Why is American medicine so expensive? One reason is that doctors are forced to get bachelor’s degrees.
The U.S. spends about 18% of its gross domestic product on health care, far more than most countries. One contributing factor that often goes overlooked: the high cost, in time and money, of becoming a physician. In a recent paper for the Mercatus Center, Jeffrey Flier and Jared Rhoads argue that the amount of time it takes to become a doctor—almost always at least a decade—constrains the supply, driving up prices. Physician incomes in the U.S. well exceed those in Europe; American generalists earn twice as much as Dutch ones.
Much of this education, especially courses required for a bachelor’s degree, has little to do with medicine. In the U.S., aspiring physicians must spend four years in college before med school (another four years) and then residencies. Europeans can begin studying medicine immediately after high school—usually with a five- or six-year course.
While the share of Americans with postsecondary education exceeds the level in most European countries, the U.S. has a much smaller proportion of medical doctors graduating each year: 7.5 per 100,000 residents, compared with 11.3 in Germany, 12.8 in Britain, 9 in France, and 14.6 in the Netherlands. Only Canada, which has undergraduate requirements and high physician costs comparable to America’s, comes close, with 7.8 per 100,000. The U.S. faces a projected shortfall of between 42,600 and 121,300 physicians by 2030, according to the Association of American Medical Colleges.
The status quo also does a disservice to young doctors, most of whom emerge from med school in debt (a median of $195,000 in 2017) and don’t begin to practice until they’re in their 30s. Why prolong the process, especially when 53% of newly enrolled med students say that before college they already had “definitely decided” to study medicine?
There have been some modest attempts to streamline medical education in the U.S. One-third of America’s 141 med schools now allow students to pursue a bachelor’s and medical degree simultaneously. But these programs are very small, and they don’t save much time, since only 20% last less than eight years. Nonetheless, their performance is encouraging. A study of Northwestern’s Feinberg School of Medicine found that students admitted through its seven-year accelerated program achieved equivalent outcomes to those completing degrees seriatim.
The Liaison Committee on Medical Education, which accredits American med schools, does not require completion of a four-year bachelor’s program as a prerequisite for admission. But it does mandate that abbreviated programs include liberal-arts courses. While some premed education in fields such as biology is clearly desirable, there is little evidence that history, literature, or social sciences is worth the additional cost it imposes. Eliminating the bachelor’s-degree requirement outright would increase the supply of doctors without harming the quality of care.
Mr. Pope is a senior fellow at the Manhattan Institute, where Mr. Rice is the project manager for health policy.
This piece originally appeared in The Wall Street Journal
Tim Rice is project manager for health policy at the Manhattan Institute.