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<p>No, but I don’t want health care to be more socialized than it already is.</p>
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<p>Last time I looked, the number of people becoming doctors in the United States was almost completely a function of how many accredited medical school slots are available, plus the rules for licensing (and, if applicable, giving visas to) foreign medical school graduates (for whom the cost and duration of American medical school training is largely irrelevant). Rumor has it that, even with our costly, drawn-out system, far more people apply to medical school than are accepted, and that most of the people who enroll in medical school graduate. As it happens, some of those who graduate do not go on to practice medicine, or stop practicing medicine before retirement, but lowering physician compensation is not likely to do much to reverse that particular trend. </p>
<p>Training doctors is something that is going to be really costly, no matter what you do. It requires a lot of individualized attention, a lot of very expensive equipment, and at some point you have to hand trainees a scalpel and let them start cutting real people. Because of that, it’s not so easy to make new medical school slots appear like magic, and even if they do appear they won’t lower the cost of medical education much, if at all.</p>
<p>Meanwhile, for many physicians, maybe most, compensation has been decreasing for quite some time relative to other professionals. The internists and family medicine specialists I know whine about this a lot. Taking debt repayment and insurance costs into account, many psychiatrists make less than public school teachers with similar experience levels.</p>
<p>I think increasing health care costs have a number of causes, but requiring doctors to get a bachelor’s degree before medical school wouldn’t make the top 20.</p>
<p>“I don’t want socialized medicine, but if we could make it cheaper and less time-consuming to become a doctor in the U.S., without sacrificing quality, more people would become doctors, physicians’ salaries would fall a bit, and health care would be cheaper.”</p>
<p>Ha! Memories of my senior thesis on physician pricing!</p>
<p>In the era where physicians set their rates, physicians with large debt may have jacked up their prices. But physicians don’t set their own rates anymore - insurance companies do. The doc with $200,000 in med school loans doesn’t get paid any more than his partner who was fully paid. The cost of health care to the consumer has very, very little to do with the cost of medical education. The streams of money are different.</p>
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<p>Yes. Insurance companies and Medicare. Doctors’ pay is going to fall. I do think there are going to be many young doctors with huge debt that are caught in this trap. Medicine is not the cash-cow that many perceive it to be. The expense of medical training in comparison to the expected pay, especially in primary care, is going to dissuade people from attempting medical school unless the government decides to underwrite some of that training. I think the responsibility for much primary care is just going to shift to PAs and nurse practitioners, with MDs being reserved for specialties and consultation above and beyond garden-variety aches and pains. Whether this is a good thing for overall quality of patient care or not, I don’t know.</p>
<p>I can’t say anything about the French, Chinese or Indian systems of medical education. However, to offer a counterbalance to some of the points raised above, the UK has 5 year medical degrees which are typically done straight after high school, and are followed by on the job training. </p>
<p>However,
- for late bloomers and people who change their mind, it’s entirely possible to do medicine in four years as a graduate, following another science degree. Similarly for law, you can either do an undergraduate law degree, or you can do any other degree and then a conversion course in one year.
- to specialised at a relatively early age does not seem odd, because the entire high school education system is different. From 14-16 students tend to study 8-10 subjects, and from 16-18, people are studying 3 or 4 subjects of their own choice (A Levels). These are generally reckoned to be at the academic level of first year US college. The gradual specialisation starts from an earlier age, hence why it’s more of a natural progression than anything else.
- medicine is incredibly competitive in terms of admissions - not only do you have to have the grades and get through the interview, but ample work experience is de rigeur. Around 60% of applicants are rejected on their first application cycle, so many will either take a gap year and reapply or do another science subject and make a decision later about doing postgrad medicine. This means that medical students are (as a result of their work experience) under no illusions as to what a medical career entails, and med schools are able to weed out the uncommitted very quickly.
- there’s a system of socialised medicine within which all students are trained, and the state funds medical training on the principle that it is an investment in their future workforce (of course, a few will choose not to work within the NHS, but most will). The NHS has a very high level of public support - no one would actually say they wanted it abolished, because it’s a very good system (despite, like all systems, having its flaws). The UK has a higher life expectancy and lower infant mortality than the US, both of which are good indicators of the efficacy of a country’s medical system. </p>
<p>Cupcake is entirely right in saying that other countries consider students to be adults in their own right at the age of 18. If you don’t turn up to lectures, that’s your business. If you want academic help, then it’s available but you have to seek it out. The drinking age is 18 (and I’ll note that one US exchange student said that he found the drinking culture much more mature, though I digress). Living on-campus past first year is rare, and dealing with dodgy landlords by yourself is generally reckoned to be part of the experience. Having parents turn up to open days is a relatively modern invention. Essentially, you’re expected to shift for yourself from the age of 18, and people are quite capable of doing so when the expectation and necessity is there.</p>
<p>To add to Boomtimg and Cupcakes responses, the UK system makes it possible for all young people who are interested and able, to contemplate a medical education. I wonder to what extent the very long and costly US process deters able, poorer students from attempting the same. With an appropriate school education and an inquiring mind, entry to medical school after year 13 does not appear to produce narrow minded medics. Indeed there are opportunities to volunteeer abroad as a student placement and an additional intercalated year can be added to pursue a related topic in depth. The result is a well educated medical establishment.</p>
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Even so, the overseas students spend a lot more time in school learning about medicine, and not waste a significant part of the first 4 years in fields that they have no interest in and have little relevance to medicine. I know of an FMG and a local comparing notes about things like anatomy and how rushed and intense it was for the local versus the overseas trained student because they have so little time here.
I also know of several instances where students didn’t get in after the 4 year BA/BS and then did 18M-2Y masters “grades-for-dollars” programs and spent time overseas to bolster their credentials - so perhaps 6-7 years after HS before setting foot in med school.</p>
<p>Still, why is it OK for an RN or a medical tech or a programmer or a mechanic or engineer or whatever to generally not be forced to spend time and money learning things to “make them worldly”, but it’s so hard for docs or lawyers or vets to avoid this hurdle? </p>
<p>SteveMA had commented that the humanities majors who went to med school were required to take all the pre-req courses - that’s not the point I’m arguing about, that they’re not qualified - if someone wants to experience all these other fields, that’s fine; what I find inefficient is the hoops that someone who doesn’t qualify for a 6 year program is forced to go through.</p>
<p>Interesting thread!</p>
<p>a) on many occasions within this thread posters have mentioned about availability of one or two BS/MD program in US. Well, there are more than just one or two. There are some 30+ BA/MD and BS/MD programs in existence … all the way from ivy such as Brown (PLME), and Nothwestern (HPME) to some lesser known such as RPI/Albany, UMKC, Baylor/Rice and etc etc. Even CalTech, which is not known for biological sciences has one in collaboration with UCSD. Not all of those are accelerated programs however. Some are as short as 6 years, but the majority are 8 years long. One important feature to note, which is common among all those programs, is that duration of medical school studies remain to be 4 years whether its a 6 year program or a 8 years program, hence it is the undergrad part of education which is either shortened or compressed by mandatory summer semesters. Contrary to what seems like a misguided belief of some posters, not all wanna-be MDs enroll (or attempt to enroll, since all those programs happen to be extremely selective and offer very limited enrollment) in those programs for quicker path to becoming a doctor, but majority enrolls because they WANT TO explore other unrelated interests during their undergrad years. Yes, BA/MD and BS/MD programs make it easy for one to explore or even pursue (in non-binding programs) other interests because of their guaranteed admission to medical school, hence they are not forced to load their schedules with hard sciences classes, however unnecessary, to beef up their resume to make it look more attractive to med school.</p>
<p>b) Somewhere someone mentioned about more advance technology being available in Italy, and their locally trained (or US) doctors performing more complicated and advanced medical procedures in South Africa and UK etc than in US. Well, I am not an expert on this subject but could it be possible that that’s due to relaxed or often ignored regulatory enforcements and has little to do with superior medical training in those countries? Here in US we live in a sue-happy society. It is no secret that many pharmaceutical and biomedical (and even other technology companies such as cell phone) companies consider Europe, Asia and Africa as their testing grounds and introduce those technologies/inventions much later, often after years, to the US market, only after they have sorted out all the flaws.</p>
<p>c) Although human body may stop growing at 18 for girls and at 21 for boys, human brain, from what I’ve heard, continues to grow till 40. I am certainly not suggesting that young people should wait till they are 40 to pick career path, but I think having to embark a career right out of high school, such as compressed BS/MD program is little too early. Career path is a decision which needs to be a very well informed decision and at 17-18 I don’t think most have enough wisdom, maturity, or knowledge to make that decision.</p>
<p>I’m the one who mentioned wider use of high-tech modalities in PT in Italy. It probably is because of relaxed regulatory practices, though not because THEIRS are more lax; more likely because ours are more byzantine. These are modalities that are being used in academic centers here, but just haven’t yet filtered down yet. Our country is also a lot bigger and there are thousands more places for the modalities to filter through. For instance, other countries’ radiology departments (in academic centers and hospitals) are probably all “film-less”, whereas there are so many place in the US yet to go digital simply because not all hospitals can yet get the technology or afford it. Nothing to do with quality of medicine. </p>
<p>Similarly, I’d totally agree that some of the advances in places like China are due to less rigorous vetting and more rigorous IRB practices in the US, but that doesn’t mean the science isn’t sound and the results aren’t valid. Many of the procedures we use here did originate in places with less rigorous regulation (like I mentioned, like the cataract surgery “factories” mentioned above). I am both glad (usually) that the US has more oversight AND can recognize that we eventually benefit from medical advances in other parts of the world. These are not mutually exclusive views.</p>
<p>Anyway, getting back to the original thread topic-- I’m not a fan of a fast track, either. Those “hoops required to go to med school”? I called that “College”. And I loved it.</p>
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<p>Law and medicine are prestigious. The BA confers prestige. The incumbents of a profession, who set the standards for entering it, have little incentive to make it easier for newcomers to enter, and they will especially oppose less prestigious paths for entering their profession. I have read of efforts to require that nurses have a BA or BS. Nursing associations want to increase the prestige of their profession.</p>
<p>There is little reason to believe that all of this status-seeking creates better lawyers, doctors, or nurses, any more than colleges’ desire to ascend USNWR rankings improves the quality of their teaching.</p>
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<p>Actually, engineers have to take significant amounts of liberal arts courses (about 25% science and math, 20-25% humanities and social studies) as part of their bachelor’s degrees.</p>
<p>Law school used to be available for those without bachelor’s degrees. Apparently, it was more affordable back then as well. Edmund Brown (Jerry’s father) resented the fact that he could not go to college because he could not afford to, although he got a law degree at a local night school while working and passed the bar exam, setting up a law practice afterward (being from a top 14 law school probably was not as big a deal back then). Eventually, he became governor of California and helped push along the expansion of California public higher education, with the CC->UC/CSU transfer route to improve access.</p>
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<p>The incumbents probably care less about the prestige than the fact that raising barriers to entry limits the supply of new providers that they have to compete with in the marketplace. Prestige might be useful as a tool to erect a barrier to entry, though – consider that having a law degree and passing the bar exam is no longer enough since the law firms are now extremely law-school-rank conscious in hiring (i.e. top 14 or bust).</p>
<p><<the uk="" system="" makes="" it="" possible="" for="" all="" young="" people="" who="" are="" interested="" and="" able,="" to="" contemplate="" a="" medical="" education.="" i="" wonder="" what="" extent="" the="" very="" long="" costly="" us="" process="" deters="" poorer="" students="" from="" attempting="" same.="">></the></p>
<p>True, though I’d put that more down to the universal and guaranteed funding for undergraduate students (and postgraduate medical students) in the UK, rather than the fact that you can be graduating with a medical degree at 23. </p>
<p>Outreach programmes also play a part, and the ability to be able to tell kids “this is how much money you will get, at a minimum, no matter what university you go to - and it will cover your tuition and living expenses, and you won’t have to pay it back until you’re earning >£21,000 per year ($31,600), and then only at 9% of anything you earn over £21k” is incredibly helpful. When going to university is in itself a great leap into the unknown because you don’t have any family or friends who have been, then removing the financial unknowns makes the world of difference.</p>
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<p>UCB, I’m not complaining about liberal arts courses vs vocational. It’s more of relevant/what the student wants/needs versus what is force-fed. DS has a degree in Comp Sci/EE and he may very well have had 25% of math and science courses, but those were relevant. His humanities/soc studies were much lower than 20% - only the two courses in philosophy is what he or I would label as pure fluff; the other three were related to business admin that he wanted to check out. AP credits probably took care of the rest, if any, but the bottom line was there were no other humanities/soc studies courses he was forced to take.</p>
<p>I don’t know if it’s a matter of CMU versus Northwestern requirements, but in the latter where DD went, her BA was loaded with things like 2 whole years of French, xx studies, and a lot more. It was not because she had any love/desire for these areas, but they were what she felt were her best compromise to meeting the graduation requirements, interest, and keeping her GPA up for med school.</p>
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<p>Keep in mind that in the British system like many other systems, the mantra that “everyone must/should go to college” doesn’t apply there to the same extent it does here. </p>
<p>Hence, while the colleges/universities may be free or nominal cost due to government subsidies, only those who have met the academic standards and depending on the HS attended have the chance to even be in the college admissions process. </p>
<p>Granted, it has been loosened up recently but up until '92, the British operated polytechnics(now universities) for students who weren’t considered as academically inclined.</p>
<p>Re: #94 and H/SS requirements for engineering majors…</p>
<p>There is likely some variation between different universities. For example, MIT has a relatively large number of H/SS requirements, on which AP credit cannot be used to fulfill (although a 5 on AP English can expand the student’s choice of courses for the “communication-intensive” course requirement). Brown is the opposite, with no H/SS requirements at all for most majors, and what is probably the minimum possible H/SS requirements to meet ABET accreditation for engineering majors.</p>
<p>Several posters have given their opinions that we could increase the numbers of physicians by fast tracking the college/med school process or by making it cheaper, thusnallowing more students to complete med school. This is false.</p>
<p>The number of physicians in the U.S. is not a function of med school slots or cost or the speed of the process. Residency programs are federally funded nationally. There is a cap on the number of residency slots nationally.</p>
<p>When new medical schools open, or when more med school spots are added, the number of residency spots does not increase. This means tha foreign med school graduates and osteopath school graduates are cut out of contention for residency spots. The number of residency trained physicians is not a flexible number.</p>
<p>Dad<em>of</em>3–nurses have to take humanities classes as do most of the majors you listed. There is a lot more to medicine than just facts and figures. Most of their job is dealing with people and taking courses in sociology and psychology, which are required for med school admissions, help dr’s understand the why behind people and how they act or react to situations. Med schools want doctors that can deal with people, they don’t want robots. Quite honestly, having dealt with (limited though) overseas doctors, their program for training their MD’s certainly isn’t what I would consider good.</p>
<p>Not so. In Miami a lot of new residency programs have just open, including psychiatry (I believe one one of the first opennings in the last 20 years), ophtalmology (OD, largest in the US), radiology, and basically all areas through Larkin Hospital / Nova Southeastern School. The new medical schools like FIU are associating themselves to Hospitals that did not have resindency programs before like Baptist Hospital, Mercy Hospital. So we ate graduating more doctors every day. And the numbers will be growing soon. Larkin is already planning a new Medical campus. They have just open their nursing school.</p>
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<p>I think the number of residency slots should increase also. What I don’t understand is why residency programs need federal funding (other than Medicare and Medicaid funds for treating patients). My wife is a doctor, and during her residency, she and her colleagues felt that they were being underpaid and overworked, effectively acting as cheap labor for hospitals.</p>