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Med school applications rise
By 2020, the U.S. could find itself more than 90,000 physicians short, according to estimates. Five years later, the shortage could be more than 130,000.
An optimistic sign: Nationally, applications and enrollments are increasing at medical schools.
But the optimism is tempered by a bottleneck: Once students graduate from medical schools, they need to complete a residency of as long as eight years, and there are not nearly as many residency slots as medical students.
There is good news for Maryland. The state’s two medical schools tend to be competitive, and few of their students encounter the residency bottleneck, according to admissions officials and several students at various stages in their medical education.
The top culprit in the predicted lack of doctors is an expected increase in the number of Medicare beneficiaries, said Christiane Mitchell, Association of American Medical Colleges’ director of federal affairs and government relations. As the U.S. population ages, people will require more medical care from both primary care physicians and specialists. At the same time, she said, one in three practicing physicians is age 65 or older — so they’ll be retiring in droves.
On top of it, the Affordable Care Act is expected to give an estimated 32 million people access to insurance, which will drive even longer lines at the doctor’s office.
Students in Maryland and across the country don’t seem to be deterred by the residency dilemma. For the class that entered in August 2013, enrollment and applications were both up compared with previous years.
The University of Maryland School of Medicine drew 4,925 applications for the August 2013 class, about 250 more than for the class that entered in August 2012. Johns Hopkins University School of Medicine received 6,390 applications this past fall compared with 5,805 in 2012.
Nationwide, the number of medical school applicants has increased each year for at least a dozen consecutive years. This fall, applications increased by 6.1 percent compared with August 2012 — one of the largest year-over-year increases since 2002, according to the Association of American Medical Colleges.
About 48,000 students applied, the AAMC found, surpassing the previous record, set in 1996, by more than 1,000 students.
“While it’s a very alluring career, the worry remains about whether they’ll actually ever be able to practice medicine,” Mitchell said.
So why does interest in medical school continue to surge despite the surefire stress and not-so-sure success?
Several medical students said it’s because they have tough skin — they’re prepared to work hard and compete fiercely with their peers. Another possibility, several people said, is that many students, particularly younger undergraduates starting the pre-med track, simply aren’t aware of potential issues down the line.
Even if med school applicants are vaguely aware of the bottleneck that occurs when applying to residency programs, it may not be top of mind at the time, said David Kurland, 27, who’s in his third year of a seven-year M.D./Ph.D program at UM (which essentially includes a Ph.D. research program within four years of medical school).
“Truthfully, I don’t think it has registered with students yet,” Kurland said. “Getting into med school is hard enough; I don’t think people really think about how hard it’ll be to get a particular spot in a residency.”
That might be the case for Brooke Hyman, 21, who is waiting to hear back from eight of the 13 medical schools to which she applied. Meanwhile, she’s finishing up her pre-med requirements at the University of Maryland, College Park. She said she knows the number of residency slots is not keeping pace with the number of students, but she has other things on her mind — like her acceptance last week to UM’s School of Medicine and her pending application to Hopkins.
“I’ll worry about [residencies] when I have to,” Hyman said. “And who knows? Four years from now, maybe there will be more spots.”
Kurland is about two years from applying to neurosurgery residency programs. He knows full well that the number of applicants will exceed the number of spots, but he said he’s not discouraged.
“I know how competitive it is,” he said. “I’ll do everything I can to get a spot, and if I don’t, I’m not going to blame the lack of funding. I’ll blame myself. And I think other med students have a similar mindset; we’re all type-A overachievers.”
Hyman knows the feeling. Competition is intense even among pre-med students, she said, and it can feel like dog-eat-dog.
“In my mind, I’m going to get a residency, and that’s all there is to it,” she said. “Maybe other people won’t, but that’s not going to be me.”
Mitchell said the career remains attractive because young people like the idea of having a meaningful effect on others’ lives.
Additionally, Dr. Milford Foxwell Jr., associate dean for admissions at UM’s medical school, said applications tend to go up when the economy is sour, as people tend to stay in school when job prospects aren’t great.
About 10 years ago, Foxwell said, the school received about 3,500 applications per class. Applications peaked at 4,925 this year, he said, after hovering between 4,600 and 4,900 for the past few years.
“There’s no doubt in my mind the economy has played a role, so it will be interesting to see what happens now that it’s bouncing back,” Foxwell said. “But there are other factors, such as the improved reputation of the school.”
The sustained interest is further highlighted by national trends in first-time enrollment, which has been steadily on the rise since at least 2002, and which increased slightly more than usual this year.
There were 2.8 percent more enrollees than in August 2012, the AAMC found, thanks to the opening of four new schools and larger class sizes at some existing ones. This fall, 20,055 new students enrolled in one of the country’s 141 schools, a 21.6 percent increase.
Maryland schools weren’t as eager to expand their rosters. For years, Hopkins has admitted 120 students per class, said Paul White, assistant dean of admissions, adding that there’s no intention to expand. The school worries that doing so would compromise quality of instruction, White said.
Maryland’s target enrollment is 160, but the school will admit a few more if necessary, Foxwell said. The class that entered in 2013 is 163 students; two years ago, 159 students entered. The school tries to get as close to 160 as possible.
The biggest change at UM, Foxwell said, has been a decline in the number of in-state students who apply. In the past, more than 1,000 Marylanders submitted applications. This year, he said, 865 did.
Not enough money to pay for residencies
Back in 2006, when new research came out showing a rapidly approaching shortage of physicians in both primary care and specialty care, the Association of American Medical Colleges rallied the troops.
Medical schools across the country banded together and set a goal of expanding the average class size by 30 percent within 10 years.
“And they’re right on target to do that,” said Christiane Mitchell, AAMC’s director of federal affairs and government relations. “They’ve taken the first step in addressing what continues to be a very significant physician shortage.”
But medical schools can only influence so much, Mitchell said. The next step in closing the gap is to add more residency slots — but somebody has to pay for it.
In 1997, the federal government capped the number of slots it would help fund at 100,000 positions. Medicare pays a third of those costs associated with the positions, and academic hospitals (where students do their years-long residencies) pay the rest. In the years since then, hospitals have coughed up the cash for 10,000 more slots, Mitchell said, but they can’t afford to add any more.
“As teaching hospitals face more and more cuts in reimbursement, you can’t expect them to come up with any more money,” she said. “So they are not going to be able to expand these positions. That’s why we’re now having a very serious conversation with Congress to say, ‘Let’s address this issue.”
There are a number of bills making their way through the chambers that would raise or remove the cap on the number of positions Congress will fund, Mitchell said. But realistically, she said, she’s not hopeful of their passing in the current political climate.
