I know we have just about killed the subject of Rice getting a medical school. The March 2019 issue of Texas Medicine has an article about the number of new medical schools in Texas. There have been three that opened in the last few years and there are three more planned to be opening soon. See pages 26-29 of the digital article for details.

https://www.qgdigitalpublishing.com/publ...5178&l=1#{"issue_id":568844,"page":0}

Seriously, I think Rice is soon going to be the only university in the state without a medical school.

(03-14-2019 06:56 PM)TFW Wrote:  I know we have just about killed the subject of Rice getting a medical school. The March 2019 issue of Texas Medicine has an article about the number of new medical schools in Texas. There have been three that opened in the last few years and there are three more planned to be opening soon. See pages 26-29 of the digital article for details.

https://www.qgdigitalpublishing.com/publ...5178&l=1#{"issue_id":568844,"page":0}

Seriously, I think Rice is soon going to be the only university in the state without a medical school.

And BCM the only med school without a university... :)

Looks like a future where it's ever more important to know where your doctor went to med school. Admissions standards are going to have to go way down to provide students for all those medical schools.

(03-15-2019 09:49 AM)Frizzy Owl Wrote:  Looks like a future where it's ever more important to know where your doctor went to med school. Admissions standards are going to have to go way down to provide students for all those medical schools.

Especially with more and more doctors leaving their practices earlier in life.

Why doctors are leaving

Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs "need a complete overhaul;" while 40 percent see "more challenges with EHRs than benefits."

With the [enforcement] of EHRs, I had to spend more time as a scribe. One night a child I was treating had a seizure and I couldn’t get the medicine to enable them to breathe because their chart wasn’t in the system yet. This kid was fixing to die and I, the doctor, couldn’t get the medicine. It was demoralizing.”

One of my doctors was complaining about this the the other day, saying that every doctor in his field on a neighboring town had quit, and that if he quits, it will be because of the computer time being taken from his time with patients.

(03-15-2019 09:49 AM)Frizzy Owl Wrote:  Looks like a future where it's ever more important to know where your doctor went to med school. Admissions standards are going to have to go way down to provide students for all those medical schools.

Haha-I'm a total doctor snob when it comes to specialists... Though I tend to care more residency than med school (as long as the med school isn't Cougar High, etc... or in the Caribbean).

But my primary care went to Texas Tech HSC and I think he's great.

(03-15-2019 09:49 AM)Frizzy Owl Wrote:  Looks like a future where it's ever more important to know where your doctor went to med school. Admissions standards are going to have to go way down to provide students for all those medical schools.

Not sure I agree with this at all. I'm pretty engaged with medical school and residency admissions, and I can assure you that there is NO dip in admission standards at all. In fact, getting a decent residency position in some disciplines is incredibly hard. Almost impossible. I doubt that, even with the proposed expansion of medical schools in Texas, there will be any deterioration in admission standards.

The need to increase the supply of physicians in the United States is pretty significant. The US has 2.6 physicians per thousand residents. The average of industrialized nations is 3.5 and the range is between 2.4 (Japan) and 5.1 (Australia). The U.S. is 2nd lowest. Further, the ratio of primary care physicians is roughly 1/3 primary care and 2/3 specialists, when "experts" suggest that the ratio of primary care providers to specialists be about 1 to 1.

(03-15-2019 11:04 AM)Kayjay Wrote:  The need to increase the supply of physicians in the United States is pretty significant. The US has 2.6 physicians per thousand residents. The average of industrialized nations is 3.5 and the range is between 2.4 (Japan) and 5.1 (Australia). The U.S. is 2nd lowest. Further, the ratio of primary care physicians is roughly 1/3 primary care and 2/3 specialists, when "experts" suggest that the ratio of primary care providers to specialists be about 1 to 1.

I've never encountered any difficulty in getting an appointment with a PCP. It's specialists that have the long lines.

Speaking for myself, I'd prefer not to dilute the talent pool just to increase numbers. How do I know - why should I believe - that 5.1 per thousand is a better number than 2.6?

(03-16-2019 12:09 AM)Frizzy Owl Wrote:  

(03-15-2019 11:04 AM)Kayjay Wrote:  The need to increase the supply of physicians in the United States is pretty significant. The US has 2.6 physicians per thousand residents. The average of industrialized nations is 3.5 and the range is between 2.4 (Japan) and 5.1 (Australia). The U.S. is 2nd lowest. Further, the ratio of primary care physicians is roughly 1/3 primary care and 2/3 specialists, when "experts" suggest that the ratio of primary care providers to specialists be about 1 to 1.

I've never encountered any difficulty in getting an appointment with a PCP. It's specialists that have the long lines.

Speaking for myself, I'd prefer not to dilute the talent pool just to increase numbers. How do I know - why should I believe - that 5.1 per thousand is a better number than 2.6?

Well, at least when it comes to Primary Care Physicians, the death rate of the population decreases with an increasing supply of PCP’s.

https://www.google.com/amp/s/mobile.reut...SKCN1Q71NC

On the other hand, the same is not necessarily true for specialists.

https://pdfs.semanticscholar.org/9bad/ee...ae1a2e.pdf

The trick is in getting medical school graduates to choose primary care.

(03-15-2019 09:20 AM)georgewebb Wrote:  

(03-14-2019 06:56 PM)TFW Wrote:  I know we have just about killed the subject of Rice getting a medical school. The March 2019 issue of Texas Medicine has an article about the number of new medical schools in Texas. There have been three that opened in the last few years and there are three more planned to be opening soon. See pages 26-29 of the digital article for details.

https://www.qgdigitalpublishing.com/publ...5178&l=1#{"issue_id":568844,"page":0}

Seriously, I think Rice is soon going to be the only university in the state without a medical school.

And BCM the only med school without a university... :)

I have no inside knowledge of any kind, but doesn't it just sort of make sense for the Rice-BCM relationship to deepen?

I know... $ and insurance contracts and $ and dealing with the feds (Medicare/Medicaid) and $... still I hope that may happen one day.

(03-16-2019 08:18 AM)TFW Wrote:  

(03-15-2019 09:20 AM)georgewebb Wrote:  

(03-14-2019 06:56 PM)TFW Wrote:  I know we have just about killed the subject of Rice getting a medical school. The March 2019 issue of Texas Medicine has an article about the number of new medical schools in Texas. There have been three that opened in the last few years and there are three more planned to be opening soon. See pages 26-29 of the digital article for details.

https://www.qgdigitalpublishing.com/publ...5178&l=1#{"issue_id":568844,"page":0}

Seriously, I think Rice is soon going to be the only university in the state without a medical school.

And BCM the only med school without a university... :)

I have no inside knowledge of any kind, but doesn't it just sort of make sense for the Rice-BCM relationship to deepen?

I know... $ and insurance contracts and $ and dealing with the feds (Medicare/Medicaid) and $... still I hope that may happen one day.

That would take leadership and a willingness to truly step outside the bounds of sitting around and doing business as usual.

So, not likely to happen.

Today we (Baylor College of Medicine) announced a new affiliation with Baylor Scott & White Health to establish a regional campus in Temple, TX.

(03-15-2019 10:30 AM)greyowl72 Wrote:  Not sure I agree with this at all. I'm pretty engaged with medical school and residency admissions, and I can assure you that there is NO dip in admission standards at all. In fact, getting a decent residency position in some disciplines is incredibly hard. Almost impossible. I doubt that, even with the proposed expansion of medical schools in Texas, there will be any deterioration in admission standards.

Residency positions haven't increased meaningfully in decades. I've never understood all these new med schools and no commensurate increase in residency slots, other than to create more 'doctors' (but not physicians) to promote nutritional supplements.

One article I saw said med school enrollment was up 52%, but residencies up only 1%. DOn't remember the time frame... but its not as if we've ever really had trouble finding people willing to take residency slots.

(11-17-2020 04:23 PM)Hambone10 Wrote:  

(03-15-2019 10:30 AM)greyowl72 Wrote:  Not sure I agree with this at all. I'm pretty engaged with medical school and residency admissions, and I can assure you that there is NO dip in admission standards at all. In fact, getting a decent residency position in some disciplines is incredibly hard. Almost impossible. I doubt that, even with the proposed expansion of medical schools in Texas, there will be any deterioration in admission standards.

Residency positions haven't increased meaningfully in decades. I've never understood all these new med schools and no commensurate increase in residency slots, other than to create more 'doctors' (but not physicians) to promote nutritional supplements.

One article I saw said med school enrollment was up 52%, but residencies up only 1%. DOn't remember the time frame... but its not as if we've ever really had trouble finding people willing to take residency slots.

Residents are paid. Medical students are not.

(11-18-2020 11:29 AM)ruowls Wrote:  

(11-17-2020 04:23 PM)Hambone10 Wrote:  

(03-15-2019 10:30 AM)greyowl72 Wrote:  Not sure I agree with this at all. I'm pretty engaged with medical school and residency admissions, and I can assure you that there is NO dip in admission standards at all. In fact, getting a decent residency position in some disciplines is incredibly hard. Almost impossible. I doubt that, even with the proposed expansion of medical schools in Texas, there will be any deterioration in admission standards.

Residency positions haven't increased meaningfully in decades. I've never understood all these new med schools and no commensurate increase in residency slots, other than to create more 'doctors' (but not physicians) to promote nutritional supplements.

One article I saw said med school enrollment was up 52%, but residencies up only 1%. DOn't remember the time frame... but its not as if we've ever really had trouble finding people willing to take residency slots.

Residents are paid. Medical students are not.

That is the main issue with residents. They are paid employees that don't generate revenue on their own. The encounter is billed by the attending physician through the program. It is not an efficient system to capture charges for services provided. This is why resident positions have not increased because it is a lot more expensive and requires significant subsidy from somewhere else.

(11-18-2020 12:34 PM)ruowls Wrote:  That is the main issue with residents. They are paid employees that don't generate revenue on their own. The encounter is billed by the attending physician through the program. It is not an efficient system to capture charges for services provided. This is why resident positions have not increased because it is a lot more expensive and requires significant subsidy from somewhere else.

I agree... but so too do Medical schools. The number and size of grants and tax advantages etc for schools is pretty significant. You could likely fund some residency positions by combining them with the numerous incentives offered for 'hard to staff' places. You can have this residency slot, but you have to do two years practice in Nowhere, California once you graduate. I know lots of them (especially as the number of graduates outpaces the number of slots increases) that would do that or more.

(11-18-2020 12:51 PM)Hambone10 Wrote:  

(11-18-2020 12:34 PM)ruowls Wrote:  That is the main issue with residents. They are paid employees that don't generate revenue on their own. The encounter is billed by the attending physician through the program. It is not an efficient system to capture charges for services provided. This is why resident positions have not increased because it is a lot more expensive and requires significant subsidy from somewhere else.

I agree... but so too do Medical schools. The number and size of grants and tax advantages etc for schools is pretty significant. You could likely fund some residency positions by combining them with the numerous incentives offered for 'hard to staff' places. You can have this residency slot, but you have to do two years practice in Nowhere, California once you graduate. I know lots of them (especially as the number of graduates outpaces the number of slots increases) that would do that or more.

You are right.
Medicine at times just plain sucks. I actually just got off the phone with a peer reviewer for a patient. I ordered an MRI of the lower back for someone who hurt their back. The other doctor asks if I was a spine specialist or an orthopedist. I guess only orthopedists or neurosurgeons know anything about the back. He pretty much deemed me as unworthy. Must have been my med school.

(11-18-2020 01:05 PM)ruowls Wrote:  You are right.
Medicine at times just plain sucks. I actually just got off the phone with a peer reviewer for a patient. I ordered an MRI of the lower back for someone who hurt their back. The other doctor asks if I was a spine specialist or an orthopedist. I guess only orthopedists or neurosurgeons know anything about the back. He pretty much deemed me as unworthy. Must have been my med school.

The God complex is real with a FEW of them.

There IS a HEDIS measure regarding the use of imaging for LBP... one of those many 'cost saving' measures where you have to wait at least 28 days after the diagnosis to order a study... because of course, legislators know more about it than you do, right?

It's one of those parts I work on and hate, mostly because of my work with you... where you did what you knew was right for the patient, regardless of reimbursement. Now its all about following a script to maximize revenue and minimize cost.

(11-18-2020 12:51 PM)Hambone10 Wrote:  

(11-18-2020 12:34 PM)ruowls Wrote:  That is the main issue with residents. They are paid employees that don't generate revenue on their own. The encounter is billed by the attending physician through the program. It is not an efficient system to capture charges for services provided. This is why resident positions have not increased because it is a lot more expensive and requires significant subsidy from somewhere else.

I agree... but so too do Medical schools. The number and size of grants and tax advantages etc for schools is pretty significant. You could likely fund some residency positions by combining them with the numerous incentives offered for 'hard to staff' places. You can have this residency slot, but you have to do two years practice in Nowhere, California once you graduate. I know lots of them (especially as the number of graduates outpaces the number of slots increases) that would do that or more.

It’s important to remember that the funding for medical students and residents come from, predominantly 2 different sources. Med schools are primarily (not all) funded by states. And rely on state legislatures and the various funding mechanisms, budgets etc for most of their money. This is usually a fairly stable stream of revenue. Most states, once they commit to create and fund a medical school are loathe to pull the plug on a school even when economic times are bad. They might tighten the purse strings but they’re not going to close an established Med school.
Residency funding is a lot different. It’s federally funded. And that means it’s subject to the whims of Congress. There has not been any meaningful increase in residency slots in the US since the early 90’s. Incredible, right. If you want to create a residency right now you must find funding...long-term, continuous funding from sources like hospitals, hospital taxing agencies, private foundations, private hospital/insurance conglomerates and states. And those entities are often reluctant to commit to millions of dollars each year for long stretches of time. (Decades). It’s not completely unheard of for residency programs to disappear when the hospital or state funding said program says they can’t afford it any more.

(11-18-2020 12:34 PM)ruowls Wrote:  That is the main issue with residents. They are paid employees that don't generate revenue on their own. The encounter is billed by the attending physician through the program. It is not an efficient system to capture charges for services provided.

Honest question: if the residents work is being billed, and their salaries are low, it seems like they should be net money makers for the hospital. Does a lot of their work not billable at all? Or is it billable but (for some reason) doesn't actually get billed? Or is there something I else I don't know (perhaps a great deal!)?