Tuesday, July 15, 2008

Couldn't We Have 200 Medical Schools Instead?

MP: Post has just been updated to correct the previous charts, which incorrectly showed the number of applications, instead of the number of applicants. Mea maxima culpa - it was one of those late night 1 a.m. posts that involved multiple computer crashes, losing data, being groggy, etc.

Associated Press -- The United States last week became the world's first nation of 200 accredited law schools, as the American Bar Association gave provisional approval to two North Carolina institutions.

In other countries, it's much harder to become a lawyer. In the United States, the doors are open and getting wider. The 150,000 students enrolled in law schools last year were an all-time high.


MP: In 1963, there were only 135 law schools in the U.S. (
data here), so the increase to 200 today represents almost a 50% increase over the last 45 years in the number of U.S. law schools.
Unfortunately, we've witnessed exactly the opposite trend in the number of medical schools. There are 129 medical schools in the U.S. (
data here), which is less than the number of medical schools 100 years ago (166), even though the U.S. population has increased by 300%. Consider also that the number of medical students in the U.S. has remained constant at 67,000 for at least the period between 1994 and 2005, according to this report, and perhaps much longer.

UPDATED: The charts below tell an interesting story (
data here):

The number of applicants to medical school keeps going up, by almost 22% between 2003 (34,786) and 2007 (42,315), despite the fact that the number of students admitted has gone up by only about 7% (from 16,538 to 17,759) over that period (see chart below).


Because of the 22% increase in applicants for only 7% more openings available in medical schools, the number of medical school applicants per available opening in medical schools increased from 2.1 in 2003 to 2.4 in 2007 (see chart below).

Because of the significant increase in applicants for a very small increase in available openings in medical school, the percent of medical school applicants accepted has decreased from 47.5% in 2003 to 42% in 2007, see chart below.

Bottom Line: One reason we might have a "health care crisis" and rising medical costs is that we turn away 58% of the applicants to medical schools. What we have is a medical cartel, which significantly restricts the supply of physicians, and thereby gives its members monopoly power to charge above-market prices for their services.

If we had 129 law schools (instead of 200) and 200 medical schools in the U.S. (instead of 129), it would probably go a long way to solving our "health care crisis." More MDs at much lower salaries along with fewer lawyers and lawsuits would be a good thing, no? Can't breaking up the medical cartel be part of the discussion for health care reform?


51 Comments:

At 7/16/2008 12:46 AM, Blogger Andy said...

You are ignoring the fact that many people apply to more than one medical school.

 
At 7/16/2008 12:53 AM, Blogger randian said...

You are ignoring the fact that many people apply to more than one medical school.

Even if true it hardly refutes the thesis.

 
At 7/16/2008 2:11 AM, Anonymous Fred said...

There are only 17,750 openings at medical schools. What does it matter how many apply?

 
At 7/16/2008 3:16 AM, Blogger das Kapitalist said...

The fact is that getting into Medical School is ridiculously competitive. Perfectly good candidates are turned away. A professor I had in college told me the reason for this was that the AMA was constraining the supply of doctors to increase demand for their services. The AMA wants to keep the number of doctors low so that they can make more money. It is as simple as that.

I can't imagine why it isn't an issue during this election year.

 
At 7/16/2008 4:23 AM, Blogger BGC said...

I agree - good work!

 
At 7/16/2008 6:43 AM, Blogger Matt said...

There are really only two things the federal government would have to do to in order to bring healthcare costs back to earth:

1) Sever the link between employment and health insurance by removing the tax advantage. Pretty quickly, that will get people to choose high-deductible plans.
2) Find some way to limit the power of the AMA. Perhaps create a competing GSE that has equal power as the AMA to accredit medical schools and license medical professionals.

 
At 7/16/2008 7:33 AM, Blogger Sophist said...

Excelent post and very well documented. I mostly agree with the reasoning. This time -- like several others times--it is both valid and sound.

As far as lawyers go, keep in mind that there are three things that are certain in life:

(1) Taxes (although due to Juandos efforts that may change)

(2) Death. Physical or even mental.

(3) That a some point in time, a lawyer will screw you.


I agree that whoever manipulates demand/suppy should be dealt with in every way possible. This includes all "legal" or illegal cartels like:

(1) OPEC
(1) AMA
(3) Market manipulators

 
At 7/16/2008 7:43 AM, Anonymous QT said...

matt,

While AMA may be powerful and may not wish competition, do they in fact fund all medical training?

As far as I know professional regulation bodies help develop guidelines for medical curriculi, set professional standards of training including residency requirements and licensing examinations, set standards of professional conduct, provide for liability insurance or set guidelines for mandatory coverage required, provide ongoing professional development courses, provide for grants & financial assistance programs and administer disciplinary programs.

Wouldn't the funding medical schools more correctly fall under the purview of government?

 
At 7/16/2008 8:10 AM, Anonymous rvturnage said...

Thomas Sowell pointed out this behavior of fixing supply by accrediting agencies in his Inside American Education book, if I remember correctly. A good book, still relevant after 15 years...

 
At 7/16/2008 8:20 AM, Anonymous qt said...

There is another consideration: cost of providing the product. Training a physician is far more expensive than training a lawyer. One would therefore expect to find fewer medical training programs and more programs in law, engineering, economics, etc.

The following passage highlights ongoing funding issues:

"In addition, during 2002-2003 medical schools derived 35.9 percent of their total revenue from faculty practice and 32.6 percent from grants and contracts (including direct and facilities/administrative costs). Maintaining these revenue streams requires considerable faculty effort and has provided some of the impetus to increase the size of the faculty,"

To imagine that the medical profession is not concerned about the number of graduates when they are studying and reporting the problem in JAMA strains credulity. It is just not logical that a profession that has identified a critical shortage of health care professionals in the next 10-15 years is actively engaged in trying to limit medical enrollment. While AMA had predicted in 1994 that improvements in public medicine would produce a surplus, this has not happened and the looming shortfall needs to be addressed.

http://www.cbsnews.com/stories/2006/06/17/eveningnews/main1726479.shtml

Average age of physicians in Arkansas in 2001:

http://www.healthyarkansas.com/stats/hpl2001/MEDFRM3.HTM

 
At 7/16/2008 8:33 AM, Blogger K T Cat said...

I know several doctors and they all hate their jobs. The job has gotten worse over the last decade as the workload on them has increased. One opthamologist I know was scheduled by her hospital to see 17 patients in one hour. It's insane. My son, volunteering at a local medical center, said the doctors rushed from one appointment to the next because they were overbooked and constantly falling behind.

If that is true, who is the AMA catering to by limiting medical school populations? In fact, I'm not sure I believe the AMA is trying to constrain the number of doctors. Do you have a source for this?

 
At 7/16/2008 9:35 AM, Blogger Brett said...

Very sloppy to confuse # of applicants and # of applications. The table from aamc includes this information in a footenote. All of those pretty charts paint an incredibly false picture.

We should expect better from an economist.

 
At 7/16/2008 10:10 AM, Blogger merloc said...

You are also unaware that you need a legitimate hospital to run the medical school. Most private hospitals don't want to waste money on teaching. You have to lower costs for hospitals to give incentive for them to start a medical school.

It is also a bit more competative then law school. 2 of my friends who didn't get in to any med school got into top 5 law schools.

If you think 150,000 for a doctor is too much to pay, I think they do the work of many nurses... maybe the nurses at 50-90k a pop are overpayed???

 
At 7/16/2008 10:13 AM, Blogger Walt G. said...

Do you have to attend law school or medical school in the U.S. to become a lawyer or doctor in the U.S.? If memory serves me correctly, that’s one of the reasons we invaded Grenada.

I’m not disputing the analysis. But, I wonder if foreign professional schools are a factor that needs to be considered over time. If trying to understand a doctor’s language is an indicator, I know we have a lot more foreign doctors lately, so I am curious where they received their medical education.

 
At 7/16/2008 10:50 AM, Anonymous Lars said...

Maybe we would have more medical schools if doctors could make a living suing lawyers for malpractice.

 
At 7/16/2008 10:53 AM, Anonymous QT said...

Walt g,

We do have more doctors coming into Canada & the U.S. from abroad to try to solve the present shortage which are bad in the U.S. and considerably worse in Canada particularly in many specialties like otolarnyxgology. Given the present restrictions on legal immigration and the need to fulfill AMA/CMA requirements, this source is not sufficient to meet the future needs of either country.

Most of us would appear to support increased medical enrollment and the development of new medical schools which would require substantial funding.

Here, there is an untapped resource, namely, Washington politicians. At present, many members of the house & senate as well as ex-presidents set up foundations in their name which raise considerable funds.

http://www.boston.com/news/nation/washington/articles/2006/05/07/limits_urged_on_political_charities/

If one created an elite panel to name new medical schools after "visionary leaders" in the House & Senate, one could leverage not only federal funding but extensive private funding networks. Only the most well-connected and influential would be considered for this honor and the panel could consist of former U.S. presidents as well as medical luminaries. Due to the limited number of new schools, the naming would carry considerable prestige.

Some members are particularly talented at finding earmarks to fund their pet foundations, like Senator Charles Rangel:

http://www.theneweditor.com/index.php?/archives/7086-Charles-Rangels-Monument-to-Me.html

Can heartily recommend Senators Byrd, Schumer, Rangel, Clinton, Dodd...what will these star-bellied sneeches do for their stars upon bars?

 
At 7/16/2008 10:58 AM, Blogger Walt G. said...

lars,

Doctors can do better than sue; they can legally kill. Lawyers don't have that Supreme power.

 
At 7/16/2008 12:33 PM, Anonymous QT said...

"legally kill"

A few salient facts for your consideration:

http://www.guttmacher.org/pubs/fb_induced_abortion.html

From the above:
"The number of U.S. abortion providers declined by 2% between 2000 and 2005 (from 1,819 to 1,787). Eighty-seven percent of all U.S. counties lacked an abortion provider in 2005;"

Number of physicians in the U.S. is given as 1.5 Million on Google Answer:

http://answers.google.com/answers/threadview?id=592995

AAMC which represents all 129 medical colleges has also been calling for raising enrollment by 30%:

http://www.aamc.org/newsroom/pressrel/2006/060619.htm

 
At 7/16/2008 12:49 PM, Blogger Walt G. said...

I didn't mean to imply anything about abortion, or anything else along those lines. You have to admit a doctor's routine mistake is often a lot more important or life altering than the average worker’s mistake.

 
At 7/16/2008 1:06 PM, Anonymous Anonymous said...

US is taking in several thousands of foreign medical graduates ( some of them are US citizens studying abroad and most are foreign MD's). overall aprox. 20-25% of practicing MD's have done their medical school overseas and have done only residency in USA. nobody is restricting this access. so the AMA cartel hypothesis does not hold completely (why not let more Americans to become MD's and bring in foreign nationals. the limiting factor is the vast infrastructure one needs to train a medical student. books, labs, computers is no big deal but one needs older docs being willing to teach and chaperone/supervise medical students while in contact with the patients( it pays less to do academic medicine than private practice).

I can not say how much is real constraint related with limited ability to involve more older docs in teaching and how much docs cartel.

 
At 7/16/2008 1:24 PM, Blogger das Kapitalist said...

The demand for a medical education is higher than the supply. Hence 97% of applicants get rejected.

What is so unique about the medical education market that there is trouble meeting the supply? It is not the cost because the cost is built into the demand and only 3% of the demand is being met.

I believe it is the accrediting agency, the AMA, that limits the number of schools that are accredited in the United States. The AMA doesn't have this power outside the United States which is why we are able to import so many of our doctors.

 
At 7/16/2008 1:27 PM, Anonymous QT said...

Walt g,

Sorry for the misunderstanding. Agree that the decisions and any errors are far more critical than those of the average worker with a few exceptions like air traffic control or structural engineering.

Designing systems for patient management and handover have become increasingly important to reduce errors.

 
At 7/16/2008 2:21 PM, Anonymous Anonymous said...

"the decisions and any errors are far more critical than those of the average worker with a few exceptions like air traffic control or structural engineering"--true--but I don't think many structural engineers or air traffic controllers have the level of arrogance often found in physicians.

 
At 7/16/2008 3:30 PM, Blogger the buggy professor said...

"Do you have to attend law school or medical school in the U.S. to become a lawyer or doctor in the U.S.? If memory serves me correctly, that’s one of the reasons we invaded Grenada" -- WaltG

No, you don't have to attend a medical school in the US to practice here. You can get an M.D. degree outside the country --- a few of my former undergrads from UC Santa Barbara went to Mexican medical schools --- but you do have to pass each state's medical exams. Presumably, too, you have to show you'd had equivalent internships abroad . . . or do them here.

My current general M.D. in Santa Barbara is one of those former students --- he was in a good program in Guadalajara, Mexico --- returned here, and has been a successful M.D. ever since, serving both Spanish-speaking and English-speaking patients. He never even knew Spanish before he arrived in Guadalajara.

The California state exams, as in law, are very demanding by the way.

-- Michael Gordon, AKA, the buggy professor, http://www.thebuggyprofessor.org

 
At 7/16/2008 3:54 PM, Blogger Walt G. said...

Thanks Buggy Professor.

So, we would need to know if the number of medical students from abroad who go on to practice in the U.S. has stayed constant from 1994 to 2005 to make a valid comparison to law schools in the same time frame. At the same time, any law students from abroad who go on to practice in the U.S. would need to be accounted for, too.

 
At 7/16/2008 4:22 PM, Anonymous Anonymous said...

the number of foreign medical graduates (FMG's) is known as all have to get credentialed through ECFMG based in Philly. as far as I know the latest numbers show a decrease in the number of foreign docs coming in the US as there are better job prospects for them now in their own countries. most of them come from India, China, Arab world and Eastern Europe and most of these countries have enjoyed rapid economic growth in the last decade allowing them to invest masivelly in new medical facilities. India is now one of the top exporter of medical services - hundred of thousands of pacients from developed world (including ten of thousands Americans) and rich from emerging countries travel to private Indian hospitals to get surgery at lower prices than offered in their countries ( knee and hip replacement, coronary bypass are at 1/3 to 1/2 of the prices charged by American and UK hospitals). some of these hospitals have US accreditation and all of their physicians are trained and licensed in the US or UK. US is still the world largest provider of medical services for foreign citizens but private hospitals in India, Thailand and Mexico are getting an increasing share of this lucrative market ( as the medcal tourist are paying cash for their services; some US insurance companies started paying for procedures outside of the US also if the hospitals meet US accreditation standards).

on the same page a larger proportion of the ones who did come to US for training (via residency programs in American university hospitals)choose to return to their countries or go to the Gulf states where is increasing demand for their skills and US requires them to go to medically underserved areas in the US in order to receive US resident status.

 
At 7/16/2008 4:22 PM, Blogger Max said...

A low supply of doctors keeps their salaries high that's true, but it also attracts smart people to the profession. If you were more lenient and accepted lower quality applicants salaries would go down and not as many smart people would be attracted to this profession. As the quality of doctors goes down the chance of us using all those law school graduates for medical lawsuits will be much higher. I personally would rather pay more but know that my health is in the hands of the top 3%.

 
At 7/16/2008 4:59 PM, Anonymous Anonymous said...

more data about FMG's ( I see the language changed: they are now called International MG) on AMA site:

http://www.ama-assn.org/ama/pub/category/211.html

all the FMG's accredited by ECFMG have to pass the same licensure exams the US medical graduates have to pass + an extra clinical skills exam + language proficiency exam + they have to graduate from an international medical school that has a curriculum that is similar to the curriculum of US med schools and verified by the ECFMG.

so 25% of the physician workforce in the US has graduated from international medical schools, and the proportion of the younger physicians is even higher. why the US medical establishment can not educate more Americans in this proffesion is not quite clear to me. it is known that medical school is quite demanding and there is a fair number of drop-out students or students who fail to pass the licensing exams and go instead to PhD's in public health or health administration.

the rapid solution will be to decrease the standards of education and licensure but that will be probably more deleterious for the society as a whole. I believe that the AMA policy to allow high quality international medical graduates to get residency training and then practice in the US does increase the supply of physicians for the American patients. as the flow of these physicians from abroad dwindles there will be more need for increasing the supply from within the US either by increasing number of US medical school graduates or send more American college graduates to foreign medical schools ( ex. by subsidising part of their education costs, or allowing them to get federally subsidised education loans to purchase medical education from abroad). ramping up the number of US medical school graduates will take longer but should be done too as demand will increase. also should be known that training a MD takes 7 to 10 years after college and requires a lot of commitement and resources.

to improve acces for routine care the physician assistants and nurse practitioners can fill in the void ( the idea of retail clinics manned mostly by these non-MD practitioners). the truth is that the current physician workforce ( especially in primarry care) is overstretched. physicians in the US are seeing in average more patients in a workday than physicians in other developed countries ( they are payed better too) but forcing more volume through the same workforce ( be it highlly skilled) will lead for sure to decreae in quality.

 
At 7/16/2008 5:07 PM, Anonymous Anonymous said...

"I personally would rather pay more but know that my health is in the hands of the top 3%".

Me too. But, don't assume that the 3% accepted is the same at the top 3% of applicants in terms of ability. There are other factors and demographics considered on the application.

 
At 7/16/2008 5:25 PM, Anonymous Logos said...

IIRC somewhere around 1/3 of those who apply to medical school are accepted by at least one school (standard advice is apply to every school in your state plus a handfull of out of state).
Medical schools generally claim that medical education is a financial looser for them, despite 100s of thousands of dollars per student in tuition. If true, that would discourage opening of new schools. As pointed out, the barriers to entry into medical education are exceedingly high. You need a major medical center with research faculty in all major fields (to teach in the classroom) and clinical faculty in all disciplines of sufficient number to accommodate all of your students. Currently the quality of accepted med school applicants is very high. A drastic increase in # of accepted students would drastically decrease quality (which could arguably be an acceptable tradeoff, however preselection of only the best students is one of several major factors that differentiate physicians from mid-levels and technical personnel.

 
At 7/16/2008 5:26 PM, Anonymous Anonymous said...

Please check out this response and some of the other posts on this topic. Very informative.

http://thehappyhospitalist.blogspot.com/2008/07/physician-cartel.html

 
At 7/16/2008 5:45 PM, Blogger Mark J. Perry said...

MP: I am very, very sorry for the initial post, where I incorrectly reported the number of APPLICATIONS to medical school instead of the number of unique APPLICANTS to medical school. Thanks to the several people who pointed that out immediately.

I had been working on the post for several hours, it was going on 1 a.m. in the morning, I lost the data and graphs several times due to computer crashes, and I rushed to get the post up before going to bed.

I realize that is no excuse, and I'll try to be more careful in the future. Please accept my apologies. One distinct advantage of a blog is that changes can be made immediately when errors have been made. I appreciate the feedback.

 
At 7/16/2008 7:16 PM, Anonymous Dr. T said...

I don't believe I have ever seen so much misinformation in one post and comment section.

First, comparing the rise in law schools since 1963 to a decline in medical schools since 1908 is just dumb. Those 168 schools were mostly small (and mostly awful).

Second, claims that medical schools have a 97% rejection rate (das kapitalist) are totally off the wall. Even at its most competitive period (1960s), the rejection rate was ~75%. The current rejection rate is less than 50%. And, that is with medical schools accepting applicants who would have been immediately rejected as unqualified 25 years ago.

Here's the real truth: being a good doctor is difficult and requires intelligent, logical, and diligent persons who also have excellent communication and interaction skills. Few people meet those requirements, and many of them choose other professions. Therefore, most of the doctors today are not very good. So, pardon me if I don't join the "it's too hard to get into medical school" bandwagon. It's been too easy to get into medical school since 1986. (The AIDS crisis resulted in many young people choosing careers outside of health care, and medical schools accepted weak applicants to fill their classrooms and get the federal support dollars.)

My background: Currently an associate professor at a state medical school. Served on admissions committee for 3 years.

 
At 7/16/2008 8:08 PM, Blogger (Z) said...

Good post. I hope the thread continues.

I've looking at a few interesting related things: physicians per 100,000 1970-2003, physicians per 100,000, by state and a list of the best medical schools.

 
At 7/16/2008 8:15 PM, Blogger Joe said...

I agree with many of the posters that the restriction in the number of doctors may not be a deliberate ploy to increase doctor's wages. Nonetheless, the AMA cartel and their monopoly on certification is still a problem. They are not serving the needs of the customers (patients). Perhaps one reason is that they have overly strict standards. A lot of people here and probably within the AMA are probably convinced that relaxing standards would only lead to poorer service and thus lower medical quality, but the high standards are restricting the number of places that can serve as medical and the profitability of medical schools and restricting the number of medical students and thus the number of doctors. Obviously, having too few doctors decreases quality of medical service. In other words, if relaxing standards can increase the number of doctors, then a balance needs to be struck between high standards and having enough doctors. If there were other certifying agencies we might have more diverse responses to this doctor shortage. From the looks of it, the AMA just sounds like it's a money problem: it costs more money to open more schools, so we just need more money, without being willing to make the type of compromises that could best serve the needs of the customers, which includes both quality medical service and affordable prices (whether one pays via an insurer or directly).

If people are worried about medical malpractice, I read somewhere (I think it was in Gladwell's Blink) that the more time a doctor spends with a patient the less likely they are to be sued; ie the more attentive the doctor is and the more the doctor listens to the patient, the better. Patients like this, and aren't inclined to sue doctors they like, even if that doctor errors. Thus, these overworked doctors are a formula for malpractice and thus means more work for the abundance of lawyers.

 
At 7/16/2008 8:56 PM, Anonymous Anonymous said...

The real problem to ramping up the number of practicing physicians is not medical school, it is residency.

Residency is the supervised training period of MDs after they have finished school and before they have any real experience. Doctors pursue residency in a specialty field (eg Pediatrics, Surgery, Internal Medicine, etc.)

Patients often don't want to go to teaching institutions as they don't want to have inexperienced physicians involved in their care. Teaching hospitals can only accept a certain number of residents based on patient volume. So even if there were an dramatic increase in the number of newly graduated MDs they would not have places to train.

 
At 7/16/2008 10:47 PM, Anonymous QT said...

Dr. T,

Thank you for your patience with us. It is a complex subject and we are all trying to understand the issues.

Appreciate your perspective on this subject particularly on enrollment rejection numbers and the difficulty of attracting students to a very demanding profession. I agree that the comparison to law is more misleading than informative.

Anon. 8:56,

AAMC has identified the shortage of residency positions as a key challenge. Unless the number of residencies is increased, one is only talking about American candidates filling spots instead of foreign trained doctors.

 
At 7/17/2008 2:45 AM, Blogger juandos said...

A very interesting variety of comments here...

Two items I noted weren't mentioned but wonder if they were somehow implied:

1) government mandated paperwork

2) malpractice insurance premiums

BTW the sophist taxes are legal but being taxed for Constitutionally (Art. 1 Sec. 8) questionable nanny state programs (and a myriad of other programs) is the problem...

qt says: "Wouldn't the funding medical schools more correctly fall under the purview of government?"

What part of the Constitution mandates federal intervention in medical school standards?

The two items I mention might be part of the reason that many doctors seem harried and that on occassion some of their work might be questionable...

'Doctors can bury their mistakes' as the old saying goes but I don't think this is quite so true...

I still of the opinion that most people go into medicine for the best of reasons, they do want to help people...

 
At 7/17/2008 2:53 AM, Blogger OBloodyHell said...

> In other countries, it's much harder to become a lawyer. In the United States, the doors are open and getting wider.

Now drop your pants and grab your socks, because sooner or later, some lawyer is about to "open doors" and "make things wider" just for *YOU*...!

:oP

 
At 7/17/2008 3:02 AM, Blogger Sophist said...

TO MP:

I still think that the number of applications is a significant number and shows the effort made from the part of the applicants to secure a position in one of the schools.

At the same time, the percentage rejected shows the limitations of the system. When one school rejected an application it does not take into account whether the same person has applied to another school.

Thus, from this point of view, and unless there was a centralized application handling system, the number of applications represents number of applicants from the point of view of the system performance and possible manipulation.

In other words, I am saying that the number of rejected applications is as important as the number of new entrances.

It would be interesting to know whether rejects overlap or some admitted to one school are rejected by several others.

In that case, it would indicate more of a policy of rejecting rather than a true evaluation of capabilities.

 
At 7/17/2008 3:19 AM, Blogger das Kapitalist said...

Dr. T.

I was clearly wrong about the 97% rejection rate. Thank you for your correction. I am not sure where I pulled the number from.

However, I think your claim that the AIDS crisis scared away qualified medical students in the 80s and it has been too easy to get into medical school ever since is a bit conspiratorial.

Right now the average medical student has an undergrad GPA of 3.62 and an MCAP of 29.9.

 
At 7/17/2008 3:31 AM, Blogger juandos said...

Two articles from the American Enterprise Online magazine that are I think tangentially involved with medical schools and their output:

Let's Move Medicine Into the Information Age

By Bill Frist

when the New England Journal of Medicine used 11 measures to compare VA patients with Medicare patients treated on a fee-for-service basis, the VA's patients were in better health and received more of the treatments professionals believe they should. According to the VA's own medical professionals, a computer system called Vista is the key to their success. "I'm proud of what we do here, but it isn't that we have more resources," explains Sanford Garfunkel, the director of the Washington VA Medical Center. "The difference is information."

======================

"Live" with Leon Kass

Leon Kass is a medical doctor, biologist, ethicist, philosopher, and teacher. After decades as a professor at the University of Chicago, he accepted responsibility for chairing President Bush's Council on Bioethics, a position he held from 2001 until last year. Today he is the Hertog Fellow in Religion, Philosophy, and Culture at the American Enterprise Institute...

 
At 7/17/2008 9:16 AM, Blogger Matt S said...

Juandos, you can't really harp on me reading the Nation and Harper's if you're puling from the AEI. Especially if it's an article by Bill Frist, the man who should have his MD license revoked for sheer stupidity. I'll read what he has to say, as my folks are doctors and I keep up on that stuff, but really. It's Bill Frist.

Also, I noticed you mentioning something about doctors filling out paperwork, and I wonder what you think of the unofficial statistic I got from my psychiatrist mother that "most doctors would rather have a universal healthcare system than the one we have now."
She obviously hasn't polled every doctor, but she and my stepdad meet a lot of doctors and this kind of debate certainly pops up at AMA meetings and elsewhere.

 
At 7/17/2008 9:46 AM, Blogger the buggy professor said...

Dr. T:

Thank you for your informative post, the only one from a knowledgeable and qualified expert.

Would you mind going farther and indicating what you think the strengths and weaknesses of medical education happen to be?

Among other things, I know from talking to older M.D.'s that they had to memorize a tremendous amount about human physiology in the first year or two of medical school --- say, before the 1980s --- and found it largely superfluous and anyway something they tended to forget by the third and fourth years of clinical training.

......

From what I remember seeing a good PBS documentary, medical education changed in the late 1980s or early 1990s . . . at any rate, in certain medical schools. They began to immerse students in the first year in clinical work.

Anyway, we'd all be grateful to you for any more illuminating remarks.

-- Michael Gordon, the buggy professor: http://www.thebuggyprofessor.org

P.S.

Mark: No need to apologize. You, like me and some other bloggers, range very widely every time you post. Until your harsher critics here try doing the same, they will continue to be uninformed just how hard it is to avoid making mistakes. Most bloggers avoid them by keeping their comments little more than rehashed opinions --- short as well --- of what others have said elsewhere on the web.

Your posts are without rival, I believe, for their data-filled charts and commentary. I say this as a moderate independent, not a libertarian. Keep up the good work, please!

-- Michael

 
At 7/17/2008 10:10 AM, Blogger Walt G. said...

I agree with the buggy professor. You should not be worried about making mistakes or feel that you must apologize for anything you write. Blogs such as these are a collaborative learning environment. Accordingly, differing points-of- view or a different methodology choice strengthens—not weakens—the post. Keep up the excellent work!

 
At 7/17/2008 10:11 AM, Blogger Marko said...

Havent read all the comments, but isn't this a result of the more or less free market? I like the idea of fewer law schools, since that would probably push up my lawyer salary. More medical schools will make doctors get less pay for what they do - I doubt they like that.

As long as lawyers make lots of money (and about 20% of us do), then they will make more lawschools.

 
At 7/17/2008 10:44 AM, Anonymous Anonymous said...

I just wanted to add my 2 cents. Because so many qualified applicants are being turned away from enter med school, I think this is causing an increase in both demand and supply of NP's and PA's....maybe that is what the insurance companies want since they are "cheeper."

:) NP2Be

 
At 7/17/2008 11:08 AM, Blogger randian said...

Also, I noticed you mentioning something about doctors filling out paperwork, and I wonder what you think of the unofficial statistic I got from my psychiatrist mother that "most doctors would rather have a universal healthcare system than the one we have now."

They think a single-payer system in the US won't drastically reduce their income, and that they will save more in bureaucratic overhead than they lose in billings. That suggests most doctors practice wishful thinking.

 
At 7/17/2008 5:23 PM, Blogger Marko said...

In my experiance, PAs are better than MDs for most routine purposes, and nurses are underutilized. Clinics do a better job of using these adequately skilled professionals.

Personally, I think medical training for doctors today is overkill. All that nonesense is not needed for most specialties. yet another barrier to admission to make them more valuable.

 
At 7/17/2008 6:07 PM, Anonymous QT said...

Juandos,

Agree that paperwork and increased liability insurance as well as gruelling work schedules tend to discourage people from careers in medicine.

Information technology has hugh potential to improve health care delivery and reduce medical errors:

http://www.annals.org/cgi/content/full/0000605-200605160-00125v1

With regard to federal funding of education & the constitution, there are a great many things that are funded by government since FDR for which there is no constitutional basis. The comment was intended to clarify the role of the AMA:

http://www.ama-assn.org/ama/pub/category/1815.html

Each of us draws a different line on social spending. Funding for medical education would seem to offer better value than many other forms of spending, ie. Amtrack, bridges to nowhere, subsidies for sugar producers and corn ethanol, etc.

Regretfully, I do not believe that the U.S. will ever fully embrace libertarianism.

 
At 7/18/2008 4:33 PM, Blogger juandos said...

Interesting but substanceless comment matt s: "Juandos, you can't really harp on me reading the Nation and Harper's if you're puling from the AEI. Especially if it's an article by Bill Frist, the man who should have his MD license revoked for sheer stupidity"....

Let's see, the Nation and Harper's very much in bed with the leftist, liberal wing who've walked off the edge of sanity quite some time ago versus conservatives who understand basic economics at AEI...

Gee! That's a toughie...

Aw heck! I'll go with the folks that understand basic economics everytime...

BTW what is this alledged stupidity you claim as the reason Dr. Frist should lose his license?

Hence the reason I said your comment was 'substanceless'...

"Also, I noticed you mentioning something about doctors filling out paperwork, and I wonder what you think of the unofficial statistic I got from my psychiatrist mother that "most doctors would rather have a universal healthcare system than the one we have now." "...

Hmmmm, I would say your mom's grip on reality is every bit as tenuous as your's...

Locally any doctor that can get into medical practice that doesn't involve having to deal with the federal government is doing so...

The Regulatory Burden Facing America’s Hospitals

Moral Health Care vs. “Universal Health Care”

 

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