Thursday, October 5, 2017

The 2017 US medical school graduates: An in-depth look

According to a survey published by the Association of American Medical Colleges (AAMC), the 2017 graduating class has a median medical school debt of $180,000. The figure has remained stable for the last three years. Nearly 27% of students say they had no debt at all.

When the cost of pre-medical education is included the total debt climbed to a median of $195,000.

Despite those numbers, 54.5% said their choice of a career specialty was not based on the level of educational debt. Instead, over 98% said they chose their specialty based on its fit with their personality, interests, and skills.

The survey was offered to all 19,242 graduates of the 140 US medical schools with 15,609 (81%) responding. Some did not answer every question.

Most of the respondents (90%) were satisfied with the quality of their medical education. Only 7.6% said that if they could do it over they would not or probably would not enroll in medical school again; 9.1% gave a neutral response; 7.7% did not answer. Over the last five years, responses to this question have not varied much.

Slightly more than half (52.8%) said they wanted to live in a large city (>500,000 population) or the suburb of a large city, and only 7.8% said they would live in a city of less than 50,000, a small town, or a rural area.

About one-third of those responding said they planned to care for an underserved population with about 25% saying they were going to work in underserved areas. How this reconciles with their plans for the location of their practices is not clear. It would be interesting to survey the same students in 10 years to see how many actually ended up caring for the underserved.

A whopping 15% of seniors said they eventually hoped to work in California while no other state even reached double figures. The next highest state graduates planned to work in was New York at 6.1% followed by Texas at 5.9%.

The answer that elicited the most buzz on Twitter was “In which of the following activities do you plan to participate during your career?” Just over 28% responded “Administration (E. G., Department Chair, Dean).” That percentage has been about the same since the question was first asked in 2015.

So how many future deans and department chairs will come from the class of 2017? By my calculation—4099. Add that figure and those wanting to become administrators from the classes of 2015 (3700) and 2016 (3927), and you get 11,716. It looks like we will not have a shortage of administrators anytime soon.


artiger said...

As someone who was raised in, and currently practices in a truly rural area (my county has less than 14,000 residents), I just shake my head when I read what people that have never lived in a town of less than 50,000 consider to be rural. Although they just don't have a clue, we have had a limited amount of success with getting students from the osteopathic schools in this region to send students to rotate with us for a month or so at a time. Most of them have enjoyed it, and have been pleasantly surprised at how life in the sticks is more livable than they thought.

Jack Williams said...

With %25 saying they were going to work in underserved areas, can HHS through the medicare fund require the hospitals to consider the willingness or the commitment to work in underserved areas as a factor in considering applicants for residency?

Skeptical Scalpel said...

Artider, there's a lot to be said for rural life. Slower pace. Everyone knows everyone else. Usually less crime. Etc.

Jack, I don't think Medicare could do that. What someone plans to do often is not what they eventually do. A few years ago, med school applicants were coached to say they wanted to do family practice so they would have a better chance of being accepted. I wanted to be a psychiatrist before entering med school. That idea faded quickly.

SolitaryFlower said...

I ran the 28% Admin figure past a medical student just now, and he grimaced. "Ugh! Why... why go through all this just to NOT practice medicine?"

Skeptical Scalpel said...

Solitary, to be fair, nearly all dept chairs and many deans practice medicine at least on a part-time basis.

artiger said...

Perhaps a medical degree is morphing along the lines of a law degree...I've heard many people talk about going to law school for the education, but having no intention of practicing law.

On another note, I have a friend who came from a medical family, and more or less went to medical school out of pressure. He dropped out of school after 3 years, hating it, and went on to get his pilot's license. He now is a cropduster with his own flying service, and has no regrets about it. He seems to be doing as well or even better than any physician around here.

Skeptical Scalpel said...

Going to med school because your family wants you to is a bad idea in many cases. I wonder what the burnout rate for cropdusters is.

Chris said...

"54.5% said their choice of a career specialty was not based on the level of educational debt." That means nearly half picked their specialty BECAUSE of their debt!

If we're loading students with incredible amounts of debt, how do we expect to alleviate the most acute shortages in the system (especially primary care) when we're asking them to take a pay cut of >50% in some cases as compared to entering a higher paid subspecialty?

artiger said...

Chris, I am in no way defending the compensation disparity between primary care and specialties, but there is a notable difference between them as to the amount of time in training. Primary care (family practice, internal medicine, pediatrics) takes 3 years of residency. OB/Gyn takes 4. General Surgery takes 5. Radiology takes 4, with more if one wants to do an interventional fellowship. Cardiology, pulmonology, nephrology, dermatology, GI, infectious disease, etc., take internal medicine plus 2-4 more years. Cardiothoracic surgery takes general surgery plus 2-3 more years. Orthopedics takes 5 years, or more with fellowship. Neurosurgery takes 7 or more years. And so on.

Also, with primary care, you have a lot more freedom of choice as to where you practice, i.e., rural, suburban, urban, academic. You can't be a neurosurgeon in an isolated small town in Alaska, as an example. So there are tradeoffs.

Lady Anne said...

As a lay person, I always felt that General Practice doctors really needed to know more than a specialist. You need to be able to recognize - and possibly treat - all manner of illnesses. Treat HTN and other cardiac problems, gastroenterological illnesses, etc. Many times a good GP can save the patient the time, trouble and expense of trotting off to a specialist.

Your mileage may differ.

Chris said...

The ability to limit your practice to a scope of your preference is (or should be) its own reward. I don’t think an extra year or two of training in service of that justifies lifetime earning differentials that can exceed $10 million

Skeptical Scalpel said...

Lady Anne, the operative word in your comment is "good." I think it's hard for GPs to know how to treat everything. Some of them more or less triage sick patients to multiple specialists.

Chris, I'm not sure how you arrived at $10 million. Among other things, there's the massive difference in malpractice premiums that most of the higher paid specialists must account for.

artiger said...

Scalpel, I'd add (in response to Chris, respectfully of course) that a year or two or four of making even low 6 figures is a big jump when it comes to accumulating savings and repaying educational debt.

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