Today Dean Baker again comes to FDL bearing false witness about medical school expansion.  He falsely claims

United Stated doctors….limit the supply of doctors domestically…by restricting medical school enrollment

He prefaces this false statement with a valid observation

Doctors in the United States have enormous political power.

The American Medical Association is perhaps the largest organized group wielding that political power.  (I’ve never joined precisely out of concern about the AMA uses that power and how corporate influences can deform that power.)  Three minutes search on Google reveal the ugly truth about how the AMA uses their enormous political power to restrict medical school enrollment.  And what sordid policy is that den of iniquity, the AMA’s House of Delegates, setting forth to restrict medical school enrollment?

Horrors!  Gentle readers, prepare for the shock as we delve into the deliberations of the 2009 AMA House of Delegates…concealed from the world in the AMA’s winter 2010 Medical Education Bulletin:

Council on Medical Education Report 4—Factors Affecting the Availability of Clinical Training Sites for Medical Students

1. The AMA work with the Association of American Medical Colleges and the American Association of Colleges of Osteopathic Medical Education to encourage local and state governments and the federal government, as well as private sector philanthropies, to provide additional funding to support infrastructure and faculty development for medical school expansion.

With respect to the AMA’s current policy, Dean Baker’s oft-repeated assertion that

United Stated doctors….limit the supply of doctors domestically…by restricting medical school enrollment

is not only baseless.

With respect to the AMA, Dean Baker’s oft-repeated statement is false and misleading.

That’s my polite medical way of describing a repeated public lie.  I know – I’m being so ungentle.  I’ll take a moment to pause for pearl clutching.

Now gentle readers, steel yourselves as we delve into the belly of the beast of United States medical education: the Association of American Medical Colleges!

I trust I will not shock your constitutions in revealing I was a student delegate to the governance of the Association of American Medical Colleges in the mid 1980’s.  As a board member of the AAMC’s Organization of Student Representatives, for over three years I attended the AAMC’s annual and quarterly governance meetings in Washington, DC.  There I had a window seat on the discussions of the real powers in medical education: the medical school deans, the teaching hospital leaders, and the professional speciality and research disciplines.  At the end of my tenure there, the AAMC agreed to allow physicians going through speciality training – commonly known as residents – formal recognition and participation in the Organization of Resident Representatives.

Over the time I was there, I got to know medical school deans and teaching society heads and the men and women from the real powers.  I listened to the observers from the AMA, and to all the other interest groups who came before the AAMC’s leadership.  We student reps and the other AAMC governance folks even spent a few memorable blizzards marooned in the Washington Hilton.  The blizzards gave us a lot of unexpected down times – some of which we spent doing liver rounds, watching buses start to slide backwards down Connecticut Ave and betting on when National Airport and Amtrack would start up again.

Gentle readers, today I stand before you to confess a terrible truth about medical education in those early Reagan years.  Even with the Hill on our side, we couldn’t get more funding from Reagan to open new medical schools – or to expand existing schools.

The AAMC’s very able staff prepped OSR and the Deans and COTH and the speciality society folks.  We’d troop to the Hill – we’d try – they’d listen.  They’d agree.  And none of us could any money from Reagan for med school expansion.  We couldn’t even get funding to keep biomed research funding at inflation-adjusted parity.

That was the mid 80’s.

The AMA House of Delegates resolution quoted above which puts the lie to Dean Baker’s repeated false statement about United States doctors opposing medical school expansion is from 2009.  What positions did the AMA and AAMC take on medical school expansion in the interim?

Once upon a time, United States physicians in the AMA and the AAMC were told by many learned men that the solution to the terrible funding crisis preventing access to medical care was to stop creating unnecessary need for more medical care.  The learned men told the physicians that to stop creating the need for more unnecessary medical care, America needed to choke off the point where medical costs were created.

The learned men told United States physicians in the AMA and the AAMC that the way to get everyone in the United States the medical care they needed was to take a single, bold step to control increasing unnecessary medical costs – a step that only the AMA and AAMC could take.  To stop the growth in unnecessary medical care, the learned men opined, United States physicians needed to stop the growth in physicians.

And for a few years United States physicians listened to the learned men and heeded their advice.  After all, United States were told the learned men were experts in their field.  They were eminent economists.

So for a time between the mid 80’s and 2009, the AMA did endorse halting expansion of medical education.  Like many other experts, United States medical leaders made the egregious error of placing their confidence in economists.

Since they were misled, the AMA reversed course.  How do we know?  The United States entity that licenses new medical schools is the LCME: the Liaison Committee on Medical Education.  Who controls the LCME?    One second’s search on Google reveals the awful truth:

The Liaison Committee on Medical Education (LCME) is the nationally recognized accrediting authority for medical education programs leading to the M.D. degree in U.S. and Canadian medical schools. The LCME is sponsored by the Association of American Medical Colleges and the American Medical Association.

Yep. The LCME reports to the AMA and the AAMC.  I know: I was in the room when the AAMC made this clear.  Repeatedly.

What does this have to do with the AMA?  Well, let look at what’s been happening in the real world while Dean Baker has spent the last couple of years repeatedly misleading readers with his assertion

United Stated doctors….limit the supply of doctors domestically…by restricting medical school enrollment

In the real world, outside of Dean Baker’s repeated falsehood, by 2008 existing United States medical schools planned to increase enrollment by 16%.  And as of 2008, a total of nine new United States medical schools were in the planning or discussion stage.

U.S. Medical School Enrollment Projected to Rise 21 Percent by 2012

Washington, D.C., May 1, 2008—An annual survey on medical school expansion, released today by the AAMC (Association of American Medical Colleges), indicates that first-year enrollment in U.S. medical schools is estimated to grow 21 percent (3,400 students per year) by 2012 to 19,900 students. Edward Salsberg, director of the association’s Center for Workforce Studies, presented the survey results during his opening remarks to kick off the 2008 AAMC Physician Workforce Research Conference in Crystal City, Va.

According to the survey, more than 86 percent of existing schools have already expanded the number of first-year students or plan to do so within the next five years. In addition, nine new medical schools are under development or discussion, according to the Liaison Committee on Medical Education External Link, which accredits medical education programs leading to an M.D. degree. The AAMC estimates that almost 800 first-year students will attend these new schools in the academic year 2012-13, based on future enrollment figures.

None of this expansion could happen without the express approval of the LCME: the group that answers to the AAMC and the AMA.

When the AMA were wandering in the wilderness following false prophets learned experts’ call to extend access to health care by restricting growth in the physician supply sometime between the mid-80’s and 2008, they had good company.

After 1989, the Russians trusted the economist Jeffery Sachs when he used his learned credentials to peddle the cult of the free market.  The result?  Oligarchs snapped up the public sector, a million Russians died, and life expectancy dropped five years.  Blind trust in economists can be deadly.

For a time between the mid 80’s and 2009, nations around the world followed – or more precisely were forced to follow – the prescriptions from learned men (and women) at the World Bank and IMF.   The learned people pushing the prescriptions brought avoidable disease, suffering, and death to millions.  The learned people pushing the lethal policy prescription of free trade and free markets and privatization are called economists.

To his great credit, Dean Baker is one of a handful of economists who repeatedly and publicly point out the deadly systemic falsehoods so many economists push upon the world.

This makes his repeated false statement about United States physicians opposing medical school expansion – and his repeated false claim they are doing so for profit – all the more glaring, as it contrasts so greatly with the bulk of his fine work.

Today is one of many occasions on which Dean Baker has repeated this false statement at FDL and elsewhere.  This is a pity, as he seems to know a great deal about his own profession of economics.  If today is the last day he repeats the tired lie he’s told FDL’s readers today about the profession of medicine, he’ll demonstrate he’s added to his considerable fund of knowledge.

And that, gentle readers, would be a good thing.

Kirk Murphy

Kirk Murphy

terrestrial obligate aerobe with endoskeleton (bony) and bilateral symmetry.

chordate, bipedal, warm-blooded, mammalian, placental (origin), opposable thumbs.

not (yet) extinct.

indigenous habitat: California Live Oak.

current habitat: Central California Coast (most northerly aspect).... 'northwest of the new world, east of the sea'

potential habitats: all potential habitats critically endangered (due to global climate change).

ailurophilic - hence allergic rhinitic.