Applications to US medical schools fall for fourth year

BMJ 2001; 323 doi: (Published 15 September 2001) Cite this as: BMJ 2001;323:592
  1. Deborah Josefson
  1. San Francisco

    Applications to medical schools in the United States have declined for the fourth consecutive year, according to a survey sponsored by the Liaison Committee on Medical Education. The committee's questionnaire was designed to assess the state of medical school education and was completed last year by all 125 medical schools in the United States.

    Applications have plummeted since reaching a high of 47000 in 1996. However, they are still well above the low reached in 1988, when only 27000 students applied for admission. Nevertheless, many schools are worried that a trend in falling applications has been established. In the year 2000 there were 37092 applications for the first year class and 17538 acceptances.

    The number of applicants shrank by 3.7% from 1999. Of these applicants, 17274 were women, a 0.9% drop from 1999. But the percentage of women entering the first year of medical school has remained essentially the same, at 46%.

    In 2000 the ratio of overall applications to acceptances was slightly greater than 2 to 1, and the grade point averages and scores in the admission tests were virtually identical to those of entering students in 1999 (JAMA 2001;286:1049-55).

    Among the reasons cited for the decline are the drop in doctors' income, reduced autonomy spawned by managed care, a perceived loss of prestige in the profession, and the long period of training, coupled with the large debt incurred by many students.

    Medical education in the United States is long and expensive: four years of undergraduate education followed by four years of medical school and then 3-7 years of postgraduate residency training, depending on the specialty.

    Medical students who finance their education through student loans incur an average debt on the loan of $80000-120000 (£55000-82000). Undergraduates considering medical school may instead choose more lucrative careers, such as in business or the technology sector.

    That economic factors may be at play is supported by a concomitant decline in the number of medical school graduates pursuing residency training in primary care specialties. Incomes in primary care specialties, such as internal medicine, family practice, and paediatrics, are typically lower than in surgical specialties or invasive subspecialties such as cardiology and gastroenterology. This decline in numbers is occurring despite governmental initiatives to recruit students into primary care.

    The rate of decline in numbers of applicants to medical school may be slowing—the drop from 1998 to 1999 was 6% Moreover, applications from minority groups have risen, despite the closure of some affirmative action programmes. The number of people from minority groups entering medical school climbed by 2% to 4266 in 2000.

    Half the medical schools surveyed reported decreases in the availability of patients for clinical teaching, largely because insurance companies do not reimburse hospitals and clinics for services provided by medical students and junior doctors.

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