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?

it’s not fair!

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”

See the article for a discussion how the AMA’s control of medical schools admissions amounts to a medical cartel.

AMA has built an impressive edifice, one that has completely insulated physicians from recessionary (“cyclical”) and until recently, technological (“structural”) unemployment. While decade in, decade out, recessions, depressions, consolidations, and (recently) outsourcing have dislocated millions of blue-collar, engineering, computer programming, and middle management employees from jobs and forced permanent career changes, physicians as a class have been almost completely immune. Unlike workers in most other industries, a competent, licensed physician with a clean record who remains unemployed despite months and months of search for work is unheard of in the U.S.

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.

But…..more to the point, the concept of the risk/benefit ratio of offering certain services is mentioned once again.

http://tennessean.com/business/archives/04/06/52770810.shtml?Element_ID=52770810

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.

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 frustration comes not from the the practice and profession of medicine , it comes from the dysfunctional sytem in which we are in.

yes medical school applicants will keep coming, but the data show that economics do influence people decsions to 1.go into medicine (all time lows for applicants),
2.go into risky or poorly rewarded feilds (marked decline in OB/GYN, primary care…both family practice and internal med, early retirements, )
3.and decisions to give up high risk aspects of ones feild. ( dropping of OB priveledges, avoiding mammography services,
not providing neurosurg services in children)

these are data easily verified.

training for 7-10 years after college and putting well over $200,000 into the post high school training and living in the modern world of mortages, car loans, etc…) has to be paid back. good intentions haven’t written any of my checks lately.

many people will (as shown by the data) just throw in the towel and find fullfillment in different modes of practice or by not practicing at all.

these adaptions are occuring now, by thousands of doc’s in all regions of the country.

change is vital in all endeavors, that’s what makes life exciting.

now…as doc’s do we drive the changes or just sit back and let the CEO’s and lawyer’s do it.