<p>I know that medical school is hard to get into and anyone who gets into any medical school should be grateful but geeze is there any medical schools with acceptance rates in the double digit percentage? What is the community colleges of medical school? Are there safety medical schools?</p>
<p>No, there aren't safeties. The competition is simply that high. There are plenty of state schools that are in the 10-15% acceptance rate ranges, and state schools do give advantages for in-state residents that push acceptance rates much higher - eg Kansas accepted 35% of instate applicants.</p>
<p>And think about it this way: Would you really want to be a patient of someone who went to med school's "community college" equivalent?</p>
<p>The connotation of community college is that it is of poorer quality and that simply cannot be found among the 125 US Allopathic medical schools. They are all great institutions and whatever differences in ranking that USNWR may come up with, the difference between the best and the worst is very small. You only have to look at the passage of USMLE and stats from the Match to realize that every allopathic medical school is doing a very good job of training their students. Yes there are some differences but that's to be expected. The overall quality though is high everywhere.</p>
<p>It's called the D.O. and Carribean route.</p>
<p>
[quote]
And think about it this way: Would you really want to be a patient of someone who went to med school's "community college" equivalent
[/quote]
</p>
<p>This is a digression, but I think that med-schools ought to be expanding their number of seats. Not to offer a "community college" equivalent, but certainly to accomodate more good students. The truth is, there are plenty of decent students who can't get into any med-school. And that's a shame. </p>
<p>Think of it this way. According to AMCAS data, the total matriculation into med-school in 1992 was 16,500. In 2005, it was 17,004, or 3% growth. Yet the country itself has grown in population from an estimated 250 million in 1992 to 295 million in 2005, or 18% growth. </p>
<p><a href="http://www.aamc.org/data/facts/archive/famg82001.htm%5B/url%5D">http://www.aamc.org/data/facts/archive/famg82001.htm</a>
<a href="http://www.aamc.org/data/facts/2005/2005summary.htm%5B/url%5D">http://www.aamc.org/data/facts/2005/2005summary.htm</a>
<a href="http://www.census.gov/prod/2004pubs/04statab/pop.pdf#search=%22US%20population%202005%22%5B/url%5D">http://www.census.gov/prod/2004pubs/04statab/pop.pdf#search=%22US%20population%202005%22</a>
<a href="http://www.census.gov/prod/1/pop/p25-1127.pdf%5B/url%5D">http://www.census.gov/prod/1/pop/p25-1127.pdf</a></p>
<p>Hence, the population of the country is clearly outpacing the number of med-students (and by extention, the number of doctors produced). I strongly suspect that this is evidence of cartelization - that the AMA and other physician's organizations are deliberately trying to keep the number of physicians down in order to keep salaries high, something that has been noted by several economists. </p>
<p>To give you an example, a lot of Americans, especially poor rural Americans, do not have easy access to a doctor. Instead, they are served by PA's or RN's who basically act as quasi-doctors for them, including prescribing medicine (PA's and nurse practitioners are licensed to prescribe medicine). So, in effect, nursing schools and PA schools are acting as "de facto med-school community colleges", in the sense that they are admitting many students who would prefer to go to med-school but can't get in, and produce graduates who end up performing many medical care functions that current doctors don't want to do. </p>
<p>The key question is not whether the AMA is acting in the best interest of its own members, which it clearly is, but rather it is acting in the best interest of society at large, which I don't think it is. The AMA clamps down on the number of students in the name of "quality", but what that ultimately means is that many poor rural Americans end up with no reasonable access to a doctor at all.</p>
<p>I believe the AMA is actually trying to increase the number of seats.</p>
<p>And I think your allegations of "cartelization" are actually openly acknowledged; that is, I believe the AMA has always started from the openly explicit position that it was attempting to restrict supply to keep compensation high.</p>
<p>But I've never seen this officially, so I could well be wrong.</p>
<p>So what's why there are some attractive programs that pay a good amount of your med school fees as long as you sign a contract to serve in the rural areas for a set amount of time.</p>
<p>
[quote]
I believe the AMA is actually trying to increase the number of seats.
[/quote]
</p>
<p>Well, it certainly doesn't seem as if they are trying very hard. A 3% increase in 13 years? Come on. If that's the best you can do, that's pretty pitiful. </p>
<p>
[quote]
And I think your allegations of "cartelization" are actually openly acknowledged; that is, I believe the AMA has always started from the openly explicit position that it was attempting to restrict supply to keep compensation high.</p>
<p>But I've never seen this officially, so I could well be wrong.
[/quote]
</p>
<p>Well, I highly doubt that the AMA would say something like this so brazenly, for it would completely undercut them in the court of public opinion, not to mention possibly attract a Department of Justice antitrust lawsuit. Nonprofits are not immune from antitrust law. </p>
<p>
[quote]
So what's why there are some attractive programs that pay a good amount of your med school fees as long as you sign a contract to serve in the rural areas for a set amount of time.
[/quote]
</p>
<p>But it evidently doesn't work very well as there are wide swaths of rural poor people who have little access to physicians, relying solely on nurses or PA's (or in some cases, no access to any health care at all except for emergencies). </p>
<p>A better method would be to simply increase the number of doctors. Especially those coming out of rural states. For example, the state of Montana doesn't have a medical school. Instead, Montana has an agreement that 20 Montana state residents can attend the University of Washington Medical School at a subsidized rate. But come on, 20? Out of a state population of over 900k? Don't you think that's a little low? Now, granted I'm sure that other Montana students are going to other med-schools, but the point is, if the state is only subsidizing 20 of its own state residents, that goes a long way to explaining why there are so few doctors in Montaha.</p>
<p>By the way, the same analysis holds for California. The UC Medical Schools bring in no more than 1000 new med students a year. Compared to the state population of 34 million, that's pitifully small. Granted, there are private med-schools in the state (Stanford, USC, LomaLinda), but that adds only a few hundred more matriculating students a year. Granted, the major cities in California can easily import doctors from other states, as they are desirable cities to practice in. But California also has a large rural interior that is underserved.</p>
<p>Its been said before by the AMA. They want a big increase in admits to med school, the med schools do not want to do this and aren't doing it. There is going to be a shortage within a decade or so unless the med schools wise up and take some more students.</p>
<p>Wow, a lot of misinformation.</p>
<p>The AMA does not decide how many medical schools there are, or how many students there are in medical school. Some medical leaders are both involved in these decisions, and are active in the AMA, but that is the limit of the AMA's influence. In fact, the significance of the AMA has been falling for many years, most doctors do not belong, have never belonged, and don't care much what the AMA says.</p>
<p>The sticky issue on the number of medical school slots is the question of the appropriate number of physicians. Simply choosing a base year and assuming that the number of physicians per population should be the same now as it was then assumes that the ratio in the base year was appropriate. Many attempts to estimate the optimal number of physicians have come up with wildly different answers. In some cases, relatively recently, there were predictions of a gross oversupply of physicians to be evident now. It did not probably did work out that way, but even now it is hard to say whether there are too many, too few, or just right.</p>
<p>Those who pay for health care (private insurance-thus employers, and Medicare-thus the federal government) are extremely interested in controlling the number of physicians for cost reasons. Unlike what one would assume based on classical economic theory, increasing the number of doctors increases the amount spent on healthcare. This has been reproduced in many different studies and no one who pays attention questions this. Doctors compensation represents a small proportion of the amount of money spent on healthcare, and the costs go up as each doctor delivers more care. This is not because the docs get more money, in fact physician income has been flat, but because of more money spent on drugs, hospitals...</p>
<p>Many people estimate that we really have enough physicians overall, but a bad distribution, with too many in desirable coastal locations (San Francisco), and too few in poor or rural areas. Although one might think the solution would be to increase numbers of physicians to the point that some were forced to move to less desirable locations to find work, this situation has been present for many years. Doctors already know that they make much less money, and face higher costs of living, by working in Manhattan, NY rather than Manhattan, KS, but they do it anyway.</p>
<p>So most who look at the issue think that simply increasing the number of physicians would increase costs while doing little to change the disparities in health care access. </p>
<p>The AAMC is currenty projecting a shortage of physicians and pushing for modest increases in numbers, but without a plan for how to get more docs to go to underserved areas. Ultimately, the question of the optimal number of docs has nothing to do with the numbers who want to go to medical school. It depends on overall healthcare finance, the state of the economy, the structure of the healtcare industry, the age of the population, and the proportion of the nation's economic activity that should be devoted to healthcare.</p>
<p>What you said is good an all how there may be enough physicians, but the truth is they are going to retire by the time the current crop of people in college now graduate from med school. If you have 100 people retiring and make only 50 people to replace them you have a shortage. This is what the AAMC thinks, but med schools don't seem to care about. The med schools don't want bigger classes, it has nothing to do with whether or not there will be enough doctors or there won't, they simply want to be in control the way they want. There is going to be a shortage once the Baby Boomers retire, that is for sure unless something is done soon. A big chunk of people in medicine are Baby Boomers and when they are gone if they aren't replaced there will be issues.</p>
<p>
[quote]
The AMA does not decide how many medical schools there are, or how many students there are in medical school.
[/quote]
</p>
<p>It is technically true that the AMA does not "decide" how many medical schools there are, or how many students there are in medical school. But the larger point holds - the AMA has been instrumental in both holding the number of overall medical schools exist, as well as limiting the competition that physicians endure from related professions.</p>
<p>"AMA created its Council on Medical Education in 1904 with the goal of shutting down more than half of all medical schools in existence. (This is the Council having its 100th anniversary celebrated in Chicago this weekend.) In six years the Council managed to close down 35 schools and its secretary N.P. Colwell engineered what came to be known as the Flexner Report of 1910. The Report was supposedly written by Abraham Flexner, the former owner of a bankrupt prep school who was neither a doctor nor a recognized authority on medical education. Years later Flexner admitted that he knew little about medicine or how to differentiate between different qualities of medical education. Regardless, state medical boards used the Report as a basis for closing 25 medical schools in three years and reducing the number of students by 50% at remaining schools."</p>
<p><a href="http://www.mises.org/story/1547%5B/url%5D">http://www.mises.org/story/1547</a></p>
<p>And then of course there was the infamous legal case of Wilk vs. AMA where the AMA was found guilty of antitrust violations for attempting to restrict competition from chiropracters.</p>
<p>The point is, the AMA has actively engaged in numerous activities designed to limit the number of people who are allowed to formally practice medicine, whether it was by shutting down numerous med schools or other cartel-style techniques to insulate themselves from other health-care providers. </p>
<p>"Consider, first, the American Medical Association, which operates in a manner very similar to that of the medieval guilds.[5] The AMA serves to reduce the number of people who can practice medicine, and thereby increases the cost of medical treatment beyond what it would be in a competitive market. According to Clark Havighurst, Duke University Professor of Law, "Professional licensure laws have long made the provision of most personal health services the exclusive province of physicians. Obviously, such regulation limits consumers' options by forcing them to use highly trained, expensive personnel when other types might serve quite well."[6]</p>
<p>Consider Friedman's description of the guild's operations:</p>
<p>One effect of restricting entry into occupations through licensure is to create new disciplines: in medicine, osteopathy and chiropractic are examples. Each of these, in turn, has resorted to licensure to try to restrict its numbers. The AMA has engaged in extensive litigation charging chiropractors and osteopaths with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible. Chiropractors and osteopaths in turn charge other practitioners with the unlicensed practice of chiropractic and osteopathy.[7]</p>
<p>Doubtless most members of the AMA believe that such requirements work to the consumer's benefit by protecting him from substandard medical care, but this only shows the extent to which interest groups subconsciously conflate their own interests with those of society as a whole. Mancur Olson cautions people to "note that the examinations are almost always imposed only on entrants. If the limits [on entry into the field] were mainly motivated by the interest of patients, older physicians would also be required to pass periodic qualifying examinations to demonstrate that they have kept their medical knowledge up to date."[8] The fact is, studies find that nonphysician providers of medical care, such as midwives, nurses, and chiropractors, "can perform many health and medical services traditionally performed by physicians—with comparable health outcomes, lower costs, and high patient satisfaction."</p>
<p>Government regulations on the chiropractic profession, lay midwifery, and on the freedom of nurse practitioners to offer services within their competence, all of which make perfect sense from the point of view of the medical guild that lobbied for them, make no sense at all from the point of view of consumer wishes (as repeatedly expressed in polling data) or from economic considerations. In many cases, such people can provide health services far more cheaply than can licensed physicians (or, in the case of chiropractors, can provide services that licensed physicians do not provide at all), but consumers are prevented from making their own decisions regarding their medical care. Given the logic of the guild structure, no one has the right to be surprised to find that the AMA has put so much effort into undermining its professional opposition.</p>
<p>Private certification boards, providing certification to physicians who meet certain standards, would of course be welcome and extremely likely in a society without state-imposed licensing requirements. Lacking a coercive element, such boards would be limited to providing information to consumers of health care services and would be unable to use their position to transform the entire profession into a guild or cartel able to crush all competition. As economist George Reisman explains:</p>
<p>[T]he members of the various state medical licensing boards around the country could constitute themselves into private certification agencies and give or withhold their seal of approval to individual medical practitioners on any basis they wished. They would simply lack the power to make the absence of their particular seal of approval the basis of fining or imprisoning anyone who chose to practice medicine without it. The consumers of medical care, who presently retain the right to judge the qualifications of the state governors and legislators who are responsible for the appointment of the members of the medical licensing boards, would decide for themselves the value of certification by this or that organization. . . . Indeed, if ordinary men and women are to be allowed to vote in elections in which their votes ultimately determine the most complex matters of foreign and domestic policy, and thus where their decisions affect not only their own lives and those of their immediate families but also the lives of everyone else in the country, then surely they are entitled to the responsibility of determining matters pertaining exclusively to their own well-being.[10]</p>
<p>Reisman further observes that if government regulations allowed only automobiles less than five years old on the roads, there would certainly be an overall increase in the quality of automobiles on the roads. But a great many perfectly serviceable automobiles would thereby become unavailable for use at all. The main victims of such alleged largesse would be, as usual, the poor"</p>
<p><a href="http://www.mises.org/story/1252#_ednref5%5B/url%5D">http://www.mises.org/story/1252#_ednref5</a> </p>
<p>
[quote]
In fact, the significance of the AMA has been falling for many years, most doctors do not belong, have never belonged, and don't care much what the AMA says
[/quote]
</p>
<p>It is true that what the AMA says has little bearing on the lives of ordinary doctors. But that's not really relevant. The AMA has great POLITICAL POWER to influence laws, and all health-care providers, physicians and otherwise, have to abide by the laws that the AMA has a hand in influencing. People who don't care about what the government does, or who don't even vote nevertheless still are forced to abide by whatever laws the government passes. And the truth is, the AMA, through licensing rules, has enacted vast restrictions on the number of providers of health-care, to the detriment of mostly poor rural people who end up with little access at all.</p>
<p>You are focussing on ancient history, and grossly overestimating the current influence of the AMA. One of its biggest problems is precisely that fewer and fewer people listen to them. They have become only one of many voices of organized medicine, and a reactionary one at that. </p>
<p>Given that the previous estimates of a severe oversupply never panned out, I am skeptical of the current predictions of an impending shortage. Often the people making the new prediction of shortage are the same ones who were so far off the mark in predicting a surplus. Much of the real evolution in healthcare availability will revolve around how the care is delivered and financed. Some of the biggest shortages are in fields that, right now, are not appealing for the combination of malpractice, lifestyle, and overall practice costs. Increasing the number of physicians will not solve these problems.</p>
<p>Individual medical schools look at the numbers of people they can educate with current resources, and the costs of expansion-which can be enormous.</p>
<p>The AAMC represents medical schools collectively, and has called for enlarging classes. </p>
<p>The number of medical students also is constrained by the number of training positions. This is effectively set by the federal government, not the AAMC, not the COTH, and certainly not the AMA. Remember, someone graduating medical school is not qualified to practice medicine, only to start an internship.</p>
<p>Although guild considerations certainly cold be used to artificially limit supply, rigid standards are really necessary for public safety. Letting unqualified people practice medicine could be disastrous.</p>
<p>Come on, sakky quoted a guy from Duke. That's proof enough, isn't it??</p>
<p>A long time ago, the AMA held most doctors as members. As recently as the 1990's about 40% of docs belonged. The membership has declined sharply since then, and now approximately 20% of docs are members. </p>
<p>The AMA does NOT speak for medicine in the US.</p>
<p>"Only about 11 per cent of AMA members are 40 years old or younger, according to the AMA. The AMA characterizes nearly one-third of its members as senior physicians age 56 and older, which contributes to a common perception that the organization is hidebound and resistant to change."</p>
<p>"AMA profitable in 2005 but membership continues to slide</p>
<p>The American Medical Association posted a $28.1 million operating profit in 2005, its sixth consecutive year in the black, but also suffered its sixth straight year of declining membership despite a national advertising campaign launched last spring to counter the trend.</p>
<p>Total revenue was up 3.8% to $280 million in 2005, and dues revenue rose for the first time in a decade to $48.5 million, an increase of slightly less than 1%.</p>
<p>The AMA said it added about 3,300 new dues-paying members, which it said was a positive result of the advertising campaign and member outreach. Still, total members fell about 500 to about 244,000, due to the loss of older physicians who died or chose not to renew, the AMA said. General and administrative expenses increased about $19 million to $194 million. "</p>
<p>(the revenue is much higher than the dues figure because the AMA is mainly an organization that sells stuff, insurance policies, books, anything else they think someone will buy. Little of its revenue comes from dues.)</p>
<p>If the AMA is your bete noir, don't worry, it is dying with a wimper. And good riddance.</p>
<p>Is the University of Washington really the best in terms of primary care? It is by the USNWR rankings.</p>
<p>Afan where are you getting these AMA statistics from, almost every doc I know is part of the AMA.</p>
<p>
<p>
[quote]
As the medical profession in the US has become increasingly specialized, organizations representing medical specialties and subspecialties have proliferated. About 100 national medical specialty societies are now represented in the AMA House of Delegates. As physicians have turned to specialty organizations to serve their needs, their support of the AMA has waned. An AMA task force on membership reported that AMA membership among physicians had fallen to 34% by 1999, and it projected that membership would decline to 23% by 2010 if current trends continue.
[/quote]
<a href="http://bmj.bmjjournals.com/cgi/content/full/bmjusa.01030006v1%5B/url%5D">http://bmj.bmjjournals.com/cgi/content/full/bmjusa.01030006v1</a></p>
<p>Indeed, the AMA formed a "Commission on Unity" to address the issue of rivalry among the various organizations representing physicians.
<a href="http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/DIR/D-625.991.HTM%5B/url%5D">http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/DIR/D-625.991.HTM</a></p>
<p>Most specialists feel their own specialty organization represents their professional (and financial) interests better than the AMA does; The AMA is well supported only by internists.</p>
<p>
[quote]
You are focussing on ancient history, and grossly overestimating the current influence of the AMA. One of its biggest problems is precisely that fewer and fewer people listen to them.
[/quote]
</p>
<p>
[quote]
The number of medical students also is constrained by the number of training positions. This is effectively set by the federal government, not the AAMC, not the COTH, and certainly not the AMA. Remember, someone graduating medical school is not qualified to practice medicine, only to start an internship.
[/quote]
</p>
<p>Afan, I think you are overgeneralizing from the percentage of doctors that are members of the AMA. That is not important. What is important is the POLITICAL power of the AMA. It doesn't matter if a group has few members, if the group has great sway with current politicians and (especially) current regulators and standards-setters. </p>
<p>To give you an example from another industry, take the telecom industry, one of the largest industries in the country in terms of employment. Few telecom engineers, managers, or any other employees have anything to do with the US Telecom Assocation (USTA). Their employers may be corporate members of the USTA, but few employees of those companies will actually have anything to do with the USTA. But the USTA is arguably the most powerful and most successful telecom government lobbying group in the country, and arguably the most powerful political lobbying group of any industry. Basically, whenever telecom (like health care) is one of the most highly regulated industries in the country, and whenever the government thinks about changing telecom regulations, the USTA is right there like white on rice, trying to adjust the regulations to the benefit ostensibly of consumers, but in reality, to the benefit of its member companies. In fact, this behavior has become so prevalent that the USTA has been repeatedly accused of practicing 'regulatory capture' - where an industry group effectively controls the regulatory agencies that are supposed to oversee them. </p>
<p>You actually highlighted one of the problems of the AMA. You say that fewer and fewer doctors are members of the AMA, or listen to the AMA. But the fact remains that the AMA still consists of ALL DOCTORS. Not nurses. Not pharmacists. Not chiropracters. Not PA's. Not anybody else who participate in the healing arts, and who, for some people (especially poor rural people) are the only health-care provider to which they have reasonable health-care access. Hence, the political positions that the AMA espouses are inevitably going to be tilted towards their constituents, meaning just doctors.</p>
<p>Nor is this 'ancient history'. Take a look at the RECENT political contributions made by the AMA. Note, these are not just political contributions made by individual doctors. These are contributions made BY THE AMA ITSELF. I doubt that the AMA it stupidly throwing money away. They are spending money on lobbying politicians for the same reason that any other group does - in order to influence laws and regulations that are favorable to its constituents. If those laws serve to hurt nurses or pharmacists or anybody else, including customers, too bad for them. </p>
<p>But I do agree with you that the AMA may be declining in membership and that other physician's groups will be gaining in sway. But don't you see - it's just going to be the same problem all over again, just with a different group involved. The REAL problem is that health care is inevitably affected by political considerations, and each lobbying group is out there to protect its own, at the expense of everybody else. It's an inevitable consequence of regulatory capture, and of political economics in general. Any new providers of health care (whatever they may be) will not have the political power of the incumbents and so will inevitably be disadvantaged in the regulatory process. </p>
<p>So I agree with your statement that the number of medical school spots and training hospital spots are constrained by the government and specifically by regulation. But that's the whole point - the AMA (and other lobbying groups) have a strong hand in forming these regulations through their lobbying. And the fact of the matter is that the AMA has a vested interest in not wanting the number of spots to increase.</p>
<p>
[quote]
Although guild considerations certainly cold be used to artificially limit supply, rigid standards are really necessary for public safety. Letting unqualified people practice medicine could be disastrous.
[/quote]
</p>
<p>I thought you might come back with that, because that is the same argument that the AMA uses. The problem with that is, as stated in the Mises article, that the average quality of US physican-provided health care really isn't all that high anyway. The best physician health-care in the country is better than anywhere else in the world - but there are also plenty of Americans who get quite shoddy service from US physicians, or (especially for the poor rural) no physician health-care at all. </p>
<p>Consider this snippet about the supposed 'quality' of US health care.</p>
<p>"...the number of accidental deaths occurring in U.S. hospitals every year. Harvard University's Lucian Leape estimated that there are approximately 120,000 accidental deaths and 1,000,000 injuries in U.S. hospitals every year. [28] To understand what staggering figures these are, imagine a Boeing 777-200 with its maximum of 328 passengers crashing every day for an entire year with no survivors. This would add up to 119,720 deaths, still not as many as are killed through medical error in hospitals every year. UCLA Professor of Medicine Robert Brook, M.D., told the Associated Press, "The bottom line is we have a system that is terribly out of control. It's really a joke to worry about the occasional plane that goes down when we have thousands of people who are killed in hospitals every year." [29]</p>
<p>Certainly not all accidental hospital deaths can be attributed to institutionalized AMA mischief. Errors by nurses, pharmacists, and sleep-deprived residents play a role as well. However, there's also no doubt that AMA-backed restrictions against greater specialization have helped wreak their havoc over time as well. [30] A later study by Leape [31] showed that just the presence of a pharmacist on physician rounds reduced adverse drug reactions from prescribing errors by 66%. [32] [33] Despite some shortcomings, the U.S. system still has some of the finest physicians, surgeons, research, and facilities in the world. However, the best aspects of the system are due to whatever vestiges of market freedom still survive, not some illusory Lexus standard supposedly created by strict statist controls. [34]"</p>
<p><a href="http://www.mises.org/story/1547%5B/url%5D">http://www.mises.org/story/1547</a></p>
<p>I think the following quote says it best regarding the supposed emphasis on "quality". If quality were really what was so important, then why force only new medical students to pass exams? Why not force PRACTICING DOCTORS to also pass periodic exams to ensure that they have maintained their skills? This leads to the simple conclusion that the AMA and state licensing organizations really serve only to protect the interests of existing members by restricting new entrants. Old doctors who have not kept up with the latest medical advances should have their medical licenses suspended. But the agencies don't seem to be interested in doing that.</p>
<p>"Doubtless most members of the AMA believe that such requirements work to the consumer's benefit by protecting him from substandard medical care, but this only shows the extent to which interest groups subconsciously conflate their own interests with those of society as a whole. Mancur Olson cautions people to "note that the examinations are almost always imposed only on entrants. If the limits [on entry into the field] were mainly motivated by the interest of patients, older physicians would also be required to pass periodic qualifying examinations to demonstrate that they have kept their medical knowledge up to date."[8] The fact is, studies find that nonphysician providers of medical care, such as midwives, nurses, and chiropractors, "can perform many health and medical services traditionally performed by physicianswith comparable health outcomes, lower costs, and high patient satisfaction."[9]"</p>
<p><a href="http://www.mises.org/story/1252%5B/url%5D">http://www.mises.org/story/1252</a></p>
<p>Sakky, I think you have been misled by these histrionics. You usually make a lot of sense. Here you are listening to a gadfly.</p>
<p>Your last post seemed simultaneously to aruge that organized medicine resists enlargement of the pool of physicians by imposing high standards for entrance to the profession, and that organized medicine resists imposition of higher standards.</p>
<p>
[quote]
Why not force PRACTICING DOCTORS to also pass periodic exams to ensure that they have maintained their skills?
[/quote]
</p>
<p>This happens now. Docs both have to recertify periodically, and they must present evidence of ongoing educational activity to maintain licenses (usually every couple of years).</p>
<p>but then we have
[quote]
However, the best aspects of the system are due to whatever vestiges of market freedom still survive, not some illusory Lexus standard supposedly created by strict statist controls.
[/quote]
</p>
<p>So if we get rid of "statist controls" who is going to require that practicing physicians demonstrate ongoing education? Who is going to require the periodic exams? Either you have these requirements, and thus statist controls to enforce them, or you don't. Cannot have it both ways.</p>
<p>Yes, lots of people are killed by medical errors. Whether that points to a low or high level of quality depends on the alternatives. What are the comparable figures elsewhere? What would be the comparable figure if admission to medical school were easier? If it were harder? If there were more or fewer training slots? If training were longer and more demanding, or shorter and less detailed? If ongoing assessment of physician skills were more common and demanding or less? This point estimate, without something to compare it to tells us only that this is the outcome of the totality of our economic and political healthcare system. By the way, there are no reliable estimates on the numbers injured by medical mistakes. Any attempt to get that figure is dominated by the assumptions used in the modelling. The real number could be very different. Statisticians and epidemiologists debate this quite a bit. That the number is large- no question. How large? No one knows.</p>