It's even more difficult to get into med school

WayOutWestMom
Fri, 10 Dec 2021 21:51:55 +0000

chmcnm:

The question for me is why haven’t we been able to increase enrollment in med schools?

The answer is complex. Educating a medical student requires more than just classroom and labs. It requires access to clinical training facilities and clinical preceptors (physicians who do small group, hands-on instruction as part of their daily patient rounds). Med student training is time-intensive and clinical preceptors see significantly fewer patients per day than a regular physician. (And this is one reason why academic physician make less money than private practice physicians. They see far fewer patients.) This also means that training hospitals generate less revenue. Also a training hospitals need to meet certain minimum standards (LCME, the accrediting body for MD programs, and COCA, the accrediting body for DO programs, set these standards) in order to be an acceptable host for med students. Patients at these training hospitals also must be willing to allow med students to see them–and patients in private hospitals are significantly less willing to be “guinea pigs” for students than patients at public hospitals.

The scarcity of clinical training sites is major bottleneck for med schools. Some med schools in New England ship their 3rd & 4th year med students all the way out to California to do their clinical rotations.

This is a huge over-simplification, of course, but it gives some basic insight into why it’s hard to increase class sizes.

Then there is the whole issue of post med school training (residency). Residency is where students learn how to be doctors. Without completing a residency, med school grads cannot get a medical license to practice. Almost all residency training is underwritten by Medicare. The amount of funding for residency has been fixed since the early 1990s and Congress is loathe is increase it. Do you really want med schools to produce more medical grads than the residency system can train? Nothing like having a half million $$ in loans and being unable to get a residency spot.

Some of the more radical proposals to reform medical education are to eliminate the MCAT and eliminate most in-person didactic (classroom) instruction and let student do individual computer based competency training (under restrictive time limits). Then using a student’s USMLE Step 1 score to decide who get to advance to clinical training. It wouldn’t increase the number of clinical training slots, but it would make the first 2 years of med school more accessible.