Medical school enrollment is too high

[myriad]

The most recent government report and analysis in Ontario indicates the overall the shortage is ended for most specialities, except family medicine - for that it will be 2017, which is still close enough anyone not yet in medical to school to come up against.

 

Going to go look this up. Thanks for the info rmorelan

[holiday1001]

LOL.... he said he is asian so that narrow things down even more

especially in a place like u of t...

[ACHQ]

Dear All,

I know that this is a very controversial thread, but perhaps I am wondering whether decrease of medical school enrollment might be something that we should consider since the job market out there right now is not as good? Of course, this can start from increasing GPA/MCAT requirement, but perhaps people can have a much more holistic input?

 

This is a better way to tactfully approach such a manner, instead of declaring there are many people you feel that are not up to par in medical school (especially since many of those people are you colleagues)...

 

I don't think anyone is arguing with you that there are too many medical students being trained, and I do (personally) as do many others believe enrollment is a bit high.

 

What I take exception to is the fact that you seem to think that anyone with a GPA below 3.90 and MCAT below 36 isn't "smart" enough or cut out for medicine. We already have examples of RESIDENTS who don't meet those standards are doing quiet well.

 

I don't think anyone wants people who aren't capable/competent as physicians. I do believe GPA and MCAT are somewhat important to a degree, but unfortunately (or fortunately depending on your point of view), a lot of things in medicine cannot be objectively measured, especially by an exam or GPA.

 

And if you look at the evidence, UofT admissions (as well as many other departments across North America) have done studies to see what predictors correlate best with medical school performance, licensing exam performance (and I even believe they are doing some now with performance as a physician, but I'm not sure what outcome measures they are using). Anyways, as thought they have shown that GPA and to some degree the MCAT correlate decently with 1st year medical school performance (e.g. grades on exams), I think the r value was around 0.5-0.7, however dramatically drops year after year after year. I believe in 2nd year its lower, and 3rd and 4th year it actually can't predict it reliably at all. So the evidence suggests that aside from 1st (and a bit) of 2nd year, GPA and MCAT can't predict who will be a "good" medical student and I think everyone here would agree that a good clerk is more important than a good preclerk.

 

What I believe is more important though is your performance, hard work and dedication IN medical school. Previous strong performance has correlated with future strong performance while IN medical school.

 

So some things to think about.

 

Also I think before judging individuals performances in PRE-clerkship, maybe judge it in clerkship when things are a bit more real

 

Just my 2 cents

[Birdy]

Well, I may as well leave this here in case anyone interested might be lurking. Neurologist, derm, med onc, addictions, physiatry, IM, and of course, family med jobs are available here. Many more in more specialties in NS and NB.

 

It's kind if frustrating to see physicians *in the specialties we desperately need* saying there are no jobs (futuredoctors' post - Dr Ng at the beginning.) There are jobs (in several fields, anyway) and they don't take much looking to find if I'm able to bring up a bunch in the Maritimes, including surgical and academic positions, many with incentives, with a couple minutes and google.

 

I get that a lot of people don't want to live in rural areas or even outside BC/Ontario/Alberta, but is unemployment really preferable?

 

It baffles me a little, as a person who is watching this from the outside (for now.) Obviously rural areas can't absorb all of the doctors who aren't able to find jobs, but at least for now demand far outstrips supply here. I'm not on that side of the stethoscope yet, so there's likely a lot of detail that I have no understanding of yet, but it seems there's quite a disconnect going on.

[CTran]

+1 to what ACHQ says.

 

Medhopefuls2016 knows exactly who I am (not very much of a secret considering my username), and it's pretty obvious to me who you are. When you incessantly flaunt your GPA/MCAT, med school acceptances, academic credentials, your identity is an immediate giveaway.

 

You like equations right?

 

GPA + MCAT ≠ intellect ≠ ability to be a successful doctor

 

Med schools give students the skills and knowledge to be competent doctors so that later, we can make the Dxs, perform the Sxs, and ultimately help patients. Your GPA does NOT guarantee that you're going to become a great doctor, nor does it mean you'll be able to better acquire the necessary clinical/surgical/emotional skills. I'd like you to stratify our class between MCAT 40s and 30s, and see who performs better in clinics.

 

Furthermore, who are you to judge the people in our class and claim that people do not "deserve" to be here? Either you have been living in a shell (and have isolated yourself from our class), or see everyone as nothing but "stats". The great thing about our class is that we have people who have succeeded in a wide variety of areas, and contribute their experiences and knowledge. We all have different skills that help us through the program. Yes, we don't all have 4.0's or 45Ts, but it doesn't make us less capable than you. If you haven't been able to see that yet, at this point in the program, you're an academic shallow and I hope you're not doing any work for admissions.

[Hockeynut]

Well, I may as well leave this here in case anyone interested might be lurking. Neurologist, derm, med onc, addictions, physiatry, IM, and of course, family med jobs are available here. Many more in more specialties in NS and NB.

 

It's kind if frustrating to see physicians *in the specialties we desperately need* saying there are no jobs (futuredoctors' post - Dr Ng at the beginning.) There are jobs (in several fields, anyway) and they don't take much looking to find if I'm able to bring up a bunch in the Maritimes, including surgical and academic positions, many with incentives, with a couple minutes and google.

 

I get that a lot of people don't want to live in rural areas or even outside BC/Ontario/Alberta, but is unemployment really preferable?

 

It baffles me a little, as a person who is watching this from the outside (for now.) Obviously rural areas can't absorb all of the doctors who aren't able to find jobs, but at least for now demand far outstrips supply here. I'm not on that side of the stethoscope yet, so there's likely a lot of detail that I have no understanding of yet, but it seems there's quite a disconnect going on.

 

I 100% agree with you. My hometown has had postings for Radiology, General surgery, all IM sub specialties, orthopedic surgery, anestisiology, family med, ER etc for years and can't find anyone. I guess people don't want to head north.

In all honesty this makes me happy as I whole heartily want to head back north/rural, the city just isn't for me.

[TheBoss]

I get that a lot of people don't want to live in rural areas or even outside BC/Ontario/Alberta, but is unemployment really preferable?

 

This is why I wholeheartedly support giving some kind of leg up in med admissions with certain geographic origins. The distribution problem of physicians is pretty bad, and frankly it seems to me that the students from large, developed cities never want to go rural when it comes down to it.

 

Sure people suggest financial incentives, telemedicine, whatever, but those are simply not effective, permanent solutions. Getting med students from medically underserved areas is simply the most effective way to get more people to go there, and even if one were to say they're not as competent, hey, its definitely better than them not working.

[medhopefuls2016]

Dear All,

 

I understand that I presented a rather radical opinion, and it is my fault for being blunt and not sensitive. For that, I very much apologize for it.

 

I hope that all of you understand that my point is never to focus on grades (MCAT/GPA/otherwise) for selection. It was merely to try to brainstorm an idea to facilitate the current job market issue.

 

I very much understand all the negative talks in regards to lowering enrollment, and I hope that you can understand my dilemma. This whole discussion has caused me (and I am sure for many others) significant distress and I apologize for it. I hope that you can let it go if possible. A

 

Again, I apologize for any distress or anger I have caused. This was certainly not my intention to start with.

[ArchEnemy]

Hey everyone, let's try our best to stay on topic.

[Leon]

 

And if you look at the evidence, UofT admissions (as well as many other departments across North America) have done studies to see what predictors correlate best with medical school performance, licensing exam performance (and I even believe they are doing some now with performance as a physician, but I'm not sure what outcome measures they are using). Anyways, as thought they have shown that GPA and to some degree the MCAT correlate decently with 1st year medical school performance (e.g. grades on exams), I think the r value was around 0.5-0.7, however dramatically drops year after year after year. I believe in 2nd year its lower, and 3rd and 4th year it actually can't predict reliably at all. So the evidence suggests that aside from 1st (and a bit) of 2nd year, GPA and MCAT can't predict who will be a "good" medical student and I think everyone here would agree that a good clerk is more important a good preclerk.

 

 

I'm actually very interested in a study that looks at admission stats and clerkship evaluations. This is probably very difficult (since I don't think clerkship evaluations have a proper numerical scale) but it would be useful. Correlations between performance in preclerkship and clerkship would be better still. It would let us know if all these endless hours in class are worth it! Considering the vastly different teaching styles at various medical schools, I think a lot of valuable research into the quality and value of medical education can be done...

[NLengr]

I 100% agree with you. My hometown has had postings for Radiology, General surgery, all IM sub specialties, orthopedic surgery, anestisiology, family med, ER etc for years and can't find anyone. I guess people don't want to head north.

In all honesty this makes me happy as I whole heartily want to head back north/rural, the city just isn't for me.

 

One problem with rural locations, at least some of them, is there just aren't enough of each specialist to make call manageable. Basically, according to most docs in the community, you need 3 people to make call manageable (1:3). So unless your Center has that, it makes it very undesirable for most people, even if they want to work in a rural area. Some hospitals compensate for this by making it's you only provide call coverage 1:3 nights or you split call with a few nearby towns, but not all centres are doing that. Those that aren't will have difficulty recruiting. I don't blame people for not wanting to work there. >1:3 call for years is BRUTAL, even if call itself isn't busy.

 

If a place has had multiple multiple unfilled job openings for years, it's likely something more is going on than just people don't wanna move there. Bad atmosphere, bad health authority, bad hospital management, old junky equipment, not enough volume to let you maintain your skills etc. Either that or it's an extremely poor location for recruitment (extreme crime rate, fly in only, lack of basic living services like clean water, surrounded by industrial plants etc).

[NutritionRunner]

Well, I may as well leave this here in case anyone interested might be lurking. Neurologist, derm, med onc, addictions, physiatry, IM, and of course, family med jobs are available here. Many more in more specialties in NS and NB.

 

It's kind if frustrating to see physicians *in the specialties we desperately need* saying there are no jobs (futuredoctors' post - Dr Ng at the beginning.) There are jobs (in several fields, anyway) and they don't take much looking to find if I'm able to bring up a bunch in the Maritimes, including surgical and academic positions, many with incentives, with a couple minutes and google.

 

I get that a lot of people don't want to live in rural areas or even outside BC/Ontario/Alberta, but is unemployment really preferable?

 

It baffles me a little, as a person who is watching this from the outside (for now.) Obviously rural areas can't absorb all of the doctors who aren't able to find jobs, but at least for now demand far outstrips supply here. I'm not on that side of the stethoscope yet, so there's likely a lot of detail that I have no understanding of yet, but it seems there's quite a disconnect going on.

 

I agree Birdy. It baffles me as well. Even in a place like Guelph, which is only an hour outside of Toronto, and hardly rural, has a hard time attracting physicians! The city is actively trying to recruit physicians: http://guelph.ca/employment-careers/careers-jobs/physician-recruitment/

 

Again, this is a place that is only an hour from Toronto! It's not like the city is in the middle of nowhere. It's a vibrant city, home to the University of Guelph with plenty of cultural, sporting, and other facilities, festivals and opportunities. Plenty of jobs for professionals and non-professionals. Plenty of opportunities and resources for families. Pearson airport is only 45 minutes down the highway, and the international airport at Kitchener/Waterloo is even closer. Yet there is still a shortage of family physicians in Guelph. I don't understand it at all. Sure, Guelph isn't Toronto, Vancouver or Montreal, but it's also not a tiny place in the middle of nowhere.

[aaronjw]

It's funny. In the mid 70s when it was felt there was a physician surplus (also followed massive physician expansion; ring a bell? Lol) one of the arguments for doing nothing was that the oversupply from urban areas would trickle down to rural and underserved areas. It didn't happen then.

 

The more I read about physician human resource planning the more I realize they just make it up as they go along.

[medhopefuls2016]

If there is any one who still feels offended, please let me reassure you that I by no means was try to demean anyone to to have a skewed or distorted view on who "deserve" to be in or not. I never used that word.

 

I do understand that my opinions are radical and perhaps skewed in terms of potentially cutting down medical school admission (through whatever methods) as a way to control the job market flow. Perhaps, I am wrong all along.

 

I want to make something very, very clear right now. I never once thought about people not having a certain MCAT or GPA as being "undeserving" of being in medical school. I treasure the diversity and all the wonderful things people around me can teach me that I don't have, and that's what is great about medicine. Further, I specifically want to make clear of the fact that I do believe that grades ALONE do NOT make for good doctors.

 

The whole point of this post is to consider whether increase in grades would be a good way to control the job market situation. We can't objectively "evaluate" extracurriculars and experiences. What's to say that one person's experience (or lack thereof) is superior to another? Grades hwoever are something tangible that perhaps we can work on. That is all. Please do not take my point wrong in any way.

[rmorelan]

If there is any one who still feels offended, please let me reassure you that I by no means was try to demean anyone to to have a skewed or distorted view on who "deserve" to be in or not. I never used that word.

 

I do understand that my opinions are radical and perhaps skewed in terms of potentially cutting down medical school admission (through whatever methods) as a way to control the job market flow. Perhaps, I am wrong all along.

 

I want to make something very, very clear right now. I never once thought about people not having a certain MCAT or GPA as being "undeserving" of being in medical school. I treasure the diversity and all the wonderful things people around me can teach me that I don't have, and that's what is great about medicine. Further, I specifically want to make clear of the fact that I do believe that grades ALONE do NOT make for good doctors.

 

The whole point of this post is to consider whether increase in grades would be a good way to control the job market situation. We can't objectively "evaluate" extracurriculars and experiences. What's to say that one person's experience (or lack thereof) is superior to another? Grades hwoever are something tangible that perhaps we can work on. That is all. Please do not take my point wrong in any way.

 

Part of the problem is the focus on objectivity to the exclusion of all other things I guess in general. I have to say that from the moment you start university every single major milestone from that point on is going to have an increasingly subjective component to it. Medical school < residency < fellowships < staff < department leadership positions etc. It just keeps getting more and more focused on intangibles.

 

and grades of course are kind of like statistics. They tell a truth that can easily be bent We all know that the same grade in different courses can mean completely different things, and similarly some programs really are just easier than others. There is no grade based objective platform to make GPA assessments either. It is all just evaluating things on the shifting sands. The US gets around this by entirely focusing on standardized testing but that has it's own flaws.

[rmorelan]

It's funny. In the mid 70s when it was felt there was a physician surplus (also followed massive physician expansion; ring a bell? Lol) one of the arguments for doing nothing was that the oversupply from urban areas would trickle down to rural and underserved areas. It didn't happen then.

 

The more I read about physician human resource planning the more I realize they just make it up as they go along.

 

ha - I think there really is a big lack of central planning there as well. There simply isn't anyone really running the show. Each hospital, each specialty, and each province is all working in relatively isolation.

 

Trickle down theories of doctor placement assume people wouldn't be willing to accept relatively large pay cuts to remain close to cities they love and want to live in. That simply doesn't the case. By the time you have the income so low people want to leave (and very definitely are grumpy about it) the cost is through the roof. It doesn't make a lot of sense. Pretty basic economic skewing I am afraid due to having all doctors at all places earn the exact same - market inefficiency results and thus gaps in supply and demand.

[rmorelan]

OP must be the most popular guy in his class

 

ha - well regardless of popularity the question is valid - I mean we should encourage exploring thinking about how and why we recruit particular doctors. I have even seen related things as interview questions in the past

[rogerroger]

Reduction of medical school admission is an extremely controversial, especially on this thread. Quite frankly, it is a very dangerous thing to say (in much the same way as discussion on abortions, two-tier healthcare, equality of access...etc).

 

The immediate interpretation with any change of admission is whether students who do not have quality A (say grades or extracurricular or anything in between) truly qualify to be a doctor when there really is no such thing as being qualified or deserving. Denying entrance to medical school does not mean that one can't be a good doctor. Entrance to medical school also does not mean that the student will make a good doctor.

 

However, the reality is that a shortage of physicians is coming to an end. The demand side of the equation partly depends on public wait times/public opinion but ultimately comes down to federal government transfer payment. At an age when governing spending on healthcare reaches just over 10% of GDP, the control of cost is important.

 

At current level of medical school enrollment, our system (in my humble opinion) is not sustainable. Long-term infrastructure and human resources were lacking, contributing to the boom-bust cycle. Whether I am a medical student or not, I wouldn't want to have to contribute to the training of medical students and physicians, knowing that they, especially the growing number of specialists, won't be able to work to their fullest potential.

 

As a tax payer, I would much rather have a reduction of medical students/residents and ensure that all of them, in the end, can find positions and their own niche in a timely fashion where they can contribute back to the society. What's the point of having all these trainees and spending millions trying to train them when some of them can't find a job to serve the society back in the end?

 

It is not opinion, it's pretty much fact that the current rates of enrollment are not sustainable. Unless there is a corresponding increase in residency funding a larger and larger proportion of new med students will be pushed into fields they don't want. Namely, family med in undesirable locations. This is not desirable nor is it a sign of a well functioning system. You are not attracting people who are going to be happy or inspired doing their job or living in these locations. You are basically forcing them down a path after 10-13 years of education...

 

There is nothing taboo about this topic. It is a very serious matter and should be spoken about frankly.

 

I would not want to be just starting out as an M1 today for the reasons specified. Heck, even as someone with a few more years of residency left in a field widely regarded as job prosperous I'm mildly concerned. You best be as well IMO and don't let anyone tell you otherwise. Who cares how medical students are selected, its all trivial. If you got a decent GPA and can interview as a normal person you can do the job. If I had things my way it would just be a lottery after these cutoffs. It is all about how many you accept, the raw numbers. There are too many med students if there are residents sitting at the end jobless in 2013 and with a FM surplus predicted for 2018. Just look at my alma mater med school UofT, they increased their spots by ~40 since my class started and convocated. There is a bottle neck and it's getting tighter every year, prepare to get squeezed.

[polarbear89]

As a current student, that terrifies me. To pay and complete medical school and then residency and to not have a job at the end makes this journey seem more and more precarious. By the time the med schools cut down, we will have many unemployed graduates and many graduates pursuing fields they do not wish to be in due to this surplus.

[TheBoss]

and grades of course are kind of like statistics. They tell a truth that can easily be bent We all know that the same grade in different courses can mean completely different things, and similarly some programs really are just easier than others. There is no grade based objective platform to make GPA assessments either. It is all just evaluating things on the shifting sands. The US gets around this by entirely focusing on standardized testing but that has it's own flaws.

 

Huh what? With all due respect, they most certainly do not; other criteria are very important every step of the way.

[rmorelan]

Huh what? With all due respect, they most certainly do not; other criteria are very important every step of the way.

 

Ha my phrasing could have been better - I was trying to say that for the academic portion, which is of course still a major part of selections, of admissions in the US they get around the issues with GPA evaluation but relying mostly on the MCAT to provide a measure of standardization. Not that the MCAT is the sole means of selecting students overall, just the main way they handle the selection for GPA (not to say they don't allow look at your transcript - the word entirely is too strong there ). They have to as they have even more variable schools in the US compared to canada and they also have so many more of them as well to consider. How else can you realistically compare down there a GPA from Harvard to a GPA from a run of the mill college?

[TheBoss]

Ha my phrasing could have been better - I was trying to say that for the academic portion, which is of course still a major part of selections, of admissions in the US they get around the issues with GPA evaluation but relying mostly on the MCAT to provide a measure of standardization. Not that the MCAT is the sole means of selecting students overall, just the main way they handle the selection for GPA (not to say they don't allow look at your transcript - the word entirely is too strong there ). They have to as they have even more variable schools in the US compared to canada and they also have so many more of them as well to consider.

Ah yes indeed, it's very hard to rely on GPA in the USA because of the variability. The impression I have is that they consider the MCAT the most important academic criteria, with a high GPA but low MCAT much harder to get accepted with that the reverse.

How else can you realistically compare down there a GPA from Harvard to a GPA from a run of the mill college?

Yeah, high grades would be so much easier to come by at Harvard . Interestingly, grade inflation is a topic of discussion at Harvard right now.

[JohnDakota]

For someone like me, the issue of 'where will I work' after residency comes a distant, DISTANT fourth to;

 

1. Can I get a job?

2. Will I enjoy what I do most days out of the week (if not all) on average?

3. Will there be significant human interaction in what I do?

 

With the graduation rates of highly qualified people from ALL backgrounds through academic institutions, all of us must accept some level of compromise on these main issues (the human interaction being specific to my needs). In the medical profession the payoffs of low unemployment rates (vs. national averages), overall compensation (vs. national averages even after debt), job security, and geographic freedom of employment are much better when taken together vs. other backgrounds.

 

Consider people who have pursued research based education programs. Even in the best of times they were limited to where the labs are which are performing the type of work they have experience in. Mostly major urban areas, but at most a handful of locations in Canada. If you become niche specific, that could be a handful in the world.

 

Backgrounds in STEMs right now just arent very marketable on their own. This goes double for people who have invested time in research based programs because research programs are being cut, and shipped to developing countries - even if you're willing to transition to industry the jobs simply aren't there, and the competition is so fierce that compensation and relative job security is pretty pathetic.

 

If I was smarter ~10 years ago and developed a successful study strategy in my first semester of my first year of undergrad, I probably wouldn't have to compromise on the main issues of will i get a job, where, and job satisfaction - I would have finished med/residency at the sweet spot where I could have worked anywhere. But I also would have never met my wife, because I would have never moved to study in graduate school. But even with the higher competition today, the field still has room to accommodate more people, especially when compared to demonstrably saturated industries like research and public education.

[aaronjw]

I counted at least 201 FTE positions in OntariOWE for a FM physician in a variety of roles with less than 20 considered remote or Rural areas.

 

Lots of locum as well.

 

Didn't take the time to go through the specialist jobs but looking at just at anesthesia and EM there were roughly 30 FTE jobs available.

 

Someone want to explain how there are no jobs for doctors yet lots of listing? Can only imagine what it's like in other provinces.

 

Site I looked at was HealthForceOntario

[JohnDakota]

I counted at least 201 FTE positions in OntariOWE for a FM physician in a variety of roles with less than 20 considered remote or Rural areas.

 

Lots of locum as well.

 

Didn't take the time to go through the specialist jobs but looking at just at anesthesia and EM there were roughly 30 FTE jobs available.

 

Someone want to explain how there are no jobs for doctors yet lots of listing? Can only imagine what it's like in other provinces.

 

Site I looked at was HealthForceOntario

 

I could be wrong but I think they're talking about projected need by the time medical trainees will be finished UG med and residency.. so ~6-10 years in the future. Those numbers aren't so rosy - even for FM if you're targeting specific geographical areas. Niagara, for example, is expected to have enough FM by 2017, where as Central Ontario, and even Mississauga-Halton are projected to still be in dire need of them.

 

Although like I said in my previous post; Adequate physician supply /= saturation. Saturation is what industries like research and public education are experiencing. Adequate supply still had significant room for accommodating other physicians, and depending on the work/life balance one wants an adequately supplied geography could be perfectly suited for them.