Med school enrollment and NP's/PA's

Papadoc · Dec 29, 2005

Numerous articles make mention that Medical School enrollment is down, and that there are a declining number of Physicians.
Can anyone shed some light on this? If it is really true, then why? And, has anyone forecasted how this will affect issues pertaining to midlevel practitioners in the next 5 years? For example, Medicare reimbursement at 100% instead of 85%, prescription rights for all midlevels, in all states, etc.

Hey Brownrice!

I don't want to argue with the article, but from my personal experience could tell you that getting in med school is still very, very competive. The ever increasing tuition, malpractice, and general dissatisfaction with current healthcare meltdown works as a deterrent for many, who went into it strictly for money, status, ego etc. But more and more D.O schools are opening in U.S, and off-shore schools are multiplying like rabbits:chuckle . AMA will still be opposing reimbursement at 100%, and granting complete prescriptive rights. Because then there will be no difference whatsoever between doctors and non-physicians. We'll wait and see.

Editorial Team / Admin · Dec 29, 2005

Papadoc is correct. Applicants are very competitive. For every spot there are two applicants.

Because of the nearing retirement of the Baby Boomers, there is a push for increased enrollments and opening of med schools up through the year 2015.

brownrice · Dec 29, 2005

Thank you kindly for the input....

So what you are saying is you don't think there will be any effect, as med schools will have provisions to combat the supply/demand imbalance?

As far as why enrollment is down, I was led to believe it was due to factors other than competition. Hasn't competition always been keen? Could malpractice factor into this at all? If so, how is malpractice different for an NP? I do believe it will be possible for NP's to attain 100% reimbursement when they are providing the exact same task. Afterall, why should they be allowed to provide the service in the first place, if it is at all deemed to be second rate, or not as good as what an MD would have provided?

Editorial Team / Admin · Dec 29, 2005

Certainly the fear of litigation is a huge factor. And, managed care as well as fierce demands of the public at large to do everything in the physicians' power to order all the right tests and make them whole again. Not an unrealistic request, but, when you have insurance companies dictating which test/dx study is/are indicated, knowing full well the denial of said test/dx study places a HUGE burden upon the physician and compromises the outcome of the patient, more and more are not desirous of making that type of responsibility for fear of litigation.

NPs are not immune from all of the above either. Many times, our hands are tied in regard to the insurance companies/medicare/medicaid, yet at the same time, we must practice by our moral and ethical compasses as well as practice safe and prudent medicine.

As for malpractice rates for NPs, I cannot cite figures or facts right now. I would need to research that. But, I'm certain many have been and will be sued in their lifetime. I am sweating out the statute of limitations in OB as we speak.......knock on wood.

As for the reimbursement factor, I have to agree with Papadoc on that one. I imagine until we as NPs can get the same lobbying power as the physicians, we will not see that 100%. Not to say it will never happen, just not any time soon. And, most probably, not in my lifetime.

DeigoT · Dec 30, 2005

Numerous articles make mention that Medical School enrollment is down, and that there are a declining number of Physicians.
Can anyone shed some light on this? If it is really true, then why? And, has anyone forecasted how this will affect issues pertaining to midlevel practitioners in the next 5 years? For example, Medicare reimbursement at 100% instead of 85%, prescription rights for all midlevels, in all states, etc.

Actually to the contrary, this year marks and upsurge in applications to med school.

www.aamc.org/newsroom/pressrel/2005/051025.htm

brownrice · Dec 30, 2005

Thanks for the very relevant article! I found it interesting to note what the article calls "Large increases in Medical School Enrollment"...Each of the ten or so Med Schools chosen for this data had an enrollment increase of approx 7 students in '05 versus 04. I would hardly call that large. And, of this survey, did they cherry pick schools with this modest increase, and not choose to feature other schools that had either flat enrollment or a drop in enrollment from '04 to '05? The AMA and all the Med schools are of course, a big business. It can't be good PR for them when it looks like attending med school has become an umpopular choice in recent years. It would be interesting to see data from all US Med schools to see if there really was an across the board increase.

DeigoT · Dec 31, 2005

Thanks for the very relevant article! I found it interesting to note what the article calls "Large increases in Medical School Enrollment"...Each of the ten or so Med Schools chosen for this data had an enrollment increase of approx 7 students in '05 versus 04. I would hardly call that large. And, of this survey, did they cherry pick schools with this modest increase, and not choose to feature other schools that had either flat enrollment or a drop in enrollment from '04 to '05? The AMA and all the Med schools are of course, a big business. It can't be good PR for them when it looks like attending med school has become an umpopular choice in recent years. It would be interesting to see data from all US Med schools to see if there really was an across the board increase.

I think it is seen as a "large increase" more so because, as you mentioned, there had been a decrease in applications to med schools for many years, and most schools have kept their enrollment numbers the same. Over the years, many theories had been given for the decrease in application, some of which were already mentioned here...litigation, decrease automony, insurance bureaucracy, less remuneration etc. It was also believed that the tech boom took some of the students who ordinarily would have applied to med school, and now that the tech boom is over.....

You mentioned "flat enrollment or a drop in enrollment," but I think the changes in the number of applications might give a better picture of the interest of lack thereof in medicine. Enrollment will not give a true picture since schools like GW received 8000+ applications this year for 100+ seats, Jefferson got over 7500 for less than 250 seats, Drexel got almost 8000 for less than 230 seats (although most candidates have applied to several schools). The other thing is, many schools have a set number of students they will accept (regardless of the number of applicants) and have kept that number the same for decades. Therefore a flat enrollment doesn't really give good information. It is also rare for a school to have a drop in enrollment. They may have a drop in applications, but they usually have many candidates from which to choose, and when that fails, they they have a wait list to choose from. Some, such as the ones mentioned in the article have recently increase their numbers due to pressure (many many qualified candidates with Mcat >30 and science GPA >3.5 are in other professions since they didn't get into med school).

What I am finding rather interesting though, is the number of people who have gotten into medicine and are getting out. Mommd (or is it Mdmom ?) website has so many dissatisfied doctors. I also have a personal friend who is an excellent surgeon, and at 42 has left medicine to write a book. Her husband was a family practice physician and he left the profession 10 years ago. My friend said she would encourage her daughter to become a PA instead of a physician.

brownrice · Dec 31, 2005

Hey DiegoT:

Thanks for the continued dialogue, facts and news. Did your friend mention why she would recommend her daughter becoming a PA instead of an MD? Why did her husband leave the profession?

DeigoT · Dec 31, 2005

Hey DiegoT:
Thanks for the continued dialogue, facts and news. Did your friend mention why she would recommend her daughter becoming a PA instead of an MD? Why did her husband leave the profession?

She felt it wasn't worth it. As a surgeon she wanted to build a "center of excellence." Well, she had no life. She would sometimes spend nights at work and rarely saw her children. She felt that work became her life. It was just too consuming. It didn't help that 90% of the surgeons in her dept were male and she was the dept chief. They made it really hard for her, and when she complained they basically told her that "maybe she needed to be home with her children and she should get out of the kitchen if it was too hot for her." She just wanted to practice medicine, but there were just too many other things that made it difficult.

Her husband, I haven't figured out. They never like talking about why he got out, she would always say "he is happier now." My boyfriend, who is a lawyer, seems to think he may have been sued in the past. Who knows?

As for recommending PA to her daughters, she said a PA is able to practice medicine, and in most cases, the level of responsibility and time commitment is not the same. The training takes less time, and the debt at the end is much less. She also felt there is more flexibility with being a PA since you are able to work in different areas without actually doing a residency in that area. Of course I was offended that she didn't say NP. Although she loves the NP role, she felt that her daughter would first need to be an RN and "RNs work too hard and don't get the respect they deserve."

Papadoc · Jan 1, 2006

Hey All!

Happy New Year Everyone!

Here is the link I've been following on SDN for quite some time. I don't think that anyone in their right mind could go through that any pages of posts.But the general theme of about 80% of respondents said they would not enter medicine once again, if they had a choice:eek:

http://forums.studentdoctor.net/showthread.php?t=195799

Have a good one:)

brownrice · Jan 2, 2006

Hey Papadoc....enjoyed the link you provided. After scanning it, I did think about this: comparing job satisfaction of MDs vs. NPs is quite different. I can't remember where to find the various threads now, but there have been Many posts from NP's saying positive things about being an NP, and that if they had to do it over again they would. Just thought this was an interesting comparison. It sort of circles back around to the original thread, regarding med school enrollment and NP's/PA's. Not that I think someone would opt for being a midlevel vs being an MD, but that perhaps fewer folks wanting to be MD's will alter the landscape for midlevels in the future.