Friday, February 22, 2013

Law school applications are way down; could it happen to med schools?

The number of people applying to law schools is in steep decline. So says a recent post on a website called “The National Jurist.”

The post cited some remarkable statistics from the American Bar Association. In 2012, law school applicant numbers were down 14% from 2011 and 23% from 2010.

For the fall of 2012, there were 44,481 first-year law students enrolled, a drop of about 4,000 from 2010.

Many schools have decreased enrollments with more than 90 cutting class sizes by more than 10%.

On January 2, 2013, the Wall Street Journal said, “The Bureau of Labor Statistics estimates that the economy will provide 21,880 new jobs for lawyers annually between 2010 and 2020; law schools since 2010, however, have produced more than 44,000 graduates each year.”

For the non-math majors, that’s a ratio of more than two graduates for every job.

There are way too many lawyers around anyway.

Could something like this happen in medicine? It might not be exactly the same, but an interesting dilemma is looming. A 2011 paper in the New England Journal of Medicine expressed concern that in a couple of years, the number of US medical school graduates will exceed the number of first-year residency training positions available.

In response to projected physician shortages, many medical schools have expanded their class sizes, and several new medical schools have opened or are soon to open.

But the problem is that many years ago, the federal government established a cap on the number of residency training positions in this country. And there are persistent rumors that spending on graduate medical education (GME) will be among the many future budget cuts. It is also not a “given” that existing residency programs could be expanded or more programs could be established even if funding became available.

Here is what Dr. Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education, had to say in that NEJM article. “We estimate that … domestic production of medical school graduates [will] functionally surpass our current total number of GME postgraduate year-one pipeline positions (posts that lead to initial specialty certification) by 2015 or sooner.” This excludes 10,000 non–US citizen international medical graduates (IMGs) and 3700 US citizen IMGs who seek GME posts in U.S. teaching hospitals.

In other words, not only will there not be enough residency training positions for graduates of US medical schools, there will be no positions at all for IMGs and US graduates of offshore schools.

Then there’s this. The other day, I heard an advertisement on the radio extolling the virtues of one of the new US medical schools and soliciting applicants for its “charter class of 2013.”

I have been a doctor for over 40 years. I’ve never heard of a US medical school advertising for applicants.

The rumor is that the school that is advertising may not be happy with many of its applicants so far.

Could this be a harbinger of things to come? What do you think?


Anonymous said...

I'm an MS4. A few months ago, a classmate and I were talking about how med school is kind of a "safe" option for smart people. If you did well in undergrad, but your passions don't point you in any single direction, you could just as easily go into business school, finance, or start your own business. Some of these options have earning potentials that far surpass medicine, but they are risky. You could go on to start the next Facebook, or you could end up being a shift manager at Arby's (if you can even find a job after graduating).

Contrast that with medical school. Unless you do something stupid to get yourself kicked out, you're almost guaranteed a residency spot somewhere and a job making $150k+ until you retire. You're saddled with an awful lot of debt, yes, but it's not so different from tens of thousands of dollars in debt being at a much lower paid job or being unemployed. In that sense, medical school isn't much of a gamble and it's a pretty safe future. But if there aren't enough residency positions in the future, that might not hold true for much longer.

Note: I'm not saying I chose medicine for the money, or that anyone should. I'm excited for my future in radiology (up to you if you still want to call a radiologist a "doctor"), but I didn't feel like medical school was my only option after undergrad.

Skeptical Scalpel said...

Thanks for the thoughtful comments. I agree with what you said including the part where there might not be a residency slot for every US grad pretty soon.

It's going to be hard to pay down that med school & college debt as a barista.

Maybe it will turn out like Germany where there are so many docs that just about every ambulance has one.

Unknown said...

Great Post. I have a solution. More Cardiothoracic Surgeons! There seems to be a dwindling amount of interest in the field and fellowship slots are not being filled. Also, are the few new cts fellows prepared to deal with our increasingly older and complex patients? Im talking the third time redos, triple valve pseudotransplants and the (gasp! ) TAVRs gone wrong. The days of the simple 3 vessel Cabg are over.

I wish for the sake of my beloved specialty, we find more good docs to take care of us in the future.

Karen Calcaño PA-C @heartsurgerypa

Skeptical Scalpel said...

Karen, thanks for commenting. The problems with CT surgery are 1) at 7 years of residency, it takes to long to become one and 2) fewer heart operations will be done as more stents take over.


Sorry if this is mentioned and I just missed it, but what is the likelihood that there will be an increase in the number of residency programs? I imagine it is a process for new programs to become approved, is there any public disclosure made about how many new programs are in the works?

Skeptical Scalpel said...

The number of new programs is being increased and existing to grams are expanding. The problems are that funding from Medicare may be reduced and the quality of new programs is questionable in some cases. It's not clear if new programs will survive without funding.

Anton Power said...

This is a frightening prospect considering I was just accepted to the class of 2017.

The debt is bad enough.

I keep saying this again and again, we don't need new medical schools. We need cheaper medical schools. Filling the primary care gap is all about making medical education affordable.

Skeptical Scalpel said...

I would like to think that something will be worked out by 2017. So far though, that has not happened and there continue to be hints of further Medicare (the source of money for graduate medical education) budget cuts.

pamchenko said...

if we keep the amount of specialty residency positions the same and just increase the primary care residency positions, won't that address the primary care shortage problem in the US? wasn't that the intent of increasing the amount of medical students?
another option is to go dental and have graduating medical students pay for certain residency spots. I am NOT a huge fan of this plan but then again it serves a need and is a potential solution. Then again it would favor richer kids being able to go into "richer" specialties and furthering the income inequality gap here in the US.

Skeptical Scalpel said...

Your plan to just increase the number of primary care slots is a good one. I foresee a problem though. I am not aware of large numbers of primary care physicians either competent or eager to train new PCPs. BTW, this is also true of most other specialties.

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