Bleg: Medical School Slots Going Unfilled?
This morning Glenn Reynolds posted the following comment from a reader:
As a physician in practice for over 25 years, I must comment.
Medical schools are actually having trouble filling the available slots they have so more schools won’t necessarily make for better care.
Much of “primary care” could be handled by nurse practitioners but patients would need to get used to not seeing “the doctor.”
Last time I checked, there were surveys that reported about 2/3 of physicians actively discouraged their children from going into medicine.
Can anyone substantiate this? I’d genuinely appreciate it. I’m always interested in learning something new.
Frankly, I believe that this is hooey. What I believe to be true is that medical residency slots are going unfilled, a horse of a completely different color. That reflects the reality that graduating doctors prefer some specialties over others, particularly primary care.
I can find plenty of citations that medical residency slots are going unfilled. Can anyone find some proof that billets in medical school are going unfilled?
According to the AAMC, total active enrollment in U.S. medical schools was:
This is totally anecdotal, rather than statistically founded. However, as the son, grandson and nephew of doctors – and as someone who considered the medical profession – I’ve witnessed first hand some relevant phenomena.
The practice of medicine over the last 40 years has become decidedly less attractive, especially when it comes to what is known as “family” or “general” practice.
For numerous reasons, including the rise of the third party payer system (with problems predicted 30 years ago by said blood relatives), a general coarsening of the society wrt doctors (respect and legal issues), and the reimbursement levels for primary care vs procedures (surgeons) the practice of medicine has become a different world.
So I have witnessed first hand, and have no problem believing, that recruitment of high quality GP candidates is difficult.
How appetizing is it to work your face off to graduate at, what, age 32? with massive debt, only to find yourself questioned about your diagnosis or treatment by patients who heard something from their neighbor or read something in People magazine?? And how about the lawyer just waiting to extract rents?? And the government telling you what to charge?
Sound appetizing? Not to me. A GP today makes what, $150K?? A plumber can make $100K. A GM auto worker can make that.
Things will get exponentially worse the more government encroaches. You think quality recruits is a problem now?????????
Drew, the AAMC site I linked to above, shows that grade point average and MCAT scores of enrolees at medical schools have been increasing over the 1997-2008 period.
I don’t discount the thrust of your anecdotes though, particularly as applied to the general practice.
Ever since the Flexner report back in 1910 the medical profession’s philosophy here in the U. S. has been better doctors, not more doctors. As PD Shaw notes when you relate the number of med school students to the population, medical schools have been increasingly selective in the doctors they’ve admitted.
Drew, I don’t know when your father and grandfather practiced but, historically, physicians have lived lives of shabby gentility. They certainly weren’t in the top 1% of income earners as most physicians are now.
Physician incomes began rising sharply after 1965 when Medicare and Medicaid were enacted into law. I’m not claiming that was the only cause but I think it’s incontrovertible that it was an important one.
Careers have intrinsic rewards and extrinsic ones. For a physician the intrinsic reward is the good that he or she does, her or his relationship with his or her patients, and the gratitude of his or her patients. A large income is an extrinsic reward. My view is that physicians have been trading their intrinsic rewards for extrinsic ones and, as the extrinsic rewards are sapped away, the profession is left without a great to deal to recommend it. But that was the decision of the physicians themselves.
I still see no evidence that there are unclaimed billets in medical schools.
Enrollment is up 10% compare to population increase from 268 to 306 million which is a 14%. So in a market that was already short on doctors we are getting even further behind. Also the large portion of the 10% increase was only last year. This is a good if it is a sign that it will continue to increase at that rate or better but is bad if it was just an unusual year. One year doesn’t make a trend. Three or more does and the trend in the last ten years doesn’t look good.
My experience in medical field pales compare to Drew’s but the couple dozen that I associate with on occasions seems to have similar feelings.
Wayne, I’m not sure I’m seeing a big jump enrollment in 2008. I think you are right that the increase in enrollment is not keeping up with the rate of population increase. But some of that is being handled by foreign doctors, which no doubt raises a whole ‘nother set of issues.
Which GM autoworkers make $100K per year…
I do not know the answer off the top of my head, but will ask when I go back to work tomorrow. I am peripherally involved in starting up a new medical school to be affiliated with my hospital. I had thought med schools were filling. Primary care residencies have had variable success at filling their spots for many years now.
Government predictions matter a lot in filling spots. In my specialty, anesthesiology, residencies were underfilled for a long while after predictions that there were too many specialists, especially in my field. The predictions were wrong, and it was impossible to recruit for years. Only recently have programs begun turning out enough graduates again.
In 2008 it went increase by approximately 1500 which is approximately 20% of total increase from 1997. Same can be said for 2007. Rough average is 1200 during that time frame of the link so 1500 would be a 25% increase. From 97 to 03 it looks like there was little increase. So what does it mean? Not a whole lot since like you said there are many other factures including increasing of frequency of people going to the doctor, foreign doctor, quality of care, etc that we haven’t gone in details. So basically we are giving our opinions.