Med School Admissions: Problem Solvers Need Not Apply
At the Pope Center, Duke Cheston explains how influence over medical reimbursement skews the balance between generalists and specialists. A rational person would move to reform the centrally planned reimbursement system that causes the primary care shortage.
But contemporary health care policy has more to do with utopian dreams than practical reality, and health planners are pressuring medical schools to fix the supposed primary care shortage by “getting different doctors.” To do this, they plan radical changes in the prerequisites for medical school. Some schools already admit students who have not taken the MCAT or any classes in physics or organic chemistry.
The American Medical Association (AMA) is calling for criteria that “correlate with maintaining ‘altruism.’” The AMA believes that the primary care shortage exists because existing medical students have too little compassion to become primary-care doctors and are insufficiently sensitive to people in need. The reason for this is that the medical school admission process selects for applicants’ “ability to acquire knowledge and to problem-solve.”
To address the supposed incompatibility of problem solving and altruism, medical schools should begin selecting people who believe in “social accountability” and act as advocates for patients on issues “related to social justice.” And as current physicians are said to be poor at community organizing, “issues related to social accountability” should be included in admissions criteria.
This is bit scary. As a patient, how do I know who is who? That is, who’s competent and who’s touchy feely?
Doesn’t sound good. I hope this doesn’t happen.
I’ve talked to numerous doctors that entered medical school with the idea of being a family doctor. Virtually all these doctors reported the pressure to specialize began almost immediately. In some cases it was blatant, where professors push their students to pursue specialized fields. In other cases, pressure was more subtle with GPs not afforded the same level of respect granted to the more lucrative subspecialties.
From an economic standpoint, it’s not hard to imagine why doctors specialize once they near the end of medical school. Students have gone through eight years of post baccalaureate coursework and face three more years of low-paying residency. If they add an additional two to three years of residency they can often double or triple their salaries and gain more respect from your peers.
Mt Sinai medical school is one of those schools that have an admissions program that doesn’t require organic chemistry or physics for some applicants. I know that these are traditional requirements but for the life of me I can’t remember the last time my doctor had to calculate a waveform probability density or the energy released in a chemical reaction. Researchers, sure, but practicing physicians aren’t scientists and it’s questionable how much physics or organic chemistry helps them practice medicine.
The financial cost of medical education is a different issue. The way we force doctors to finance their education makes them more mercenary then they want to be. We could have Medicare pay for their education in exchange for lower fees and seeing more Medicare and Medicaid patients. We could look at financing medical education like a partnership. High income specialists pay more, lower income primary care physicians pay less.
Why not let the market determine physician fees, based on supply and demand rather than Medicare labor-theory-of-value hocus pocus formulas. Then the subsidies could be the same for all physicians and they could choose their own specialties without government direction.
Mr. Chesterton’s article is interesting and worth reading, but he fails to mention 2 other reasons that medical students and residents move toward specialization.
In spite of earning less, generalists are still held to similar malpractice standards as specialists. Why take on similar risk for less financial reward?
Also, there tends to be a lack of respect for the generalist. The knowledge and skills necessary for a generalist are (erroneously) viewed as less intellectually rigorous. A generalist, by definition, is not an expert–and is thus not as highly regarded, esp. in academic centers where most of medical education takes place.
Beth, it might be true that the specialists think they are smarter but that’s more a function of ego than anything else. As for “respect”, much of that is income based, a family practice physician makes in the $200,000 range, an orthopedic surgeon two or three time that amount. As for malpractice costs, I don’t think that’s true. Actual premium comparisons are hard to come by, but from what I’ve seen surgeons pay much higher malpractice premiums then family practice physicians.
There’s a body of literature asserting that if there were more PCPs, the quality of medical care would be better. I’m not totally convinced, nor do I think that the literature suggests a general theory.
My (casual) theory is that PCPs are the most likely to be harmed by third-party payers, because what they do is the most difficult to observe and measure. Surgeons are the least difficult to observe and measure: How many knee replacements did you do and how did they turn out?
A third-party payer is worse at determining this than the patient herself, but he’s better at determining this than he is at determining the value of a consultation with a PCP, which can encompass who-knows-what.
In a patient-directed, consumer-driven health-care environment, I doubt that any PCP would ever have anything to do with a health insurer. Patients would pay them directly.