We need more doctors

A few weeks ago I helped my brother move to Chicago where he started medical school. Amongst the things my brother and I talked about on the trip was the U.S. healthcare system and how incredibly difficult it is to become a physician in America.

During my brother’s white coat ceremony the keynote speaker spoke about how difficult it was to get into the Stritch School of Medicine. In 2021 over 60,000 people applied to medical school and of that number nearly 13,000 applied to Stritch. They gave interviews to just 600 people. Of those 600 people, 300 people were admitted to the school. If you applied to Loyola, there was a 2% chance that you would end up attending.

The speaker talked about this with pride and it was meant to inspire students and remind them of how special they were. And it was true, I did feel an immense amount of pride in my brother. I witnessed him struggle through the application process and spend months wracked with anxiety over whether or not he would get an interview callback.

Yet I couldn’t stop thinking of all the other brothers and sisters who went through that process but weren’t one of the select few who made it in.

On top of being one of the smartest people I know, my brother worked tremendously hard in order to get into medical school. He went through challenging pre med courses in undergrad, volunteered as an EMT in college, studied for the MCAT, worked in an urgent care clinic during the peak of the pandemic, and then worked in a bullet related injury trauma clinic.

When we talk about getting into medical school, he has often mentioned the many friends of his who followed a very similar path. Many of them got better grades and MCAT scores than he did. They also took years off to volunteer and build up their resume for a chance to get admitted to medical school.

The application and response process for medical schools is opaque and unforgiving. There are multiple submission deadlines and secondary applications that an applicant must pay for and complete. There is no feedback during this entire process.

Many of these close friends got rejected from all the schools that they applied to. They were left wondering where their application fell short and if they should go through the arduous process of applying again. He talks with frustration how so many highly qualified and motivated individuals are denied the opportunity of serving their communities.

When you look at it all together, it’s no wonder there is a massive physician shortage in the U.S. We make it so incredibly hard for those who want to practice medicine to actually pursue that path.

My brother talks firsthand what the impact of a lack of doctors (and other medical professionals) has on the communities he’s worked in. Personalized attention with a focused plan to address key health issues is completely out of reach for much of our population.

The physician shortage isn’t an accident. It is the result of specific policy decisions made to build the system as we know it today. The number of practicing physicians per person in the United States is much lower than in most developed countries.

In the early 1980s with heavy lobbying and support from the American Medical Association, the Association of American Medical Colleges, and other prominent medical associations a narrative of “physician overproduction” became common.

In response to this narrative, medical schools established a voluntary moratorium on new schools and froze existing enrollment. These self-imposed measures weren’t lifted until 2005.

It also led to the federal government slashing funding for residency programs in teaching hospitals across America. The Balanced Budget Act of 1997 permanently froze the number of residents Medicare funded per hospital at 1996 numbers.

As our population has grown it has become harder and harder to become a physician. GPA requirements have skyrocketed in the face of increasing numbers of “weed-out” classes for pre-med students.

According to a Princeton Review study, the average undergraduate GPA of all admitted medical school applicants is a 3.71 while in just the 1990s the average undergraduate GPA for a med school applicant was 3.4.

On top of the difficulty of actually getting into medical school, the average student ends up with an obscene amount of debt before they even begin practicing. Many graduates have $200,000 to $400,000 in outstanding student loans when they enter the workforce.

This leads many medical school students to pursue hyper specialized and high paying vocations such as neurosurgery, dermatology, gastroenterology, etc. These incentives don’t align with the current population needs for more internal medicine (family, pediatricians, internists) doctors.

Becoming a doctor is seen as this exclusive, elite profession that only the smallest sliver of the population will ever achieve. The reality is that this exclusivity is largely artificial. It is one of the many factors that has led to poor overall health outcomes relative to countries of similar wealth.

Frankly, I don’t care if my doctor got a B+ instead of an A- in undergrad organic chemistry. I only care that they have a strong foundation in medical training and a passion for helping patients. If we empower thousands upon thousands of highly qualified people to pursue their passion I just might be able to get more than a five minute conversation at my annual checkup.