I Concur Not
Medical School Accepted Applicants 1992-2001
| 1992 | 1993 | 1994 | 1995 | 1996 | 1997 | 1998 | 1999 | 2000 | 2001 |
| 17,465 | 17,361 | 17,318 | 17,357 | 17,385 | 17,313 | 17,373 | 17,421 | 17,536 | 17,456 |
Total change: -.5%
Medical School Matriculants, 1995-2006
| 1995 | 1996 | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 |
| 16,252 | 16,201 | 16,164 | 16,170 | 16,221 | 16,301 | 16,365 | 16,488 | 16,541 | 16,648 | 17,003 | 17,370 |
Total change: +2.5%
Notice that without the grudging increase in 2005/2006, the net increase in medical school enrollments since 1991 would be essentially zero.
What effects does this have? As the US health industry expands, it must suck in more and more foreign medical graduates. This is one of the reasons why the ratio of doctors to population is so low in many countries – a huge proportion of their graduates emigrate to the US. These countries therefore see little incentive to expand spending on educating medical staff because of the high probability that they will simply leave, taking their training elsewhere. The US thus effectively off-books a huge education budget, often shifting the burden onto the poorest countries of the world.
As regards continuity of care, this is of course important. But medical journals are now increasingly full of studies analyzing at what point sleep deprivation tends to kill and injure more patients through physician error and lack of empathy than errors introduced through shift handover. And there is the problem of the high mortality and injury rate among interns and residents from vehicular accidents and workplace incidents.
I have yet to see many convincing papers that demonstrate that EU interns and residents kill more patients because of increased transfer rates due to their work hours being fixed at a much lower threshold than US interns and residents. Ideally, these are currently 58 hours per week max, and no more than 11 hours per day. One effect of implementing the new short hours (decreasing to 48 hours in 2009-20012) is a committment to a proportionate expansion in matriculating doctors.
The Nordic countries have long exceeded these restrictions with much shorter hours-per-week and maximum shift hours. Maybe someone can find out how this affects patient mortality and outcomes?