Can most medical schools increase the numbers of their graduates? That is, instead of maybe only accepting the top 100 of their applicants, maybe broaden that to 105 or 110? Something like that. An increase of maybe 5 to 10 percent.
I guess part two. If they can do this, why aren’t they?
Briefly, they can and they are, but current American Association of Medical College directives about class size or trying to accredit new schools will increase the total size of the physician workforce slowly; they take 7-11 years to go from matriculation to “independent practice,” although the actual transition to contributing to patient care is fuzzier and happens much earlier.
Do you remember the red scare of the 50’s? Of course you don’t. I don’t either, but in order to beat the ruskies at any possible technology advantage including nukes, science programs were massively inflated with government funding. This funding produced the people that invented everything from the seventies on. Even today scientific graduate programs are almost entirely government funded. People come from every country in the world to go through our graduate programs, because they are the best. They almost always stay, designing products that employ americans to manufacture. There are not enough americans to fill these positions.
Not only can the government increase the number of doctors. It can do so very effectively.
Article on CNN.com today about a primary care doctor that is “fed up”.
So, related question to my OP; can they turn out more in a particular specialty only? Make deals with tuition or something such that if the doctor practices in primary care, they get some kind of perk?
Link to article http://www.cnn.com/2009/HEALTH/08/25/harris.primary.care.doctor/index.html
And hijack of this hijack. I admit to being amused that his phrasing is such in the article that he appears to say that he only makes a few hundred dollars, while saving the system thousands. Really doc?? You only make a few hundred dollars?
Well my medical school is slowly trying to increase class size from 100 to 110 (currently) students to 150 over the next 6-10 years or so. The key thing is though, it’s going to cost 10 Billion Dollars to improve the facilities and create more classrooms to fit those students, to hire the teachers and staff and to basically improve the currently outdated medical stuff. The new facilities should be done in about 4-5 years. So then after that, they can start training up to 150 students. All for 10 billion dollars worth of renovations (though due to budget cutbacks and all, I think they only got around 8 billion of that from the Gov. the rest had to come from private sources). So uh, there you go. Just donate a couple billion dollars and the schools will figure out something in order to increase the students.
Yeah, studies have shown that most doctors don’t employ enough nurses and PAs for maximal productivity. (It probably comes down to a dislike for delegation and mistrust of the skills other healthcare workers.) Thus the best way to increase medical productivity would be to increase the supply of nurses and PAs.
Fact is there aren’t that many people who want to be doctors and can handle the curriculum. The career alternatives for these very high-IQ people would be law and top-flight business, which are both vastly higher paying. So even if the total number was increased, it would be difficult to fill the extra slots with qualified applicants. More realistically, standards would be bastardized, just like standards for college graduation after we decided that everyone had to go to college.
Part of it may be doctor’s wages haven’t kept up with others.
What I mean is, that perhaps 20 years ago a doctor would make twice as much as say a controller of a hotel. Now the controller could conceivably make more.
A GM at a major downtown hotel in Chicago is gonna pull in about $300,000+ a year.
A controller anywhere from 150K-300K. Directors of other departments in hotels make similar amount in Chicago.
They don’t even need a degree. OK most have them but plenty of them have worked their way up.
There is a time invested verus money returned ratio and with medicine you don’t see that increase as the years go by.
It must be frustrating for doctors to go through all the hassle and find themselves making only similar amounts of money as others who had much less hassle. Of course there is a satisfaction I imagine doctors get, helping a person that a controller wouldn’t ever be able to get.
On the whole, no I don’t think medical schools could increase the number of graduates significantly in the space of a year (5-10 people isn’t really significant since it’s within the normal fluctuation). It would take significant investment in the schools infrastructure and administration.
Residency and fellowship spots are limited, so in that sense, yes they can. They already have primary care scholarships, rural medicine scholarships, and under-served area scholarships whereby your tuition and board is paid, but you are committed to serving as a primary care physicians in an under-served area.
I think that what gets lost in the discussion about increasing the number of doctors is how incredibly expensive and time consuming it is to educate medical students.
We also have the option of increasing the number of doctors through immigration. Obviously, a certain amount of that is already taking place.
As noted, PAs and FNPs can do a lot of primary care. I think the challenge is configuring a practice so that the primary care MD is getting a return on his/ her education, using that education, getting a return on the work done by people supervised, and not being overwhelmed by malpractice risk for people supervised.
Medical students need hands-on training, with a patient and a mentor. These do not come cheaply, and when more students are added, more patients and more mentors are needed.
To get those, you need a teaching hospital, a faculty, residency programs, all of sufficient size to have enough of those things to train those extra students. And you need patients and mentors in all disciplines: Surgery, Medicine, Pediatrics, OB/gyn, Radiology, Orthopedics, Pathology, Opthalmology, Intensivism, Emergency, etc. etc.
And you’ll expect this system to pretty much operate 24/7/365.
And you’ll want to have students willing to pay a quarter of a million dollars or so for the chance to be worked to death over 4 years, to enter a residency program where they can earn slightly over the minimum wage per hour spent in Mr. Hospital for 3 to 7 years. Then go into private practice to be told by bean counters that they’re not ordering enough tests on their patients to justify keeping them around, so they’d better produce more.
Agreed. I love mentoring medical students (and do so routinely in my practice) but goodness knows having students in my clinics slows things down - at least if I teach around each patient’s case it does. So my training students makes me less efficient in helping my patients but hopefully makes more doctors down the road to see more patients.
Sorry for the split posts, but just to put some of the numbers linked to above in perspective, the average indebtedness (a number arrived at after exhausting savings, family contributions, or other resources) of US medical school graduates at graduation in 2006 was $120,000 for public medical schools and $160,000 for private medical schools. The AAMC predicts that these grow to ~$151,000 and ~$205,707 respectively after residency if students take advantage of deferral during residency (which most all students do) during which they’re making about twice federal minimum wage. https://services.aamc.org/publications/index.cfm?fuseaction=Product.displayForm&prd_id=212&prv_id=256
The rules on deferment have changed recently, but regardless, after graduation, typical educational debt far exceeds the "50-100% of starting salary"rule (please note that salaries provided in the prior post are for median and not starting salaries) often espoused by financial aid counselors in other education settings, especially if you go into primary care.
After you factor in the much more nebulous opportunity cost of 7-11 years of training for applicants which succeed in the medical school admissions competition (for example, my mid-range private school annually receives about ~9500 applications for ~200 spots), the lost opportunity to spend a decent salary before you’re 30 on the types of fun things that professionals in their late 20’s often spend money on, and its pretty clear that one shouldn’t enter medicine just for the financial compensation.
And as a further piece of advice to people considering medicine, you also might not be able to afford to do anything else once you’ve stared this process, so think long and hard about how certain you are medicine is what you want to do prior to applying to medical school.