The greatest change in medical school and medical education would be to increase seats both in the schools and in residency programs. There is a shocking shortage of doctors across the country and medical care is going to suffer, especially those in underserved areas. All of these highly motivated and qualified applicants should be able to find a seat and a residency.
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Currently, there is an excess of residency positions. There are over 39,000 residency slots available in the US Match for 2023, with over 36,000 of those for first year trainees (PGY1). In 2022, US MD and DO schools graduated 28,337 students. So there are plenty of residency slots for US grads. (Excess available slots are filled by US IMGs and FMGs.)
The number of available US med school seats has increased by 35% since 2006, and 3-5 NEW med schools are opening every year.
The biggest bottleneck in medical training is the lack of clinical rotation sites for med students. It takes not inconsiderable time and money to train clinical preceptors. Additionally the presence of med students slows down clinicians, forcing them to see fewer patients on rounds or in clinic on a daily basis. Training med students is a big money loser for hospitals.
As for providing physicians for underserved areasâgraduating more physicians alone wonât solve this problem. The problem is complex, multifactorial and potentially irresolvable. One straight-forward example-- medically underserved areas generally donât offer strong school systems for physician offspring to attend nor any job opportunities for physician spouses who are usually highly educated individual themselves. Would you encourage your child to live someplace where your grandchild couldnât get an adequate education? Or where they couldnât find a job within commuting distance of where their partner practices medicine?
There are also all sorts of funding issues that, again, are complex and potentially irresolvable. Medically underserved areas have high numbers of uninsured and underinsured patients, many of whom are elderly. Although Medicare reimburses at a higher rate for patients in medically underserved areas, the reimbursement rates are still below the cost of delivering medical care so that clinics and hospital are continually operating at a financial loss.
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I think this is extremely insulting to physicians in the UK.
Itâs also untrue.
the level of competitiveness for entry into medical education is every bit as high as it is in the US. UK med school applicants as a group have the highest grades and standardized scores of any group applying for a specific undergrad university major. (Medicine in the UK is a. combined 7 year course of study that encompasses both undergrad + professional school similar to how BA/MD programs in the US operate). The acceptance rate into medical school in the UK is low, with ~70% of all applicants being rejected.
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To add to Wayoutwestâs comments- itâs also untrue that the pay in the UK is âpoorâ.
The pay is on par with other educated professionals. So itâs not âpoorâ, itâs upper middle class. But you donât have the enormous split between orthopedic surgeons at the high end and pediatricians at the low end. And since you donât have 18 year oldâs going into 6 figure debt to obtain a medical degree, you keep out the âI wanna get richâ crowd who make bad financial decisions thinking theyâll be pulling in 7 figure salaries by the time theyâre 35 so they can retire their debt.
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My understanding is that the NHS is a large employer in the UK paying very poorly. Private sector pay will be anchored with a spread to public sector pay, and will not be independently determined. I have had family in the UK with kids interested in medicine explicitly complain.
Even in the US I am told that medical pay has stagnated and work has gone up a lot over the past two decades. Over time I am seeing very motivated and driven high school kids get into college and drop out of the pre med track because itâs simply not worth the trouble.
If you make entry into the medical profession a lottery, leaving no agency to the individual , and also other fall back options with a bio major remain lackluster, large numbers of top kids will simply not bother.
At the end of the day you cannot wish away the economics of a profession.
Sorry, again, this just isnât true.
While some specialties (cardiology, dermatology, nephrology, EM) have seen their salaries decline, others have seen increases, often substantial increases over the past few years. In the past year (2021-2022) alone, starting salaries for OB/GYN have risen by 14%; radiology by 12%, and anesthesiology, gastroenterology, neurology and psychiatry by 7%.
The average salary offer to an experienced orthopedic surgeon is still over $500K/year.
The biggest decline in medical salaries is because medicine is no long âeat what you killâ. Private practice is essentially non-existent. Even physician owned practice groups have become a rarity.
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My family in the UK is mostly physicians.
They complain about a lot of things (as do their colleagues all over the world). What is distinctive about the UK complaints is bureaucracy-- what it takes to refer a patient with what you suspect is an unusual condition/disease, or an unusual presentation of a more common disease. They need to appear before a committee to get approval for tests which are quite ordinary in the US; they need to make a case for exploratory surgery (not the model here where a doc will say âletâs open you up and see whatâs going onâ. They envy the US model of being able to refer as appropriate (as long as the patient has insurance, which of course is not an issue in the UK).
They do NOT complain about the pay. They are well compensated for the work they do. They go on vacations and do NOT spend the entire time on the phone (not unusual in the US- even if youâve got great coverage, most MDâs cannot just disappear for a week at a time). They donât spend their 30âs and 40âs paying off their educational debt, they donât spend their 50âs and 60âs worried about retirement. They donât chew up every night and weekend âmanaging the practiceâ because they donât have a practice to manage. The receptionist quit? Someone elseâs problem. The lease on a piece of equipment is up and you need to get competitive bids on a replacement? Thereâs an entire procurement office which handles that, not the individual doc.
You donât go into medicine in the UK planning to live like a billionaire- because you wonât be. But thatâs a terrible motivation for medicine regardless of the NHS, or whatever pay system you happen to be operating with.
I donât think itâs a terrible thing if kids (whether US or anywhere else) are being discouraged from medicine because they think the pay is âterribleâ. That leaves the field clear for people with a real aptitude for medicine and a true commitment to being a physician.
Iâm sure your cousins in the UK will find suitably renumerative work in another field.
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I was thinking the same thing when I read that section.
Meanwhile my extremely âdevoted to medicineâ lad has been telling me all the incentives heâs been getting to stay or go to various places once he finishes residency. Heâs only half way through his second year of residency (of 4 years, then probably a fellowship). These arenât generic offers (âDear Residentâ), though of course they are likely doing the same thing to others. Theyâve seen (or heard) how he is on the job and are specifically approaching him.
Heâll have some hard decisions to make, but heâs loving it all - and this without getting high pay at this point. He was never in it for the pay and never will be. Teaching positions pay less and heâs more attracted to them at this moment.
I have a few friends who have gone the academic medicine route⊠and none of them regret it. Even the one doing some esoteric branch of cardiology (it is hard to ignore the money a cardiologist in practice can earn).
Kudos to your son!!! We live in a country where some of the best and the brightest opt for lower paying career tracks (elite lawyers who leave their white shoe law firms for government service, top computer scientists who work for the NSA and CIA instead of the private sector, etc.) and it is pretty awesome to think aboutâŠ
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Itâs nice to know that not every one of our best and brightest is making a beeline for the most lucrative possible job. That there are some students who are looking to medicine because they care - not just because they want to be the next plastic surgeon to the stars.
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You cannot set up a system assuming the good will of 50k people coming into the medical services market on an annual basis. If you ignore economics because you have a friendâs kid or a nephew willing to work on terms that you think are âniceâ, and you think that these people are representative, the system will be sub par.
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I think the system is sub par because some are in it for the money and prestige.
I imagine we can all name some folks who never should have become doctors. If not, then look at a few rating systems.
I think doctors should be well paid as many do a fantastic, difficult job that isnât something âanyoneâ can do, plus need many years to reach that point, but I wish we could eliminate those who donât have a love for the job too.
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Evidence for this?
Nobody is ignoring economics. We are not advocating for a system like Cubaâs where a doctor and a house painter and making the same salary.
But what is broken if an experienced pediatrician is making $350K as a hospitalist with no on-call weekends and three on-call nights a month, zero risk (no practice to manage, no employees) and no expenses other than driving to work like everyone else???
Are you suggesting that only morons want to become pediatricians because of these economics?
US News reports that the median salary for a pediatrician was $170k in 2021:
If a doctor has no loans when they are done with medical school, that can be a comfortable life. But how often does that happen?
While society doesnât benefit from people becoming doctors just for the money, it also doesnât benefit when potentially excellent doctors reject the field because of insufficient money (after subtracting loan payments).
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Until med school acceptance becomes a decent majority instead of around 40%, I donât think this is a problem at all. Those who reject the field due to not enough money probably donât select welfare (or other govât subsidy) for their future. They find somewhere that fits them - even other medical options - that also need competent people.
I have always respected what you have said in all your posts. You are obviously very knowledgeable and give great advice. This is the only area that I have to strongly disagree with you on.
@neela1 is correct. Salaries have not just stagnated - they have gone down. I have been working for 25 years and have received only 2 raises, I do not make as much as when I first started when you factor in inflation. (One raise was only $50, and I donât remember if that was q 2 weeks vs q 1 month)
My parents and uncles were physicians across a wide range of fields (surgery, internal medicine, OBGYN and radiology). Looking at the median salaries of these physicians today, my parents and uncles all made over todayâs median. And 2 of the 4 made over the 90% percentile of todayâs respective groups (I wonât say which two). They practiced primarily in the 70s and 80s. And, with the rate of inflation, the take home pay today is much less than it used to be. And the hours today/volume of patients required to be seen is much higher. (Iâm not even mentioning all the additional things today such as MyChart emails, overhead, paperwork, management today that were not in the past).
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I wonder if this is regional.
I actually pulled the data from the southeast, where it is the highest in general
Salaries are the highest or stagnation is the highest?
Sorry. I know what my they made in the 70s and 80s practicing in the Northeast. Back when they gave me a quarter to bring to school for lunch each day.
I am looking at physician salaries today for each field, median, and range from 25% to 90%, and can be broken down to different regions of the country. I pulled the southeast, because that is often where the highest is (at least in my specialty it is the highest in the southeast). And how much is school lunch today? More than a quarter for sure.
And I guess stagnation would refer to me. Decrease would be the term that is best for the long term.
I remember at the beginning of my career, back when our business manager would meet with our group to go over then numbers. I would bring up the need for raises to keep up with inflation, how I will be practicing for decades, with one arm up in a horizontal manner to indicate my salary, and my other arm at a 45% angle indicating inflation and how for people at the end of their career it doesnât matter so much but for someone like me, the lines get closer and closer thus the need for raises otherwise I will get in trouble. His/her answer was a simple yes. I think I received my first raise about 10 years later (minimal as I said) and a second one 2 years ago.