Tell me why? Ain’t nothing but a heartache… Ain’t nothing but a mistake… to be a doctor

Although not in the same realm as the song by the Backstreet Boys, becoming a doctor contains its own share of lifetime heartache. An article from 2008 titled “Reasons Not to Become a Doctor” from Forbes neatly summarizes the difficulties faced by doctors in the US. These include rising costs to practice, rising malpractice insurance fees, repaying school debt, and lower salaries with longer hours(a 7% decline in real salary when adjusted for inflation) just to name a few and to not mention the daily difficulties faced by doctors. Sure sounds like an attractive field combined with 10 or more years of education and training. Along with other factors including an aging population and retiring workforce, the AAMC projects a shortage of 150,000 physicians across all specialties by 2025. In a recent New York Times article “After Years of Quiet, Expecting a Boom in U.S. Medical Schools” the response has been an expansion in the number of medical schools in the US and the AAMC has called for an increase in enrollment by 30%.

Of course this plan has its criticisms. Physicians usually end up in places where there are already enough.

“When you add more physicians to an area, they just add more services, and their salaries don’t go down anywhere near in proportion to the increased supply,” said Dr. David Goodman, professor of pediatrics at the Dartmouth Institute for Health Policy and Clinical Practice and a practicing physician who has studied work force issues for 20 years. “More care may not be better, but it certainly is paid for,” Dr. Goodman said.-“After Years of Quiet, Expecting a Boom in U.S. Medical Schools”

Salaries probably don’t go down because doctors may be a constant cost industry, an industry where long run average costs remain the same. They need to cover their overhead, insurance costs, and debt while still being paid appropriately for the years of training and long hours they work. While increased supply in the physicians may not have short term increases in benefit for the general population, having a large supply of medical workers including nurses and physician’s assistants on hand may be well worth it for the future when the allocation of medical services to the general population has improved. The future benefits may not only be limited to the U.S. but to developing countries as well.

With the increased number of medical school graduates, the limited residency positions in the U.S. will be primarily filled by U.S. graduates rather than international medical graduates (IMG) who now often take undesired residencies. This will serve to limit the number of IMG from African countries like Ghana and Nigeria who lose almost all their graduates to migration. The result of migration is a severe shortage of physicians in Ghana where the ratio is 6.2 physicians for 100,000 people compared to the U.S. where it is 279 physicians for 100,000 people, yet there will still be a shortage in the U.S. But with more graduates, the establishment of sister relationships between medical schools in the US and developing countries can serve to help relieve the burden of shortage by providing exchange students an opportunity to study in the US and sending more U.S. students to serve in an impoverished region. This approach can hopefully increase medical supply in developing nations even if it does mean becoming more dependent on temporary exchange students and denying their own students an opportunity to go abroad.

For all of this to occur, we have to keep in mind that it has to be worth it or we will always be in a shortage.


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