The practice of medicine has been regarded as an honourable and lucrative profession since ancient times, when Greek physicians-philosophers, Galen, Aristotle and Hypocrites, taught their students under open skies. Doctors are especially well rewarded in the United States, where primary care physicians often earn on average $189,000 per year, while a specialist can command an income of $259,000 or higher. These benefits notwithstanding, the US has been suffering from a chronic shortage of doctors (MDs) as the country’s some 141 medical schools have failed to train enough of them to meet the growing need.

Although admission to medical school remains highly competitive, interest among young Americans in pursuing a career in medicine has been waning, as many don’t care for the long hours of stressful work that doctors are required to perform.

Another factor is the high cost of studies. It takes at least seven long years to train a doctor in the US, following a four-year undergraduate degree, and even longer for surgeons and specialists. Most students borrow large sums of money to pay for their extended medical training, which may take them years to pay back.

Currently, there are an estimated 774,000 physicians working in the US, of whom nearly half are approaching retirement age. Recently, the American Medical Association warned that in three years, the country would have 63,000 fewer doctors than it would need, and as the population ages, this number will climb to twice as much by the year 2025. The shortage of general physicians is especially acute, since many new doctors choose to become specialist which enables them to draw much higher incomes.

Although the estimates vary, according to a recent report in the medical journal, Lancet, the US will need to train some 5,000 more doctors every year to make up the gap. It represents an increase of 30 per cent in the current output of approximately 18,000 doctors. The problem is not limited to the dearth of medical schools. The numbers of residency positions at hospitals, critical for clinical training, have stayed frozen for the past 15 years. Consequently, without an increase in the residency positions, expansion of the medical schools alone would not solve the problem.

Much of the shortfall has so far been made up by foreign-trained physicians, many of them from developing countries — India, Pakistan, and the Philippines. It is estimated that nearly five per cent of all practicing physicians in the US are of Pakistani origin and even a larger percentage originated in India. Now that President Obama has been re-elected, his Affordable Health Care Plan faces no real threat of being repealed. When fully implemented, it will extend medical benefits to 30 million Americans who now have no insurance, placing further strain on the medical system.

In order to relieve the physician shortage, it has been proposed that immigration of foreign-trained doctors should be encouraged. Also, there are plans to open 18 new medical schools in the next few years which will address the long-term problem.

As opposed to the shortage of medical doctors, there is currently a virtual glut of PhDs in the US, especially in biomedical sciences. A PhD degree used to promise a prestigious academic appointment on a university faculty, with life-long job security.

No more! Only about 14 per cent candidates with doctoral degrees in life sciences are successful in finding coveted faculty positions. Academic positions have become highly competitive and scarce. Most medical research in the US is supported by the US Government funds distributed by the National Institutes of Health (NIH) through a highly competitive process. Most universities expect its faculty members to generate grants to pay for their salaries and research. However, the federal research budget has remained frozen at 30 billion dollars a year. Consequently, universities, so dependent of federal grants, are not expanding their academic staff.

Traditionally, many PhD degree holders spend a few years in acquiring further training under some senior investigator as a postdoctoral fellow, prior to moving on to a permanent position. Unable to find permanent positions, many are now trapped in postdoctoral positions that are low paying, with few or no benefits, such as pension and medical insurance. Ultimately, many drift into other professions where their original training would have little or no application.

Besides academia, drug and pharmaceutical industry used to employ a large number of chemists and biochemists, offering an alternative and lucrative career path. However, the pharmaceutical industry has been cutting back and laying off its research and development staff. Some of their research work has been contracted out to countries such as India and China where it can be carried out cheaply. But the situation is not so grim for all PhDs. Unlike those in life sciences, scientists with degrees in physics and computer sciences are doing very well.

The present disconnection between supply and demand of physicians and basic scientists is likely to be temporary. Eventually the market forces operating the US economy will assert themselves, leading to the establishment of a new equilibrium.