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Pre-Medical Student Osteopathic Medical AssociationSteps Being Taken to Reduce Physician Shortage
Published: June 25, 2008
Category: Medical (MD, DO), News
by Alison Hayward, M.D.
SDN Staff Writer
The past decade has seen a major position change by the American Medical Association regarding the projected need for more physicians nationally. Reversing a long-held stance, in 2002 the AMA recognized that calculations had incorrectly predicted an excess of physicians, leading to a critical shortfall. Having barred the opening of new medical schools for almost twenty years, the organization had to quickly backpedal and not only encourage the opening of new schools, but recommend that existing schools rapidly scale up enrollment.
From 2002 to 2013, it is expected that medical schools will increase enrollment by 20%. This will provide approximately 3,400 new medical students per year. Also, four new medical schools have been accredited since the moratorium on new schools was lifted – Florida International University, University of Central Florida, Texas Tech University at El Paso, and San Juan Bautista in Puerto Rico. Schools in the pipeline for accreditation currently include new schools in New York, California, Pennsylvania, Michigan, Virginia, and New Jersey.
Yet despite this expansion, the AAMC has reported that we still face an anticipated shortfall of physicians of 70,000 by 2025, a staggering number – other sources predict a shortfall as great as 200,000. It is clear that correcting a shortfall of this magnitude will take drastic measures on both a local and a national level.
Even though medical schools are increasing their number of seats, the question still remains – will potential medical students still want to fill them? As Amjed Mustafa, MCAT program manager at Kaplan Test Prep and Admissions, points out, “We’re looking at a problem that we call ‘physician shortage’, but it’s really 3 problems: supply, demand and distribution of labor. From the supply side we have doctors coming into the system but more doctors going out of the system. A third of physicians today are over the age of 55. Adding to the supply problem is that younger doctors are pushing for ‘quality of life’ specialties with fewer hours. From the demand side, the number of people over 65 is going to double over the next 30 years, and that is going to affect the need for physicians. Adding to the demand woes, research is showing that people are going to the doctor more frequently. Additionally, there are distribution problems amongst specialties, with primary care and specialties like geriatric medicine suffering the most.”
This is an apt summary of a problem that has recently been brought into even sharper focus with the impending Medicare cuts, which are planned to go into effect June 1st, 2008. These cuts will reduce physician payments, already insufficient to cover the costs of Medicare patient visits, by 10%. For physicians already feeling the pressure of massive student loan debts and frustrated by being constantly nickel and dimed by insurance companies, this additional financial pressure is expected to be a catalyst for limiting care of elderly patients. Studies performed by the AMA show that the majority of doctors feel this legislation will force them to restrict numbers of Medicare patients, leaving the question for many young doctors and medical students – who will take care of our parents?
There is some momentum to reverse the Medicare cuts, but the time available to get this legislation passed is dwindling and causing hopes to dim. The presence on the horizon of another 5% cut slated for January 2009 makes the situation even more dire. There is, however, positive legislation on the table as well, to evidence the fact that many on Capitol Hill are concerned about the shortage. The Physician Shortage Elimination Act is currently under consideration, a bill that would provide scholarships to medical students and increase grants available to primary care facilities in shortage areas for expansion of residency programs. This bill would also add funding to the National Health Service Corps, the program that provides financial support to medical students and physicians who commit to practicing primary care in shortage areas, which has faced cuts over recent years under the Bush administration.
Approximately 20% of the nation’s population lives in a designated Health Professional Shortage area, according to the U.S. Department of Health and Human Services. As many in healthcare are acutely aware, primary care is suffering most from the shortage, since financially-conscious physicians are flocking to higher-paying specialties. Although there has been much mention lately in the media of the disparity between which healthcare services are most crucial for patients to receive (primary care and preventative services) and which healthcare services are most highly compensated (highly specialized and invasive treatments), solutions to this problem seem to be in short supply for now.
As Kaplan’s Mustafa notes, financial considerations are not the only barriers to increasing medical school enrollment. Quality of life concerns figure prominently in the minds of many who are considering a career in medicine. “In a 2006 survey, 63% of medical residents said that free time availability was a major concern, and they are going for specialties that have a better work/life balance,” Mustafa explains. “Becoming a primary care physician during a time when primary care physician availability is extremely limited does not lend itself to a relaxing balance between work and home life. This also comes at a time where the median tuition and fees at medical schools over the last 20 years have increased by 229% at private schools and 479% at public schools, and the average student debt is $140,000. Kaplan prepares thousands of aspiring doctors every year for the MCAT and the medical school admissions process – and as dedicated and passionate as they are about their prospective careers, we know that for many students this is at the forefront of their concerns.”
The recent push towards shift work in creating positions for hospitalists in many medical specialties, from internal medicine to pediatrics to obstetrics, is evidence of this trend. Hospitalists in these various specialties enjoy a set number of hours in the hospital, the flexibility of shift work, and the freedom from work-related responsibilities when they are outside the hospital. Primary care physicians, in contrast, though they may now be able to utilize hospitalists for admissions and inpatient care, still must carry pagers, be on call overnight, and work uncompensated after hours to complete their charts and negotiate with insurance companies on their patients’ behalf.
The concern of many is that these combined financial and lifestyle factors, aside from creating dissatisfaction amongst practicing physicians and potentially speeding retirement or career changes, will also decrease the interest level of potential medical students, particularly high quality applicants. Despite the argument that a decreased supply fuels demand in a free market, a particularly unappealing job may not respond as expected to increased demand unless compensation increases significantly. Those who are attracted to an unappealing, but high paying job may not be the applicants who will make the most compassionate physicians. News of the shortage thus far has indeed increased interest in careers in medicine. Applications to medical schools have been on the rise, and in 2007, the entering class to U.S. medical schools had the highest GPA and MCAT scores on record. Will these trends continue? Conclusions remain speculative at this point.
How are we currently compensating for the shortage in physicians, particularly in the primary care arena? Through what is popularly termed “the brain drain”, the United States is drawing physicians from other countries to replete its healthcare workforce. A landmark New England Journal of Medicine article from 2005, ‘The Metrics of the Brain Drain’ estimated the percentage of foreign medical graduates working in the United States at 25%, of which 60% hailed from lower income countries. These foreign medical graduates were primarily ‘drained’ from India, Pakistan, and the Philippines. This article concludes that by draining the healthcare workforce from countries in desperate need of physician retention, we are adversely affecting the health of the populations of these countries, particularly in the rural areas. This is part of the distribution problem that Mustafa brought up, noting: “There is a widening gap in the number of doctors per capita when comparing areas with high average per capita income versus those with lower incomes.”
The physician shortage, predicted to continue for the next 10-20 years at a minimum, is clearly a complex problem whose full significance may not be realized yet by the general population or by our government officials. Through sustained, varied, and co-operative measures to increase the numbers of medical professionals, it is clear we will have to continue to address this issue for many years to come.
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51 Responses to “Steps Being Taken to Reduce Physician Shortage”
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So, this may be putting the cart before the ox or whatever, but what happens in 2040 or 2050 when we have tons of physicians and all the baby boomers have died? Won’t the US have a huge oversupply of doctors?
You do realize that generation X and the new generation has even more people than the baby boomeres right? And then they will be old too…so the supply of old people will keep growing.
Weldon,
I figure that by 2050, a majority of the population will be replenished by first or second-generation immigrants from another country since Americans can’t seem to keep up with birth rates. Thus, there won’t be an oversupply of doctors since baby boomers will be replaced by immigrants.
The american birth rate although low compared to developing countries is above the death rate. This combined with immigration like you said will leave doctors in demand.
You left out the 5 new accredited osteopathic medical schools each with 100-250 students in enrollment size.
No matter how many slots AMA wants to open for Medical School, these extra physicians will not end up in primary care. They will all go to lucrative specialties. The primary fix is to correct the renumeration for primary care physician and make it more lucrative to practice primary care where physicians are working almost 24/7.
Pretty ignorant of the physician author to leave out mentioning the 5 new medical school that grant DO degrees out…..its a shame on her part
Another quality physicians pool which is not mentioned in this article is the thousands of dedicated, highly educated, competent MDs who went to US schools based outside the countries and have entered primary care specialties over the past 30+ years (Ross Medical School, SGU, SABA, AUC). Many of these folks are working at hospitals/clinics throughout the country as primary care providers (IM, FP).
The main thing that needs to be fixed is better pay or at least stop drops and then fix hours. No physician in this country should be working more than 70-80 hours. Fine as a resident, not fine for the rest of your life or at least 20 years.
If this keeps up, I can only see myself practicing medicine post-residency for only 10 years. Everybody better get on Obama’s case from pre-meds to attendings that our workplace quality needs to improve. Burnout is so much more evident as I go through medical training.
Gary if that is your true feelings then maybe you should be looking into another career path or review the Hippocratic Oath. For years it has been my dream to become a Physician.
To be a medical professional is to uphold an Honorable tradition and it’s no different than being an owner of a business. For both depend on the public to for their livelihood. A business owner that doesn’t meet the needs or demands of his/her clients goes out of business quickly, same for a Phrygian.
“which has faced cuts over recent years under the Bush administration”
I love phrases like this…”faced” means it never happened, though threatened and “under the Bush Administration” is misleading. The congress has the purse strings, Honey, not the President’s administration. Many people died from cancer “under the Bush administration”, I guess it’s his fault.
Listen Philip, no matter how grand of a dream “becoming a physician” may be; if it doesn’t pay your bills - then you can’t stay in business, be you a healer or a widget-maker. If your practice LOSES money on say, every hysterectomy performed (a reality in some places), then you won’t do any hysterectomies anymore. Then, everyone loses - both patient and physician alike. On top of your operating costs, add 200K of medical school debt that you can’t default on and now you’ve got a handle on the problem of primary care.
Hi all:
- Normalforce/toot: Sorry for leaving out the DO schools, I did this article based on research on the AAMC website press releases (as you know, they only accredit MD schools) and other newspaper articles/web media. None of those sources mentioned the new DO schools, so I wasn’t aware of them. I did find the following link that shows new schools with provisional status: http://www.osteopathic.org/index.cfm?PageID=sir_college
- scott: In fact, you are wrong. What I should have said was that the program’s budget has been cut by the Bush administration (approved by Congress). I should have been more blunt. Also, your comparison to cancer deaths is not logical - the budget for the Dept of Health and Human Services is directly proposed by the Bush administration. Bush is only indirectly and theoretically responsible for increases in cancer deaths due to cutting primary care funding and thereby a major source of cancer prevention.
In 2006, Bush’s proposed budget cut about 4 percent from the NHSC (this cut went through). In 2007, the proposed funding was flat. For 2008, Bush’s proposed budget called for an addition $10 million to be cut, a 7.2% decrease. So the budget for the NHSC, directly due to cuts proposed by our President, has been decreased sigificantly, despite our primary care shortage. I do not exempt the Congress from blame for allowing these cuts to go through.
In 2003, the NHSC had a budget of $171 million. In 2008, the budget was only $116 million.
How does the AMA keep new schools from opening? Other professions have been prosecuted for anti-trust for trying to control provider surpluses.
what gary said is accurate. You cant work someone to death(ungodly hours), pay them very little and expect them to be satisfied. Physician burnout and low satisfaction is what isgoing on. I should not be thinking of getting out of medicine at my early age.. ive been practicing attending for 5 years; but daily i think about leaving medicine and in the next few years that will become a reality
I don’t know if anybody thought of this, but nobody is “forcing” people to work 60-80 hours per week. Is there a gun to your head telling you to work? The better than average salary of doctor (even primary care docs) might mean that a 60-80 work week is justified. If it is truly a concern then stand up and fight for your rights. Only work 40 hours a week like the shift docs mentioned in the article. If people start complaining about poor service because doctors are unavailable, maybe the AMA and the public will do what they need. This is a free market. If the demand for health care is there, people will pay. Placing pay and health care on the same table and choosing between the two isn’t easy for many docs - ethically. Can docs really deny health care because they reached 40 hours that week and the have to get home to the family? I would say, in some cases, yes. Doctors are noble, but they are not martyrs.
Good news about the looming Medicare cuts, the House of Representatives has overwhelmingly voted against implementing these cuts and it is expected to be approved in the Senate. But President Bush is set to veto it should it get to his desk. Looks like only the Democrats have our interests in mind.
Jim and Phillip,
Sounds like students talking and haven’t practiced a day of medicine. Or seem to be in an oblivious state of mind that I could use some days.
Honorable tradition? Get your head out of your own behind. There is a honor and then there is indentured servitude + litigation. The oath is a bunch of BS that keeps getting modified over years like many texts to fit the current needs. Did you know the original text supports the idea of NO consent? We are not suppose to be explaining things to the “common” man and letting out secrets. That means no WebMD and more. We get to be judge and jury, not the patient. Also, no abortions or doing surgery. You going to follow that too. The oath is like a commencement speech, utterly worthless.
Free market? HMO and Medicare is not free market. Each one pegs rates based on the other. It’s not like somebody is going to pay you cash because most people who show up to a physician’s office are under some sort of insurance scheme and if not, the self pays don’t pay in a timely manner. If you don’t make payments on your house, it gets taken away. Same don’t work for your body. I can’t ask for a kidney. Maybe I should be able to.
Like a business? I wish. I’m closed so go away. I reopen tomorrow morning. That’s what businesses do. No problems there. Same for health services. Also, no one sets a ceiling on your value in business. I should be able to make people bleed out of their wallets. Does that make sense? Nope.
In conclusion, medical professionals need to look out for themselves FIRST, not ANYone else. You have to work in the scheme of our political world, not fantasy land. You determine your value, not some lazy nurses who want to encroach on primary care and specialties, not fatty Michael Moore and his other high-risk no return cohorts, not baby boomers who think they should pay you less so they have posh retirements. It’s brutal, but docs have to learn to say NO. Someone is getting their cord pulled, and it’s not going to be us if it’s up to people like me.
Is a physician’s union feasible!?
I would like to hear more about how the AMA was keeping medical schools from opening. Can you elaborate?
Physician unions are not feasible. Apparently, it’s anti-trust violation. Another thing physicians need to be able to lobby for is the right to strike when they don’t see their demands being met.
I assume it could be possible as long as emergency services are available. But, the bigger problem is doctors not bashing each other all the time. How many surgeons think they are better internists and vice versa? There is a lack of cohesion, and maybe the stuff going down now might finally force people to collaborate rather than be divisive.
Gary, I couldn’t agree more.
For all you pre-medical and medical students, Yes, we all entered this profession with the wide eyed optimism Phillip displays. We all wanted to become doctors to make a meaningful difference in our patient’s lives. But being an overworked, underpaid, undervalued physician, whom many patients are now suspicious and believe we are the ones trying to scam them for every dollar they have, is incredibly taxing on your motivation. Yes, that warm fuzzy feeling you get when you save a patient’s life is incredibly rewarding, but when you’re up to your knees in paperwork, arguing with insurance companies on behalf of your patients, spending more time with patients than your own family, and wondering how in the hell you’ll ever get yourself $200K out of debt… then tell me how inspiring the Hippocratic Oath is. I am a good person, and I am a doctor because I care about my patients, but this job is becoming more and more difficult. I think about my patients and would never want them to suffer on my behalf, but sometimes you have to ask yourself, WHAT ABOUT ME? What about all the hardworking physicians who, as you pre-med SDN students know, takes years of schooling and training? After all that hard work, you’ll find it’s very anti-climactic. Yes, I love being a doctor, but I certainly loathe all the baggage that comes with it.
Has anyone done a study finding out the correlation between choosing “lifestyle” occupations and the huge influx of female medical students and doctors? If in fact women choose lower-stress (and therefore lower-productivity) jobs, it argues that they are making less use of an expensive medical education, and therefore preferences for women in medical school admissions should be abandoned, or even reversed.
Banning/curtailing females from medical school is not going to solve the problem even if somehow a study showed something odd like that. Husbands who are never home instead doesn’t make sense either.
Once again, people including docs in their blindness want us to give up more when the rest of society needs to take a hit. I refuse to belly up because people are whining. We shouldn’t have to throw away everything so others can benefit. Last time I checked, no one was our advocate so it really irritates me when one of our flock criticizes our needs/wants. This is not about being fair. It’s about getting everything you can because someone else will keep trying to get into your pocket.
It would be nice to get rid of the shortage. It would also be nice to get this country out of debt. Both are not happening anytime soon or ever. At least in the meantime, let’s BAN medical litigation and curb medical school costs.
I believe the AMA blocked new schools thru accrediations (so with the AAMC) since there is no point in creating a med school if it won’t be recognized or accredited… plus the Government (thru lobbying be AMA) limited the number of residency slots pretty level for the past 20 years or so (meaning if you wanted to add a Neurosurgery slot at hospital X, then another program had to remove a slot from some other specialty (or the same])…
An assumption that was made was that hospitalists/shift workers only have 40 hour jobs… that isn’t true.. what is appealing about them (who may still be working 5-6 12hr shifts a week meaning 60-72hrs a week) is that you have well set, defined hours, you work when you are on, you don’t when you are off. Plus, if you are an internist, you ARE providing primary care…
What needs to be gone is the illusion that you are that one patient’s doctor and everything dealing with them is on you… these shift workers work in this way (i read and article about Ob shift workers and so how some of people were being delivered by doctors they have never met but as long as the doctor was competent it worked out better because they were better rested).
Anonymous: I’m pleased to inform you that there is already a union for residents. Check it out:
http://www.cirseiu.org/
For those inquiring about the limiting of new medical schools during the ’80s and ’90s, there was a moratorium on new schools, so no new schools could be accredited. For those with PubMed access, this article looks interesting:
http://www.ncbi.nlm.nih.gov/pubmed/18261478
i hate to mention this, but how do mid-level practitioners figure into this? what if the problem isnt that we need more physicians, but need to give mid-levels a larger scope of practice? then you docs can have your specialties and subspecialties and afford your massive debt. is it possible that enhancing the scope of practice for mid-levels would be a really good thing for physicians? this of course brings up the concern over whether mid-levels are sufficiently educated to successfully operate within an enhanced scope of practice. mind you i’ve abandoned medicine as a career and am an unbiased observer…not trying to start any fights.
Hey Julian, So you are a practicing physician of 5 years and feel that you may jump ship? I’d love to chat and get your perspective on what it’s like when one becomes an attending (and what hardships you face).
My “name” is my SDN avatar.
homosacer
I think you have a valid point. Perhaps the AMA should stop pumping millions $$ fighting against the other doctors out there. It seems most psychologists, optometrists, podiatrists etc are already trained more than allowed to provide.
the us and most industrialized nations have sub replacement fertility rates(and have for the most part for over 30 years), the poster a couple ago doesnt understand this
true about immigration but steps need to be taken so other countries dont have their health provider resources drained
and when we have just hovered above this rate is only because of the birth rates of latin american immigrants, who hopefully wont be underrepresented in the future but probably will
oh please! we can’t worry about immigrants who come into our country and flood our systems and don’t pay for the health care they receive in the ER. We have to more concentrated on tax-paying citizens, who actually pay the bills and the physicians.
In our business we call those ‘abusers’ of the system.
At this point I don’t know if fixing the system is even possible.
Abusers? haha you make me laugh. Give them temporary documentation in order for them to work legally, pay taxes, pay for health care, and yes… pay them minimum wage (Something I highly doubt the American Business man would be ok with).
I doubt an illegal Latin American immigrant is going into a health care scene for plastic surgery to fix their noses. Its more than likely a work related injury that had been put off way too long because they had no other medical alternative.
Don’t blame Latin American immigrants, they’re not the people hiring lawyers to sue physicians.
When you say things like that, the amount of schooling and/or education you have received is not in question. Just you intelligence.
Interesting chat. I’m a mom of a med student - would really like to see more recognition in the US of the accredited schools outside of the US - students who attend foreign schools (many US born and raised) are just as passionate as those who make it into US limited education spots, and really struggle to find clinical rotations as many US hospital clinical spots are held for US med schools only. Same with scholarships and low-interest student loans.
I am really concerned about the number of hours that physicians work, are pushed to work, or just chose to do so. We hear stories about clinical rotations where surgeons are on call - have emergency surgeries throughout the day, maybe all night and then continue with regular scheduled surgeries the next day sometimes going more than 24 hours with no sleep. There should be limits on operating hours per day, per week or like they do for pilots and flight crews. Same with those going into residency.
God is good - He takes care of each of us. If He called you to be a physician He will open doors for education, clinicals, and take care of your physical, mental, spirital and financial needs. Just have faith and thanks for all you do for others.
Amen sister, God is good all the time.
I am disappointed that no mention of a single payer system appeared in this article. With such strong complaints with the insurance industry and the headaches it causes, where is the solution? A recent survey study by the Indiana University School of Medicine found that 59% of physicians favor “government legislation to establish national health insurance.”
Such a program would lower overhead, free practitioners from the restraints of HMOs and allow for more patient doctor time resulting in higher quality of care. Do your own research, http://www.pnhp.org.
As for the vast problem of litigation, is there any real solution that is seriously being considered? Both presidential candidates say that they will address this issue. The best solution I see is the formation of a medical jury when malpractice is being claimed. The jury will be formed by medically educated persons that have specific knowledge in the area that the accused failed to perform.
Uilliam:
Thanks for the comments.
I don’t disagree with your conclusion that a single payer system such as the one proposed by PNHP would have benefits, however, it is a controversial topic, and some would argue that it could affect the shortage adversely if the establishment of a single payer system resulted in decreased monetary reimbursement to physicians.
I think the effect of a single payer health system on the physician shortage is very theoretical at this point and would be tangential to this article. But I have always been intrigued by the controversy surrounding the single payer system and I will see if we can do an article more focused on that specifically in the near future.
To the mom of an MD:
I wish God was that protecting, but I think God has left doctors to do their own fighting for now. Leaving things to God is a cope out, and it explains why doctors have failed in recent years. Second, taking docs from outside of the US so they can meet “needs” here is bogus. I find that being very similar to sending American jobs offshore because no one here wants to the pay them and can find cheap labor somewhere else.
To those who believe in a single payer system:
It would be awesome in terms of only 1 type of form. The system would work much faster. However, doctors need to be wary of their rights. If physicians could be GUAWRANTEEED 175K per year adjustable with inflation, elimination of non-economic damages, and work hours limited to 60 hours per week, I can only see a majority of American physicians loving it. Yes giving up the high ceiling which is clearly already gone, but at least we can protect ourselves from the ground sinking even further.
The key point is doctors need to lobby for themselves, not anybody else. The goal is not screw our patients, but to avoid the middlemen taking more cheese and then leaving us with the disgruntled patient who are usually to stupid to know who is actually billing them. How many of you find patients blaming you for someone else’s misdeeds?
Once again, lobby for your rights starting the day you become a medical student. Call your reps and senators because if you don’t, no one else will. You come first no exceptions.
Lots of misinformation here. The AMA does not put a cap on the # of med schools. As long as you meet the LCME criteria, you are in.
Florida recently added 3 new med schools, and not a single one of them was “approved” by the AMA. They met the LCME criteria, and got their accreditation, end of story.
In fact there are currently 35 new MD/DO schools opened in the past few years or in planning.
So lets end this myth that that AMA is secretly pulling strings to keep new schools from opening up. If you want a bogeyman, look at the dentists. They actually closed down dental schools in the 1980s to “protect against a surplus.”
You want another bogeyman, take a look at vet schools. They purposefully wont accredit new schools regardless of the quality of the school.
http://www.lcme.org/faqlcme.htm
This website kind of gives the real story. The AMA and AAMC are indirectly involved in med schools. Anyway, I like the idea of standards in education rather than meeting needs. I assume nobody else would want a shoddy product.
And what about residency spots? Fix that bottleneck. Then we can get all the FMGs to come here and provide you all with the care you so deserve. But then there will be patients who don’t like their English and think they are immediately incompetent.
The solution(s) are important and unsettling to hippies. First, rationing care is most important. The major university that I work with is 65% medicaid and self pay aka no pay. You can’t survive on that. Somebody NEEDS to die because that’s nature, and I hope it’s an old man with a dumb family than some teen, young adult, child, mother….You get what I mean. That’s the way it should be. No buffet options. Second, cut costs by eliminating the middlemen. F### insurance agents and other morons selling the obvious. Let them worry about relatively optional things such as life insurance.
There are lot of foreign medical graduates waiting for residencies in US hospitals. If residency slots are increased, they can help to overcome the shortage. Most of them will be willing to work in primary care and in under served areas.
I do not think we should ever need to look outside the US for residents. There are numerous applicants to US Medical Schools who are turned down, yet completely competent. Not every well qualified applicant is afforded a position in a US Medical School.
The Physician shoratage is not due to a lack of desire or capability from American citizens. Nor is it due to rising debt or undesirable working conditions. There are plenty of people who would be content to practice primary care, but they are not accepted because either there was someone who looked better on paper or because there was not room for more students.
My comments in no way advocate for substandard practitioners. What I am saying, however, is that while there are many problems with the entire system (which I could go on and on and on about), the shortage is not in response to a lack of qualified minds.
As a premed student, I know hundreds of people in my school who are dying to get into medical school but fear they wont. If medical schools stop weeding out students with lower GPAs or MCAT scores and base admissions a little more on how much they want to enter the profession, there would not be a projected doctor shortage. In addition, if the cost of applying to and attending medical school was not so high (applications in the thousands and tuition close to $60,000 a year)- doctors would be in less debt and therefore, might be more inclined to work a few more medicare/medicaid cases.
Basing admissions on how much you want to enter the profession? That would solve the shortage, sure, but in a life-or-death profession, do we really need quantity over quality? “I really, really, really want to save your life, but…well…umm…”
macgyver:
Indeed, you are correct that the AMA does not directly approve or deny proposed new medical schools. As I noted, the AMA merely holds a position on whether or not medical schools in general should expand. Due to faulty projections, they expected an oversupply of physicians rather than a shortage. These projections affected the opening of new medical schools, contributing to the so-called ‘moratorium’ on new schools.
The schools you mention were LCME accredited since the reversal of the AMA position on the physician supply in 2002. The point made in the article is that there was an approximately 20 year period that saw a lack of new allopathic medical schools, in part due to the expectation that there would be an oversupply of doctors. I’m not sure what, if anything, the AMA was doing during that time to prevent new schools from opening, other than holding the position that medical schools should not expand. Perhaps that was enough to keep new medical schools from beginning the arduous accreditation process. It was specifically a public stance, rather than being secret or underhanded as you imply.
Regarding the admissions thing, it’s not really choosing quantity over quality, it’s giving people a chance to pursue their career aspirations despite having messed up maybe one semester in college or not being a good standardized test taker. Of course it doesn’t mean that medical schools should start accepting people with 1.0 GPAs, but I hear some schools don’t even look at some applications if the gpa isn’t a 3.0 or even higher… we pay hundreds of dollars for applications and supplements… don’t every application deserve a chance? Besides, the student would still need to go through the medical school curriculum, clinical training, boards and such - in my point of view, to be denied the chance to become a doctor because the person failed the medical school training is more fair than to be denied because of undergraduate classes that are not directly related to medicine. One can also argue that doctors learn most of their job information and skills during residency and a line must be drawn somewhere - but medical school is still school… is there really that much of a harm in letting more people into school?
I work for the NYC Department of Health and Mental Hygiene. I take doctors, medical students, and residents with me on my field cases. These people are from all walks of life, some are in the most recognized medical schools and some are from less stellar schools. I remember taking a exchange program resident from England with me and I asked her about the medical school system in England. She told me that England right now does not have an exam like the MCAT to evaluate applicants rather applicants must have certain test scores over their high school years in order to apply (and of course you’re guaranteed in since you’ve got those test scores). The medical system there recently ran a trial exam on the medical students very similar to the MCAT. The results showed that generally those medical students who were better in test scores were “worse” doctors. This just goes to show that it’s not your GPA and MCAT scores that “make” you a good doctor; it’s your character. Sure you need to have the adequate intellect to understand science concepts and to remember techniques and anatomy and reactions. Most people have that capability even if it does not “seem obvious” by their MCAT and GPA. People mess up in life. Everyone needs to be given second chances to get back up. Personally, I was in specialized (honors) programs and classes from elementary school through high school. In my first college experience I was dismissed after three years due to a horrible GPA because me life was all messed up. So does that mean I am not intellectually capable of handling medical school requirements? I KNOW I am more than capable. I have many friends who are doctors too. Some of them I can honestly say are idiots most of the time. They say stupid things and do stupid things. How did they become doctors??? If idiots with higher GPA and MCAT score can become doctors, all the moreso for wise people with lower GPAs and MCAT scores. I’ll tell you how: they went to a nice college and got a decent MCAT score. Anonymous is right, let more people in to medical school who have lower GPAs and MCAT scores. Their real mettle should be tested when they are more mature in medical school rather than be judged on their less mature past.
I agree with Inspector Chien and Anonymous, and I would like to add, if there is a physiscian shortage, has the profession of medicine brought it on itself? Outrageously-priced education, horrible hours (school AND residency): who said that that is the best way to mold a person into the medical field? How much caring and compassion can you have when you’re dragging your tongue on the floor at hour #36? Many educationally qualified (not necessarily the super summas) will not consider medical education because they do not want to have the monetary equivalent of two mortgages to pay back (one for a home, one for med school). They also don’t want their lives to “begin” 12 years later than the average-aged professional (computer sci, finance, teaching, etc) - many good years are lost to rigorous schedules, so much lost living to try and recoup ! If only it could be done in a more humane way - as it stands, the very system we encourage our patients to follow is the same system that is threatening your lives.
I’m impressed with the thought put into most of the posts above. I would say that many of you have summed up many of the struggles that a large portion of physicians are facing today in medicine. I am reminded of the reason that many of my classmates are drawn to fields like anesthesiology, ENT, Optho, Ortho, and EM. In addition to having the opportunity to practice more specialized medicine, many of these applicants want the opportunity to 1) Earn a substantial amount of money and 2)Work somewhat reasonable hours (~50-60/wk).
For those physicians who are not in fields which are the highest earning, there are a wide array of financial responsibilities which chip away at their overall salary. While one would initially think to themselves, “How would earning $140-190k per year not be enough to live a good life?”, one has to remember how much it costs to pay taxes, pay back loans, pay a house payment, pay insurance premiums, raise children, etc. I would however say that after paying for those costs, individuals in the primary care can still make a sufficient amount of money to raise a family. Have you ever met a starving doctor? No. Have you ever met a physician who bought a larger house than they could afford? Possibly. It isn’t only about earning enough, it is about saving enough.
I would say that as physicians we should be defending how much we earn. We should defend ourselves in this system of checks and balances between physicians, insurance companies, govt/medicare/medicaid, and patients. However, in becoming angry about how screwed we are, we can’t forget how interested we are in the physiology and pathology behind our patients’ problems as well as how interesting each patient actually is. I had an ENT attending tell me during my 3rd year of medical school, “Every single patient has something interesting about them, you just have to find out what it is.” I believe in what he said. In working so many hours, and seeing patients so quickly we often times don’t get the opportunity to find out the interesting things about our patients. In addition to defending our salaries and job title in the medical field, we can’t forget to continue to discover the interesting characteristics about our patients that made us want to “help people” in the first place.
So yes we do need to prevent ourselves from getting screwed. But we also need to continue to do so with at least half of the idealism that initially attracted us to medicine.
When I applied to medical school, I had the opportunity to enter a family business in real estate and make a ton of money, or enter medicine with interests in going into primary care knowing that my friends who didn’t go to college might earn more money than me. I’m still glad I chose to enter medicine. Well, and the real estate market is in the dumps now.
Good luck with your struggles in medicine. Just don’t let the man get you down.
why not let the free market decide how many doctors there will be instead of having central planners? this is a case for freedom!!
I couldn’t agree more with the comments made from jim on june 25th. My father is a pediatric dentist and one of the only dentists in our town to take medicaid kids. Recently, the state audited his charts and tried to fine him $100’s of thousands of dollars for a clerical error in processing medicaid files. It took countless hours for my dad to fight the system, and he threatened to go to the papers. If the state was going to charge him and possibly put him out of business, who was going to take care of those medicaid kids- he threatened to stop taking medicaid, and therefore, families in my town would have to drive over an hour to see a children’s dentist. These threats worked against the state, and they backed down, knowing the outcome of this would potentially cause a great uproar in my county and the state. This shows that if a doctor is willing to fight for it- change can occur and maybe if there are more docs out there to help fight we may actually decrease the “headaches” associated with medicine and increase wages and returns for future docs like myself. . I am a pre-med and will be in medical school this summer. Over the passed two years, I have not had one doctor I know tell me to go into medicine, its saddening. I wish I was encouraged to go into this profession, rather then encouraged to get away from it.