Recruiting students for medicine.

The applicant-to-acceptance ratio in the nation's 127 medical schools has slowly but steadily declined during the last decade to 1.7:1 (60.5% acceptance rate) for the 1987-1988 academic year. The 28,123 applicants in this academic year represent a decrease of 3200 applicants from the previous year. The decline in the number of applicants is even more striking because it occurred despite the welcome increase of female applicants between 1965 to 1988 (36% of the entering class in the 1987-1988 academic year). The laudable changes in the Medical College Admission Test (MCAT) examination, which take effect in 1991, will not solve this problem. We believe that the causes of the flight away from medicine as a career are several and represent the combined effect of changes in the practice of medicine itself and their negative impact on the profession, as well as deeply-seated shifts in values, attitudes, and aspirations among the young people in our society. We discuss several factors concerning the phenomenon in question and offer some suggestions concerning solutions for this important problem. Our goal in this brief essay is to stimulate discussion and awareness among physicians concerning medical school admissions and to galvanize into action the medical profession and other key persons who are keenly interested in high-quality health care for our people.

Where have all the students gone? An epidemiologic study of US nationals applying for certification by the Educational Commission for Foreign Medical Graduates, 1969 through 1982.

Larger and larger numbers of US nationals are studying medicine abroad and they now comprise the foremost national group of foreign medical graduates (FMGs) seeking to enter the US health care system. The Educational Commission for Foreign Medical Graduates (ECFMG) is currently conducting a comprehensive study of 205,542 graduates of foreign medical schools who, during a 14-year study period, 1969 through 1982, have sought its certification, an established prerequisite for FMGs applying for training in an accredited hospital residency program and/or licensure within the United States. This report summarizes preliminary data on the 17,642 US citizens included in the study who attended 431 different medical schools in 79 foreign countries. Particular attention is given to their performance on the combined medical knowledge-English language competence examinations requisite to the awarding of ECFMG certification.

Computer predictions of New Zealand doctor numbers.

Considerable debate has been generated about "the coming crisis in medical manpower" with most current analyses predicting a large surplus of doctors in the late 1980s. However, predictions can be complex because of potential fluctuations in the input variables due to political and social factors. Variables affecting active doctor numbers include the numbers of medical students graduating each year, immigration, emigration, the proportions of males and females, age at retirement, and extent of part-time work. A computer simulation is described which enables the relative effects of these variables to be compared. It is found that adjustments in the medical school intake have a relatively small short-term effect compared with the effects of adjustments in several of the other variables, particularly immigration numbers.