Why Is This One Different from the Rest?

While I think that increased scrutiny of medical education in the United States, one example of which is this op-ed in the Washington Post from medical resident Akhilesh Pathipati:

U.S. physicians average 14 years of higher education (four years of college, four years of medical school and three to eight years to specialize in a residency or fellowship). That’s much longer than in other developed countries, where students typically study for 10 years. It also translates to millions of dollars and hours spent by U.S. medical students listening to lectures on topics they already know, doing clinical electives in fields they will not pursue and publishing papers no one will read.

Decreasing the length of training would immediately add thousands of physicians to the workforce. At the same time, it would save money that could be reinvested in creating more positions in medical schools and residencies. It would also allow more students to go into lower-paying fields such as primary care, where the need is greatest.

is not only completely warranted but long overdue, I find it sad that a physician is so ignorant of public policy related to medicine, economics, and human behavior in general, let alone an MD-MBA as Dr. Paripathi is. I strongly doubt that lowering the cost of medical education will have much effect on the number of graduate physicians who pursue primary care. IMO the greater factors in choice of specialty are revenue expectations and lifestyle reasons not costs.

But the biggest thing missing from his analysis is that the gating factor in the number of physicians isn’t the number of qualified applicants or the length of classroom medical education, or any factor other than the number of medical residents that the Medicare system will pay for. Most Americans aren’t aware of it but each and every medical resident in the United States is subsidized to the tune of $80,000+ per year.

Post-high school medical education in the United Kingdom, from classroom to specialization is around nine years. It’s the same in Germany and slightly longer in France. We, as in so much are the outlier.

1 comment… add one
  • steve Link

    Mostly correct. If you actually talk with medical students you will find that not many are very financially sophisticated. They really do worry about paying their loans, so if they were lower I suspect that more would go into primary care, just not sure how many. The lifestyle for primary care is generally better, so w/o the big debt it might help. True, a lot millennials want a cushy lifestyle AND lots of money, but I think that most of them realize that isn’t really going to happen.

    One of the things puzzling me about this is that Congress capped the number of residents it will pay for at 100,000. We have a total of about 900,000 licensed physicians (maybe 100,000 of those are inactive). It seems like we should be able to replace everyone every 9 years or so. Must be a much higher dropout rate than I have appreciated. Tis a puzzle.

    Steve

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