The need for health care reform and new health care policies keeps making the news almost every day. Better access to health care includes better access to the knowledge and services of physicians. That would imply new health care graduates should grow as the population grows, but medical school degree data published by the National Center for Education Statistics shows no growth at all. For the academic year 1985-86, they report 15,938 Medical School Degrees. They have not reported a number as high as that since, although MD degrees reached 15,730 for the year ending June 2007.
In that same period the resident population reported by the Bureau of Census increased 66.2 million. It was 237.9 million in 1985 but reached 304.1 million in 2008. Despite continuous growth in America’s population it does not train more physicians.
Becoming a physician is a long and expensive process that takes four years of college prior to 4 years of medical school. Medical school tuition reported by the American Association of Medical Colleges in 2008 averaged $23,593 for the 75 public university medical schools; $41,235 for the 50 private university medical schools.
In some states a medical school graduate can get a license to practice medicine after completing a one year internship, but most states require two years in a medical residency program. During residency programs hospitals typically define pay as a stipend, apparently to save money paying low wages, so the residency period continues to be a period of financial drain on medical students.
Those admitted to America’s service academies at Annapolis, Maryland and West Point, New York pay no tuition. America trains its military officers at public expense. For medicine though America puts the burden to pay for at least 10 years of training on the individual. Much of this medical expense comes during a time in life when people usually begin to support themselves and pay their own living expenses. For many in medical training living expenses are a burden that generates even more debt to pay off later.
Some of the strain in the current system shows up in physician employment reported by the Bureau of Labor Statistics. Family and General Practitioner jobs are in decline. There were 135 thousand reported as recently as 2001, but 106 thousand reported for 2008. It also has the lowest entry pay of reported physician specialties, $73 thousand.
An entry wage of $73 thousand dollars will not be sufficient to support a family and pay the debt from 10 years of medical education. It is time to recognize that a major component in health care reform needs to be more physicians. They need to grow at least as fast as the population. That is not happening with the current system and we have to doubt it ever will. It’s time to train our physicians like we train our generals: at public expense.