People keep wanting to make the decline in medical school applications and shortfalls in some residency areas into an inclusion and diversity issue, and it’s not. While technically, this is the lowest number of applications we’ve had since 2017, it is about the same as we had applying in 2013 and 2014. That is, the number of applications for medical school has been decreasing for years now as a general trend. We’ve heard all sorts of explanations - the deterioration of the ‘Fauci Effect’ (the interest people had in becoming clinicians in 2020), more selective admissions, costs, and social and economic uncertainty.
Related to the other article this week on making doctors - when being a physician was heralded with great respect, and was a needed service - applications zoomed up 20%. When we hear doctors disrespected and maligned - applications zoom down. Seems pretty clear to us. Money isn’t the top issue in deciding to embrace the hard path to becoming a physician. It’s just *an* issue. Respect ranks higher.
Medical School Applicant Trends 2024-2025
Like most of STAT’s articles, this is a well-researched piece exploring the origins of the physician shortage, the current factors exacerbating the problem, and calls for a set of reforms at the national level to address it.
We think the approach is warranted but overly simplistic for a couple of reasons:
First, there’s the assumption that technology will decrease the need for physicians. That’s not the case—technology and AI will increase the need for highly trained physicians. We’re going to live longer, with more chronic (formerly fatal) conditions.
Second, that increase will come with an increase in sub-specializations—sub-specializations that cannot be delivered outside of dense urban areas. Medicine is going to get more intense, patient presentations more complex, and sub-specialization more demanding.
Primary and acute care medicine are their own fields and should be considered separately from increasingly complex specialized medicine. The regulatory (and legal) barriers preventing physicians from forming hospitals, particularly in underserved areas, need to end. Certificate of Need regimes in 35 states, often captured by large systems, must also be abolished.
And lastly, you don’t make a new doctor in medical school—you start in high school. You start in the early college years. Focusing solely on end-stage training, both in the nursing and physician training systems, won’t have the impact you’d achieve by starting earlier.
A Key Bottleneck in the U.S. Physician Shortage - STAT
Citing work hours which equate their $75,000 salary to around $18 per hour, medical residents are pushing for union. They aren’t actually asking for anything at this point that they don’t already have, they just want their protections in writing. The university has denied collective bargaining (residents are public-sector employees, and do not have automatic collective bargaining rights in Colorado).
This unionization effort is pretty low-drama, but reflective of a wider trend in medicine. As systems grow larger, and physicians find their patient care, their career options and their autonomy threatened, efforts to unionize have increased.
Medical Residents at the University of Colorado Push for a Union
A 24-year-old G2P1 presents to labor and delivery in latent labor at 37 weeks. Her contractions are every 5-6 minutes, and her cervix is 2 cm/80% effaced/-1 station. She is Group B Strep positive and is receiving penicillin IV for prophylaxis.
Her pregnancy has been complicated by gestational hypertension, and her blood pressure at admission is 140/90 mm Hg. Fetal heart rate (FHR) tracing initially shows a baseline of 140 bpm with moderate variability and accelerations. No decelerations are noted.
She requests medication for pain relief and is given morphine 10 mg IV x 1 dose. Shortly thereafter, the FHR tracing shows decreased variability and very few accelerations.
Which of the following is most likely responsible for the change in FHR tracing?
-Group B Strep positive
-IV morphine
-Gestational hypertension
-IV penicillin
-37 weeks’ gestational age