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Mass exodus of Physicians? - 12/13/2010 9:16:47 AM   
tazzygirl


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I keep hearing about this mass exodus of physicians. This topic was brought up in Treasures thread about Adult Abortions. Since its way off base, i decided to toss it up on its own thread.

Here is what sparked this one.

quote:

ORIGINAL: CreativeDominant

quote:

ORIGINAL: tazzygirl

quote:

This is going to be made plain by the coming exodus of doctors unwilling to subject themselves to further, deeper, government control. But I digress.


I have been waiting for the mass exodus for the past ten years or so. And still waiting.
Dr. K. Miller, M.D. A neurologist who chose to go back into nursing. Dr. L. Spaulding, M. D. An OB-GYN who chose to go into nursing due to ever-tighter regs and higher malpractice premiums (cuz we ALL know it is the OB-GYN's fault when something goes wrong. Look at all the legal ads advising you to sue your OB-GYN). Dr. S. Thompson, M.D. Gave up his medical practice to become an R. N. and teach. Those are 3 from a small town...my town. Multiply that by the number of towns between 10 and 15 thousand across the U.S. I'd say that equals a pretty good exodus though it may not be massive yet. I have considered going back to teaching at a college somewhere...at least then, I will KNOW what the hell I am going to be paid.

But this is off the topic, is it not?



quote:

Dr. L. Spaulding, M. D. An OB-GYN who chose to go into nursing due to ever-tighter regs and higher malpractice premiums (cuz we ALL know it is the OB-GYN's fault when something goes wrong. Look at all the legal ads advising you to sue your OB-GYN).


First, these changes have been occuring since long before the Health Care Law went into effect. As in the case of your OB-GYN, its insurance, not government, making the changes. OB has a high lawsuit rate. It has since the OB who delivered my son quit the OB part of his practice and just practiced the GYN part. For this Dr to not have taken that route and left the medical field speaks of more problems than just the changes we are speaking about here.

But, according to your numbers, 45000 Drs have left the field. I will even give you that. But, you state no dates, just a list of three Drs that can be verified in no way.

According to the WSJ, there were over 954,000 practicing physicians in the US, 2010. According to you, we are now down to 900,000 this year.

Did you know that there was a cap placed upon residencies in the US by Congress in the 90's? One college had 5000 qualified applicants for 100 slots? Any idea how many new schools have been opened in the past ten years?

There isnt a shortage of people willing to go into the field. There isnt a mass exodus of those leaving. There are many retirning. There are limitations on the residencies which are a requirement. Its the exact same problem in Nursing. Enough people want to become one, just not enough schools or slots to train them all.

Figure out that problem and the medical field will have plenty. But to slide all this into Obama's lap is false.

------------------

Thoughts?

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RE: Mass exodus of Physicians? - 12/13/2010 10:12:34 AM   
pahunkboy


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Locally the trend is for small offices to merge with the big medical centers.... in the past 15 years in particular.

In time- we could very well have just one medical center (choice)  here.

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RE: Mass exodus of Physicians? - 12/13/2010 10:33:26 AM   
KenDckey


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When I looked all I could find was a limit on the number of hours residents can work.    That is an OSHA requirement.   Just couldn't find a limit on residents except by hospital choice.   I don't believe that they are required to accept anyone that applies.   That isn't cost effective.

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RE: Mass exodus of Physicians? - 12/13/2010 10:34:16 AM   
Louve00


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I also suspect a lot of the misinformed are listening to the people instilling these fears, too.  And the fear is instilled to get people to do (and think) what they want them to do (and think).  

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RE: Mass exodus of Physicians? - 12/13/2010 11:25:11 AM   
flcouple2009


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quote:

ORIGINAL: pahunkboy

Locally the trend is for small offices to merge with the big medical centers.... in the past 15 years in particular.

In time- we could very well have just one medical center (choice)  here.



That's not a local trend Hunkie and has a lot to do with the cost malpractice insurance.

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RE: Mass exodus of Physicians? - 12/13/2010 11:35:46 AM   
KenDckey


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I also believe that there is a shortage of doctors in rural areas.    I know I have to travel 175+ miles for specialists.  I could go 100, but I use it as an excuse to see my sister.  LOL   Also, because the 100 mile doctors are in Nevada instead of Arizona, I would have to change my primary care to over there instead of local.

But, If I remember correctly, wasn't it not to long ago that the Govt was giving incentives for any doctor, including foreign ones, to come to rural areas?

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RE: Mass exodus of Physicians? - 12/13/2010 11:38:02 AM   
DomKen


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there's always going to be fewer specialists in areas with low population density. There simply aren't enough people needing specialists in every small town.

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RE: Mass exodus of Physicians? - 12/13/2010 11:39:20 AM   
pahunkboy


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quote:

ORIGINAL: flcouple2009

quote:

ORIGINAL: pahunkboy

Locally the trend is for small offices to merge with the big medical centers.... in the past 15 years in particular.

In time- we could very well have just one medical center (choice)  here.



That's not a local trend Hunkie and has a lot to do with the cost malpractice insurance.



I feel bad for the DRs-  they are trying so hard to help humanity.     - and they get squeezed from every direction.

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RE: Mass exodus of Physicians? - 12/13/2010 11:53:10 AM   
Louve00


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I think there are factors involved.  Aside from the slots that are available to educate a Dr.  There is rural vs urban areas.  The area I live in is growing.  I have seen two medical plaza's open recently and a third is being built.  The two already built are filled with physicians.  GP's and specialists have practices in those plaza's.  The third will be an oncology plaza.  So, the three physicians that left CD's home town in no way represents the couple of dozen new physicians that have moved into my area.  Granted some physicians have and are retiring, but a lot of practices are bringing in physicians to replace the retiring ones. 

Not for one skinny minute would I believe one town or even one county would be accurate representation for the whole nation.  Nor would I be quick to blame gov't for Dr's leaving their professions, when CD himself referenced the legal aides encouraging people to sue, and that being the reasons for Dr's abandoning their careers.


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RE: Mass exodus of Physicians? - 12/13/2010 12:38:40 PM   
Hillwilliam


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quote:

ORIGINAL: pahunkboy

quote:

ORIGINAL: flcouple2009

quote:

ORIGINAL: pahunkboy

Locally the trend is for small offices to merge with the big medical centers.... in the past 15 years in particular.

In time- we could very well have just one medical center (choice)  here.


I have a REALLY hard time feeling sorry for anyone with a 6 figure income.


That's not a local trend Hunkie and has a lot to do with the cost malpractice insurance.



I feel bad for the DRs-  they are trying so hard to help humanity.     - and they get squeezed from every direction.



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RE: Mass exodus of Physicians? - 12/13/2010 12:55:26 PM   
KenDckey


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oh we have specialists.   lol   but the govt said I have to go to phoenix or vegas   can't use the local ones   I have military insurance   and yes I pay preiums and have copays   lol

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RE: Mass exodus of Physicians? - 12/13/2010 1:00:52 PM   
DomYngBlk


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quote:

ORIGINAL: tazzygirl

I keep hearing about this mass exodus of physicians. This topic was brought up in Treasures thread about Adult Abortions. Since its way off base, i decided to toss it up on its own thread.

Here is what sparked this one.

quote:

ORIGINAL: CreativeDominant

quote:

ORIGINAL: tazzygirl

quote:

This is going to be made plain by the coming exodus of doctors unwilling to subject themselves to further, deeper, government control. But I digress.


I have been waiting for the mass exodus for the past ten years or so. And still waiting.
Dr. K. Miller, M.D. A neurologist who chose to go back into nursing. Dr. L. Spaulding, M. D. An OB-GYN who chose to go into nursing due to ever-tighter regs and higher malpractice premiums (cuz we ALL know it is the OB-GYN's fault when something goes wrong. Look at all the legal ads advising you to sue your OB-GYN). Dr. S. Thompson, M.D. Gave up his medical practice to become an R. N. and teach. Those are 3 from a small town...my town. Multiply that by the number of towns between 10 and 15 thousand across the U.S. I'd say that equals a pretty good exodus though it may not be massive yet. I have considered going back to teaching at a college somewhere...at least then, I will KNOW what the hell I am going to be paid.

But this is off the topic, is it not?



quote:

Dr. L. Spaulding, M. D. An OB-GYN who chose to go into nursing due to ever-tighter regs and higher malpractice premiums (cuz we ALL know it is the OB-GYN's fault when something goes wrong. Look at all the legal ads advising you to sue your OB-GYN).


First, these changes have been occuring since long before the Health Care Law went into effect. As in the case of your OB-GYN, its insurance, not government, making the changes. OB has a high lawsuit rate. It has since the OB who delivered my son quit the OB part of his practice and just practiced the GYN part. For this Dr to not have taken that route and left the medical field speaks of more problems than just the changes we are speaking about here.

But, according to your numbers, 45000 Drs have left the field. I will even give you that. But, you state no dates, just a list of three Drs that can be verified in no way.

According to the WSJ, there were over 954,000 practicing physicians in the US, 2010. According to you, we are now down to 900,000 this year.

Did you know that there was a cap placed upon residencies in the US by Congress in the 90's? One college had 5000 qualified applicants for 100 slots? Any idea how many new schools have been opened in the past ten years?

There isnt a shortage of people willing to go into the field. There isnt a mass exodus of those leaving. There are many retirning. There are limitations on the residencies which are a requirement. Its the exact same problem in Nursing. Enough people want to become one, just not enough schools or slots to train them all.

Figure out that problem and the medical field will have plenty. But to slide all this into Obama's lap is false.

------------------

Thoughts?


Amen Tazzy. There are plenty of qualified people that don't get selected into Med School. They have the grades, scores, drive and want to be a Doctor but don't get in based on the limited number of placements. Our medical system is rigged by the AMA for the AMA. If we opened it up to qualified applicants health care would be miniscule compared to what it is today.

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RE: Mass exodus of Physicians? - 12/13/2010 1:37:34 PM   
KenDckey


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DYB   I think that is part of it for sure, the other parts are insurance, lawyers, and qualified teachers (docs like practice not teaching cause there is more money in it - retired Doc told me this once when we were discussing it)

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RE: Mass exodus of Physicians? - 12/13/2010 3:03:27 PM   
tazzygirl


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quote:

ORIGINAL: KenDckey

When I looked all I could find was a limit on the number of hours residents can work.    That is an OSHA requirement.   Just couldn't find a limit on residents except by hospital choice.   I don't believe that they are required to accept anyone that applies.   That isn't cost effective.


The new schools and expansion at existing schools will increase first-year enrollment by 21% in 2013, according to a May 2009 Center for Workforce Studies report. But the Balanced Budget Act of 1997 capped the number of new Medicare-paid residents that each teaching hospital can claim.

http://www.ama-assn.org/amednews/2010/03/29/prl20329.htm

This is how teaching hospitals afford to train residents.

Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.

But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.

There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.

Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.

Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill.

"It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.

While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.

One provision in the law attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services.


http://online.wsj.com/article/SB10001424052702304506904575180331528424238.html

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RE: Mass exodus of Physicians? - 12/13/2010 3:08:27 PM   
KenDckey


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ugh  that is one way to get them to join the military  ugh

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RE: Mass exodus of Physicians? - 12/13/2010 3:16:54 PM   
tazzygirl


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Its almost laughable that those screaming that Obama-care will cause a shortage of Physicians in this country. Hell, it was a Republican Congress that passed that!

Anyone else seeing a trend here?

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Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

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RE: Mass exodus of Physicians? - 12/13/2010 3:57:58 PM   
littlewonder


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quote:

ORIGINAL: pahunkboy

Locally the trend is for small offices to merge with the big medical centers.... in the past 15 years in particular.

In time- we could very well have just one medical center (choice)  here.



They've done the same thing here. There are very few individual offices here anymore. Almost all have merged with one of two hospitals in the area. Very few individual doctors can afford to practice on their own.

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RE: Mass exodus of Physicians? - 12/14/2010 12:20:40 AM   
truckinslave


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Libs amaze me.
There is this assumption that their socialist schemes will be applauded by those hurt by them.
0bama0Care promises doctors three things: increased supervision/regulation/interference, increased legal exposure, and reduced remuneration.
Libs look at that and say: "Oh, no. They'll stay".
I disagree. They are intelligent enough, and well enough situated, to make as much money with less stress and shorter hours (docs work loooooong hours); and their skills are increasingly in demand overseas.
They seem to disagree also  http://webcache.googleusercontent.com/search?q=cache:_QxFJSWWZIAJ:www.investors.com/NewsAndAnalysis/Article/556398/201012091905/New-Poll-Confirms-IBDs-09-Finding-Of-Doctor-Exodus-Under-ObamaCare.htm+ibd+poll+doctors&cd=2&hl=en&ct=clnk&gl=us discusses and IBD poll of doctors, over a third of whom are threatening to quit.

There's already a shortage.
Deny there is any possibility of severe unintended consequences.
Assume. And deny.

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RE: Mass exodus of Physicians? - 12/14/2010 4:42:39 AM   
tazzygirl


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Their 2008 survey yielded

quote:

The last time the foundation asked doctors about their plans was in 2008. In that survey of 11,950 responding physicians, including family physicians, general internists, pediatricians and obstetrician-gynecologists, just over 51% planned to continue practicing as they had been and only 11% said they would retire. Slightly more than 7% talked about changing to concierge medicine, and nearly 8% planned to switch to locum tenens.


The 2010 survey...

The survey was completed by 2,379 family physicians, internists, pediatricians, obstetrician-gynecologists, cardiologists, orthopedic surgeons, radiologists, anesthesiologists, general surgeons and hospitalists in June, July and August. About 59% were part of physician-owned practices; 41% were employed by a hospital or other large entity -- below the overall 52% employed physician rate reported by the Medical Group Management Assn.

Only 26% of respondents planned to continue practicing as they have been for the next three years. A total of 14% planned to switch to locum tenens work, and 11% said they will take hospital jobs. About 16% intended to switch to concierge or cash practices, and 16% planned to retire.


Other notable changes between the two surveys done by the same group...

The question about hospital employment was not asked in the 2008 survey but was added in 2010. That's because of increased hospital interest in hiring physicians, particularly in the wake of the Patient Protection and Affordable Care Act.

The 2010 Physicians Foundation survey found significant dissatisfaction with the new health reform law. The major goal of the survey, "Health Reform and the Decline of the Private Practice," was to assess physicians' views of the legislation.

According to the survey, 67% felt "somewhat" or "very negative" about it when it was enacted in March. An additional 27% were "somewhat" or "very positive." After the initial reaction subsided, 10% felt more positive but 39% were more negative.

Of the respondents, 54% believe patient volume would increase because of reform, but 69% said they did not have the time or resources to treat additional patients while maintaining quality of care. A total of 68% believe that reform would diminish the financial viability of their practice.

"There's general anxiety about big government, and it is shared by physicians," said Tim Norbeck, the foundation's executive director.

This anxiety was compounded by numerous short-term Medicare pay patches in 2010.

According to the foundation's survey, physicians place reform of the sustainable growth rate formula (36%) above health reform (34%) as the policy that could have the greatest effect on their practices. An additional 30% said they were unsure which of the two would be the bigger issue.

Although the Physicians Foundation's survey documented a malaise among some physicians, experts cautioned about generalizing based on the results. Foundation representatives said the survey was mailed to 40,000 physicians and e-mailed to 60,000, with 2,379 completing them for a response rate of only 2.4%.

Even those conducting the surveys don't expect that every physician who says he or she will make a change will do so. However, "a certain percent are going to make a change, and this will have a significant impact on the delivery of health care," said Mark Smith, president of Merritt Hawkins & Associates, a physician placement firm in Irving, Texas, that conducted the survey for the foundation. "We are going to see a migration away from private practice to employment."

For example, the foundation noted that many of the options physicians might choose would involve treating fewer patients, which could exacerbate doctor shortages.

Dr. Lauer, who hopes to retire in five years, said he has no regrets about moving 2,000 miles from central New Jersey to southeastern New Mexico to leave private practice for hospital employment.

He said he still works hard, but it's eight to 10 hours a day rather than up to 14. He said he gets to spend more time with patients, because appointments are longer than they were at his medical group.

At first, Dr. Lauer said he wasn't sure whether his new job would be the right fit. "But I'm now quite happily employed at this small community hospital," he said. "The cardiology clinic keeps getting busier, and we're doing testing that they could never do before. To me, it's very satisfying."


http://www.ama-assn.org/amednews/2010/12/13/bisc1213.htm

16% who state they are considering retiring is a far cry from 1/3 as you stated. Now, if you believe 2.4% of those responding speak for the over 900,000 physicians practing (which is 2379 Physicians speaking for 900,000 or a percentage of 0.2643 %).. well... the math does not add up.

16% of 900000 = 144,000 Physicians who "may" retire. How many of them are baby boomer Physicians whose time have come to retire? Oh wait, your link provides that. Of those who said they planned to retire, 28% are 55 or younger and nearly half (49%) are 60 or younger. Meaning over half, or 51% are 60 and older. 8% = 72000.

One impetus for early physician retirement is the recent steep rise in malpractice insurance rates, which are literally driving physicians out of some states. Further, physicians site managed care, increasing government interference in healthcare and declining reimbursement as other reasons for early retirement. The nurse shortage also is contributing to low physician job satisfaction and the desire to leave medicine. Indeed, some experts believe attrition may cause a net decline in the number of practicing physicians in coming years. The MGT of America, a higher education consulting group, predicts that by 2020, more than 23,000 physicians will retire or die each year, while the number of physicians entering the workforce each year will remain constant at around 16,000 to 17,000, if the medical education system does not change. At present, there is no concerted effort to increase the number of medical graduates. In fact, recent Bush Administration proposals have called for a decrease in funding for medical residency programs.

http://www.newphysician.com/articles/needed_4.html

And that magical number of being 65 for retirement doesnt fit in medicine.

Things look grim for Gil Rodriguez, M.D., vice president of medical affairs at Southwest Washington Medical Center, Vancouver, BC. Already confronted by a doctor shortage, Rodriguez expects to be hit with dozens of physician retirements in the next five years, creating the need for a multimillion-dollar recruitment effort. A number of the retiring doctors will be in their 60s or beyond, an age when no one would begrudge them a gold watch. But others will be much younger, and they’ll shave off years of productive practice when they hang up their stethoscopes.

Early physician retirements constitute a new trend, one that’s being reported by doc recruiters and hospital executives around the country. A decade ago, doctors routinely worked well into their 60s. Not so anymore, at least not as much. Now, Rodriguez and many of his colleagues view any doctor 55 or older as “at risk.”

While the frustrations of managed care take a lot of blame, Michael Whitcomb, M.D., a senior vice president at the Association of American Medical Colleges, says that doctors have started paying attention to investment programs that would allow them to retire early.


(articles date, 2001... looooooooooooong before Obama)

http://www.nejmjobs.org/rpt/early-retirement-physicians.aspx

And, finally, to bring up the point of enrollment in schools... your article stated...

The doctors also told us — 67% to 22%, with 11% not responding — that they expected fewer students to apply for medical school in the future if the plan became law.

Btw, 97.6% of Physicians who were polled by this group never responded in any form.

Data released recently by the Association of American Medical Colleges, or AAMC, show that first-year enrollment at U.S. medical schools in 2008 totaled more than 18,000 students, the highest enrollment in history.

http://www.aafp.org/online/en/home/publications/news/news-now/resident-student-focus/20081119med-school-enroll.html

Despite the nation’s ongoing financial difficulties, early indicators such as the Medical College Admission Test (MCAT®), suggest that next year’s medical school applicant pool will continue to edge upward. From January to August of this year, more than 67,000 individuals took the MCAT exam, a nearly 3 percent increase over 2008.

http://www.physiciansnews.com/2009/10/20/medical-school-enrollment-continues-to-rise-to-meet-physician-need/

Again, your survey does not match reality. Enrollment is up, and schools would enroll more if it werent for that pesky Congressional act limiting the number of residency slots.

The numbers, according to the data, broke down as follows: Black student enrollment grew by 2.9%; American-Indian student enrollment increased nearly 25%; and Hispanic student enrollment was up by 9%. Women made up 47% and men 53% of the incoming 2010 medical class. Altogether, U.S. medical schools received 42,742 applications for the 2010 freshman class compared with 42,269 in 2009.

The total number of first-time applicants in 2010 increased by 2.5%—up to 31,834 applications—over 2009. “The growth in first-time applicants demonstrates that medicine is still a compelling career choice for many individuals,” said AAMC President and CEO Darrell Kirch.


http://www.ethnicmajority.com/wordpress/education/2010/10/medical-schools-make-gains-in-minority-enrollment

< Message edited by tazzygirl -- 12/14/2010 4:51:31 AM >


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Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
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If you want it sugar coated, dont ask me what i think! It would violate TOS.

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RE: Mass exodus of Physicians? - 12/14/2010 5:31:35 AM   
DomYngBlk


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quote:

ORIGINAL: KenDckey

DYB   I think that is part of it for sure, the other parts are insurance, lawyers, and qualified teachers (docs like practice not teaching cause there is more money in it - retired Doc told me this once when we were discussing it)


All sorts itself out if there is less money in it for Doctors. How motivated are lawyers going to be in chasing ambulances that don't have a lot of cash riding in them? Fuck Doctors, rig the system in your favor then cry about it.....Wait...that sounds like Wall Street...lol

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