We have a project in progress that will cut the cost of health care in half, make it affordable for all, and save US $2 trillion. It is a capital markets solution. Could anyone please get me in touch with Mr. Robert F. Kennedy Jr. ?
200 More Medical Schools, Add 20,000 seats –
Years to Equilibrium and the cost for expanding
medical / osteopathic physician training
Proposal: Open 200 new physician schools immediately (within 24 months)
Fact: The MCAT scores about 45,000 science students a year. You can’t even sit for the MCAT until after completing more than a year’s worth of heavy college level science courses (usually stretched out over 3 years). The MCAT test takers compete for about a third that many medical school seats.
Cutting to the chase: If twice the seats were opened, all seats would be immediately filled. If three times the seats were opened, all would be immediately filled. If Ten times the seats were opened, applicants from past years would fill them.
Comparison of law school versus medical school enrollments: The 10 year graduation total for Harvard Law school is about 4,400 lawyers. The same 10 year graduation total for physicians from Harvard Medical School is about 1350.
The 10 year graduation total for Yale Law school is about 1,400 lawyers. The 10 year graduation total for physicians from Yale Medical School is about 850.
The 10 year graduation total for Brigham Young University Law School is about 1,200. The 10 year graduation total for physicians from BYU medical school is zer0.
There are approximately 250 law schools in America, including correspondence and on line formats. In two generations, the number of attorneys has increased from one lawyer for 695 Americans in 1951 to one lawyer for 264 Americans in 2000.
U.S. allopathic medical schools graduated 15,676 in 2002, and 16,138 in 2008.
I could keep these comparisons up for the 2500 colleges in the country, but if you haven’t gotten the idea by now, it would be useless to try.
What would it take to cure America’s doctor shortage? Nurse shortage? Researchers?
How would the medical / osteopathic schools be opened? Associate with existing hospitals.
Existing hospitals (12,000 in number), already have auditoriums, medical libraries, offices, laboratories, equipment, and staff, some of which could become faculty. The Set up for the medical school, by associating with such is estimated at $20 million each. Thereafter maintaining a student in medical education is $120 thousand a year. Assume 4 years each of first degree health education (MD or DO), 2 to 4 years of interning, 4 years of residency, for a total of 12 years post undergraduate college. Some specialties will be less, others more.
How high is the goal for physicians? 7 million.
Two decades ago the author of a research article commented that ”we” (speaking of the medical industry, but really he meant ‘he’) did not know the preferred ratio of patient to ‘surgeons’ (I read physicians.). He didn’t know, but the Veterans Administration knows the ratio. Why is that important? The Veterans Administration sets the highest standard for quality health care, because it trains a fourth of our physicians., and is by far the largest so to do. The DVA’s goal is to have 1 physician per 60 patients, which is the Veterans’ Administration standard. Lower goals are available, all the way down to third world countries that have one physician to 50,000 population and more. Unless of course the physicians are not available for any price. See the Phoenix VA appointment wait list scandal Spring of 2014, resulting in the resignation of the Secretary. A newspaper article passingly noted there are not enough physicians.
Aren’t present medical school seats enough? No, they are not even in equalibrium to replace existing attrition of the present physician population. The allopathic schools produce only 2% a year, which would require physicians to have a working career of 50 years, in addition to 14 to 16 years of college. There is no allowance for seats to expand for the increased population, or to catch up with a century of artificial limits on health training.
There are 750,000 physicians in the U.S., of whom a fourth are trained overseas, leaving 3/4ths or about 563,000 US trained physicians. Assume a loss of 3% per year from retirement, disability, incapacity or death. This requires replacement of 22,500 (750*10^3 * 3%) physicians per year which is more than the medical school seats available. For nearly a century, there has been no expansion in medical education for increased population, much less for longevity (increase of life expectancey from age 65 to 85, which has improved over the past 2 generations). Read that footnote on the Flexner report to understand how this came about. Thus the pressure to import foreign trained physicians, half of whom are from India and Pakistan.
The states have widely varying costs and training opportunities.
What is the cost for expanding medical schools? About $110 billion investment yields 10,000 physicians per year and then continue to spend $17 billion a year thereafter.
Assume each new physician (medical / osteopathic) school has 100 seats for the entering class. Thus the cost of 100 physician schools, or adding 10,000 seats would be as follows:
Opening door costs of $20 million for each of 100 schools is about $2 billion.
10 * 10^3 (students) *$12 *10^4 (expense) per year
100 new Physician Schools with 100 seats per school – 2 decade plan
BY year 7
This year the medicare receipts will not cover medicare expenses.
By year 14
Thereafter the country will train 10 thousand more physicians for ever, plus the 22,500 previously noted, or 32,500 The annual cost and production achieves equilibrium.
2051- Note - At about 30 years from graduation, attrition will take away 3% per year, or 3,000 Population projections indicate an increase of U.S. population to 420 million, so the effect will be to under staff by half.
At about 40 years from graduation, attrition will take away 10,000 per year for equalibrium in physician cumulative production. i.e. 10,000 are added, and 10,000 are taken away.
Result: 100 new physician schools would expand the present physician population by 50% over a 50 year period, and then maintain the physician population at about 1.1 million physicians.
What is required to get a physician to patient ratio (1 to 60) preferred by the Veterans administration? For a population of 420 million in 2051, the number needed is 7 million physicians. We start with a base of 750 thousand physicians.
2061 with 1657 new schools, the 6,250,000 physicians are added to the 750,000 physicians maintained by foreign immigration and existing schools. There would be about 7 million physicians , for a ratio of 1 physician for 60 patients.
Note maintaining 7 million physicians won’t prevent deterioration of the ratio. As US population grows the ratio would deteriorate, at the rate of 11 patients per 100 million population, or about 19 percent per 100 million additional population.
What ‘level of care’ is the policy? The present level at 2008, is not what it was in 1965, and is declining several percent each passing year.
What if the governemnt can’t afford it? This doesn’t have to be a government project. After Medicare was passed, previously charitable Hospitals went from non-profit to profit. So could schools.
Is this all? No, the same deficiency in education applies to nursing, pathology, and other health care professionals.
What of Nurses as substitutes for Physicians? Duke University is spending $200 million to add 216 students. Which is a little under a million per student, a number used for this report. California is expanding nurse practitioners in 2013, but not seats.
What of physicians?