Medical school admissions are notorious for a reason: according to the Association of American Medical Colleges, each school on average accepts a mere 6.5% of applicants, barely a hair above Harvard College’s acceptance rate of 4%.
Every year, tens of thousands of people apply to medical school, hoping to gain entry into one of 172 programs across the USA. At the end of the admissions cycle, only 43% of them receive even one acceptance. This number doesn’t include the thousands of students culled from the pre-medical track prior to applying, between taking required courses in physics and organic chemistry, excelling on the 8-hour long MCAT exam, and more. In the end, only ¼ of students who start out as pre-med reach the point of applying–a drop-out rate comparable to that of Navy SEALS. In light of a national healthcare provider shortage, the competitiveness of medical school admissions might raise eyebrows.
On the surface, the hyper-competitive nature of medical school admissions appears well-justified. Medical students are training to be future physicians, whose hands will care for hundreds of vulnerable lives over the course of their career. Ensuring that selected students can face rigorous medical training, including an intense 4-year residency, is simply due diligence on the schools’ part.
At the same time, as the USA’s population grows larger, older, and sicker, the need for more physicians weighs heavily. The Association of American Medical Colleges estimates that the country could be between 37,800 and 124,000 physicians short by 2034. The shortage can already be felt now, particularly in rural and under-resourced areas, where the nearest doctor is often hours away. With the need for more doctors so strong, and the application process already so selective, why can’t medical schools accept more students?
The primary reason is limited federal funding for residency programs. Every year, the government pays hospitals across the country to train resident physicians, who go on to independently practice. Due to an influential–but inaccurate–report claiming an impending physician surplus, in 1997 Congress passed the Balanced Budget Act, which slashed the number of residency slots available to graduating medical students and capped residency funding at 1996 levels. For over two decades, funding for residencies has been frozen, even while the number of medical students and applicants have skyrocketed.
Because medical students cannot practice without having gone through residency, a limit on residency funding and therefore positions effectively bottlenecks the number of students that medical schools can accept. The Biden administration recently addressed this issue in 2021 by promising to fund 1,000 additional residency spots over the next 5 years in areas with limited healthcare resources. While a promising move in the right direction, these additional spots are dwarfed by the 124,000 physicians the nation is expected to be short of in the next decade.
In order to adequately prepare for the nation’s future health, more funding must be allocated towards expanding current residency and medical school programs and opening new accredited ones. Until then, thousands of otherwise qualified applicants will continue to be barred from training in medicine and alleviating the shortage.