Solving the Doctor Dilemma:
DECICCO, ERNEST M.
NATIONAL REPORTS Solving the Doctor Dilemma By Ernest M. DeCicco American doctors earned an average annual income of $18,122 in 1957 and now make more than $20.000 a year. Yet the...
...This system is preferable to philanthropy, government scholarships, parental help and corporate donations...
...Since 1947, the medical care component of the Consumer Price Index has risen 53 per cent, or twice the increase of all the other items taken together...
...Of course, the medical profession contends that great intelligence is the sine qua non of its work, and that accommodating the foreign physicians or markedly increasing medical school enrollments would lower its standards...
...Some medical schools that were expanding their facilities in 1950 today must seek out applicants, and deans are lamenting the noticeable decline in their quality...
...Of the high school graduates failing to pursue a college education, 21 per cent had IQs over 120...
...in law 46 per cent...
...The New England Journal of Medicine has taken physicians to task for a poor policy on charges and has suggested that "fees should be reasonable and just...
...The price system as a method of allocating scarce resources into channels demanded by consumer sovereignty is preserved and the direct beneficiary of the profits of medical training pays for it...
...A study which traced the careers of the graduates from the University of Minnesota's High School in the years 1921-45 disclosed that the average IQ of those becoming dentists was 112, physicians 123, lawyers 127, MAs 127, and PhDs 132...
...Paradoxical as that may seem, one of the reasons for this is that tuition is both too high and too low...
...With loans to repay, too, trainees will choose schools on the basis of cost and expected returns...
...in the social sciences it was 52 per cent...
...The $12,622 earned in excess of the high school graduate is 22.7 per cent of this total...
...In 1959, the nation's 85 medical schools spent $227 million and lost money, forcing presidential tours of the fund raising circuit...
...In comparing medical students with graduate students in 24 other major fields, the former ranked 3th in mathematics, 7th in physics, 7th in chemistry, 2nd in biology, 20th in social studies, 20th in literature, 20th in fine arts and 16th in the verbal factor...
...another 50 per cent come from the 27 per cent of families that make slightly less than $10,000...
...Quality will not be impaired by a higher impost because student selection presently depends upon the initial distribution of income, not mental endowment...
...That the concept of responsibility does not operate in the "doctors' market" is indicated by the fact that the American Medical Association alone has received almost 1,000 requests from communities for help in finding a doctor...
...Evidence suggests that doctors have created and promoted a cult of ability...
...The $19,600 cash tuition expenditure is too high for most families...
...There is no evidence of their hesitating to set fee schedules and to adjust them from time to time...
...In ranking occupations by status, the National Opinion Research Center disclosed that physicians scored second only to Supreme Court Justices...
...One effective solution can be found in recourse to the credit mechanism...
...The difficulty can be surmounted by the Federal Government guaranteeing the loan, just as was done for GI home mortgages...
...Yet it recently forced 4,000 unlicensed foreign interns and residents off hospital staffs...
...Surely a large potential supply of humans is capable of absorbing a medical education without deterioration of quality...
...This is a small price to pay for an anticipated income of more than $1,500 a month for 42 years, of $510,000 more than that earned by the high school graduate...
...Ironically, at the same time, $300 million was spent to promote the sale of drugs...
...But the facts do not support this myth...
...The resulting scholastic competition should improve the quality of instruction and pressure the high cost schools into lowering their tuition...
...Physicians are strongly organized at national, state and local levels...
...Evidently the doctor is a well-trained mechanic, but a poorly educated man...
...Two years of internship at only $40 a week brings his cost to $55,600...
...If grades are used as a measure of ability, rather than IQ tests, medical students are not found to be any more gifted as a group than students in graduate schools of arts and sciences...
...Three parts are devoted to physics, chemistry and biology and only one part to social studies...
...In 1940, professors and practitioners both averaged about $4,200 a year...
...Doctors are an extremely intrepid lot...
...This plea is a reminder that doctors are unhindered in practicing the prerogatives of business statesmanship only to the extent that they are exempt from competition...
...The Association of Medical Colleges Educational Service has reported that 43 per cent of all medical students come from the 11 per cent of families that have incomes exceeding $10,000 a year...
...This means that 59 per cent of the medical students had poor academic records...
...Ernest M. DeCicco is an instructor in economics at Boston University...
...Of those who went on to study mathematics and the sciences, 73 per cent had achieved undergraduate scholastic ratings of outstanding or superior...
...Given knowledge of the rate of return and a chance to borrow the funds, new entrants to medicine can be expected to provide better medical coverage for more people at lower costs...
...The ghost of Thurman Arnold and the Antitrust Division does not haunt medical society meetings...
...The Robin Hood Syndrome is symptomatic of this confidence: Soak rich patients and be charitable to the aged and poor...
...Science and medical student profiles thus appear in a more favorable light than those of social science students...
...This action will also keep 1,5003,000 unlicensed foreign doctors from coming here...
...By 1957, professors made $7,459, physicians averaged $18,122...
...The profession itself acknowledges its overwhelming bargaining power by its actions on complaints about high fees...
...Yet the number of students applying for entrance to medical schools has dropped from 22,279 in 1950 to 15,172 in 1958...
...Comparative data are available in eight parts: mathematics, physics, chemistry, biology, social studies, literature, fine arts and the verbal factor...
...Only such fields as agriculture, drama, music, education, home economics and business ranked lower than medicine on this portion of the exam...
...and in business administration 30 per cent...
...Since ours is an acquisitive society in which success is pursued at any price and a man's worth is measured by the dollar, it is surprising that the attractive rate of return has failed to increase the number of doctors so as to competitively reduce fees, medical income and hence the rate of return...
...in the humanities 41 per cent...
...These examinations, it should be noted, are strongly weighted toward the natural sciences...
...What can be done to correct the present inefficient functioning of the price system...
...As can be seen from the table, a doctor of medicine achieves his preferred position with an investment of $55,600: Four years of college costs $8,000 and four years of medical school costs $11,600, a total cash outlay of $19,600...
...By raising tuition substantially, medical schools could erase their deficits and earn a surplus for expansion and for scholarships to intellectually rich but financially poor students...
...The verbal factor is perhaps the best measure of general intelligence, but there the neophyte doctor placed 16th out of 24...
...The results of the Graduate Record Examinations given by the Educational Testing Service of Princeton, New Jersey, further support the conclusion that testimony by the medical profession on the quality of its practitioners represents nothingmore than unjustified conceit...
...Commercial banks, however, will not make such loans because of a lack of collateral in the event of nonpayment...
...This shows the annual investment return on the cost of acquiring a doctor of medicine, a doctor of philosophy and a bachelor of arts degree...
...Tuition is too low in the sense that an income of $18,122 would not yield a return of 22.7 per cent if tuition were set at a realistically higher level...
...A huge prospective market of students is capable of satisfactorily absorbing a medical education...
...The dilemma posed by this situation at a time when the nation is suffering from a serious shortage of physicians is clear from the table below...
...With fees assured by Blue Shield and various other medical insurance plans, the paternalistic burden is easier to bear and adds to the image of doctors as public benefactors...
...In 1960, 66,000 masters' degrees were earned and about 9,000 PhDs...
...Other schools would be able to raise fees, dissolve deficits and expand enrollments...
...Despite the nation's population growth and the fact that people today spend twice as much as their parents spent for medical care, the nation's medical schools are graduating relatively fewer doctors than they did in 1910...
...While in training for these eight years, the medical student foregoes the opportunity to earn the $80 a week, or $32,000, accruing to a high school graduate...
...The shortage of physicians is the chief reason for their economic success...
...in medicine 41 per cent...
...A study was made recently of graduate students who had received their undergraduate training at Amherst College, Brown University, Harvard University, Oberlin College and Chicago University...
...The other columns are similarly computed...
...Collection through the withholding tax system, accompanied by a small premium to insure against the borrower's premature death, would be efficient and painless...
...A $20,000 loan for 20 years at 4½ per cent can be serviced at a cost of $144 a month, or $34,560...
...The medical profession's selective largesse makes it a junior welfare state, but one opposed to democratic governmental assumption of responsibility...
...thus it restricts the supply of doctors PhD College AB Faculty College Physician Members Degree Average Annual Income $18,122 $ 7,459 $ 8,100 Exceeds High School Graduate By 12,622 1,959 2,600 Cost (Expenses & 'Lost' Salary) 55,600 42,000 24,000 Annual Rate of Return on Cost 22.7% 4.6% 10.8% and prevents the competition necessary to lower fees...
Vol. 44 • March 1961 • No. 12
