Without a shortage of doctors or some other pressure there is little political will for more money for medical education. It is hard to look at the data and think that the increasing cost in medical school is decreasing the “quality” of the applicant pool to medical schools.

In private schools I suppose there are slightly different forces at play concerning the rise in the cost of medical education.

What I believe is a major factor is that the cost of medical education is influencing students away from primary care. Maybe when the number of PCPs is hindering the public’s healthcare there will be the will to increase taxpayer subsidization of public medical education.

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

You predicted my Meyers Briggs – actually I am an ENTP (not J).

I know many doctors who are both thinkers and feelers. I believe being a thinker is a sine qua non – then you can rank us on a “touchy feely” scale.

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.

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.

I don’t disagree that universities have little incentive to rein in costs as long as they can get easy money from the borrowings of their students. But you are missing the other part of the equation.

Students would exercise their ingenuity to overcome a larger personal obligation to pay the costs of medical education only as long as the expected future income and working conditions from medical practice offered an inducement to be more creative.

Would the potential reward be worth the extra effort? I am not so sure. I think that present practice conditions would not necessarily suffice to attract those with the creativity and ingenuity to accept a higher financial risk than at present.

Are you advocating replacing the didactic components of medical school by kind of correspondence instruction? That might reduce staffing costs to the institution, but I am not sure that would be an inducement to share those savings with students.

Your comment about skipping class is interesting. Most students I studied with did so out of a costs-benefits analysis, made possible only by the note service.

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.

is their data on how many students are listed as applicants but decide to drop out during the application process or only faint heartedly apply and choose only one or two schools ?

Also some med schools such as Boston University accept a very high proportion of Foreign students, which would make the accetance rate lower for US students.