Medical school bottleneck worries analysts, who foresee shortage of doctors

Kiera Berger has a major in genetics and cell biology, a solid GPA and a score on the Medical College Admission Test that's about average for science undergraduates.

She applied to 10 medical schools, and every one turned her down.

The University of Minnesota student had discovered a cold reality that's striking many hopeful seniors this commencement season: The number of medical school applicants is increasing much faster than the number of openings, and being average isn't good enough anymore.

Last year, more than 43,000 students applied to the nation's medical schools. Only 42 percent of them got in — the lowest acceptance rate in more than a decade. The number of graduates — 18,200 last year — has risen over the last 10 years, but only modestly.

That bottleneck worries many health care analysts, who foresee a shortage of doctors over the next decade as the population ages and the Affordable Care Act increases the number of Americans with health insurance. By one estimate, the nation will be short 90,000 physicians in the next decade. In Minnesota, the estimate is 2,000.

But many programs, including the University of Minnesota Medical School, are at capacity. The class size on the U's Twin Cities campus expanded from 165 to 170 after the Association of American Medical Colleges (AAMC) called for an increase in admissions a few years ago. But vice dean for education Dr. Mark Rosenberg said it can't grow any more without adding residencies, the training programs where students get practical experience.

In order to practice medicine in the United States, students must complete a residency after they finish medical school. Medicare is the largest source of funding for residencies, but a cap on federal funding has created a residency squeeze at hundreds of hospitals.

"Even if we train more, unless we increase the number of residency positions, it's not going to do us any good," Rosenberg said.

To avert a doctor shortage, the AAMC in 2006 called on schools to increase admissions 30 percent by 2015. Officials say the schools are on track to reach that goal by 2017, but meanwhile, the applicant pool continues to improve and competition has become fierce.

The deadline for students to accept admission offers is May 15. Afterward, schools can send acceptance letters to wait-listed students if they have spots to fill. Come June 3, the rolling admissions process begins, and rejected students can try again amid an even more competitive pool.

Looking at plan B

From the moment she started college, Amelia Black did everything right.

In her four years at the U, the microbiology senior attained Latin honors, researched in a malaria lab, volunteered at a children's hospital, studied abroad in Australia and shadowed physicians on a trip to Guatemala. When she applied to 17 med schools, she got into four and was wait-listed for two.

Students like Black are the "professional athletes of science," according to Tricia Todd, assistant director for the Health Careers Center at the U.

"These students have to be on their game from the day they set foot on this campus if they're going to be successful getting into med school," she said.

But four years increasingly isn't enough time to accomplish everything top applicants need to do, said associate dean of admissions Dimple Patel at the U's Medical School.

More students are taking a "gap year" after college to broaden their experience; the average applicant age is going up, reaching 24 in 2012.

Now Patel encourages students who don't get into med school to take a year off for additional preparation and to decide if becoming a doctor is their best choice. She urges them to think of a plan B.

For Phillip Thomas, a gap year paid off. After getting a pile of rejection letters in his first cycle, he took the time to work in a lab, volunteer at a children's hospital and relentlessly study for the MCAT. He did so well on the test the second time that Kaplan Test Prep hired him to teach classes.

Thomas is now a third-year medical student at the U who got a spot on the admissions committee so he can review applications and help other students like him. Applicants, he said, need to convince a med school that medicine is the right career for them.

"I wanted to make sure that my application reflects my desire to be here and my goal that I want to be a physician," he said. "This is what I want to do with the rest of my life."

Finding a different dream

When Todd recognizes a student who may not have what it takes or be the right fit, she sits down with them to have a "courageous conversation."

"Medicine isn't the right place for you," she said she tells students, "or if you're going to go into medicine you're going to have to change your portfolio and it's going to have to look a lot stronger than it does now."

She finds that many students are on the right track; for others, she tries to help them find another career in the field — public health at a state agency, for example, or physician assistant.

For Kiera Berger, becoming a doctor used to be her only dream. Everything else, she said, felt like settling for less.

To explore other career options and build research experience, she got an entry-level position at a genetic testing company in Wisconsin. She'll work there for at least two years before applying to medical school again.

"It's still probably at the top of my list," she said, "but it used to be the only thing on my list."

Rebecca Harrington is a University of Minnesota student reporter on assignment for the Star Tribune.