Medical Schools, Heal Thyselves!

USA Today reports that medical school applications, particularly among Black and Latinx students, are up almost 20% during this pandemic year. This is wonderful news. Many applicants express a desire to practice in medically underserved communities. I fear their medical training will rob them of that opportunity.

In Tuesday’s Dispatch, I discussed medicine’s predilection for superstar specialists. They get the money and the glory. This reality has created a significant oversupply of specialists and undersupply of primary care physicians (internists, pediatricians and family practice doctors). 

The situation is critical. Kaiser Health News reports that U.S. medical school graduates in 2019 filled a record low 41.5% of a record high 8,116 primary care residency slots. How can this be? Enhancing primary care services is essential to reducing America’s social inequities and exploding levels of chronic disease.

The obvious economic answer is to train more primary care physicians and pay them more money. This also should mean training fewer specialists and paying them less money. With a few notable exceptions, the medical education complex ignores this supply-demand imbalance and uses its influence to distort appropriate allocation of healthcare resources. 

It’s gotten so bad that Kaiser Permanente thought it was more cost-effective to open a new medical school than to retrain new MD’s in their vertically integrated care model. 

Let’s hope growing numbers of righteous and aspiring MDs will transform medical education from the inside. They may be U.S. medicine’s last best hope.

Read all dispatches from Dave Johnson here.