Surge in the number of medical schools

[LarryC]

There are more and more concerns that we're moving into a shortage of doctors, and there have been discussions on the forum about US medicine holding down numbers for economic reasons. Whatever the causes, the ACA (Affordable Care Act aka "Obamacare") is probably going to aggravate things as patients find it possible to see real docs instead of emergency rooms.

Recently, after many years in which the number of medical schools was stuck at around 126 or 127, there has been a recent upsurge in starting new schools and moving that number steadily upward to 138 currently, with more to come:

Monday's issue of the LA Times discussed the ongoing effort of UC Riverside to open a new medical school. Turned down last year by the LCME, the school has new funding and recently underwent a new LCME site visit. The LCME currently lists three "Candidate" medical schools: UC Riverside, the Frank H. Netter MD School of Medicine at Quinnipiac University, and Western Michigan University School of Medicine. Listed as "Applicant" schools are: California Northstate University College of Medicine, Palm Beach Medical College, and the King School of Medicine and Health Science Center. California Northstate and Palm Beach are for-profit institutions. There are currently no LCME-accredited for-profit schools. University of Arizona College of Medicine-Phoenix recently received stand-alone Preliminary Accreditation from the LCME.

Numbers of graduates can be found here, http://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_States. It shows that male graduate decreases almost offset female increases, with a pretty slow overall increase in total MD medical graduates so far. That will accelerate as more schools come on line and begin to admit and graduate (4 years later) more and more MDs.

Keep in mind that the above figures are only for MD schools and graduates. Osteopathic (DO) schools are also increasing, and adding to both total numbers and increases.

Starting a medical school is a very expensive and sometimes political process that takes upwards of 10 years as a rule before you see the first doctor graduate. These factors are the biggest barrier to new schools and more doctors. Of course, a new grad is at least 3 to 7 years away from actually starting practice, because of the additional training and specialization required and desired. Even the family physician, the successor to the old general practitioner, takes 3 years after med school.

So, it can take 10 to 20 years from initial efforts to start a school, to moving new physicians into practice. I think they're playing a lot of catch-up now.

[jacksonbart]

I think you also need to consider how many graduates of a US medical schools who are from other nations and intend to return to those nations after their graduation, the US is the largest exporter of graduate education. Also those graduating will often choose specialities that pay better than general practitioner such as dermatology, neurological surgery and orthopaedic surgery.

[LarryC]

You are absolutely right. I didn't try to assess total numbers of physicians, only the med schools upswing. As I recall, "international medical graduates" (IMG's) make up 20% or 25% of US physicians!

Some have complained for years that med schools were not graduating enough, while hospitals were offering too many residency positions. The gap between around 15,000 or so US med school grads annually and enough positions to admit over 20,000 residents per year has been seen as a magnet drawing IMGs into US practice. Why is this is significant? Residency training is virtually the ONLY pathway to medical practice in the US -- all states but one require residency training before they will issue a license. So, you can't practice without it. There are a number of barriers to IMG's entering residency, which probably holds their numbers down.

Perhaps strangely, or perhaps not, there are still no studies of whether higher pay by specialty influences the number trying to enter them, but I think you're right about the desire. Nevertheless, IMG's have made up higher percents of primary care specialties like family medicine, internal medicine, and pediatrics, than many super-competitive specialties. Nevertheless, it looks to me that residency programs choose residents mostly based on qualifications, and many IMG's compete extremely well against USMG's, so we do see IMGs in some high-paying specialties.

[tube fanatic]

It isn't just medical schools which are on the upswing. Check out this article about optometrists:

http://www.healio.com/optometry/primary-care-optometry/news/print/primary-care-optometry-news/%7B3320E43B-DFBC-4697-B93C-9D775AE012D0%7D/Optometric-profession-debates-increase-in-number-of-schools

Only in this case the concern is a massive oversupply. In some parts of the country there are so many in a small area that none are able to earn a passable living. I have a relative in the field who has been expressing concerns over this for years.