Mr. Hancock, you nailed it. Period.

Don't forget the costs involved in becoming a doctor - both the direct (tuition for 4 years of college and 4 years of med school plus the low salaries in residency training that work out to about $10 an hour) as well as the indirect opportunity costs.

How many people do the medical schools turn away? It seems to me they would be a pretty good way of creating an artificial shortage, which would keep pay up.

Mr. Osler - the medical schools could increase their sizes as much as they wanted to (if they could afford the costs - educating a medical student isn't cheap), but the problem is the limited number of residency placements. Where does this limit come from? The federal government, which funds graduate medical education through medicare payments.

There is an elephant in the room that no one is yet discussing: the fundamental philosophies that govern specialization versus primary care. Specialists are trained to aggressively treat disease. Family practice physician training is a more rounded training, and aggressive family practice docs don't last long in the business. Many research facilities (Hopkins included) lean toward very aggressive disease treatment. This isn't inherently bad because we need research institutions, but it does lend itself to an atmosphere that contraindicates preventive medicine at basic levels--which is the realm of family practice.

Coming from a family where many relatives are in medicine (brother is a nurse, father is a family practice doc, aunt is a cardiologist, several pharmacist cousins, pharma husband, another aunt a geriatric nurse), the results of the study don't surprise me at all. I know many individuals who attended KU med school, as well as other schools in the top 20. The results reflect that many midwestern institutions are also aware of the problems that face rural medical communities, and try to train and prepare family practice docs accordingly. Hopkins doesn't have the capability to do this, nor really should it try.

After doing an internship, it takes two years to become a family practice physician or pediatrician - thereafter, they quickly hit their "low" salaries with decent hours. It takes 6 years to become a neurosurgeon, with greulling hours (90+ hours per week), all at the $low/hour rate. This goes for the other subspecialties as well. Interventional cardiology, vascular surgery, orthopedics with fellowhips -- all at least 6 years of post-internship training.

There is a reason why subspecialists get paid what they do. They have trained more hours/years to aquire very specialized skills, all the while doing the unthinkable current American glutton nightmare: delaying the gratification of higher pay and better hours.

Hancock you are a disappointment - go follow around a neurosurgery resident for a week like a real journalist should- every hour, all day and night - multiply your experience by 6 years, and then write something more accurate

The real culprit is the AMA, who controls accredidation of medical schools. They purposely keep The number of medical schools in this country artificially low. Fewer schools means fewer doctors are turned out, and when the supply of doctors is well below demand, they can set higher rates. Additionally, because there is less competition (other schools), medical schools can charge a premium for tuition.

We need to start by doubling the number of med schools in this country. Having to compete will force schools to reduce tuition in order to attract students. Those that graduate will not be saddled with as much debt, which they need to recoup through higher fees. Additionally, it would increase the supply of doctors, limiting their ability to command such high fees. The AMA has abused its position as a monopoly, and should be broken up by the government based on anti-trust law.

Seems like there's enough responsibility to share around the table. The medical schools get a good bit of funding through research. The research that gets the funding is usually concerned with new treatments, new instruments, etc., which are usually within the realm of the specialists,
so obviously, there is a bias to produce more specialists. Then there's the issue brought up by Darwin Rules. My only rebuttal to his/her argument is that the specialist CHOSE the specialty. Was the choice because of the potential earnings or because of the challenge and excitement? I'd be very careful diminishing the expertise of the general practitioner. If his/her diagnosis isn't correct, the patient may never get to the specialist. And no one has even mentioned the insurance companies who have created a cookie-cutter mentality in general medicine, almost mandating which tests can be done and rewarding docs who treat the patients most economically. And the malpractice attorneys who have created a whole new specialty of "defensive medicine." What boggles my mind is why would anyone even want to go into medicine anymore at all? Thank heavens some do.

It always surprises me to read comments from outsiders about selection of specialties based on income or service reimbursement.
My colleagues and I picked our specialties based on what we enjoyed and the challenges that the position posed.

Money almost never entered the picture. In fact, money was only discussed after the physician was out in the field practicing and reflecting on salaries vs. expenses.