaker applicants could be allowed to pay their own way through US schools.

Just a thought.

 

[skypilot]

I agree with Skip. The limits on the U.S. spots are an attempt to create a two tiered system of medicine with the lower tier populated by International Grads and DOs.

This two tier system is also perpetuated when U.S. medical graduates say how much better the education they received in the states is, so they deserve to get the best jobs, even if statistically their claims can be refuted. It is also very self serving when they demean the education of DOs.

The idea is also that if there is a big oversupply of doctors, the IMG spigot can be shut off, preserving the balance of supply and demand that results in large incomes for doctors in the U.S.

I think that this system is not working as intended, except with regards to income, because of the huge demand for medical care in the U.S. and the large influx of highly talented and skilled IMGs taking up the higher rungs of medicine in practice and academia.

 

[volvulus]

I don't think you understand that medical education is expensive. The tuition at most US schools covers a fraction of the costs needed to train students. The rest of the expense is underwritten by the state if the school is public or more likely endowments if the school is private. In order to increase class size, more faculty would need to be hired, more administration needs to be hired, and most importantly more resources in the hospital would be eaten up in training additional students. MD's that work in the university hospital are expensive and more would have to be hired to train students.
In addition, if more spots were opened up the quality of the avg US med student would decrease. THere is a reason why there are way more applicants than spots. Each school wants the best and brightest. So in the end why would a school want to take more students and lower their prestige and plus find ways to fund the education of additonal students?

 

[skypilot]

Everything you about the economics of training students is true Volvulus. But in the end you are saying that although the U.S. needs more doctors than it produces we don't have the resources to produce them.

What is happening is that the wealthiest country in the world with the best universities is taking trained doctors away from third world nations. I think the number of FMGs as a percentage of all the doctors in the US approaches 25%. We should be exporting doctors not importing them. If we have the best medical schools in the world why aren't we producting more doctors for the world?

 

[volvulus]

skypilot, you make a good point. But why should the US care about producing doctors for the rest of the world? I don't think the point you made is relevant. US med schools exist to train US doctors and not for students who want to leave the US. Why would the US spend all that money to train a student and then have them leave? Also, most US students don't want to leave a country as you said was the richest and with the best universities.

 

[Skip Intro]

Originally posted by volvulus
skypilot, you make a good point. But why should the US care about producing doctors for the rest of the world? I don't think the point you made is relevant. US med schools exist to train US doctors and not for students who want to leave the US. Why would the US spend all that money to train a student and then have them leave? Also, most US students don't want to leave a country as you said was the richest and with the best universities.

Agreed. And, we do have a lot of programs such as Doctors Without Borders, etc. that serve special roles in world medicine.

However, this still doesn't directly answer the question as to why close to 200,000 physicians currently practicing in the U.S. are foreign-trained, and what impact that has on the countries from whom we are "robbing" doctors.

I like the FAU model, as it is akin to Ross' and SGU's education models. This didn't pass in Florida because it would have opened Pandora's box. Most medical schools in the U.S. are struggling to keep their ledger's balanced. You institute such a model, and the ivory towers at some of those institutions come crashing down.

Furthermore, the problem is that we have TOO many stipulations placed on medical schools in the U.S. with regards to LCME requirements. This is protectionism masquerading as standardization, as they know that by such requirements such medical education models cannot establish themselves in the U.S.

It would make FAR more sense both cost-wise and educationally to have more schools that teach via the FAU-proposed model, and then have such schools filter into to hospitals that can teach the clinical portions. However, this model already exists for the off-shore based schools and Mexican "fifth-pathway" schools. So, the AMA turns a blind eye to what goes on and attempts to preserve the image that medical education is some elitist and incredibly recondite pursuit that should be limited to a rare few U.S. students who are gifted enough to understand it's complexities. Poppycock. This is all about image over substance. The AMA knows it. And they work hard to preserve that image.

Trust me, they could EASILY "shut-off the valve" of IMGs coming in from the Caribbean and elsewhere if they wanted to. They've been discussing this for years. They recognize that they can't, however, because it would cause an EXTREME doctor shortage in this country.

See no evil, hear no evil...

-Skip

 

[skypilot]

I guess I should have stated my point differently. The U.S. medical education system should be cranking out at least enough docs to meet the needs of the U.S.

It is only cranking out 75% of the docs needed. Many very well qualified applicants are rejected because there aren't enough spots for them in the U.S.

Maybe as a very wealthy nation we could also afford to train a few docs for service in foreign countries.

 

[DrMom]

Originally posted by skypilot
Maybe as a very wealthy nation we could also afford to train a few docs for service in foreign countries.

I know lots of Drs who provide care in foreign countries. Granted, they aren't there full-time, but some of them put in 6 months or more each year.

 

[BellKicker]

Originally posted by skypilot


What is happening is that the wealthiest country in the world ....... is taking trained doctors away from third world nations.

Are we talking about Luxembourg now?

About those spots. I think the problem lies in the fact that everyone who got in or through med shcool benefits from keeping student intake low. Come on, I love the doctor shortage. You probably do, too. Some very wealthy countries have too many doctors. Some places you have to sit on a wait-list just to start residency.

 

[skypilot]

I wish I was in Luxembourg right now. Thanks for lightening up this discussion. Obviously the shortage of licensed physicians benefits us! It would really stink to invest $200k and then be unemployed.

Actually one of the things that attracts me to medicine as a career in the U.S. is that it is so international. If you work in internal medicine so many of your colleagues will be from outside the U.S. that any preconceived notions of the superiority of U.S. medical schools will be blown away.

 

[Skip Intro]

Excellent comments, skypilot and BellKicker. Nothing more to add than that acknowledgement.

-Skip

 

[Apollyon]

Skip Intro
Future Doctor? Who? Me?

Off the anti-bias crusade?

When I was an MSIII, I asked a doc from India whether this apparently huge influx of doctors from the subcontinent was draining them, and she said not in the least - there are more than 100,000 new doctors in India every year. If there WAS a drain, they wouldn't let them leave.

Also, in Europe, are most people sponsored, or do most pay for medical school? I know that, in the UK, virtually all students go for free, and, way back when, a doc told me to go to school in France, because it would cost $100/year. Yeah, one hundred.

 

[Skip Intro]

Originally posted by Apollyon
Skip Intro
Future Doctor? Who? Me?

Off the anti-bias crusade?

Off the anti-bias crusade? Me? Never. But, thanks for noticing. I've just decided to be a little less "over-the-top", if you will, in 2003. And, if I may continue to be so bold, I think that yours and my posts speak for themselves and are ususally sufficient enough to demonstrate that the Carib schools are not, counter to popular belief, populated with nitwits.

Originally posted by Apollyon
When I was an MSIII, I asked a doc from India whether this apparently huge influx of doctors from the subcontinent was draining them, and she said not in the least - there are more than 100,000 new doctors in India every year. If there WAS a drain, they wouldn't let them leave.

Okay, since you have shown yourself to be an evidenced-based type of guy, much to my resounding approval and thanks, how many IMGs praciticing in the U.S. are Indian nationals who emigrated to the U.S.? I don't think the concern is about India, no offense to India intended. It's more the eastern European countries that suffer, no? Personally, in my experience, I've worked with a Croatian physician (unlicensed working as a medical director in a pharma company), a Chinese MD/PhD, a Bulgarian physician, an internest from Yemen, another internest from Turkey, two Russian doctors, several South American and Latin physicians, and only one Indian physician who was actually from Holland. All were under the age of 45. I know that's not a representative sample, but I'd like to know how many are actually Indians from India practicing in the U.S. and not first-generation offspring who went to U.S. medical schools, U.S. kids who went to India for their education, etc. Is it possible to break that down that way? Maybe in the past it was traditionally and predominately Indians who emigrated, but I think you'd agree that there are a lot of Eastern block physicians/residents on the wards now than there was before the iron curtain fell. I'm not there just yet. Am I wrong?

Originally posted by Apollyon
Also, in Europe, are most people sponsored, or do most pay for medical school? I know that, in the UK, virtually all students go for free, and, way back when, a doc told me to go to school in France, because it would cost $100/year. Yeah, one hundred.

Ah, zee Fraench SEE-stem. Clearly, zee best in zee 'ole werld, no? I speet on you, you stoo-PEED Uh-mare-ee-canz! P-tooh!

Actually, despite that they are a bunch of pinko, socialist, arrogant... (I'm kidding).

Seriously, IMHO, the French system is, not uniquely, the most fair type of medical education system. Everyone who wants to try their hand at being a doctor gets a shot. But, it is cutthroat as a mofo. At the end of each year, you have to pass an exam. You compete with all other students taking that exam. You don't pass, you're out. This happens pretty much each year for the first few years (if I'm remembering correctly) until the appropriate "numbers" are achieved. And, I believe you start at age eighteen. The French pride themselves in their educational paradigm, and the very few French docs I've actually met so far in my life have been excellent.

You don't see a lot of French doctors practicing in the U.S. for some reason, do you?

 

[youngjock]

those rich doctors are just greedy! they talk about compassion, etc, etc. but to the end, they don't want to lower their own price.

i don't want lots of money, i will be happy if i can work as a doctor and have enough money to have a comfortable life.

 

[volvulus]

youngjock,

good. Then why don't you stay and practice in a third world country. I've worked hard getting into a US school. I want fair compensation for all the hard work and years I've put into my training. If anyone thinks I'm greedy when I'm over 200K in debt with six years of residency behind me they can go to hell. I'm going to try to make as much as I can.

 

[Celiac Plexus]

Someone already made the point that it costs a LOT of money to make a doctor. Making more spots in med school will just bump up the cost. FMGs are a source of cheap, highly-trained, labor that the U.S. is taking advantage of. It's a good deal for the U.S. and it's a good deal for FMGs... financially. FMGs typically have little or no school debt (at least compared to the average U.S. graduate), and the U.S. doesn't have to shell out the cash to train 'em. Then the FMG works cheaply as a resident for a few years, and lives modestly on 35-40K/yr. It's a win-win situation.

As for "robbing" other countries of their highly educated citizens... that's laughable. No one forces the hordes of FMGs to come to the U.S. It just happens that the U.S. is a great place to live and practice medicine in. It also compensates the average doctor at a rate that is much, much higher than in places like India, Pakistan, etc... For the FMGs that come here, and pass all of the licensing exams, apply, interview, and actually land a spot, it's a dream come true. If you want to blame anyone for a "brain drain" of another country, then you can blame the FMGs themselves. Personally, I say more power to 'em. By luck I was born an American, but if I wasn't I might also want to come here and practice.

Finally, about docs being "greedy"... that is obviously a belief that only a seriously naive individual could hold. 4 years college + 4 years med school + 5-7 years of residency = ~ 150K debt, huge lost income opportunity, and immeasurable personal sacrifice/difficulty... There is no way that your run-o-the-mill greedy bastard would go through all of this just so that he/she could break even by age 35 - 40 (in more and more cases even OLDER), and then begin to think about buying a house, or a car, or having a family...

 

[MacGyver]

There is a myth out there that needs to be cleared up.

Some people mistakenly think that increasing the number of docs will result in lower healthcare costs because more docs leads to greater competition.

This is not accurate, because the customers (i.e. patients) dont have perfect knowledge of who is offering the best service.

Look at the big cities of the USA. They have the most doctors per capita, AND the highest healthcare costs per capita.

More doctors leads to more treatments, more technology, and more patients than there would be previously. Doctors work to change the demand; therefore a simple supply-demand labor pool does not work for medicine.

I do agree that there are too many foreign students coming to the US for medicine. I can understand maybe 10%, but 25 and close to 35% in residencies is ridiculous. I would however support only opening more med schools is the foreign doctors coming to the US are decreased.

There is no doctor shortage in the US. We are in the upper 50% of industrialized nations with respect to per capita doctor ratio.

 

[hedging]

Originally posted by MacGyver
I do agree that there are too many foreign students coming to the US for medicine. I can understand maybe 10%, but 25 and close to 35% in residencies is ridiculous. I would however support only opening more med schools is the foreign doctors coming to the US are decreased.
[/B]

The above quote makes no sense. What are you saying?

In France, college/graduate training are subsidized. Because physicians are not very well paid, the field is not very competitive. Engineering is actually more prestigious than medicine.

I met my wife's grandmother in a French hospital while she was dying. The facility was shabby and the staff had a bad attitude. She was neglected. I guess you get what you pay for and she didn't have to pay anything due to socialized medicine.

 

[BellKicker]

Hi Hedging,

For your information........ The French medical system was found to be the best in the world in a WHO study a couple of years ago. And they don't have socialized medicine in France; they have a mix of public and private health care.

Socialized medicine, that's us up here in Scandinavia. We compare rather favorably with the US on most numbers (life expectancy, infant mortality)........ but I will admit that I'd rather be rich and sick in the US than anywhere else in the world.

Later.

 

[youngjock]

that is why i think that so many of premeds are so fake. they volunteer not because they really want to, they just want to make themselves look good in front of the admission committee.

seriously, your janitors work harder than you do, they clean up, they work at the odd hours, etc.

i didn't say that doctors should not earn enough to pay back their debts. I was saying that they are greedy for keeping so many qualified applicants outside.

there is no profession that i know of that keeps qualified applicants in this country. this is a country with a can do attitude.

why are so many citizens have to be forced to study medicine in carribean schools? is this country big enough for every one?!

time for a big change in the med. school applicantion process!

Originally posted by volvulus
youngjock,

good. Then why don't you stay and practice in a third world country. I've worked hard getting into a US school. I want fair compensation for all the hard work and years I've put into my training. If anyone thinks I'm greedy when I'm over 200K in debt with six years of residency behind me they can go to hell. I'm going to try to make as much as I can.