Thursday, April 22, 2010

Training New Physicians in the US

According to the Association of American Medical Colleges (AAMC), the number of doctors graduating from our nation's medical schools has been essentially flat since 1981, with 15,632 medical doctors graduating in 1981, and 16,167 graduating in 2008. The average annual production of new physicians for the period 1981-2008 was 15,819 per year.

The economist in me looks at this information and concludes that given the scarcity of physicians' services today, it is no wonder that the cost of medical care has risen sharply. The law of supply and demand makes this so -- more demand with no more supply results in higher prices -- the invisible hand of economics ensures this.

Over the past year, Americans have been exposed to almost constant debate regarding how to divide up and pay for the increasingly scarce supply of medical services. However, there has been little to no discussion about how America might expand its capacity to deliver medical care to the nation. Again, the economist in me is attracted to the idea of increasing the supply of medical services not only to meet current demand, but also to increase competition and eventually lower the cost of delivering healthcare to citizens.

America needs more good doctors to care for our sick and ill. If society must choose between building more medical schools versus sending more astronauts to the moon, then I for one would vote for more medical schools. In the mean time, our nation would benefit from a public debate about how to expand the healthcare industry in order to meet future demand while reducing costs. Part of that debate should focus on how to train more physicians.

7 comments:

pmckibbin said...

I doubt very much that you will ever be given the opportunity to make such a clear cut choice as sending men to the moon vs. building new medical schools. How about, say, 'economic stimulus' or 'healthcare reform' or 'cap and trade' initiatives to stop global warming, or the federalization of student loans, vs. new medical schools? Not likely either. There are many legitimate investments our country will not be able to make because of the tsunami of redistributive spending now bearing down upon us.

tim said...

that exporting democracy to societies with no discernible middle-class, shipping billions in US currency to be handed out like S&H green stamps in pre-emptive wars, and spending 60% of our national budget on defense is where the real fat is. Pounding on #hcr and its realignment of student loans, or the downstream high tech economic boons that will come from space exploration makes you seem more politically active than econmically savvy.

#disappointing.

TV

pmckibbin said...

I wonder if any reader could elucidate the reasons behind this lack of growth? This seems like an important research question.

Anonymous said...

25% of physicians in the US are DO (Doctors of Osteopathy) not MDs... DOs and MDs are essentially the same when it comes to the care they can provide in primary care settings and specialties. This is a significant rise in DOs in the same 30yr period of time. Where's THAT data represented on this chart?

Dr William J McKibbin said...

Hi Anonymous, actually, the number of Doctors of Osteoathy (DO) in the US is less than 80,000 as of 2010, which represents less than 9% of the total number of practicing physicians in the US. However, the addition of DO's is a step in the right direction. Nevertheless, the supply of practicing physicians in the US still lags demand by a wide margin. Thanks for your comment...

Anonymous said...

Increasing med school enrollment without increasing residency slots would be dangerous. Unlike doctors that graduate from 6 year MD programs in Latin America or Europe, when you finish your last year of med school you CANNOT legally practice medicine. Your MD degree cannot be re-validated pretty much anywhere unless you complete a 1 year internship (aka, the first year of residency). A doctor that goes to med school in a country like Mexico can start processing their ECFMG license to qualify to try to get a US residency as early as their 4th year and 100% qualify before even graduating in their country.

To legally practice in the US after a complete internship you must also pass the Step 3 exam which isn't exactly cheap (costs about 1,200 dollars) and must process a state license. A foreign trained doctor from a 6 year program automatically qualifies to do this exam if they can fork the cash.

Now, while a fresh US MD graduate can't practice medicine a doctor from a 6 year program once they pass the professional exam at their university can qualify to a temp license and work freely even though they still have 1 year left before they graduate. The only drawback of getting this temp license so early is that you need a graduated doctor to become your legal guardian and not many doctors are willing to do that to a med student they barely know.

Now getting back to my first point, in Mexico there is an annual residency match exam where an average of 26,000 doctors fight for only 6,000 slots. Obviously 20,000 doctors don't match. At least they can still work as a GP doctor and hope for next year unlike a fresh US MD who will have to fall back on their undergrad degree (hope it's a marketable BA degree).

Increase med school seats without increasing residency seats and you will be assured a lot of MD's will be jobless with a useless degree that cost them 250,000 dollars with an insane interest rate.

This indeed will be a great incentive to make many brilliant doctors either not study medicine or study it in some other country where the degree is only 10% the cost and with guaranteed hopes of getting a job the second they graduate.

The whole system is a mess.

Dr William J McKibbin said...

Hi Anonymous, interesting comments, thanks...

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