Why is Daniel D. Federman '49 smiling?
While most medical schools nationwide are struggling to cope with drastically falling applicant pools, Federman--who is the dean for students and alumni at Harvard Medical School--says his institution is still in good shape.
"We are not at all worried about the quality of our applicants, and some schools are," Federman says.
"The numbers are down at Harvard, but the quality doesn't seem to be down," says Curtis Prout '37, the Med School's assistant dean for student affairs.
But such optimism belies a drastic drop in applications.
While 4160 applicants vied for 165 spots at the Med School in 1980, only 2438 applied for the same number of openings this year--amounting to a 41 percent decrease.
Harvard's prestigious name may have allowed it to maintain a quality student body despite the smaller pool. Nonetheless, even Harvard officials admit it's getting tougher and tougher to attract qualified applicants.
They say the medical profession is not as appealing as it was twenty years ago. With increased government regulation and a tarnished public image of doctors, less students have opted for a career in medicine.
As a result, schools like Harvard are trying to improve the profession's image the only way they can--by producing more compassionate, well-rounded doctors. Yet to do that, the schools must first make sure that they have a sufficient supply of talented applicants--a task which is becoming increasingly difficult.
The numbers are staggering: According to the American Associa- tion of Medical Colleges, 36,727 studentsapplied to American medical schools in 1981. In1989, only 26,915 applied--a 27 percent drop overnine years.
Students, faculty and practitioners attributethe drop to many causes. Financial constraints,the loss of professional autonomy, increasingfederal regulation and the consistently large timedemands head the list.
Medical tuition increases have matched thehikes in other professional fields. Unfortunately,Harvard doctors say, the salary increases have notmatched those rising costs.
"The costs have increased and the amount ofloan indebtedness has been very critical in all ofthis," says Alvin F. Poussaint, associate dean ofstudent affairs at the Med School.
A 1989 study by the Association of AmericanMedical Colleges found that 83.4 percent of allmedical graduates have educational debts. Theaverage educational debt of graduates in 1988 was$38,489, 8 percent higher than it was the yearbefore.
Med School Dean for Student Affiars CarolaEisenberg adds that tuition hikes have hit Harvardand other private institutions particularly hard,since the high costs have forced many students toattend less expensive state schools.
Finally, Poussaint says, the elimination ofcertain federal grants 10 to 15 years ago--whenthe government thought there were too many medicalstudents--have made attending medical school evenmore difficult.
Once in practice, many doctors say, thesituation only gets worse. As insuranceregulations over medical procedures continue toincrease, many physicians complain they have lessautonomy and less time for their patients.
Not surprisingly, that dissatisfaction has beentransmitted to up and coming students.
"Older physicians are really upset by the lossof autonomy. They are really upset aboutmalpractice insurance, and the huge increase inpaperwork," says Jessica A. Spira, a second-yearstudent at the Med school.
These factors have made the impact of otherdetriments--like the large time commitmentmedicine traditionally extracts--seem even worse.With lifestyle and family to consider, studentssay, many more prospective doctors are shunningmedicine.
"I think the lifestyle considerations are rightup there with the money," Prout says.
Nam H. Tram, a second-year student at the MedSchool, says the rough lifestyle of medicalinterns makes the career especially undersirable.He says that an although an intern may earn$30,000 a year, that intern usually works about100 hours each week, making for a relatively slimhourly wage.
In general, students and administrators agree,the medical profession's status has diminishedover the last few years. Most say that doctors donot command as much public respect as they usedto.
There is "a sense of concern about thededication and the long-range commitment toothers--a question about whether that's beentarnished in society," Federman says.
Poussaint says this changed image is apparentin modern television portrayals of doctors. Hesays gritty, realistic portayals of physicians onshows like St. Elsewhere are a far cry fromthe super-doctor images on Marcus Welby,M.D..
"I think that it's clear that these shows thatmake the doctor totally ideal aren't popularanymore," he says.
Winning Back Applicants
So far, Harvard has taken little direct actionto fight the drop in applications.
"If they're doing anything, it wouldn't be fromthe admissions office," says Helen Rakin, a staffworker in the Med School's admissions office.
But students say the admissions process has atleast changed its tone, in an effort to encouragemore applicants to attend. Spira says that whenher sister applied to medical school in the 1970s,the interview process had a reputation for beingmuch more stressful.
"The interviewing seems to be getting lessstressful," says Spira. "They're trying toencourage people to come."
Two other prominent schools, however, havetaken more direct action to increase applicantpools and attract a more well-rounded studentbody.
For the last four years at Baltimore's JohnsHopkins Medical School, applicants have not beenrequired to take the Medical College AdmissionsTest (MCAT), the standardized test almost everyother school in the country uses. Instead, Hopkinsallows applicants to submit any of four admissionstests, including the Scholastic Aptitude Test.
David M. Trabilsy, director of admissions atHopkins, says that requiring the MCAT often forcesstudents to spend an unnecessary amount of timepreparing for the test, when they should befocusing on their undergraduate experience.
Meanwhile, faculty at the University ofPennsylvania Medical School decided three yearsago to accept students who had not completed thetraditional "pre-med" course requirements--a mixof biology, chemistry, physics and math. Instead,says Vice Dean for Education Frederic D. Burg, theschool has a "competency requirement," whichallows for limited coursework in the usual pre-medareas.
Burg says the "competency requirement"increases the school's appeal, and attracts morewell-rounded applicants.
"We should not stand in the way of innovationby not having traditional course requirements,"Burg says. "The school is recognized as having amore liberal approach to a person's readiness toenter medical school."
Burg says the new requirements have worked. Forthree out of the last four years, applications toPenn Med School have increased. This year, Pennreceived 300 more applicants than it did lastyear.
Harvard administrators have resisted suchchanges, however, saying they are unnecessary.
"I do know that we have very well-roundedstudents because we take into consideration thingsother than MCAT scores," Eisenberg says. "I thinkthat all those things [initiated at Hopkins andPenn] have been thought of, but no changes inadmissions have taken place.
Rakin agrees, saying that Harvard has alwayslooked beyond mere science ability in selecting astudent body.
"Harvard looks for an applicant that's anall-around candidate," she says.
Producing Better Doctors
For a school so seemingly disinterested inaltering long-standing admissions practices,Harvard has shown a surprising willingness tochange its curriculum. Many point to the NewPathways program--a still experimental teachingprogram--as an example of how Harvard MedicalSchool has met the profession's changing demands.
The program's methods are a radical break withthe past. Students spend less time in lectureslearning about physiology, and more in studygroups talking about doctor-patient relationships.
The program is more popular with students thanwith outside academics. But Harvard has stuck byit nonetheless.
"I turned down some schools it would have beenfinancially easier to go to because of the NewPathways," Spira says.
Tram says New Pathways succeeds in teachingstudents to be more compassionate. In addition,its case study method stresses actual learninginstead of rote memorization.
"You need to be competent. But you need to becompassionate too," he says.
And because New Pathways allows students morefree time, it allows the Medical School to producemore well-rounded doctors.
"Everyone here is working in some capacity. Butto have free time to do research, to do whatyou're interested in--at other schools you don'thave this opportunity," Tram says.
As a result, administrators and students say,Harvard has begun to regain its popularity withapplicants. Faculty hope this year's applicantincrease--109 more than last year--is the start ofa new trend for the Med School.
The Immediate Future
Unfortunately, administrators say, the signsare not so promising from undergraduates.
According to a study by the College's Office ofCareer Services (OCS),student interest in medicinedropped from 19.3 percent in 1976 to 10.2 percentlast year. Meanwhile, interest in lucrative lawand business careers has generally remained steadyor increased, luring away many qualified students.
"If I want to make money, business school andlaw school makes a lot more money than we do,"Tram says.
Among current Harvard undergraduates, interestin the life sciences has declined similarly. Thenumber of students concentrating in biology andbiochemistry--the most common pre-medconcentrations--dropped 29 percent over the lastfive years, from 688 to 487.
But Hope W. Wigglesworth, health careerscounselor at OCS, says job interest is cyclical,and predicts the declining interest in medicalschool will start to level off soon.
For now, doctors and academics are looking fora bright side to the increasing dearth of medicalstudents. Since the medical profession has becomeless appealing, many say new doctors must be morecommitted to helping people and less interested inprofits and status.
"A person has to love the career to go intoit," Tram says. "It's really a commitment."
"Maybe people are thinking a little bit longerand harder about why they want to be a doctor,"Wigglesworth says.
But so long as the medical profession continuesto lose its appeal, many say that kind of optimismis of little help.
As Poussaint says, "the changing face ofmedicine--it's much more of a big blur."