We assume that there will always be enough of the right kinds of physicians, available whenever we need them.

It is a self-deception.

Costs and benefits figure into the decision to apply to medical school, as they do for decisions to enter any profession. Up until now, we have enjoyed the benefits of a profession that has been appealing to applicants from the highest ranks of college graduates, people able, dedicated, and generally well-qualified to sustain the years of additional hard work necessary to qualify in medicine at the levels commonly expected of today’s physicians, a level of expertise and training that is the highest in the history of medical education. It is almost as if we cannot imagine things being any different. But we should step back and imagine just that.

Most doctors work either for themselves, in solo practice, or with a small number of other doctors. Their small businesses cannot absorb “bad” years’ business the way that diversified large companies with substantial reserves might. There just isn’t that kind of security in the medical business. Little changes in office reimbursement from Medicare and private insurers, or big changes in business costs like malpractice premiums can close office doors. Unlike other industries, there isn’t the same possibility of passing off steep cost increases to the consumer, neither is it possible to reap endless efficiencies by increasing the volume of business. Cognitive work takes time and cannot be compressed to trade volume for price. And sweatshop conditions are just as unpleasant in healthcare as anywhere else, for everyone on both sides of the examining table.

There are few professions that expect the numbers of years in training as does medicine. There are fewer still that cost as much in accumulated tuition and living expenses before a graduate can work in his or her field. The more unattractive that medicine and medical practice becomes by virtue of poor reimbursement and high practice costs, the more likely that the thoughtful and well-qualified prospective medical students will think twice before going to medical school.

We expect the best from doctors, and despite some who disparage the profession, we generally get the best. Will we be just as happy to draw our doctors from the middle or bottom of the deck rather than the top?

I don’t know where Bernie is coming from, but he appears to be oblivious to what is happening coincident to the high malpractice premiums.

In my community alone, a group of 17 radiologists publicly announced terminating mammographies last year because of the high malpractice risks, the only saving grace being a local hospital coming up with enough financial support to reconsider their decision. Despite this, waiting lines for women for their scheduled annual mammograms are quite long, sometimes two to three months, mainly because other independent radiologists quit doing them because of the increased liability risks.

Despite the traditional disclaimer that 15 to 20% of mammograms cannot detect malignancies, that still leaves radiologists quite vulnerable.
It’s like swimming in an ocean infested with sharks, but but little room to escape.

Enough bright students will still enroll in medical schools, but they are certain to avoid the high-risk specialties, and probably will
skip areas in the country where yearly liability premiums can go as high as $250,000. Unless you want to go bare, which a lot of surgidal and high-risk physicians in the southern area of my state are doing.

But who wants to practice under those conditions? We cannot all sell herbal medicines which Bernie passionately believes in.

oops, second website address is
a typo.
correct address:

http://www.aafp.org/match/graph05.html

interesting comments, and i must agree from a business/economics standpoint that going into the medical profession is a stupid idea for individuals smart enough to make lots of money doing something less stressful. however, all of this misses the main point: medicine isn’t about the money. that’s something the profession picked up during the 70s, 80s, and 90s, and should hopefully die off during my generation or the next. is there a huge risk in getting an MD? yes. is there is a huge cost outlay? yes. is it worth it to do something so vital to society, regardless of whether you can get that new BMW or play golf @ Augusta National? yes.

admission standards won’t decline; those who truly want to practice medicine will continue to apply, and patients will be all the better off for it.

hey poor med student…just to let you know. I have a used 1992 chevrolet, have not vacationed anywhere in the past four years except with family (to save costs),
have a home that is a small starter, and do not go to three star restauraunts or have any club memberships.

before you genralizw about other physicians financial situations, you might do some investigating.

I and many of my colleagues live on tight budgets. a BMW is not on my priority list.

The cost/benefit of medical education, versus law or MBA/business has already been explored. It was in NEJM back around 1994.

If all you are interested in is dollars and cents, the best investment is a MBA. Second best is a tie between specialty medicine and law.

Primary care medicine came in dead last.

Poormedicalstudent (PMS for short?) yes, people will continue to go into medicine. The decline in standards for medical students will continue to go down as long as there are old farts to complain about it. I remember as a kid seeing Dr. Kildare complain about it in the 1950’s. (no smileys available to indicate joke……….well not the Dr. Kildare part, I really did see that).

Thing is, those medical students will go out of the low risk/reward ratio fields or arrange their lives to avoid low risk/reward services. They will still be in medicine. I bet you will do the same thing. Heck, despite the rhetoric, foreign medical grads and nonphysician practitioners do the same thing.

Don’t blame anybody who makes that choice.

Mammograms dont help.

Let the lawsuits continue. !!!

Maybe the lawsuits are good.

If you want your patients to not die of breast cancer, get them to lose weight.

http://www.update-software.com/abstracts/ab001877.htm

The currently available reliable evidence does not show a survival benefit of mass screening for breast cancer (and the evidence is inconclusive for breast cancer mortality). Women, clinicians and policy makers should consider these findings carefully when they decide whether or not to attend or support screening programs.

medical school hard to get into? “just do it”

according to http://www.aamc.org

the avarage rate of applicants to matriculants (MD granting programs) is only about one in two.

those are GREAT odds.

furthermore, many doc’s also apply to D.O. programs which are virtually identical to M.D. programs. furthermore the aamc estimates about 8,000 people who fail to get in, will do added education to beef up their chances of getting in.

getting in is relatively easy.

Good luck in finding a state who will commit the millions /year it takes to expand programs

anyway anyone else is free to receive their care exclusively with a nurse practitioner. you can get all assesments/diagnoastics/and therapies via this route.

as far as truly shitty jobs, I do agree with you.
I cannot account why so many individuals fail to graduate from high school or fail to aplly themselves to do well in
college. Most Information technology training stops at the Bachelors level, a few go on to 2 additonal years for a masters. a very few go onto to the 4 years for PhD, very few go the 7 years beyond college to just get to the point where they can practice their trade.

you can also look at the investment of money

high school costs= a few hundred/year.

college = 23,000/year (or higher)

med school = 30,000/year (or higher) thus just by the point you get an MD you now owe an assed 120,000 (often times much higher). then you still only average 25,000/year for three years following while working 80-90 hours/week.

the MD is not a gift, it must be worked for.

anyway, as med school aplpicants continue to dwindle
med school will be obtainable for almost anyone who has an inkling to do it. good luck staying in.

I do remember one individual in our med school class who was 40 and just starting med school. he struggled but made it.

“just do it”

Bernie you’ve done it again. Where DO you find this material?

Sociologically, physicians are products of the middle class. Especially children of immigrants. It’s a field where you can advance based on your own individual skills (as opposed to family connections) so it is attractive for a new kid on the block.

As such, they usually understand the concept of menial jobs. Certainly had my share. My own immigrant parents wanted me to become a doctor so as to avoid the menial work they had to do (and I did as a youth). In my neighborhood (in the USA), the primary language spoken by my family and neighbors, friends, etc., was not English.

In that, I have something in common with the Jewish medical students of a generation or two ago, and the Asian medical students I see today.

Remember the chief of staff at the hospital where I first worked. An old Yankee, his family had been seriously rich for a couple centuries, large swaths of geography named after his ancestors where I grew up. He was the sole physician in the entire extended clan. He admitted he was the black sheep.

You see, Bernie, if you are connected and rich and not used to menial labor, you usually go into the family business (the law firm or General Motors or the US Senate).

If you want to go back to the days before the Flexner Report, go ahead and lobby for it. The free-market economists actually think it would be a good idea to eliminate all licensure laws and specialty boards, anybode who wants to call himself a physician can do so.

Who am I to argue with Milton Friedman?