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You are listing state colleges in TX with a heavy instate bias while I was talking generally about private schools with little instate bias for OOS students for comparison purpose with UMKC(may be I should have been clearer). Also CA schools like UCLA cost almost $63k with their $10k summer tuition. Once you factor in higher COLA (may be 25% higher) in CA, total COA it will be much higher at those CA schools compared to most other med schools.
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Regarding the new laws that help to skip residency - not sure if it is just a coincidence that the laws were first passed in TN and FL where one of the largest healthcare systems (that also fund a number of residencies) has a significant presence. Those type of healthcare systems with significant clout could hire IMGs in those states. The bills were passed in a very bi-partisan manner. You can see that similar laws are already in progress in VA, AZ, WI, ID legislatures.
https://www.cato.org/blog/more-states-move-let-experienced-foreign-doctors-serve-their-patients
Regarding “first world” residency requirement - I don’t think there is such a thing any longer, it is a “flat world” as Tom Friedman would put it. Ultimately, quality will be measured using objective criteria, not first vs third world.(By many of the key metrics for healthcare - life expectancy at birth, infant mortality etc. - China is fairly close to US at this point or may have even surpassed in a few). It won’t be too hard for most countries that supply IMGs to US today (India, Pakistan, Jordan etc.) to establish equivalencies as they all may have residency programs that are 3-6 years long - especially if large health systems support that. For primary care, some of those countries may have an extra year of residency.
Considering the current fiscal debt/high interest rates and the need to moderate healthcare spending (since significant portion of federal spending is in healthcare), I wouldn’t be too surprised if law makers want to open up the supply side citing looming physician shortage. Then on the demand side, throw in the changing reimbursement methods that emphasize value over procedure. With the help of technology/data/AI, it may become easier to quantify value vs procedures performed.
Also there is potential evolution of consumer driven healthcare that encourages consumers to shop around - especially potential extensions of Trump-era transparency laws regarding prices, implemented for hospitals. Let us say, once a patient is recommended to have a non-emergency procedure/surgery, what if the patient could shop around for the cost in a very convenient app where they could review multiple bids that will help to minimize their out of pocket costs since most patients have high deductible plans?
Buying a car involved countless hours of haggling and paperwork at dealerships not too long ago(was probably a worse experience than a surgery or dental work), today it is a few taps/swipes on your mobile phone. So you will never know how things change in the next 30-40 years - the duration for a current high school senior to go through their med school training and practice medicine. It will be an interesting ride.