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:
Is it true that there is a surplus of qualified candidates for medical school?
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?
Where do you live? Because this is completely untrue of any Medical school in the US.
Answer: What do you mean by qualified?
Answer: Admission to medical school isn’t capped due to future earnings potential, but they are capped, usually for one of three reasons:
[ol]
[li] It is incredibly, incredibly expensive to educate medical students[/li][li] 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.[/li][li] 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.[/li][/ol]
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.
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 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
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.)
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.
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.
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.
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.
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).
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.”
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.
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.
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.
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.
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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.
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.
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.
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.
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…
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. :rolleyes:
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.
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.