Medical School Enrollments Plunge

      Mothers who dream about ``my son the doctor'' may be in for a rude awakening.

      Applications for the medical school class that enrolled this fall were down nearly 4 percent from last year - part of a trend that has seen a 21 percent plunge in applicants the last five years. And a closer look at nationwide numbers released Wednesday finds there were 26 percent fewer male candidates this year than five years ago, twice the rate of decline among young women.

      All of which, health analysts say, is the clearest sign yet that the troubled medical profession no longer is as singularly seductive as it once was.

      ``When you''re a starry-eyed young person in college, and all you hear when you turn on the TV or pick up the paper is about which doctor killed which patient, why would you enter that profession?'' asks Dr. Tom Delbanco, a professor at Harvard Medical School, which along with Tufts University has fared better than the national average. ``When I went into medicine my mother thought I was going to be a God. The bloom is off the rose.

      ``We''ll still have plenty of doctors. My worry is that they won''t be as good as the old ones.''

      But the president of the Association of American Medical Colleges, which compiled the figures released Wednesday, says quality is not being compromised. Grades and test scores have stayed high among those applying and those enrolling, and ``it''s remarkable that our applicant pool has remained as strong as it has given the economy, the other opportunities young people now are facing, and the state of medicine,'' says Dr. Jordan Cohen.

      ``When I graduated from medical school in 1960, the commonest answer as to why my cohorts wanted to go to medical school was, `I want to be my own boss,'''' adds Cohen. ``Today, the mantra is, `I want to help people.'' People who continue to apply to medical school are precisely the kind of people we''d like to see. They''re incredibly dedicated, idealistic and community-service oriented.''

      While it is difficult to measure the public-spiritedness of those medical students just starting their first year, other trends are apparent in the new numbers:

      - There still are more than twice as many young people applying to medical school as there are slots available.

      - The gap between male and female students continues to narrow, with 8,830 men among this year''s entering class compared to 7,473 women.

      - After three years of disappointing declines, there was a slight increase this year in the number of applications from ``under-represented minorities,'' a category that includes blacks, Native Americans, Mexican American/Chicano and mainland Puerto Ricans. There actually was a tiny decline, however, among minorities who enrolled, which Cohen says is probably a reflection of states like Texas and California eliminating their affirmative action admissions.

      It is critical to get more minorities into medical school ``because we are not producing enough physicians who are going to be available to minority communities. Medical school graduates tend to go back to where they came from,'' says Dr. Joseph Martin, dean of the Harvard Medical School, which has done far better than the national average in attracting minorities.

      As for trends in total applicants, Harvard saw an enormous spike several years ago when it introduced online applications, then saw the numbers decline slightly but remain well above the level five years ago. At Tufts, applications have been static the last two years. But at Boston University, applications for this year''s beginning class were down 5 percent from last year and down 19 percent from five years ago.

      Robert Sarno, dean of admissions at Tufts, says young people frustrated by cutbacks in affirmative action programs in other states may be applying in larger numbers to medical schools in Boston. And he says that his data, like the figures nationally, show that today''s candidates are every bit as qualified as ones in previous years.

      Cohen''s organization suggests two sets of reasons for the decline in medical school applications nationwide. The first involves the strong economy and the growing number of choices of other high-pay, high-satisfaction professions. The second includes concerns about the medical profession, from a perceived loss in physician autonomy to ``recent changes in the health care marketplace.''

      Martin says the decline in applications hasn''t reached a crisis yet, but it is important to continue tracking it. And he worries not just about declines in students applying to medical school, but the growing numbers of those who graduate and choose a profession in biotechnology, business or some career other than medicine. While numbers on that trend are hard to come by, he adds, ``I have seen one graph showing that up to 20 percent are going into something besides medicine.''

     

c.2000 The Boston Globe