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In the 1960’s and 1970’s the HHS ( then the HEW) social engineers, infused with the hubris of the economic success that America enjoyed as the only modern industrial power left in tact following the second world war, “KNEW” few tweaks medical care would bring it under their control.
More specifically, they felt that soaring physicians incomes were placing too large a claim on resources available and needed remedial economic action.
And so began an ambitious program of direct subsides to medical schools that rewarded them for increasing the numbers of medical students enrolled. Their goal was to flood market with docs and allow the Law of Supply and Demand reduce the physicians’ incomes.
The Law of Supply and Demand Rescinded for Doctors
Imagine their consternation to discover that the Law of Supply and Demand apparently had been repealed in regard to Physician’s incomes, since graduating more Docs did not have the hoped for effect of reducing their incomes.
Further analysis yielded this explanation. The physicians at that time were mostly organized as individual and small group practices that thrived by providing health care as a cottage industry. Physicians were entrepreneurial and when they started a medical practice, they made sure it survived financially.
The medical schools were subsidized to increase their number of docs they graduated.
Once in practice each new Doc became a more or less independent source of medical care; ordering tests, dispensing medicines, and admitting their patients to hospitals for even more expensive medical care.
The Government Scraps a Program that Didn't Work
So the HEW which put the medical school enrollment subsidy into place, slashed it out of existence and the number of graduating doctors started to drop.
However the Education Industry endorsed the goal of making education more available for all Americans, medical students included.
Sally Mae came into being and students could, for the first time, borrow the entire cost of their educations on the promise of their imputed incomes as graduated professionals.
A medical education was longest and costliest, but also promised the biggest pay back.
This was the dawn of the age of physician who had very large education debt to repay over years immediately after graduation.
How Education Debt is Changing our Health Care
The large education debt precluded most of these physicians from borrowing more to open their own health care practice. Docs with large debt were amenable to becoming employees and not entrepreneurs.
Breathtaking medical education debt has caused the evolution of healthcare to the point where most Docs are employees and enthusiastic enlistees into the recent innovation of Accountable Care Organizations.
Accountable Care Organizations are “bite-sized” chunks of docs that are easily managed by Medical Administrators.
Employed physicians eschew the pesky individualism that once made independent docs impossible to regiment. They will prescribe only the Meds they are permitted to prescribe by their employers, etc., etc.
As health care reform expands patient eligibility the need for more primary care docs will reward the institutions that can tailor a medical education that is responsive to that need.
Osteopathic Medical Schools Flourish in the new environment
Traditional allopathic medical schools have not been able to adjust to the new economic and political realities. It may be surprising for you to learn that the largest medical school in our country is Lake Erie College of Osteopathic Medicine, (LECOM).
LECOM has several innovative programs that equip the physician for 2011 and not 1961. And Now two Osteopathic Medical Schools LECOM and AT Still, of Phoenix Arizona, have begun to apply their updated methods to Dental Education.
When Cable Television renews the "Marcus Welby" franchise by updating it for current realities, the new series title will be: "Marcus Welby, Jr. DO".