Because of the ultra-low acceptance rates at the highest-ranked institutions in the U.S. News Best Medical Schools rankings, some of which accept less than 4 percent of applicants, many aspiring doctors wonder why it is so hard to get into medical school. This is especially perplexing, given the barrage of news stories about doctor shortages in rural communities and low-income urban neighborhoods in the U.S., and the constant public discussion about an extreme scarcity of physicians in certain medical fields, like primary care and psychiatry.
Dr. Robert Hasty, founding dean and chief academic officer of the Idaho College of Osteopathic Medicine, says one of the major reasons it is so difficult to get into medical school is that there has been growing interest in health care careers, which has led to a spike in the number of med school applications.
Hasty says demand for a medical education is "near an all-time high," so the typical premed student should expect to face stiff competition. "People really want to become physicians, and now more than ever," he says. "I would say this is especially true of the millennial generation. And I can tell you that, here at (our school), we hear from high-quality applicants everyday ... and these are people with really high MCAT scores and GPAs, that this is their second year, third year or even fourth year applying to medical schools. And years ago, they would have gotten accepted the first time through, but the demand is just incredible."
Statistics from the Association of American Medical Colleges reveal that there were more than 10,000 more applicants seeking admission to a U.S. med school during the 2018-2019 school year than there had been 10 years prior, a roughly 25 percent increase over the 10-year period.
Hasty says young people are especially eager to find work that allows them to have a positive impact on society, and the emphasis on science, technology, engineering and math in contemporary U.S. schools has boosted the number of people who want to become doctors.
"The current millennial generation, their desire to serve and give back is really incredible," he says, adding that Generation Z, which is just starting to apply to medical school, also shows a strong interest in public service.
Hasty also suggests that U.S. high schools and colleges are doing a better job of engaging students in science classes than they had in the past, which is spurring an uptick in interest.
Is There a Shortage of U.S. Medical Schools?
Hasty argues that new U.S. medical schools are not opening up fast enough to account for the rise in U.S. demand for a medical education, and the new schools that are opening are not necessarily located in places with severe doctor shortages, such as rural areas.
Dr. Richard Olds, the president of St. George's University in the Caribbean who was previously the founding dean of the University of California—Riverside School of Medicine, says few medical schools opened between the late 1970s and early 2000s, and very little expansion of medical schools occurred during that period thanks to an inaccurate but widely publicized labor market forecast projecting a surplus of doctors. Meanwhile, he says, the need for doctors in the U.S. was rapidly rising, and medical schools were not meeting that need.
"Our country has been increasing in population and aging, and that combination increases doctor demand astronomically," Olds says. However, because medical school enrollment did not increase significantly for about 30 years, it is hard for that enrollment to rise quickly enough now to catch up to the high and expanding level of health care needs in the U.S. Still, many medical school administrators and professors and concerned about doctor shortages and actively attempt to combat the lack of primary care providers nationwide, Olds says.
"There will be, for the foreseeable future, way too few medical school slots for the future demand," says Olds, whose institution is the fourth-largest producer of U.S. physicians. St. George's boasts more than 9,000 alumni practicing in the U.S., according to a 2016 medical census published by the Federation of State Medical Boards, a national coalition of state medical regulatory boards.
Would New U.S. Medical Schools Solve U.S. Doctor Shortages?
Research on the doctor labor force released in April by AAMC predict a shortage of between 42,600 and 121,300 doctors by the year 2030.
U.S. medical school enrollment has expanded significantly since 2002, with class sizes rising by about 30 percent during that time period, according to the AAMC. But Jason Farr, senior vice president of recruiting for The Medicus Firm, a health care provider recruiting company based in Texas, says the U.S. doctor shortage has multiple causes that have nothing at all to do with the number of spots at U.S. medical schools. One important factor, he suggests, is the significant number of U.S. doctors who are at or nearing retirement age. Another factor, he says, is that contemporary doctors are more eager to find work-life balance than their predecessors in past eras, and many doctors are unwilling to put in the long hours that previous generations of physicians did.
Farr questions whether increasing the number of U.S. medical schools would address the doctor shortage at all, and he cites the residency match results report published this year by the National Resident Matching Program, which showed more residency applicants than residency spots. According to Farr, until there are enough residency spots for the current graduates, the doctor shortage will remain.
Experts say that a scarcity of U.S. residencies has created a bottleneck in the U.S. doctor supply chain, thwarting some individuals who want to become physicians from fulfilling their ambitions. This roadblock in the career path of aspiring doctors occurs after they have invested four years into receiving a medical degree. And experts say that this predicament will continue unless and until the number of U.S. residencies increases.
Dr. Darrell G. Kirch, AAMC's president and CEO, says the underlying issue is a lack of federal funding to support the expansion of residency programs.
Because medical school graduates are typically expected to complete a residency before becoming licensed physicians, Kirch says "there simply won’t be enough doctors to provide the care Americans need" without an increase in funding for residency programs, which has been frozen since 1997.
Dr. Matthew Mintz, a clinical associate professor at the George Washington University School of Medicine who is also an internal medicine physician, agrees. According to Mintz, addressing the U.S. doctor shortages is really in the hands of federal legislators.
"In order to increase practicing clinicians you need to increase the number of residency slots," Mintz wrote in an email. "However, residency slots are funded by Medicare. Thus, the only way to increase the number of practicing doctors is to increase Medicare funding. Currently, both sides of the aisle are talking about how to cut (or at least preserve) Medicare funding. Calls to increase Medicare spending to fund new residency slots is usually met with deaf ears on both sides of the aisle."
Why Do Certain U.S. Regions Have Extreme Doctor Shortages?
Experts say one reason for extreme physician shortages within specific geographic regions is the fact that doctors generally prefer to live in wealthy, metropolitan areas with an abundance of highly educated individuals like themselves as opposed to lower-income areas with less educated populations, which are generally the areas that need doctors most.
In addition, experts say that, medical schools tend to be located in major metropolitan areas that have plenty of physicians. Because freshly trained doctors often practice close to where they went to school or close to their hometowns, they tend to settle down in areas of the U.S. where there are already a significant number of doctors.
Will Getting Into Medical School Always Be Difficult?
Experts say that medical schools deliberately have a rigorous vetting process that is designed to ensure that anyone they admit is capable of passing tough medical courses and enduring demanding clinical training. No matter how many applicants are competing for spots in medical schools, these schools typically have high standards, and they want to identify the best and brightest students.
"Medical schools set up a great number of hoops for applicants to jump through: a prescribed undergraduate curriculum with numerous prerequisites, the MCAT exam, a complex and multipart application, traveling to interviews, exhaustive days interviewing, and a constant requirement for professionalism throughout," Dr. McGreggor Crowley, an admissions counselor at the IvyWise admissions consulting firm, wrote in an email.
"These hurdles exist for many reasons. First, med school admissions committees want to establish a mechanism to identify the best applicants in their pool. It can be challenging to differentiate applicants based solely on objective information like a GPA or MCAT score. Second, the process is designed to be intense to ensure that those going through the steps are willing to endure the trials and hardships inherent in the practice of medicine."