Artifical Salary Inflation - Doctors & Engineers

[Borzo]

Is there a conspiracy to keep doctor's salaries high?

Medical schools where I live have a minimum standard for application. For example, you need a 93% average, and you need to show drive, motivation, and ability. Of all the applications that are received - that meet these criterion - only a tiny fraction of people are accepted.

This leads me to believe that you could easily double or triple (or more) med school admissions, without a drop in the quality of doctors that are produced.

The claim I hear is that there aren't enough places/teachers/hospitals to train any more doctors, and that is why admission numbers are so low (even though qualified applicant numbers are so high). Can someone tell me if this is true or not? Why can't they simply double or triple the size of med schools?


On the other hand, before the bubble, admission into computer/electrical/aerospace engineering programs was just as difficult as getting into med school. Average salaries for new graduates of the programs I was looking into was over 70k, and it was not unheard of for people to start with 100k.

Then at some point the tech, computer, communication/telecom companies decided to donate huge funds out of the goodness of their hearts, to triple or even quadruple admissions into computer/electrical engineering. They built new buildings, and hired new staff. The quality of graduates didn't decline, however, because qualified applicant's were plenty.

What did decline was the starting salary of graduates as hired by these "sponsoring" companies. In fact, partially due to a huge increase in supply, starting salaries dropped by up to half (eg down to 40k for the same job).


My view has always been that: The medical associations are smart. They regulate how many doctors are on the market, therefore keeping salaries artificially inflated. (This may apply to lawyers as well, and other regulated professions.) Engineering associations failed in that task, however, and that led to a quadrupling of graduates and hence the predictable plummeting of their salaries. (Also a conspiracy, IMHO :P)


So my specific questions are:

1) Is it true that there is a surplus of qualified candidates for medical school?

2) Why aren't admission numbers higher? Is it true that there just aren't enough teaching doctors and spots in training hospitals? Why can't these positions be increased?

[Crawlspace]

Originally Posted by Borzo

Medical schools where I live have a minimum standard for application. For example, you need a 93% average, and you need to show drive, motivation, and ability. Of all the applications that are received - that meet these criterion - only a tiny fraction of people are accepted.

Where do you live? Because this is completely untrue of any Medical school in the US.

1. Answer: What do you mean by qualified?

2. Answer: Admission to medical school isn't capped due to future earnings potential, but they are capped, usually for one of three reasons:

1. It is incredibly, incredibly expensive to educate medical students
2. Contributing to point one is that med students have to be supervised (to a greater or lesser extent) once working in the hospital, so the number that can be supervised is limited by the number of doctors in the hospitals affiliated with the school.
3. There are a limited number of patients that a school can reasonably expect to have access to. Students need patients to learn so the school needs to work out a decent class size to patient population ratio.

However, the limitations of the number of US medical graduates is usually made up for by American students who went to med school overseas/the Caribbean and by importing physicians from other countries. In addition, I believe 2 new med schools opened this fall with a third set to open next fall.

When you get to residencies, some of them are capped due to the expense and minimum requirements placed on hospitals. However, there are a few specialties that do seem to cap the number of spots available in order to ensure good job prospects.

[iamthewalrus(:3=]

In the Wikipedia Criticisms section of the AMA entry, it notes several critics that point out some things the AMA has done to limit the number of doctors. So, yes, there are groups within the medical community that attempt to limit the supply of doctors in order to maintain the high pay of current doctors.

Obviously, there's a tradeoff to be made between keeping standards high and keeping expenses low. The current mechanism of medical instruction is expensive, but there do exist less expensive options (which, possibly, produce inferior doctors). Existing doctors and organizations like the AMA have an interest in keeping their pay and prestige high, but they also have the most experience in what makes a good doctor, which necessarily makes them a biased but important source when considering health policy.

This sort of problem crops up in a lot of areas. Often, the most successful firms and individuals are the ones who know the most about their fields, and have valuable suggestions for how to improve things. But they also have an interest in remaining the most successful, so they're going to be biased towards the things they are good at, and towards maintaining their dominance.

I wouldn't call any of this a conspiracy.

[AndyLee]

I don't know about MDs but dental schools have really declined. There used to be four in the city of Chicago, now there is only one school, U of I, training dentists, while more and more dentist are needed. Or I should qualify that by saying affordable dentistry not necessarily the dentists themselves

[Martin Hyde]

It'd be interesting to see how many spots there were at medical schools in say, 1950, 1960, 1970 and how many spots there were in say, 1980, 1990, 2000 and 2010. Compare the number of spots in medical programs to the population, and see if the Student Spot:Population ratio is such that we have an institutionally lower ability to train doctors, relative to population, than we did in the past.

If so, it would definitely suggest that at the bare minimum we haven't kept our rate of medical instruction up with the rate of population growth. I think that is essentially indefensible from any objective view (if say, 2 spots at medical school per 100,000 population units was acceptable in 1970 then 0.5:100,000 in 2011 is too small a number of spots relative to population.)

[md2000]

What planet is OP on?

When I started a computer degree in the 70's and when I went back and finished it in the 80's, it was trivial to get in to computer; engineering was not much more difficult. Mind you, if you could not keep up with the work, you flunked out in due course.

OTOH, even in the mid-70's the compettion to get into med school was intense. You needed a mid-90's average. Pre-med students would overenroll and drop the non-bird (or non-mickey-mouse) courses before the drop date so that their optional course was not a lot of work and did not drag their average down. One year a dozen or more pre-med students were flunked out because they were caught cheating; their organic chemistry assignment was to determine an unkown substance and purify it. The profs put radioactive tracer in the stock solution to find who was diluting the sample with pure stock to get a better result. Pre-med students would lock themselves in their room and study 18 hours a day to get the marks to get in. A howl of protest went up when the U of Toonto medical faculty decided to add interviews and community participation to the selection criteria - of course, it was likely an excuse to weed out Chinese students with poor language skills but better marks and academic ability than the whie competition. Thousands applied and a hundred or so made the cut.

From what I heard and read about the issue, competition was the same in the USA. It doesn't get any easier nowadays. Add to that the incentive that med school is seen (wrongly) as the key to BIG BUCKS, and the explanation is not starving the supply but too many applicants. (In Canada, a GP is NOT a license to super riches).

yeah, to some extent the supply is limited. To another extent - the guy I started college with got into med school. I dropped out of college after almost 4 years, worked in the real world for 6 years, came back, and this guy was still interning for his specialty and finally at age 31 about to make real money. These guys spent a huge amount of their early life in intensive training, then they have to make decisions every day that may involve life or death, even if it's a simple headache or stomach pain complaint. Any surprise they feel they should make big bucks?

Oh, and the guys who didn't make the cut at med school, applied to dental school.

[alice_in_wonderland]

Originally Posted by Borzo

Why can't they simply double or triple the size of med schools?

Originally Posted by Crawlspace

1. It is incredibly, incredibly expensive to educate medical students
2. Contributing to point one is that med students have to be supervised (to a greater or lesser extent) once working in the hospital, so the number that can be supervised is limited by the number of doctors in the hospitals affiliated with the school.
3. There are a limited number of patients that a school can reasonably expect to have access to. Students need patients to learn so the school needs to work out a decent class size to patient population ratio.

So, (I used to work in a medical school) firstly here in Canada the OP's description of the applicants vs. accepted students to medical school is true. The school I worked at accepted about 5% of applicants.

Why can't they double or triple the class? Where do you suppose the students would sit? Currently the class is about 120 students per year. They all attend class together. In the medical school at the moment, there are three lecture halls that can accomodate that many students. If the number was tripled there would be one lecture hall that could accommodate them. Why don't you guestimate how much building a new 400 seat lecture hall costs and multiply it by four.

The fact of the matter is that medical schools that were built in the 60s and 70s to teach 20 students per year don't have the infrastructure necessary to teach 400 per year. They don't have the space, they don't have the staff, the don't have anything. Now, new medical schools can be built that will accommodate larger numbers but that's not fast. I would imagine a decade at least, to get a new building approved, get the millions of dollars of funding in place, etc. etc.

[sevenwood]

Originally Posted by Borzo

This leads me to believe that you could easily double or triple (or more) med school admissions, without a drop in the quality of doctors that are produced.

OK, I've got to ask: how did you come to that belief?

Let's take any situations where significantly more people are applying for admission than are accepted - just for sake of discussion, lets take folks applying to be fighter pilots. Let's assume that only the top X% of the applicant pool is accepted.

Now let's triple the acceptance percentage and examine the incoming class. It now consists of that top X% that would have been accepted under the original scenario - plus the next 2X% of applicants that weren't as good as the original top X%. That pretty much assures a drop in the quality of fighter pilots that are produced.

Now if you'd have claimed that the padded pool of accepted applicants would still have produced doctors of acceptable quality I might have agreed with you - as long as we agreed on what level of quality was acceptable.

[treis]

It's pretty clear there is a shortage of spots. Many students who don't make it into U.S. schools go to the Caribbean, and then end up in the States after passing their exams.

[Crawlspace]

Originally Posted by alice_in_wonderland

So, (I used to work in a medical school) firstly here in Canada the OP's description of the applicants vs. accepted students to medical school is true. The school I worked at accepted about 5% of applicants.

I wasn't intending to reference the low acceptance rate, which of course is low (I think at one point schools like NYU and Boston U were getting ~10,000 applications for ~120 spots). But the claim that there are minimum grade requirements in order to even apply is not true of any medical school in the US (that I am aware of).

Originally Posted by Martin Hyde

It'd be interesting to see how many spots there were at medical schools in say, 1950, 1960, 1970 and how many spots there were in say, 1980, 1990, 2000 and 2010. Compare the number of spots in medical programs to the population, and see if the Student Spot:Population ratio is such that we have an institutionally lower ability to train doctors, relative to population, than we did in the past.

If so, it would definitely suggest that at the bare minimum we haven't kept our rate of medical instruction up with the rate of population growth. I think that is essentially indefensible from any objective view (if say, 2 spots at medical school per 100,000 population units was acceptable in 1970 then 0.5:100,000 in 2011 is too small a number of spots relative to population.)

While not an indication of the number of med school spots, according to Wiki:

". . . the total number of physicians in the United States increased by 142.3 percent between 1975 and 2008, from about 394,000 to 954,000. Physician workforce growth was much greater than national population growth during this period. As a result, the total number of physicians per 100,000 people in the United States climbed from 180 in 1975 to 314 in 2008."

[Martin Hyde]

That would definitely then show physicians have grown as a portion of the population since then, and that the physician population is growing faster than the population at large.

Now, the harder thing to measure is "demand for physicians."

I genuinely don't know much about medicine in the 1950s, but what was the demand for doctors back then? Did people go to specialists in the 1950s? Or was it more "routine care go to your family doctor, big problems go to a hospital?" I do remember when growing up the only doctor's visits I had to go and sit in waiting rooms while parents or grandparents were being treated were the local family doctor. When my parents however become elderly and I was an adult, at one point my dad was seeing his normal physician, a cardiologist, a gastroenterologist, a dermatologist, and maybe a few more I can't even remember now.

[jtgain]

Originally Posted by sevenwood

Now let's triple the acceptance percentage and examine the incoming class. It now consists of that top X% that would have been accepted under the original scenario - plus the next 2X% of applicants that weren't as good as the original top X%. That pretty much assures a drop in the quality of fighter pilots that are produced.

Disagree. The entrance requirements are simply predictions on how well the student will do in medical/law/engineering/fighter pilot school. Assuming the curriculum requirements remain the same, there is no reason to believe that the school will graduate people who are of lesser quality than existing doctors.

[bump]

Originally Posted by Borzo

On the other hand, before the bubble, admission into computer/electrical/aerospace engineering programs was just as difficult as getting into med school. Average salaries for new graduates of the programs I was looking into was over 70k, and it was not unheard of for people to start with 100k.

I don't know if that was ever true, except for a very few select graduate programs. I started in a computer science undergrad program in 1991 (well pre-internet boom), graduated in 1996, and never expected to make more than 30-35k per year out of school, because at the time, that was about the average for most CS graduates of my school.

It wasn't the hardest major to get into... I think you had to have a 2.75 cumulative GPA to transfer in, but it wasn't the hardest either.

[runcible spoon]

Originally Posted by jtgain

Disagree. The entrance requirements are simply predictions on how well the student will do in medical/law/engineering/fighter pilot school. Assuming the curriculum requirements remain the same, there is no reason to believe that the school will graduate people who are of lesser quality than existing doctors.

Right; that only works if you have a 100% accurate test of skill for fighter pilots/doctors/whatever. Which we don't. Furthermore, the point being made originally was that if you're already taking 5% of the 93rd percentile (and given a bell curve, it's even smaller), you're really talking about the 99.65 percentile. So yeah, you're getting a slightly lower skill, but it's the difference between 99.65% and 99% - not so huge.

[Una Persson]

Originally Posted by Borzo

On the other hand, before the bubble, admission into computer/electrical/aerospace engineering programs was just as difficult as getting into med school. Average salaries for new graduates of the programs I was looking into was over 70k, and it was not unheard of for people to start with 100k.

Cite? I've been pretty involved in Engineering and Engineering education for more than 2 decades and never encountered this.

The mean salary for all EE's of all experience levels and education levels and time on the job is a pretty low: $87,770. These are 2010 numbers.

http://www.bls.gov/oes/current/oes172071.htm

Computer engineers (who in most States are not recognized as real Engineers since they can't be licensed) have a mean of $101, 600 for the same criteria, which is actually starting to get up there.

Aerospace is $99,000

When they start requiring a Masters for a PE license, NSPE is trying to enact, then the number of Licensed Engineers will likely drop considerably. Which is one reason so many Engineers are fighting tooth and nail to prevent that from happening.

[The Niply Elder]

Originally Posted by alice_in_wonderland

Why can't they double or triple the class? Where do you suppose the students would sit? Currently the class is about 120 students per year. They all attend class together. In the medical school at the moment, there are three lecture halls that can accomodate that many students. If the number was tripled there would be one lecture hall that could accommodate them. Why don't you guestimate how much building a new 400 seat lecture hall costs and multiply it by four.

.

I feel the need to inform you of the fact that huge lecture halls around the country's universities go vastly underused. Any given lecture hall that may seat hundreds of individuals at any one particular time are used on average for 2 or 3 periods per day on average. They are nit filled to capacity at any given class lecture, and they are most definitely not occupied most of the regular working day, nor much even way fucking less used outside of working hours.

No, the reason that more med school graduates do not graduate is definitely not due to a lack of warm wood bench seat supporting bums, it is due to not enough professors are available to teach a class.

So the solution is simple. If the government would subsidize tuition and professors salaries, we would have a very reasonable increase in med school graduates, which would in turn reverse the trend of the medical field having the highest inflation rate of all industries.

[Wizard One]

So, you propose to select students lacking drive, motivation, and ability?
We have enough trouble with malpracticoners now, you'd LOWER the bar?
If they lack drive, they'll not study and learn. The same is especially true with those lacking motivation.
Lack ability and either have buildings raining around our ears or have physicians killing people.
Meanwhile, the EXPENSE of that professional education increases every year, with physicians ending up with between 80k and 100k in student loans.

As for the nice chap who considered 99% and 99.65% equal, which one would YOU have carving on your brain, in delicate areas? The 99% surgeon or the 99.65% surgeon? Frankly, I'd be looking for the 99.9% surgeon...

[Balthisar]

Originally Posted by Wizard One

As for the nice chap who considered 99% and 99.65% equal, which one would YOU have carving on your brain, in delicate areas? The 99% surgeon or the 99.65% surgeon? Frankly, I'd be looking for the 99.9% surgeon...

Surgeon? Big difference. I need doctor to write me a script because I know that I want selenium sulfide and my stupid government thinks that I'm not responsible enough to self-prescribe, then I'll take the 10% guy as long as he's cheap.

Same thing for dentists. I just want a teeth cleaning right now; I don't even have the choice to not have a dentist look at me; it's required, even though I only need a semi-skilled hygienist to do the work. It's like requiring a Ford engineer to supervise an oil change.

[KarlGrenze]

Originally Posted by The Niply Elder

I feel the need to inform you of the fact that huge lecture halls around the country's universities go vastly underused. Any given lecture hall that may seat hundreds of individuals at any one particular time are used on average for 2 or 3 periods per day on average. They are nit filled to capacity at any given class lecture, and they are most definitely not occupied most of the regular working day, nor much even way fucking less used outside of working hours.

The above may be true for undergraduate or even graduate students attending the regular campus of the university.

But, I have to tell you, many universities keep their health-related professional schools in different campuses, sometimes different cities. Students attend the classes as a group, taking mostly the same courses throughout the semester, sitting for about the same tests, participating in the same labs. Hence, they don't use the resources (facilities) that are usually available to other students.

What alice says is true.

Now, some schools have a way of increasing the numbers by offering more online-lecture based courses, and having the students show up only for testing. Still, for the practical parts, they cannot expand more than their labs have capacity for. Yes, they can split the class into groups. It's one thing to have 1 hour labs for 4 hours, it is another to expand that to the whole day to accomodate all the students (could be done, but it is certainly a hassle). Nevermind where they're going to find all the supplies, or have time for someone to clean up after the lab is done.

[KarlGrenze]

Originally Posted by Wizard One

So, you propose to select students lacking drive, motivation, and ability?
We have enough trouble with malpracticoners now, you'd LOWER the bar?
If they lack drive, they'll not study and learn. The same is especially true with those lacking motivation.
Lack ability and either have buildings raining around our ears or have physicians killing people.
Meanwhile, the EXPENSE of that professional education increases every year, with physicians ending up with between 80k and 100k in student loans.

As for the nice chap who considered 99% and 99.65% equal, which one would YOU have carving on your brain, in delicate areas? The 99% surgeon or the 99.65% surgeon? Frankly, I'd be looking for the 99.9% surgeon...

Meh. Actually, yes, you need someone smart to be a doctor. But someone too smart will get bored by the inane usual stuff that most doctors, in their specialties, see. You really don't need so stringent criteria, so much desire for intelect.

Not to mention, that, at least in the US, the type of smarts used to be able to attend med school (or vet school, or dental school), ie, passing undergrad, is not necessarily the type of smarts that you need to be able to make good decisions as a doctor. Sure, many smart people are capable of switching gears and ways of thinking, but some don't, or it is very difficult. And then, that 4.0, excellent shadower, outstanding MCAT taker, who did undergraduate research... Is no more capable of making the right decision than the one who got there with the average or slightly below average portfolio.

[Mijin]

Originally Posted by Balthisar

Surgeon? Big difference. I need doctor to write me a script because I know that I want selenium sulfide and my stupid government thinks that I'm not responsible enough to self-prescribe, then I'll take the 10% guy as long as he's cheap.

Even in the case of the surgeon, I think you'd be surprised.
I was based at a neurological hospital for a year, and contrary to the popular image, brain surgery is not supposed to be about throwing around complex conceptual ideas and thinking outside the box. It needs to be as standardized as possible.

Heck, we'd love it to be routine, but every hemisphere is different and tech and understanding is progressing all the time, so it won't be that for a long time.

But I didn't, for example, see anything in the work that I thought someone with an average IQ would struggle to grasp. They work damn hard, and I hold them in the highest of esteem, but I do think a reasonable proportion of the population, sufficiently motivated, could do the job.

[md2000]

Originally Posted by KarlGrenze

Meh. Actually, yes, you need someone smart to be a doctor. But someone too smart will get bored by the inane usual stuff that most doctors, in their specialties, see. You really don't need so stringent criteria, so much desire for intelect.

Not to mention, that, at least in the US, the type of smarts used to be able to attend med school (or vet school, or dental school), ie, passing undergrad, is not necessarily the type of smarts that you need to be able to make good decisions as a doctor. Sure, many smart people are capable of switching gears and ways of thinking, but some don't, or it is very difficult. And then, that 4.0, excellent shadower, outstanding MCAT taker, who did undergraduate research... Is no more capable of making the right decision than the one who got there with the average or slightly below average portfolio.

What's the difference between 99% and 99.65%? The smarter one may have a slightly lower GPA because he was busy doing a side project or practising for the Olympics. Or, he was so smart he was bored silly even in challenging classes. Or she went to a college that marked slightly harder, or had a cold while taking the standardized tests (or it was that time of the month). The difference in judging of less than 1% is probably as much noise as anything.

My experience in science classes too, was that high marks indicated some smarts, but the correlation between marks and demonstrable smarts was less than perfect. Some people are just realy good at book learning, but fail at real-world analysis.

My friends in med school said too that people who found the curriculum challenging were given plenty of second chances and could even repeat a year - once they had gotten past the entrance criteria. The fact that it happened indicates something. Also, read any catalog of malpractice suits and you will find that being "smart" enough to get into med school does not always translate into real-world capability either.

[KarlGrenze]

I'm guessing that was not directed at me, but at the person I quoted, since I'm "on your side".

[Balthisar]

Originally Posted by Mijin

But I didn't, for example, see anything in the work that I thought someone with an average IQ would struggle to grasp. They work damn hard, and I hold them in the highest of esteem, but I do think a reasonable proportion of the population, sufficiently motivated, could do the job.

Actually, thinking about it further, we're talking about surgeons. Not diagnosticians. Everyone that I know who programs robots could probably learn to be a surgeon. Oh, yeah, they actually have robot surgeons, now. Mechanical; not intellectual.

[Minnie Luna]

Originally Posted by alice_in_wonderland

So, (I used to work in a medical school) firstly here in Canada the OP's description of the applicants vs. accepted students to medical school is true. The school I worked at accepted about 5% of applicants.

Why can't they double or triple the class? Where do you suppose the students would sit? Currently the class is about 120 students per year. They all attend class together. In the medical school at the moment, there are three lecture halls that can accomodate that many students. If the number was tripled there would be one lecture hall that could accommodate them. Why don't you guestimate how much building a new 400 seat lecture hall costs and multiply it by four.

The fact of the matter is that medical schools that were built in the 60s and 70s to teach 20 students per year don't have the infrastructure necessary to teach 400 per year. They don't have the space, they don't have the staff, the don't have anything. Now, new medical schools can be built that will accommodate larger numbers but that's not fast. I would imagine a decade at least, to get a new building approved, get the millions of dollars of funding in place, etc. etc.

I work at a Dental School. We don't have the space to add more students, we are at 116 for the Class of 2013, we had 2201 applicants for those spots. Our largest lecture halls holds 120, we have 2.

There is talk of building a new facility for us, but that is not going to happen for another 10-15 yrs. First and second year students spend a lot of time in the teaching labs and are already fighting for resources and time in the simulators. If you add more students and don't add more resources, your students will be unhappy. Unhappy students will eventually lead to a decline in the quality of applicant, and so on... Administrators are keenly aware of what they can and can't do with regards to student numbers.

Where I work, faculty already complain about their teaching load, imagine if they had to teach twice as many students or *gasp* teach their lectures twice to two different sections. Faculty at med school and dental school are vastly different than undergraduate faculty. Their primary focus is research, not teaching. You also have two sets, clinical and basic science. Clinical faculty see patients, teach and many do research as well. Basic science faculty teach and do research. Take a guess at what takes priority over teaching? Patients and research. (I am not saying that some faculty don't enjoy teaching, but not one here has it as their main priority.)

[Mijin]

If one teacher is teaching 120 students then in the long term there really shouldn't be a problem getting enough teachers or teaching time (presuming that at least a handful of those 120 will be qualified to teach someday).

If it's lack of investment then that's another thing. I don't know much about how medical teaching is funded in the US. Is it entirely from tuition fees?

[BubbaDog]

Originally Posted by Wizard One

As for the nice chap who considered 99% and 99.65% equal, which one would YOU have carving on your brain, in delicate areas? The 99% surgeon or the 99.65% surgeon? Frankly, I'd be looking for the 99.9% surgeon...

I don't dispute your claim but it reminded me of a discussion I had once with a friend who gave me an example of proof that the reverse is sometimes true.

He told me that his brother-in-law was a very sober individual because he was a heart surgeon who lost 75% of his patients soon after operating. The effect of so many people dying under his hands made it difficult for him to socialize on some days so he spent a lot of time alone reading or playing solitaire.

I commented to my friend that maybe his BIL should not be doing surgery if he was so bad at it.

His reply was something like, "No, you don't understand. He's such a good surgeon that he only performs the most difficult of surgeries that other surgeons won't or can't perform. In essence, he saves 1 in 4 people who are clearly medically marked for death."

[md2000]

Originally Posted by Mijin

If one teacher is teaching 120 students then in the long term there really shouldn't be a problem getting enough teachers or teaching time (presuming that at least a handful of those 120 will be qualified to teach someday).

If it's lack of investment then that's another thing. I don't know much about how medical teaching is funded in the US. Is it entirely from tuition fees?

In university (science classes) it was a prof teaching 100 to 300 students with twice-weekly lectures. There were tutorial classes where graduate students would provide closer to 1-on-1 support, plus there would be help times when you could ask an attendant in a study hall. This provided jobs for graduate students to help them with tuition. In 1970's the tutorial raio was about 1 to 12 or 15; by the 1980's to save money this was up to about 1 in 50.

I'm not sure what medical schools do for lab technicians, surgeon training, or even tutorial help. I imagine they are less likely to opt for huge classes, at leat in labs; you don't want people to squeak by not knowing the material, you want a good 2-way interaction to be sure the information is being understood.

So it's not just classroom sizes. you need to hire 3 times as many anatomy techs who can watch students individually chop up their Uncle Fred's body donated to science, and ensure the lesson is propery learned by asking eah one, "OK, show me the main blood vessels into the liver". Where are you going to find and train those people? Unlike latin profs, to get doctors who will teach you have to compete with real-world salaries. Lab techs who are trained in cadaver dissecting is a pretty specialized field. The pharmacist dispensing restricted drugs for experiments, the materials they use, etc. all cost money.

Plus in Canada, and I'm sure in state schools in the USA, half or more of the cost of the university student is atually paid by the government rather than tuition. If you want to triple the med school, you have to convince the govenrment to spend a few billion a year more.

So the real question is, are we really that short of doctors, or just not making proper use of what we have?

[kenobi 65]

Originally Posted by md2000

So the real question is, are we really that short of doctors, or just not making proper use of what we have?

The U.S. may actually be facing a shortage of certain kinds of doctors -- primary care physicians, general practitioners, family doctors, internists, etc.:
http://online.wsj.com/article/SB1000...528424238.html

My understanding is that, over the past few decades, more medical students have been electing to become specialists -- it can pay better. My understanding is also that most medical doctors in the U.S. leave school with a mountain of debt from their med-school tuition, and spend a good portion of their careers paying that off.

[KarlGrenze]

Originally Posted by Mijin

If one teacher is teaching 120 students then in the long term there really shouldn't be a problem getting enough teachers or teaching time (presuming that at least a handful of those 120 will be qualified to teach someday).

If it's lack of investment then that's another thing. I don't know much about how medical teaching is funded in the US. Is it entirely from tuition fees?

In the US, many professional schools (health sciences, law school) have had part of the budgets they used to receive from the state and federal governments decreased, sometimes to a significant amount. When that happens tuition (already more expensive than undergraduate tuition) goes up. Students in many of those professional schools do not have the time to also have a primary outside job that can cover the expenses, as one would have in undergraduate studies. So many resort to student loans.

Even just taking out the bare minimum to cover the expenses and eke out a living, many students end up with six-figured student loans debt, on top of what they may have had for undergraduate studies.

Becoming a teacher for medical (or veterinary) students requires a PhD. in basic sciences, and depending on the course, the person also has to be a trained MD/DVM with boarded specialty. Those are years adding on to the studies, when many people just want to get out and start making a (semi) decent living to pay back the loans.

Again, with budget cuts, there are hiring freezes in many medical and professional schools. Those that have tenure or are on tenure track stay, but if someone retires, they may not immediately fill the position with someone new, and they definitely won't open a new teaching position even if there are qualified candidates begging for one.

[iamthewalrus(:3=]

Originally Posted by Wizard One

As for the nice chap who considered 99% and 99.65% equal, which one would YOU have carving on your brain, in delicate areas? The 99% surgeon or the 99.65% surgeon? Frankly, I'd be looking for the 99.9% surgeon...

You're mistaking entrance scores for skill as a doctor. If the entrance score were that predictive, we wouldn't need medical school. Just look at the numbers and hand 'em a scalpel.

The fact is that the methods we use to determine entrance requirements (GPA, position in class, standardized tests, letters of recommendation) are way too coarse to accurately differentiate between the 99th percentile and above. They're probably too coarse to differentiate between the 95th and the 99th, too.

[kenobi 65]

Originally Posted by KarlGrenze

Even just taking out the bare minimum to cover the expenses and eke out a living, many students end up with six-figured student loans debt, on top of what they may have had for undergraduate studies.

I found some numbers on this, for perspective. These are from 2007; if anything, the numbers are probably even higher now.

- On average, a medical school graduate has an educational debt of $139,517 upon graduation.
- 75.5% of graduates have a debt of at least $100,000.
- 87.6% of medical school graduates carry an outstanding educational loan.

Source: http://www.studentdoctor.net/2008/12/student-loan-debt/

[Mijin]

nm misread

[F. U. Shakespeare]

Regarding computer science grads starting at $70,000+...

I went to grad school in 1999-2000, and some of my younger classmates were in touch with people still in undergrad. They claimed some were getting starting offers ivo $90,000. This was because of the artificially high demand for programmers to fix Y2K problems - there was a shortage of people who knew COBOL and other old languages.

That was a very different climate than today though.

[Grateful-UnDead]

Originally Posted by Crawlspace

Where do you live? Because this is completely untrue of any Medical school in the US.

1. Answer: What do you mean by qualified?

2. Answer: Admission to medical school isn't capped due to future earnings potential, but they are capped, usually for one of three reasons:[list=1][*] It is incredibly, incredibly expensive to educate medical students[*] .

I am curious: why is it so "incredibly, incredibly expensive" to train medical students, as opposed to say chemists or engineers?

In my days in both undergraduate and graduate school in both engineering and chemistry school we spent all kinds of hours in very expensively equipped labs, using some very expensive materials and equipment; all in addition to sitting in expensive lecture halls for days on end.

How is that different to medical students? Where is the expense differential?

[Crawlspace]

I mentioned this up in a similar thread a few years back and Qadgop filled in the details better than I ever could have here.

[md2000]

Originally Posted by Grateful-UnDead

I am curious: why is it so "incredibly, incredibly expensive" to train medical students, as opposed to say chemists or engineers?

In my days in both undergraduate and graduate school in both engineering and chemistry school we spent all kinds of hours in very expensively equipped labs, using some very expensive materials and equipment; all in addition to sitting in expensive lecture halls for days on end.

How is that different to medical students? Where is the expense differential?

My buddy in medical school at the time mentioned the gynecology class. One day they had a live subject - with a doctor supervising, they would poke around while the (trained) subject would help them along, "now you're feeling the uterus, yes, that's my right ovary..." I don't know what they pay these people, but that's just one class of many, and training is hard enough, let alone finding women who for any price are willing to provide running commentary while being groped by a group of 100 strangers. The supervising obgyn alone if he makes $200,000 a year (low?) is making $100/hr. - plus benefits.

Even with engineers, the complaint at my university towards the end of the 80's was that equipment was outdated and the program was in danger of losing accreditation; the Engineering students' union voluntarily agreed to a $1500 annual lab fee tuition hike to help modernize the equipment.

Expanding a medical school is not a simple matter of moving to a bigger lecture hall.

We may think medical costs are ridiculously high, but proportionately, very little is going into doctors' pockets.

[suranyi]

Originally Posted by Grateful-UnDead

I am curious: why is it so "incredibly, incredibly expensive" to train medical students, as opposed to say chemists or engineers?

In my days in both undergraduate and graduate school in both engineering and chemistry school we spent all kinds of hours in very expensively equipped labs, using some very expensive materials and equipment; all in addition to sitting in expensive lecture halls for days on end.

How is that different to medical students? Where is the expense differential?

Because medical students need real patients to practice on. The infrastructure required to handle real patients is super expensive.

[audiobottle]

As a current 4th year medical student, I can offer some perspective on the differing costs of education between us and, say, somebody studying for their chemistry or biology PhD.
Medical education at most places is divided into two two-year divisions: pre-clinical and clinical. The pre-clinical is what most people are familiar with when they think of school. We sit in lecture halls, we study in the library, we take exams. For the most part, space wouldn't be an issue. At my school lectures are recorded, so on any given lecture day there are only about 60% of the class in attendance. Space IS an issue with the anatomy labs and microbiology labs, however. Cadavers are very expensive to prepare and maintain throughout the months of gross anatomy. A ratio of 4-5 students per cadaver is optimum; more than this and it becomes too difficult to see and learn. There is some push toward "virtual" cadavers, but it's still a definite minority.
The clinical years are when all the medical students start rotating through the hospitals. In my mind, this is probably where the bottleneck is. It is extremely expensive to have medical students in a hospital. There are extra costs for attending physicians (doctors who have already finished residency) to take the time to teach on top of their already busy days, extra costs for insurance for each student, extra costs in facilities such as basic office supplies, etc. Most hospitals are not equipped to handle 200-400 medical students rotating through every year.
It is not so simple as building a new lecture hall or hiring more professors. A basic infrastructure needs to be in place, and that infrastructure is not present everywhere in the country. That's why there most schools are grouped around big cities, and some states may not even have a medical school.
As for the issue of the number of qualified applicants versus accepted applicants, I can tell you that not being accepted does not automatically mean you would be a terrible doctor. As others have said, a test score does not guarantee success, which is why there is so much emphasis also being placed on non-academic factors, such as volunteering experience, community service, and being well-rounded in general. However, the lack of spots means that a lot of potential physicians don't get in, and may spend years reapplying or just give up and go into another field.
I hope that helps clarify some issues.

[bump]

Originally Posted by F. U. Shakespeare

Regarding computer science grads starting at $70,000+...

I went to grad school in 1999-2000, and some of my younger classmates were in touch with people still in undergrad. They claimed some were getting starting offers ivo $90,000. This was because of the artificially high demand for programmers to fix Y2K problems - there was a shortage of people who knew COBOL and other old languages.

That was a very different climate than today though.

That, and who in their right mind was going to come out of undergrad in 1998-1999 and do COBOL, even for 90k, if there were a zillion relatively high paying conventional JAVA or C++ or website coding jobs out there that would still be useful after 12/31/1999?

[Interconnected Series of Tubes]

How many medical school slots there are is mostly irrelevant.

The real bottleneck in the supply of doctors comes from the shortage of residency positions relative to national and international graduates. Residency spots are enormously expensive. No residency, no doctor.

[Grateful-UnDead]

Originally Posted by Interconnected Series of Tubes

How many medical school slots there are is mostly irrelevant.

The real bottleneck in the supply of doctors comes from the shortage of residency positions relative to national and international graduates. Residency spots are enormously expensive. No residency, no doctor.

I have read the posts above, and doing some quick back of the envelope direct costings, I still can't see why a medical education is so much more than any of the other sciences of engineering disciplines.

What is the reason residency costs are so expensive? What are the costs involved?

Has anybody ever put together a line item costing for a medical education?

I'm not trying to be a jerk here, I am just curious and would like to see some numbers.

[Implicit]

Originally Posted by Grateful-UnDead

I have read the posts above, and doing some quick back of the envelope direct costings, I still can't see why a medical education is so much more than any of the other sciences of engineering disciplines.

What is the reason residency costs are so expensive? What are the costs involved?

Has anybody ever put together a line item costing for a medical education?

I'm not trying to be a jerk here, I am just curious and would like to see some numbers.

A quick google turns up this abstract based on data from 1990:

Residency training programs differ substantially in costs and productivity across services. While residents do generate patient care, they also generate costs and may reduce the productivity of other personnel. Diseconomies of scale are found for residents in medicine and surgery; economies of scale are found in psychiatry. Evaluated at the means of teaching facilities, the marginal cost of a surgical resident is $252,361, of a psychiatric resident is $138,811, and of a medical resident is $90,525.

[suranyi]

Originally Posted by Grateful-UnDead

I have read the posts above, and doing some quick back of the envelope direct costings, I still can't see why a medical education is so much more than any of the other sciences of engineering disciplines.

What is the reason residency costs are so expensive? What are the costs involved?

Has anybody ever put together a line item costing for a medical education?

I'm not trying to be a jerk here, I am just curious and would like to see some numbers.

It's not the medical education that costs so much, it's the medical school -- if you want to create more of them. A medical school requires a hospital. (The residency positions require hospitals even more directly.) A modern medical school requires a modern hospital. A hospital is far more expensive to build than any engineering lab.

[california jobcase]

There are many more hospitals in the U.S. than there are med schools. How much of a difference is there between a regular modern hospital and one attached to a medical school?

[Implicit]

Originally Posted by california jobcase

There are many more hospitals in the U.S. than there are med schools. How much of a difference is there between a regular modern hospital and one attached to a medical school?

Many private hospitals aren't comprehensive enough, even within a speciality, and can't expose new doctors to everything they need to learn. Not to mention there needs to be funding from somewhere and staff that can and will teach, many doctors choose non-teaching hospitals specifically to avoid that.

[KarlGrenze]

Note that some hospitals may be affiliated with more than one school or may accept students from more than one medical school in their clinical rotations. IIRC, that's how some of the so-called Caribbean schools and other smaller medical schools work (and also how different students from different schools get externships and experiences outside of their "home" medical school).

[BlinkingDuck]

Originally Posted by BubbaDog

I don't dispute your claim but it reminded me of a discussion I had once with a friend who gave me an example of proof that the reverse is sometimes true.

He told me that his brother-in-law was a very sober individual because he was a heart surgeon who lost 75% of his patients soon after operating. The effect of so many people dying under his hands made it difficult for him to socialize on some days so he spent a lot of time alone reading or playing solitaire.

I commented to my friend that maybe his BIL should not be doing surgery if he was so bad at it.

His reply was something like, "No, you don't understand. He's such a good surgeon that he only performs the most difficult of surgeries that other surgeons won't or can't perform. In essence, he saves 1 in 4 people who are clearly medically marked for death."

THAT is a man for whom I'd like to buy a drink.

He really, really needs an attitude adjustment though...one that says having 3 out of 4 die on you makes you feel good.

I know, easy for me to say...but he really needs to feel good about what he is doing...and he should.