… doesn’t see that many pre-med students. Those she sees in her classes tend to be exceptional students, impressive in both the arts and sciences.

Although this blog follows with some care perennial, notorious, headline-grabbing medical school scandals – professors who put their names on pharma-subsidized, ghostwritten research papers; professors guilty of investment-related, or other forms of mercenary conflicts of interest – it has had little to say about where pre-med students go when they leave undergraduate classrooms. And that’s because the institution of the American medical school is rarely written about in the press.

One knows vaguely about our shortage of MDs. (Though if you’re UD and you live in wealthy Bethesda, Maryland, you see the opposite of this, a place as jammed with MDs as it is with lawyers.) In many places – say, Oneonta, New York, a place not far from UD‘s upstate house – you’re more likely to be treated by a DO than an MD.

The DOs, foreign doctors, American doctors with foreign degrees, physician assistants with some prescribing privileges, etc. etc., that thrive in the United States in part because of our MD-shortage are rarely the focus of major news articles; but a recent New York Times piece about how

New York State’s 16 medical schools are attacking their [largely Caribbean] competitors. They have begun an aggressive campaign to persuade the State Board of Regents to make it harder, if not impossible, for foreign schools to use New York hospitals as extensions of their own campuses.

has generated a great deal of reaction. UD will write in more detail about this after her Christmas lunch (with, among others, her niece, who’s an American-trained MD, and her niece’s husband, a Boston University medical student). Hold on.


Hokay. Yikes. Medical education, as UD feared, is an immensely complicated, immensely contested business. UD enters the business as in a first-level dream (Last night, she and her Cambridge family watched Inception.), so be patient with her…

It’s obviously incredibly important that medical education, above all other forms of education, be excellent; and the intensity, rigor, and duration of American medical education is reassuring. But:

1. There aren’t enough doctors, or rather there aren’t enough geographically dispersed primary care doctors.

2. The medical establishment, in the form of the AMA, remains a trade-restricting force, even though few doctors actually belong to the organization.

3. There are so few American medical schools producing so few doctors (and so few doctors among this group who want to go into primary care) that a thriving secondary educational establishment has emerged over the last few decades, mainly based in the Caribbean. Here, Americans unable to gain admission to domestic med schools get their first two years of coursework, and then enter American hospital programs for their second two years of clinical work.

4. As American medical schools slowly increase their number of slots (under pressure of an impending shortage which will in a couple of decades be far worse than the shortage we now have), and as new med schools open up here, there’s suddenly competition for hospital slots from the established Caribbean schools — and the for-profit Caribbean schools have an advantage in placements because, unlike the American non-profit schools, they pay the hospitals quite a lot to take their students. Plus their graduating classes tend to be much bigger than American graduating classes.

Details here. This is the most I can write for the moment. Off to lunch. Major snowfall here.

More later.

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4 Responses to “UD, an English professor…”

  1. theprofessor Says:

    DOs get essentially the same training as MDs, don’t they?

  2. Margaret Soltan Says:

    I’m no expert, but yes, I think they do.

    As with Caribbean grads, the main difference seems to lie in their intellectual aptitude/readiness for the career, as measured by med school entrance exams.

    Also like foreign med school grads, they tend overwhelmingly toward primary care.

  3. superdestroyer Says:

    The Washington Post had a story about this when the newspaper profiled a family practice physician in Post, Texas. One of the cultural changes the newspaper skipped over is that women physicians do not want to live in small towns, so as the number of women in medical school increases, the number of physicians who will ever think about working outside of a large metropolitan area shrinks. Also, as physicians marry other physicians, those couples can only find work in large cities.

  4. GTWMA Says:

    You can look at some of the data on applicants and accepted students here.


    (See Table 24 for example)

    You can see some very strong students (at least by the scores) get turned down. The AAMC has slowly expanded enrollments in the last few years, but if the choice is no doctor versus a somewhat lower quality doctor (by the scores) trained in the US versus Caribbean, which would you want?

    The gap between male and female doctor placements in rural areas has narrowed in the last decade. There was a recent article on which med schools produce the most rural docs. West Virginia topped the list.

    The best way to produce rural docs is probably to recruit med school students from PAs, NPs, nurses and others already practicing in those areas. Or, we could do as some other nations do and require some practice in rural areas for those who receive subsidized medical education (which is, effectively, 100% of American medical students–despite the heavy burden of medical debt on students, studies show that tuition pays for something less than 10 percent of the costs of medical school).

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