• Lots and lots of people still want to be doctors

    As I noted last week, I get a little annoyed by the seemingly constant public complaints of physicians, coupled with threats to leave medicine and dire warnings that no one will want to be a doctor in the future. This is in spite of it still being one of the most trusted professions around, and one that is darn well compensated. So it’s nice to see that the general public hasn’t bought into this meme yet (from the AAMC 2011 Medical School Enrollment Survey):

    • First-year medical school enrollment in 2016–2017 is projected to reach 21,376. This projection represents a 29.6% increase above first-year enrollment in 2002–2003 and comes close to reaching the 30% targeted increase by 2015 the AAMC called for in 2006.
    • Of the projected 2002–2016 growth, 58% will be at the 125 medical schools that were accredited as of 2002. New schools since 2002 will experience 25% of the growth, and the balance (17%) will come from schools that are currently in LCME applicant- or candidate-school standing.
    • More than half (56%) of the 2002–2016 enrollment growth has already occurred, with 2,850 of the projected 4,888 new slots already in place as of 2011.

    We’re facing a physician shortage, and in order to address this, the American Association of Medical Colleges recommended we increase the number of students training to be doctors. They’ve pretty much accomplished that goal. This is in spite of the bad press.

    And get a load of this:

    Applying to medical school is a grueling, time consuming process that, for many, does not end with acceptance letters. While business schools extended offers, on average, to nearly half of all applicants in 2010, and law schools admitted a rough average of 35 percent of prospects, medical schools accepted a much smaller portion of their applicant pools, according to an analysis of graduate school data reported to U.S. News.

    In 2010, 521,876 applications were submitted to the 121 medical schools that reported entrance data to U.S. News. On average, just 8.9 percent of applicants were admitted—and at a handful of schools, the acceptance rates were drastically lower.

    I look at numbers like that, and I thank my lucky stars I got in. I’m pretty sure the acceptance rate at my school was even lower.

    Regardless of what some say, I don’t think we’ll have any trouble finding bright, dedicated people to become physicians in the near future.


    • The number one reason HC costs as fraction of GDP in USA is twice that of Europe is that doctor incomes are also double. Insurance companies add only a small fraction to the impact of high doctor wages, hi prices of medical equipment and drugs.

      But it is much easier to demonize insurers. We can easily rationalise insurance by using mandates to obviate adverse selection. Biltaeral mandates, i.e. requiring insurers to sell lifetime renewable insurance. But then we need price controls to make sure providers can’t use MONOPSONY market power to inflate prices insurers must face.

      Yes we can lower doctor wages. In the 1980s HC was only 11% (one ninth) of GDP. Why should it be more than 17% of GDP now?

      • http://query.nytimes.com/gst/fullpage.html?res=9B00EEDE163AF936A3575BC0A9619C8B63

        I know it’s sexy to target doctors pay as the driving force of health expenditure growth…
        But the reality as described in the article listed above is that physician fee’s are 20% of expenditures, and that of those expenditures about half of that actually makes it to physician salaries.

        So…. lets say you cut physician fee compensation by 25%.
        If you assume fixed costs being taken from those fee’s, then that would effectively cut salaries by 50%.
        Oh and that 50% pay cut isn’t just for the unarguably overcompensated orthopods, dermatologists, and urologists, but for FP’s, pediatricians, and psychiatrists…
        And the net benefit, a lowering of health care expenditures by 4%

      • Physician salaries make up about 7%-8% of health care spending. Eliminate all physician salaries, and we still spend too much. Spending that is controlled by physicians is much larger than the salaries. While salaries probably need to come down some (remember that training costs more here), you need to address other spending to control costs. Aaron wrote a series on this. Link to post on doc salaries.



    • Will there be residency slots for the additional graduating MD’s and DO’s? What is the outlook for postgraduate training>

    • Cmon Adam you know that 8-9% acceptance rate stat is total nonsense.

      The REAL acceptance rate is somewhere around 50%. Instead of looking at applications, look at the # of applicants. 1 applicant may send off 30 applications adn get rejected from 29 programs, but statistically his chances of acceptance are closer to 50%.

      Also, these studies are flawed because the AAMC who runs these studies pretends that osteopathic schools dont exist. There are nearly 60 new medical schools (including DOs) so the number of new med students is going up by closer to 50%, not 30%

    • A month ago my 9 year said she wanted the first 4 seasons of House MD for her 10th birthday (as well as Minecraft). As a shrink, I held my breath when I asked her why–I didn’t think she had been watching for one thing–“Because I want to be the kind of doctor who examines dead bodies and figures out why they died” she said excitedly. From my daughter this is not gruesome, more an extension of her analytic mind and love of mystery. And House MD is about exotic illnesses.
      Had she said she wanted to be a doctor because she “wanted to heal people, etc” I would have said “Wonderful” and gone into the next room and cried.
      In 12 years taking care of the Boomers will be a purely servile endeavor. Unlike these statistics imply, it will not be an applications Hunger Games, but it will be a hunger games alright. The pincers of student loans and Medicare are already in place.