The old song goes "The rich get rich and the poor get children."

Populations admitting the most medical students in the US only have 9% of
children wha are medical school age. They are reproducing more slowly.

Populations admitting the fewest have 11 - 12% of children who are medical
school, professional school, college, and higher education age.  This will
become our national leaders.

There is no guarantee that they will understand those outside their class,
in fact they seem to be walling themselves away from this in "tiers."

Over time and under the influence of standardized tests, we admit more and
more who have slightly better MCAT scores or other standardized tests for
college or advanced placements. In succeeding generations those admitted
with higher scores admit more like them with slightly greater MCAT scores.
Then we wonder why we have few physicians in rural and underserved areas,
but forget that we have been excluding the students who would have become
physicians more likely to return to similar populations. We also forget
that we have also been killing off the teachers that would have returned,
and would have improved the potential of humble origin students in more
than just 1 generation.

Over time it becomes more and more difficult to support 2 or more tiers,
except in the eyes of those that do not understand basic math or those that
do not have a basic orientation to people skills and relationships.

Basic math is also one of the reasons that the US has so many more
specialists. When you start with a lower primary care reimbursement and
increase it at the same rates, or even smaller rates, you end up with more
pay for specialty care. This translates to more emphasis in society, more
employees working for specialists (often recruited from primary care
offices and poorer sites), more resources, more urban location, less busy,
more disposable time, more dissatisfaction, and more leadership positions.

Over time, the same basic math. Not always the consequences that you want
however.

Robert C. Bowman, M.D.
U of Nebraska
[log in to unmask]

-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]


To unsubscribe, send the following message in the text section -- NOT the subject header --  to [log in to unmask]
SIGNOFF SDOH

DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.

To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header.
SUBSCRIBE SDOH yourfirstname yourlastname

To post a message to all 1000+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.

For a list of SDOH members, send a request to [log in to unmask]

To receive messages only once a day, send the following message to [log in to unmask]
SET SDOH DIGEST

To view the SDOH archives, go to: https://listserv.yorku.ca/archives/sdoh.html