Medical-school applicants basically need to have near-perfect GPA's and very high MCAT scores to get accepted to an accredited U.S. institution. Even among that much better qualified pool of applicants, only about 50 percent get accepted. Imagine if only half of our high-school grads who applied for college got in to any college — there would be riots at admissions offices every spring.
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If you're among the lucky ones to get accepted, there's an ever-expanding amount of requirements, including coursework and hands-on training. The average time a medical student spends in school is now a whopping 14 years. Sure, extra training is usually a good thing, but that's a looong time to ask a smart, young person to take him or herself out of the good salary-earning pool for science-skilled workers. A med-school student is likely to see his or her college classmates who majored in the hard sciences making big money elsewhere before they even get to dissect their first cadaver.
All that extra time in school brings up another little problem called "tuition," which serves as an additional barrier to entry to those students still willing to blow a decade and a half in school. That tuition problem translates to a median $170,000 debt for graduating med students. Again that's median, so half of all medical-school grads actually have debt more than that. Many of them are in the neighborhood of more like $500,000 in the hole.
At this stage, the government again plays a big role in the supply-chain jam. One of the key problems is that the number of residencies hospitals establish for new med-school grads is almost entirely dependent on Medicare funding. The baseline for that funding hasn't changed enough since 1997 to meet demand. Teaching hospitals have been complaining about this for at least five years. But by getting into bed with the government decades ago and allowing Medicare to dictate residency spots, this was a predictable Faustian bargain.
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So, you survive all of that and — yay! — you become a doctor. Think it ends there? Nope! The government keeps throwing up hurdles.
First, there's the malpractice insurance that boasts premiums of about $250,000 per year for many surgeons and specialists. And then you'll find you're never quite out of school as certifying bodies like the American Board of Physical Medicine and Rehabilitation (ABPMR) impose a rigorous and all-too-frequent testing of doctors. While the re-certification process is on a 10-year cycle, there are some requirements for physicians to do "maintenance of certification" each year. This costs doctors a lot of of time and money. This is something that Dr. Paul Teirstein complained about in an editorial earlier this year in the New England Journal of Medicine, titled, "Boarded to Death." I have had several physicians in different specialties from different parts of the country tell me that, while they support continuing education, they believe they're being squeezed unnecessarily by organizations that have a financial incentive to continue to squeeze them. One physician told me earlier this year that he's thinking of hanging a sign up outside his office that says: "The doctor can't see you now, he's studying for another useless test."
All of this takes place before you can bill your first patient, or more likely, fill out your first reimbursement paperwork for an insurance company or Medicare. It's one thing to discourage unqualified people from providing life-saving care and fly-by-night schools from training them, but our current system of educating, insuring, and re-certifying doctors has gone too far for way too long. Remember, the best future doctors will be the same people with the same skills the tech sector is gobbling up for far more money and with far less formal training.
What we're left with is a system that not only leaves us short of the needed number of doctors, but also discourages those who do finish their training from going into any kind of private practice. Punching a clock at an expanded hospital facility may seem attractive to medical-school grads who have already assumed enough financial risk, but will the best innovations in patient service and care come out of that cookie-cutter atmosphere? And as acquisitive and aggressive as many major hospitals are about setting up off-site clinics, will they really reach as many people as the traditional neighborhood doctors setting up offices in their residential neighborhoods?
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And while testing outfits like the American Board of Internal Medicine (ABIM) and the American Board of Physical Medicine (ABPMR) have official government-blessed not-for-profit status, Dr. Teirstein points out that the ABIM makes millions more than their expenses and pays its chief executive and board members quite well. The smaller ABPMR reported nearly $12.9 million in total assets, nearly $5.7 million in total revenue and nearly $4 million in total expenses in 2013. Those expenses included nearly $500,000 in total compensation for its executive director, who isn't even a doctor.
And, while I'm never short of criticism of Obamacare, the Affordable Care Act isn't responsible for creating this problem. Though, it hasn't done anything to fix it either — and that's a big problem.
Of course, no one wants a bunch of quacks out there pretending to know how to treat sick people. But breaking down some of these barriers won't lead to that kind of scenario by a long shot. Capping insurance liabilities, reducing the frequency of re-certification tests, opening up opportunities for more private-sector investment in residency programs, etc., are all things the government can do to get out of the darn way of potentially thousands of future doctors.
It's time to get America out of the waiting room.
Commentary by Jake Novak, supervising producer of "Power Lunch." Follow him on Twitter @jakejakeny.
This article has been updated to reflect that the ABPMR reported nearly $12.9 million in total assets, nearly $5.7 million in total revenue and nearly $4 million in total expenses in 2013.