What's Up? Docs!

March 08, 1994|By DANIEL S. GREENBERG

WASHINGTON — Washington. -- Among the puzzlements of the moment is the record-breaking rush to get into medical school.

With over 43,000 applications on file for admission next fall, the queue is up by 7 percent over last year's level, according to the official scorekeeper, the Association of American Medical Schools. As recently as 1989, fewer than 28,000 applied for admission.

Since the number of medical schools in the United States has remained constant at 126 for many years, the competition for entry has heated up for the annual allotment of about 16,000 freshman slots. But more and more keep trying, though medical education is the most expensive and grueling of all academic disciplines. Indebtedness of $50,000 to $100,000 is no rarity among medical graduates.

The big increase in applications comes at a time when government regulators and insurance managers are draining the medical profession of independence and prestige. Doctors increasingly complain about second guessing by bookkeepers. Lots of them say that if they had to do it all over again, they wouldn't.

Forecasts abound of lesser financial rewards for doctors under any kind of health-care reform, or even if no reform takes hold. And recently, a tide of ethical purity has swept over medical practice, washing away freebies that many physicians had come to regard as unofficial compensation for the rigors of medical practice.

Back in the good old days, docs and their mates could vacation gratis at costly spas in return for sitting still for sales pitches from pill manufacturers. The word around the trade, as reported by renegade drug executives at congressional hearings a few years ago, was that a $100 dinner could buy a healer's attention for an evening of pharmaceutical salesmanship.

All that is presumably gone now, banished by agreement of the Pharmaceutical Manufacturers Association and the American Medical Association. However, the ethical purists never rest.

Lately they've been pointing their righteous fingers at such venerable perquisites of medical practice as free pills for doctors and their families. Attacks have been directed at the ancient custom of ''professional courtesy,'' i.e., doctors treating doctors, and even members of their families, without charge. Unfair practices, say the critics, since they shield doctors from the realities of medical costs.

So, why the rush to medical school? No one really knows why these student tides come and go. But some things are obvious. Even if medical incomes aren't booming as they once were, they nonetheless remain high, averaging well over $150,000, with specialists making two or three times that figure, and sometimes more.

A lot of lawyers and business-school graduates, young and old, are looking for work, but the demand for doctors remains high. Health care, in fact, is one of the few remaining growth sectors in the American economy. Regardless of clever schemes to restrain medical expend- ,12l itures, the health industry is inevitably destined for growth. That's assured by the aging of the population, costly technological innovations and public demands for medicine to produce miracles.

While doctors tend to be realistic and modest about countering the ravages of age and disease, the loved ones of patients are often keen to try anything, regardless of futility and costs. The constituency for medical service and spending is robust.

Medical earning power probably accounts for a large share of the surge in medical-school applications. Another big factor is a big increase in the enrollment of women in medical studies. The old-boy system used to confine women to a tiny share of admissions, but they now make up some 40 percent of freshman medical enrollments. In some schools they've achieved a 50-50 share.

In addition to financial opportunity and the decline of sex discrimination, might there be humanitarian motives, too, behind the growth in medical school applications?They're hard to measure, but let us hope.

Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.

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