A Day in the Life ScenariosHuman Interest


Being accepted to medical school has always been a difficult challenge. There are a lot of applicants for the limited number of positions available and competition for those spots is fierce. It seems that every year there’s a new record number of applicants (applicants increased  25% over the past decade), and the number of applicants per available slot increases, as well. As an example, in 2019, 53,000 aspiring students sent an average of 17 applications each to U.S. medical schools, and remarkably, only 41% of the 53K were accepted. Why is that and what can be done about it?

In the United States, over the next 10 years, it is estimated there will be a shortage of doctors that ranges from 42,000 to 132,000, depending on whose report you read. Additionally, there is a significant maldistribution of physicians leaving many areas of the country underserved. Pleas from communities desperate for a physician, or physicians, are seen all the time, but in spite of this, it has become even more difficult to be accepted into the physician career path. Over the past 10 years, the percentage of applicants accepted to medical schools has dropped 3%, from 44% to 41%.

Some of the deficit has been lessened by an increase in the number of osteopathic physicians (DO’s, ie. Doctors of Osteopathy). A recent statistic showed there are currently 34,000 students studying to become osteopaths. That means that of all “medical students,” 25% are attending schools of osteopathy and seeking a DO degree. It seems a large percentage of the 59% of med school rejects are pursuing a DO degree, instead. If it helps to increase the number of practicing physicians, I’m all for it. However, it makes me wonder why MD schools are rejecting so many applicants.

To be accepted to medical school today, you must somehow distinguish yourself from the other applicants. It’s not enough to have a 4.0 GPA, be in the 90th percentile on the MCAT (Medical College Admissions Test), and be a science geek. You must be well-rounded, have a cause or a project you espouse, be a campus leader, or have a hobby that establishes you as unique. It also helps to have other medical experience—work in a lab, assist a professor, be a nursing assistant, etc. Also, diversity quotas come into play. These qualities and experiences are important for providing the American public with doctors whose personalities vary greatly. All doctors shouldn’t all be brainy internists, cocky surgeons, or ordinary family physicians. Someone has to go into psychiatry or pathology.

In the past, accusations were made that there was a doctor shortage because the AMA wanted it that way. It was alleged the AMA controlled the number of med schools and med students accepted to limit the number of doctors. Thus they would be in greater demand, and be paid more. That’s a ludicrous argument that was destroyed years ago when Medicare took control of how much doctors get paid. That just isn’t true. 

We have a “shortage” of doctors today because many practitioners are leaving medicine for retirement, or are fed up with the loss of physician autonomy, abysmally low payment for services, and red tape; they are just quitting. Many are working fewer hours or are employees of a hospital or health care organization that only requires them to work 8:30 to 4:30. Many doctors become consultants or advisors, and for a fee, share their expertise with other entities. Whatever it is, this “pseudo-shortage” is a problem that affects patients’ access to care. Fewer practicing physicians means fewer available appointments, longer wait times, and delayed care. I lay this right at the feet of the Center for Medicare and Medicaid Services (CMS) because payment for physician services is an insult and disgraceful. Doctors have decided not to take it any more.

In a blog about U.S. medical schools I published this Fall, I reported that in the period from 2000 to 2020, the number of U.S. schools granting MD degrees increased by 30 (125 to 155), and medical school enrollment increased by nearly 23,000. Those are big increases, but they are offset by the growing U.S. population and people living longer. One would think that 30 more med schools and 23,000 more doctors would alleviate the doctor shortage problem, but it hasn’t. So what is the answer?

Dr. G’s Opinion: Med school classes are now over 50% women. Blacks, Hispanics, and Asians are well-represented, as well, and guys like me and most of my 183, 1969 classmates are the minority. The increasing number of osteopathic graduates helps to lessen the “shortage,” and provides the diversity everyone seems to be striving for. However, if only 41% of applicants to med school are being accepted, there have to be a lot of qualified students who are being passed over. 

One solution, obviously, would be to increase class size and open new medical schools or additional schools of osteopathy. That is easier said than done. Students could also be incentivized to practice in areas of need, eg. an underserved community could award a scholarship or stipend to a student in return for an obligation to practice in the community upon completion of training. The U.S. military has done that for decades, and I’m sure it’s been used to lure doctors, too. 

The government’s solution is to flood the market with physician assistants and nurse practitioners, which in my opinion, is short-changing the public. As such, training programs for these practitioners fill their slots with ease. Many students are opting for this route because of the much shorter length of time to achieve a degree and begin working. They, also, quickly gain a level of respect enjoyed by primary care physicians with many more years of training and experience even though levels of knowledge differ significantly. 

I don’t have a good solution for the problem. I do think filling quotas is not the best policy unless 50% of the most qualified applicants really are women. Accepting the best of the best is  still the most desirable policy. 

If I were to apply to medical school today, my grades, et al. would not have been good enough to be accepted. Fortunately, though, I was accepted and gave 48 years of my life to be the best student and best doctor I could be. I hope I achieved that end, and did some good for my patients.

References: Gilkison WM. U.S. Medical Schools: Have They Changed in 20 Years? Dr. G Opines  2021 Oct 19;DrGOpines.com.


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