4 ms·

OT but does anyone have insight into why there are so few med schools in the US? There are way more prospective students than admissions slots. Are there high c

OT but does anyone have insight into why there are so few med schools in the US? There are way more prospective students than admissions slots. Are there high capital costs or something I haven't considered that make starting a med school unprofitable even with average tuition fees being so high?

rfrey 6y ago
Because medical associations understand supply and demand.
bavell 6y ago
I don't know much about it either but AFAIK there's an industry group that artificially controls how many licensed doctors in each field there are. They reduce supply which naturally increases doctor compensation among other things.
- iamkroot 6y ago
  The American Medical Association, which is a rotten cabal. Fantastic podcast about them by freakonomics: https://freakonomics.com/podcast/nurses-to-the-rescue/ https://freakonomics.com/podcast/nurses-to-the-rescue/
eitally 6y ago
This might help: https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries https://skeptics.stackexchange.com/questions/4561/does-the-a...
sct202 6y ago
There are limited residency spots for med school graduates and if you don't get one you can't become an actual licensed doctor. The MD schools try to keep their admissions in line with the number of spots because that would be a raw deal to just pump out people with degrees in $500k in debt who will never get licensed. The residency spots are not controlled by the medical associations or the schools.
- wbl 6y ago
  The AMA lobbies very hard against expension every year.
  - biohax2015 6y ago
    Do you have a source for this? I hear about it all the time but have never seen any evidence.
    - wbl 6y ago
      I was incorrect. Recently they have been lobbying for an expansion.
moneywoes 6y ago
Keeps compensation high for physicians. Also, residents are very expensive for hospitals.
0239kffkk 6y ago
The other question that is rarely asked, is why isn't much more of the training and services restricted to physicians expanded to other professionals? That is, it's not just "why aren't there more physicians?" but also "why do we need a physician for X?" There are lots of provider types who could easily expand their scope of practice with additional training, and who are currently prepared to do so. The AMA lobbies heavily against any attempts to do so all the time, every year. Pharmacists, PAs, dentists, optometrists, psychologists, nurses, ... the list goes on and on. Every year they lobby heavily to just have the opportunity to offer more services, and more services independently, the AMA fights back against it in lobbying, and politicians respond to it. The crisis in some ways highlights how absurd this is. Right now I know of many med schools whose in-class training is about 1.5 years, and some are trying to make that 1 year. The rest is studying for licensing exams and clerkships. Now many of these schools are graduating them early to help with the pandemic. Compare that with PAs, who often are required to have substantial medical clinical experience before starting their programs. Then they do... 1.5 years of coursework and about .5 years of clerkships before going on and then... practicing under the supervision of an MD. So, then, what's the difference between a new MD and a PA with an extra 1.5-2 years of supervised experience, especially given that extra 1.5-2 years of experience is probably more independent than what the med student gets? The current model is absurd, and at some level I have no sympathy for complaints that hospitals are understaffed right now. This is solely the fault of the AMA and their lobbies at some level. Many services could be offloaded onto other providers, who could easily expand the scope of what they offer, especially in the middle of a public health crisis per se. There could also be a much greater diversity of training routes than undergrad -> MD -> specialty (just for example, undergrad -> specialty doctoral/professional degree -> expanded training).

rfrey 6y ago

Because medical associations understand supply and demand.

bavell 6y ago

I don't know much about it either but AFAIK there's an industry group that artificially controls how many licensed doctors in each field there are. They reduce supply which naturally increases doctor compensation among other things.

iamkroot 6y ago
The American Medical Association, which is a rotten cabal. Fantastic podcast about them by freakonomics: https://freakonomics.com/podcast/nurses-to-the-rescue/ https://freakonomics.com/podcast/nurses-to-the-rescue/

eitally 6y ago

This might help: https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries https://skeptics.stackexchange.com/questions/4561/does-the-a...

sct202 6y ago

There are limited residency spots for med school graduates and if you don't get one you can't become an actual licensed doctor. The MD schools try to keep their admissions in line with the number of spots because that would be a raw deal to just pump out people with degrees in $500k in debt who will never get licensed. The residency spots are not controlled by the medical associations or the schools.

wbl 6y ago
The AMA lobbies very hard against expension every year.
- biohax2015 6y ago
  Do you have a source for this? I hear about it all the time but have never seen any evidence.
  - wbl 6y ago
    I was incorrect. Recently they have been lobbying for an expansion.

moneywoes 6y ago

Keeps compensation high for physicians. Also, residents are very expensive for hospitals.

0239kffkk 6y ago

The other question that is rarely asked, is why isn't much more of the training and services restricted to physicians expanded to other professionals? That is, it's not just "why aren't there more physicians?" but also "why do we need a physician for X?" There are lots of provider types who could easily expand their scope of practice with additional training, and who are currently prepared to do so. The AMA lobbies heavily against any attempts to do so all the time, every year. Pharmacists, PAs, dentists, optometrists, psychologists, nurses, ... the list goes on and on. Every year they lobby heavily to just have the opportunity to offer more services, and more services independently, the AMA fights back against it in lobbying, and politicians respond to it. The crisis in some ways highlights how absurd this is. Right now I know of many med schools whose in-class training is about 1.5 years, and some are trying to make that 1 year. The rest is studying for licensing exams and clerkships. Now many of these schools are graduating them early to help with the pandemic. Compare that with PAs, who often are required to have substantial medical clinical experience before starting their programs. Then they do... 1.5 years of coursework and about .5 years of clerkships before going on and then... practicing under the supervision of an MD. So, then, what's the difference between a new MD and a PA with an extra 1.5-2 years of supervised experience, especially given that extra 1.5-2 years of experience is probably more independent than what the med student gets? The current model is absurd, and at some level I have no sympathy for complaints that hospitals are understaffed right now. This is solely the fault of the AMA and their lobbies at some level. Many services could be offloaded onto other providers, who could easily expand the scope of what they offer, especially in the middle of a public health crisis per se. There could also be a much greater diversity of training routes than undergrad -> MD -> specialty (just for example, undergrad -> specialty doctoral/professional degree -> expanded training).