Tuition is only a fraction of the real cost of training a medical student. The bulk is provided by the government.

The saying holds true that you get more of what you subsidize. Thus, there have been no real pressure to reduce the cost of medical education, as long as students are happy to keep borrowing their portion.

There’s certainly ways this could be done. Given that the curriculum for the first two years of medical school is pretty standardized, it seems a lot of money is wasted as 100 plus institutions try very hard to reinvent the wheel every few years. There also seems to be a failure of schools to take advantage of the outstanding capacity of medical students to learn in a self directed manner. I doubt more than half of my class attended lectures on any regular basis, preferring to tuck themselves away in a corner of the library with books and notes.

While I would be loathe to diminish the quality of medical education, you can bet if students had to bear the total cost of their training (currently close to a million dollars between medical school and residency) there would be all sorts of clever ideas on how to cut the cost.

“I still believe that altruism, while a wonderful theoretical construct, would never provide enough excellent physicians. In know that seems skeptical, but being 56 makes skepticism seem rational.”

It seems that being a physician demands a certain set of somewhat conflicting skills.

You have to be intelligent, quick on your feet, practical, logical, able to work through a diagnostic algorithm in a very short amount of time, focused, possess a very good memory, and be able to withdraw your emotions to a certain extent when needed. You need to make decisions based on logic . The picture is one of a firm, clear cut individual.

In short you are a thinker.

On the flip side, you are not dealing with a project or a goal you must accomplish-you are dealing with a person. Thus you need to have empathy, caring, compassion, warmth, understanding, listening skills. You must be able to make choices on an emotional level refelceting how your patient feels.

Thus you must be a feeler.

Modern psycology has a rough guide to personality many of you likely took at some point in college as career guidance. MBTI tests and such. They are online if you google. It seems that thinking and feeling are rough opposites. We all can do both but tend to favor one or the other much more strongly.

Thinkers are much more likely to do well in the highly logical classes before and during med school. Most drs will be thinkers and many very highly intelligent people are thinkers. Thus the very good med students db mentioned.

Feelers will go into medicine to help others but will likely not do as well on the course work overall but be much better with patients. Thus the students who deeply care but don’t do as well.

I heard somewhere-no I have no refs-that when patients and drs observed dr-patient interactions and then rated them on a scale of best to worst dr, the patients and drs opinions were almost were totally backwards. Maybe patients are looking for feelers and drs are looking for thinkers.

Some of the best drs I have had were nurse practitioners-well at least from a patient perspective. Perhaps the shortage of GPs could be addressed by training many more nurse practitioners who coordinate care under a dr and use the dr as a consultant? Are there shortfalls to this idea?

Perhaps you guys shoiuld go take a quick MBTI test on the internet and see where you fall. Are you the thinker or the feeler? I can make predictions-db ENTJ, matte ENFP, rich ESFJ, jb ESTJ. The drs who take the extra financial gain knowingly? ESTPs mostly.

CHenry-
Only after costs are shifted enought to change the behavior of applicants (either choosing cheaper schools or different fields altogether) will schools have an incentive to cut costs and pass the saving on to the applicants. Obviously we haven’t reached that point yet.

I don’t know about a correspondence course curriculum, maybe more of a “mentored self directed study program” in the appropriate areas. I was thinking more along the development of a few competing high quality curriculum (notes and taped lecture series) to be used by the different programs. After all, the US accredited school are supposed to be teaching roughly the same thing the first two years. It wouldn’t work for all areas, obviously (like labs), but given the present level of subsidization, you could make school essentially free for students with a little bit of outside the box thinking.

Tina- I’m an INTP.

unfortunately whether or not some one is a “feeler”
when starting medical practice probably has less import than what the doctor evolves into. some doc’s become more humanistic, other become less.
the forces that make up the environment in which we practice has a lot more to do with how we practice than the personality traits we start out with.

The forces that push on physicians start out with med are school debt, then quickly the high cost of practice
(financially, legally, emtionally) then so often leads
to the business mentality.

Personality certainly plays a role in shaping a doctor, but seldomly do circumstances and finances allow one to practice as many really wish they could.

Why are so many doc’s avoiding or leaving OB/GYN or primary care ? it probably has little to do with personality and everyhting to do with the environment that exists today