Sunday, October 28, 2007
It takes a fair amount of time for growing pains to get worked out when expansion comes to professional sports. The athlete pool is diluted and sometimes importing players from other countries fills the void. Baseball has Japan and Latin America to draw from, hockey has Europe and soccer has the whole world. These imports remind us that there is plenty of opportunity to hone athletic skill outside of the United States.
The medical world is slowly realizing that the US is running out of doctors and a real shortage is looming. Within a dozen years, there is the potential need for 200,000 more physicians and the training may not be available for those docs in this country. While medical schools are increasing enrollment and 15 new schools of medicine and osteopathy have opened, those newly minted MDs may not have a place to get their graduate training.
Not so long ago, the standard training to become a practicing doctor was four years of medical school to get the MD degree, then a year of internship if successfully completed, let the new doc apply for a license to practice medicine in a state. That year of internship was spent in a hospital rotating through the different specialties of medicine. While that was the minimum requirement, many docs continued to specialty training in residency programs from 3-10 years or more in length and became specialists like pediatricians, anesthesiologists and neurosurgeons.
Times change and almost all physicians take a minimum of three year of postgraduate training prior to entering the primary care specialties of family practice and internal medicine. The depth of knowledge required has grown so much that there is pressure to add another year to that minimum.
The growth of postgraduate training for doctors is a certainty, but the question becomes “who will pay for it?” Medicare is the backbone of the training budget with private foundations kicking in the rest, but should a few thousand new docs need to be trained every year, the money to do so is presently lacking. The cost of a resident is more than just the salary. A first year resident out of medical school may make close to $50,000 (not bad except for the average doc graduates with $100K in student loans) but these people need to be taught, so there is the cost of the education programs including faculty and support staff. The math says it will cost billions extra each year to rebuild the medical supply.
The alternative is to look to the rest of the world and import doctors from other countries. For the past two decades, as the population in the country grew, medical schools did not increase enrollment. The needs were filled by foreign born docs. But as the rest of the world’s living conditions and economies improve, the United States finds itself in competition with other first world countries for a finite number of doctors. There is also the ethical issue as to whether doctors trained in Africa and Asia should be lured away from the needs that their home countries may have, instead of providing training, support and infrastructure to increase the medical presence in third world countries.
There is no doubt that free agency in sport has allowed athletes to cross international borders and help shore up teams in the US leagues. Instead of home grown, it has been easier and cheaper to find that talent elsewhere. It’s a little harder in medicine. A good nurse takes four or more years, a good doc more than 10. Hard to make a run for a pennant when your starters are a decade away.