i think what you're saying sounds good and it makes us all feel a little better, but there just isn't any way to prove it. in addition, the problems that current and future do students now face have never been realized in the past.
when the economy declines and jobs become stagnant people tend to turn to education. we now have previous engineers, chemists and other individuals with graduate level degrees applying and being accepted into new do schools. i don't think you can just easily dismiss the newer schools and their incoming students as inferior to the grads at longer established do schools. well, you can, but i think it would be foolish. and for anecdotes, my graduating class at rvu matched 4-5 into ortho.
my point is that going to a do school is probably no longer a good financial decision. declining reimbursements across all specialties, increasing student loan debt, fewer residency slots, and increasing competitiveness in all specialties will eventually catch up to us.
Oh man. I always love it when someone comes on here and posts things that sound reasonable, but are nothing more than fear mongering and incorrect assumptions that "feel" correct because they are repeated on SDN often enough. Let's do this.
1) It sounds good because it is correct. Ask any program director. They will happily tell you exactly what I wrote, since I was literally paraphrasing the 30-35 I've talked to on the matter for some residency oversight work I did (more on that later). The big point they keep stressing is that in the last 13 years 28 new medical schools opened. For context, in the 13 years before that only 4 opened. And they repeatedly say that, despite the massive increase in medical students being trained, they see NO difference in applicant quality or number of qualified applicants who apply to their program. The older directors can back this up for up to 2 decades of experience with no difference between the "stagnant" years and the "med schools spreading like herpes" years.
1a) I can go as far as to predict exaclty what they will say on the matter based on what program they represent. A highly competitive program (derm, radonc, uro, ophtho, ortho, top teir university IM): There is absolutely no difference in applicant numbers or applicant quality in the last 20 years. zero. zilch. nada.
Mid teir IM program, or middle difficulty specialty (EM, gas, regular rad): They see more applicants, but mostly because there are many more people with bad scores who are reaching too high. They see no change in their pool of applicants they take seriously.
Low teir program, most FP, Peds programs: They see a dramatic increase in applicants, with no real change in quality of *applicant*... but the people they accept have IMPROVED in quality over time because they match more often than before (when they scrambled more often).
2) So, as far as not being able to prove it? You literally just need to ask any program director and they will almost across the board tell you the same thing. That residency spots vastly outnumber american students... still... to this day.
Vastly. And that the "oh so precious" competitive spots are self-selecting. There are only so many applicants because there are only so many medical students in america smart enough to be able to apply to these and have a legitimate shot, and that number doesn't vary year to year no matter how many more you enroll. The ones who would be smart enough to get these positions would be enrolled somewhere no matter what. The mid teir residencies? They also already fill up with people who naturally fall into that level of acheivement and adding more students hasnt made that category budge at all. Adding more students has only made the lower ends more dynamic, and over there what it has actually lead to is that more people MATCH to these programs and DISPLACE offshore and foreign physicians and scramblers. People forget that there are thousands (yes thousands) of spots that are filled by non-american trained physicians each year. Thats thousands of spots we can still expand american training to, if we can all get over our superiority complex that makes us think that we are all entitled to train at a university hospital on a coast even if we are the bottom of our class.
3) I see you are from RVU. I think you suffer from the same problem many of your classmates do: situational dyslexia. If there is a sentence that can be rearranged in any possible way to make the words order rearrange so that an objective comment, or even a positive statement, can be made into a personal attack, you will manage to misread the sentence that way. The inability of many of your classmates to read english and amazing ability to find prosecution where there is none will never cease to amaze me. (rant over. I just have had so many discussion here where RVU students claim everyone is out to get them, and then cannot quote one single person saying anything negative, only other RVU students claiming they heard "someone else" type it once... it drives me up a wall sometimes).
3a) I never said the new schools have inferior students or should be dismissed. quite the opposite. I said that they get the highly qualified students from the area, or the highly qualified ones who have some loyalty to the school's "brand" (whatever that may be). My comment was that opening the new schools leads to below-the-threshold students becoming DO students because they join the total DO student pool anywhere in the united states. Lets say two new schools open. They each seat 150 people for a grand total of 300 new seats. That means 300 people who would not be american medical students are suddenly american medical students. This is NOT because all 300 enroll into these two new schools. Its because the total DO student body just increased by 300 people. And they ARE neccessarily 300 "previously below the threshold for acceptance" students because the DO pool is large enough to get pretty much every student who is qualified and would want a DO degree already. New schools definitely still have >50% (probably more) people who are totally qualified no matter what right in their first class. They do get a disproportionate amount of those new stragglers, but they still wouldnt even make up half of the seats in ANY new school. So when RVU has three ortho residents, those three people would be in a different school if RVU didn't exist. They wouldn't be sitting at home going "oh gee golly, im so bummed no school accepted me." They chose to go to RVU, and good for them and good for RVU. But they had choices (even if they didn't realize they did).
4) You are correct that poor economies drive people back into education. I have nothing to add there, except I would caution you that jumping through the hoops to get into a med school, if you were previously in a different sector, requires a few years of preparation and is somewhat less effected by the poor economy --> more students trend you see elsewhere in educational fields that you can just apply to, pay the tuition, and enroll.
5) Declining reimbursements among all specialties you say? Really? Care to actually look up the numbers on that (not repeat attending anecdotes. Because I can do that as well and it will paint a bleak picture). Let me suggest something to you: perhaps all of your attendings bitch and complain because everyone hates change and is terrified of what it will do when they have figured out how to "work" the current system... but maybe, just maybe, they aren't losing money. maybe, just maybe, any source you check will show you that reimbursments have actually stayed somewhere between a 1% loss and 1% gain with most fields holding perfectly steady in the last 10 years. And maybe, just maybe, what most people are complainging about is the physicians who worked >15 years ago, when the medical system was, and everyone admits this, flawed to a point of MASSIVE physician overpayment because HMOs and PPOs and ACOs were so disorganized that physicians could charge outrageous prices and get them as long as physicians around them charged similar prices. and that really all the bitching is about the closing of many loopholes that previously made physicians extravagently rich added to a general fear of change that may or may not do a blessed thing to payments.
5a) If you have ever wondered why it has been illegal for ~15 years for physicians to collectively bargain or discuss pricing structures? See #5 for that reason. so many physicians gamed the system that now we all pay with overpowered insurance companies who can bargain and discuss price structures with each other when we cant. The system does suck... but not any more than it sucked in ~2000 when the last big change happened. Nothing has really changed, from a payment point of view, since then. so saying reimbursements suck suddenly is a terrible mischaracterization given the stability for a decade and a half.
5b) DO and MD schools both cost pretty much exactly the same, and both degrees pay pretty much exactly the same, So why would DO school be a bad investment but no comment on MD school?
6) Loan debt is increasing. Even the blind squirrel gets the nut dead center sometimes.
7) Fewer residency slots? fewer? Residency slots increase by about 200 spots year. Its not a significant increase, but its a steady yearly increase. Everyone misunderstands the CMS payment "freeze". Its (1) not a freeze, (2) has no impact on pediatrics, which is entirely immune to CMS limits, (3) doesn't impact any IM or FP program in a "rural" area, (4) doesn't prevent money from being moved from an under-utilized residency to founding a new, more desirable, residency, and (5) doesn't prevent new hospitals from opening up hundreds of spots for residency, which is happening yearly, it only limits the residency spots at existing teaching hospitals.
8) see my first few points.... competitive fields are not becoming any more competitive. The hurdle to be a legitimate candidate in the field self selects a certain number of students that is stagnant and not reflective of total student body size.
