[golfing eagles]

Originally Posted by Ponygirl

Thank you blueash

I too was confused abt the stats for people applying to medical school.

If you use the 52,000 number for 17,000 slots. That’s an acceptance rate of over 32%.

In actuality the number for acceptance is closer to 4%

Some exact numbers are: My son went to George Washington university med school. 15.216 applications for 181 slots. Acceptance rate of 1.09%

As usual, statistics don't lie, but people are "confused" with statistics. Blue and I were referring to the number of individuals that applied 40 years ago and more recently. She cited 36,000 in 1983, I remembered 125,000 from something I've seen in the past. She may very well be right in the number, but I believe the point I was making is valid regardless.

The statistics cited in the post above are for applications, not individuals. Most candidates apply to 5,10,15 or even more schools, so the total number of applications far exceeds the number of applicants.

[SusanStCatherine]

Originally Posted by Topspinmo

I thought AHC act was supposed fix the health care system?

Here's my take on why the ACA did not fix the healthcare system.

I have often heard the ACA was designed to fail so that the American general public would be asking for total government control - "Medicare for All."

Before the ACA, there were many people with pre-existing health conditions who could not obtain health insurance or afford healthcare. The ACA addressed that by offering coverage to all and requiring everyone to have coverage. Requiring all to pay was later found unconstitutional. Therfore, many people don't pay into it, and the premiums and deductibles have skyrocketed. People who can afford to pay will purchase the health insurance, while others either qualify for subsidies or skip coverage. Basically those who have $ are paying for those who do not.

I know my family has suffered these astronomical premiums and never reach our deductible. We do not yet qualify for Medicare. We did not have an employer plan and are limited to the plans on the ACA exchange. Here in Florida we have Florida Blue and I have not found a decent provider to take it. As we approach age 65, the premiums skyrocket based on what I consider a pre-existing condition I cannot control - my age. None of the other conditions matter. Nevermind if we are extremely healthy and in our early sixties. Yet those who are most likely to use the health insurance (those with pre-existing conditions), are not charged any more for their high risk.

Government regulations and insurance company involvement drive up the cost of healthcare. Insurance companies donate to government office holders and this cycle continues.

You could say the ACA was successful in making health insurance affordable to those who could not obtain it before. Insurance is not healthcare, as many found out. Some of these people have subsidies for low premiums and deductibles and yet they still cannot afford the bills.

That's my take from what I've seen FWIW, and I'm sure some will disagree.

[Glarramendy]

Originally Posted by justjim

Village Health will not accept our State Government Medicare Advantage plan, and our Primary Physician of 20 plus years has retired. Ironically, the doctor recommended by our retiring physician left for “greener pastures” before we could even get into to see him. Makes you wonder what is happening to our medical system that has such a shortage of doctors, nurses and other medical technicians. We would prefer an internal medicine doctor where we could develop a patient/doctor relationship but we have already found it challenging to find any doctor taking on new patients in the surrounding area. Perhaps the Walk-in emergency clinics with doctors and physician Assistants are the only solution now available for medical care in the area. Unless you are having a heart attack, we have marked off the hospital’s E.R. as a place of very last resort.

Try a family nurse practitioner.
Or PA.
My personal belief you can’t go wrong with either.

[golfing eagles]

Originally Posted by Glarramendy

Try a family nurse practitioner.
Or PA.
My personal belief you can’t go wrong with either.

Unfortunately , you can.

[GoRedSox!]

Regarding the ACA, I don't think the costliest increase was the elimination of pre-existing conditions...because if the plans are affordable, many people will buy them and not have pre-existing conditions. But the elimination of the individual mandate ensured that the population on ACA plans were sicker and costlier individuals. If everyone was required to have a plan, the costs would be spread over more plans with healthier/younger people.

I know some people will say that the healthy are subsiding the unhealthy. While this may be true, none of us really knows when we may go from being healthy to not as healthy.

So much of the total medical spend in this country is for people in the final year of life. So no matter what, we all pay for that.

As for Florida, I believe that there is a math problem which manifests itself in several ways, and one of them is health care. There are so many people moving here and the growth has been so fast that medical care can't keep up with population growth. The same percentage of physicians would have to be moving here as the rest of the population, but I don't think physicians are as likely to give up a job or location they have been in as the rest of the population so this is one of several areas FL has to play catch up.

I am stating my opinion, not claiming to know it all or stating hard facts or statistics. As always and as my wife will happily verify, I could be wrong.

[kkingston57]

Originally Posted by Berwin

We've lived here for about a year and a half now. The problem with health care around here was explained to me as basically being the snowbird situation. Half the year, there aren't enough patients to attract quality doctors and the other half there are too many patients for the few doctors that are here. I was told that if it was a life threatening situation, do whatever you can to get to Gainesville. Ironically, several months later our primary care doctor referred my wife to his colleague who in turn referred her to another specialist who sent her to Gainesville where she got the treatment she needed.

Small part of the problem. In meantime developers including others in the area are building homes for retirees and very little is being developed for the worker bees including professionals. A good new doctor(except for geriatrics) has 0 incentive to work here.

[kkingston57]

Originally Posted by golfing eagles

First correction for this thread:

What makes you think "they" won't "pay"????? Are you privy to some information that I'm not?

When they first started TVH, one of my partners and I were invited to join. I retired, he took a job as medical director at one of the centers. This was 10 years ago and the compensation package was more than competitive for this area. It has kept up with inflation, and there are other incentives that I'm not at liberty to discuss.

Second correction:

"Specialists are more important anyway."

For some things, mostly procedures and certain specific conditions. For most conditions, a "specialist" is superfluous. Unfortunately, due to the proliferation of lawsuits, even well trained internists are quick to make an unnecessary referral to reduce liability.

Third correction:

There is turnover in medicine everywhere you go. Due to an increasing and aging population, there is a relative shortage of doctors , nurses, and almost all other health care workers. Forty years ago, there were 120,000 applications for 17,000 medical school seats. Five years ago there were only 25,000 applications. Our best and brightest are avoiding careers in medicine due to the many years of education, the increase in litigation, and relatively low compensation in comparison to other careers available to them.

Fourth correction:

Medicare advantage plans pay the same as traditional Medicare. Their savins is from limiting panels of physicians, deals on pharmaceuticals and medical supply companies, etc.

The Villages is a challenging location for recruitment of physicians. If they are younger with young families, there is little to attract them here. Therefore, we usually get older physicians near the end of their careers, contributing to the "revolving door". In addition, offers are VERY competitive elsewhere. As an example, even though I'm retired for 8+ years, I still get contacted with offers every week. Yesterday's was from the Tampa area, offered a 4 day work week, limited patient schedule, no "on call" responsibilities, 6 weeks vacation, and a compensation package of about $500,000/year. There is no way TVH can compete with that.

More corrections may be forthcoming as posts with "inaccurate" information accumulate.

Good response especially your last paragraph.

[Cliff Fr]

Both my wife and I are on an Advantage plan and are satisfied with it. We live outside the Villages in the Ocala area. We both have been able to get referrals to specialists when needed. We've also been to an urgent care center and the PA there was also very good. We both use the annual blood panel test to modify our lifestyle and eating habits as necessary in lieu of taking a script to cover up a symptom.

[ThirdOfFive]

Originally Posted by golfing eagles

And I found sources that support my position previously. Maybe I was wrong in the actual number, my source might have been in error. No matter. So, using the numbers you posted above, of the "increase" in applicants from 36,000 to 52,000, how many are Americans who attended American Universities and how many are learning English as a second language?

Many thanks for your informed replies in this thread. Learned a few (quite a few) things I didn't know.

Quite interested in your take on foreign applicants for local positions, especially as we have a niece in her second year of residency in Bangkok, Thailand, and who is looking to emigrate to America once her degree is finished. I heard that the local hospital is (or was) offering $10,000 for a referral of any applicant for the position of MD, if it would be his or her first position after fulfilling degree requirements and if that person is hired. She is looking at coming to Florida, specifically here.

Do you know anything about this?

[golfing eagles]

Originally Posted by ThirdOfFive

Many thanks for your informed replies in this thread. Learned a few (quite a few) things I didn't know.

Quite interested in your take on foreign applicants for local positions, especially as we have a niece in her second year of residency in Bangkok, Thailand, and who is looking to emigrate to America once her degree is finished. I heard that the local hospital is (or was) offering $10,000 for a referral of any applicant for the position of MD, if it would be his or her first position after fulfilling degree requirements and if that person is hired. She is looking at coming to Florida, specifically here.

Do you know anything about this?

Sorry, not much. It used to be called the "fifth pathway", I don't know if that's changed. In general, I believe, even if a doctor completed a residency internationally, even if they were in practice for a while, they still had to repeat their residency in an accredited US hospital program. This may have changed. I'm sure if you niece is contemplating this action she will have more up to date and accurate information than I do.

[ThirdOfFive]

Originally Posted by golfing eagles

Sorry, not much. It used to be called the "fifth pathway", I don't know if that's changed. In general, I believe, even if a doctor completed a residency internationally, even if they were in practice for a while, they still had to repeat their residency in an accredited US hospital program. This may have changed. I'm sure if you niece is contemplating this action she will have more up to date and accurate information than I do.

Thanks.

[mntlblok]

Originally Posted by golfing eagles

Ok, I'll start, maybe ski bum can add to this. First of all, it is a very complex issue with a long history. The problem starts in 1966 with "The Great Society" and the formation of Medicare and Medicaid, as well as the birth of health care insurance as a near necessity and the massive proliferation of lawyers and litigation. As opposed to the "old days" when an office visit was cheap, there were now 3rd party payers that shoveled taxpayer money at providers. We had records on an index card from the stone age prior to EMRs and an office visit was $3.00. Going further back, my mother saved her obstetricians bill from 1947 and all pre-natal, delivery and post-partum care was a whopping $45.50.

Now, along with these government programs came government regulation that further drove up the cost of care. And of course , in order to pay, they wanted a specific diagnosis. This led to a complex system of charge coding under CPT and diagnostic coding under ICDM. To get these diagnoses, the technology exploded as well as specialists and sub-specialists, further driving up cost. So about 1972 those "wise" men in DC decided to "capitate" medical schools---pay them $$$$ to increase total medical school class size from about 9,000 to over 17,000. Remember, our population was only about 210 million back then. So with tons of taxpayer money on the table, almost all 100+ medical schools double their class size. But just like major league pitchers on a 5 day rotation and 20 expansion teams, this was the first dilution of the talent pool. The theory was that more doctors would drive competition up and cost down. However, it turns out, that more doctors just make more work for more doctors, particularly higher cost specialists. Then, technology exploded----ultrasound, CTs, MRIs, endoscopy, cardiac catheterizations, bypass surgery. And every new procedure was dumped into Medicare part B at an exorbitant starting cost, diluting the $$$ pool for routine primary care. The litigation forced doctors to order these expensive imaging procedures and refer to specialists, mostly unnecessarily just out of self preservation.

So now the next phase: When I applied to med school, there were 125,000 American graduate applications for 17,000 seats. Between lower physician compensation, increased regulation and increased litigation, our best candidates decided to get an MBA in 2 years and get better salaries rather than spend 7+ more years to start a medical career. That, plus the huge amount of student loans incurred. So once again the talent pool was diluted. Our teaching hospital can no longer fill their programs with American graduates, so they had to turn to FMGs for bodies to fill the space. Some are very good, some are dreadful. My residency program had 14 positions for 3 year Internal Medicine candidates and received 10,000 applications. Nine thousand were from FMGs and went immediately into the garbage. The remaining 1000 were easily pared down to 200 from which 14 were chosen. Now, 45 years later, I recently had reason to look at the staff of that program----much to my surprise I couldn't even pronounce the names of over 1/2 of them.

So now, fast forward to our situation in TV: Diluted talent pool due to the reasons listed above as well as a population that is now 330 million, residency programs filling with FMGs, and a less than desirable area of Florida for young physicians with a young family. Of course medical care is less than spectacular compared with Boston or NY. That doesn't mean it is horrible either. Remember, let's just assume there are 35,000 cardiologists in the US---only one of them is the best---and he can't keep all 120,000,000 appointments with cardiologists---somebody gets second best, and third, and down the line.

Hope this helps

Thank you. Great summary. Had no idea that an MBA was so valuable. I guess I don't hear that much about salaries these days, but had gotten the impression that plenty of science Ph.D.s weren't getting much for their efforts. Had gotten the same sense for engineers. But, I'm very "out of the loop". I've certainly known of a significant number of lawyers who weren't bringing in bucks proportional to the effort involved in acquiring the degree. Have *never* had much of an idea of how the world works, coming up in a less than blue collar environment. When I've seen published average incomes of various medical specialties in "relatively" recent times, nothing was close to 500K. Just checked. Looks like the numbers have nearly doubled since I last took a look. Wow. Physician Starting Salaries by Specialty: 2022 vs. 2021

[blueash]

Originally Posted by golfing eagles

And I found sources that support my position previously. Maybe I was wrong in the actual number, my source might have been in error. No matter. So, using the numbers you posted above, of the "increase" in applicants from 36,000 to 52,000, how many are Americans who attended American Universities and how many are learning English as a second language?

https://www.aamc.org/media/6116/download?attachment

Less than 2% of successful applicants to US Medical Schools are not US citizens or non permanent resident. Some of those, perhaps many are primary speakers of English. Many others speak English better than those born here. The data does not answer your question as to what undergraduate school these non citizens attended. Would University of Toronto, or McGill, or Oxford be a problem? How about Jamaica.. an English speaking country.

Tell us how you feel about a US citizen attending a non US undergraduate school then applying to a US medical school. Is that a problem for you? You asked about that situation as if it is one. It apparently is not for US medical schools as per the last report I found looking at that exact issue, a higher percentage of US citizens who attended school abroad were admitted to medical school than those that stayed in the USA.

https://www.aamc.org/media/5961/download?attachment

If you want data, the AAMC has a button you can click and they will produce any data set you request if they are able.
Data & Reports | AAMC

[golfing eagles]

Originally Posted by blueash

https://www.aamc.org/media/6116/download?attachment

Less than 2% of successful applicants to US Medical Schools are not US citizens or non permanent resident. Some of those, perhaps many are primary speakers of English. Many others speak English better than those born here. The data does not answer your question as to what undergraduate school these non citizens attended. Would University of Toronto, or McGill, or Oxford be a problem? How about Jamaica.. an English speaking country.

Tell us how you feel about a US citizen attending a non US undergraduate school then applying to a US medical school. Is that a problem for you? You asked about that situation as if it is one. It apparently is not for US medical schools as per the last report I found looking at that exact issue, a higher percentage of US citizens who attended school abroad were admitted to medical school than those that stayed in the USA.

https://www.aamc.org/media/5961/download?attachment

If you want data, the AAMC has a button you can click and they will produce any data set you request if they are able.
Data & Reports | AAMC

I'll just leave that one alone. Clearly, when it comes to these types of issues, we are never going to agree. That's OK, we'll just chalk it up to "diversity".

[Escape Artist]

Originally Posted by justjim

Village Health will not accept our State Government Medicare Advantage plan, and our Primary Physician of 20 plus years has retired. Ironically, the doctor recommended by our retiring physician left for “greener pastures” before we could even get into to see him. Makes you wonder what is happening to our medical system that has such a shortage of doctors, nurses and other medical technicians. We would prefer an internal medicine doctor where we could develop a patient/doctor relationship but we have already found it challenging to find any doctor taking on new patients in the surrounding area. Perhaps the Walk-in emergency clinics with doctors and physician Assistants are the only solution now available for medical care in the area. Unless you are having a heart attack, we have marked off the hospital’s E.R. as a place of very last resort.

Poor medical care and/or lack of good doctors is the biggest downside of The Villages for me. It’s something I noticed almost immediately after moving here. I had to wait over two months to see a primary care physician then a couple of weeks before my appointment I was informed she had left. Back to square one!

I’ve seen a lot of praise for The Villages, and the Morse family and their genius in planning such a place and the continued expansion but one thing they lacked foresight on was that a predominantly senior population needs a lot of medical care, hospitals, clinics, doctors, nurses, medical technicians, etc. A doctor told me that central Florida just isn’t a place that attracts the best and brightest and those doctors with families don’t relish living amidst a senior community of 125,000 and growing. No, they did not think this aspect through, nor the fact that most seniors are living longer now, many well into their 90’s, and there would not be the “turnover” they anticipated when they made their best laid plans.