Wednesday, August 10, 2005

Supply and Demand.....
Brought to my attention by Shrinkette, a New York Times column from a OB/GYN resident describing the woes of his chosen profession as it relates to finding residents: Wanted: Workaholics to Become Obstetricians
In the last decade, the number of students entering the specialty has plummeted. In 1996 and 1997, applicants for obstetrics and gynecology residencies were lined up around the block. Since then, the number of applicants has gone into free fall. Only 743 graduating medical students in the United States applied for 1,142 residency slots in 2004. More than a third of the slots went to foreign medical graduates or remained empty.

Men in particular shy away from the specialty. In 1999, more than 40 percent of graduating residents were men. This year, men make up only 10 to 15 percent of the applicants. During my residency interview at Columbia, Dr. Richard Berkowitz, a prominent high-risk obstetrician, assessed the extent of the crisis. "I've been through the best of times and the worst of times," he said. "This is the worst of times."
The problem? Lifestyle:
More than any time in the past, medical students want careers with predictable schedules.

They want to go to their children's soccer games, read for pleasure and not be called in to the hospital at night.

Specialties like dermatology, radiology and anesthesiology offer flexibility. Obstetrics and gynecology does not, and students are turning away from the most demanding specialties in unprecedented numbers.

Obstetrics is consuming and unpredictable. The hours are long and caring for sick patients can blot out all other priorities. The stakes are high: very often you are caring for two patients and not one, and bad outcomes can be catastrophic for a family.

Red State Moron comments on the "workaholic" aspects of obstetrical training and practice, something he has first-hand experience with. There is also a link to a USA Today story about the use of laborists by hospitals (similar to hospitalists or emergency surgeons). This post is about how supply and demand has worked in Dr. Friedman's favor now, but may not in the future. Currently supply and demand has gave Dr. Friedman, much to his surprise, the opportunity to interview at a high-level programs:
Oddly, as an ambitious medical student I benefited from this. I applied to 26 residency programs, most affiliated with famous hospitals and prestigious universities. I expected to get interviews at about half, with serious interest from a couple of places.

But soon after my demographic information went online, interview requests flooded my in-box.

Every program I applied to offered me an interview, many even before they saw objective criteria like my grades and board scores.
So he was able to match at a very prestigious program, one that may not have been open to him otherwise. But unfortunately the medical system does not respond to market forces concerning reimbursement. So in a few years, despite the reduced numbers of obstetricians, Dr. Friedman will likely find that while he has taken the place of 1.5 OB/GYN's he may not be seeing the money of 1.5 OB/GYN's.
If medicine did operate as a free market the looming shortage of OB/GYN's would allow for each individual to raise their rates. OB/GYN would become more appealing and more individuals would choose OB/GYN as a career, or more OB/GYN's would move into an area and prices would reach an equilibrium. If medicine operated as a free market, that is.
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