Washington. -- President Clinton's drive to tame health-care costs must contend with a perverse statistical omen fresh out of the computers: The number of applicants for medical school reached an all-time high this year -- 42,625 individuals competing for 16,000 first-year slots. Five years ago, with the same number of openings available, only 26,000 applied for admission.
Humanitarian values have always driven many young men and women to pursue medical careers. But the craving to do good would seem to be insufficient to account for a 64 percent surge in applicants in a mere five years. Might it be, then, that the increase also arises from the expectation that bountiful income and high social status for doctors will continue to survive Washington's thunderings about the runaway costs and wastefulness of medical care?
Mr. Clinton's cost-cutting plans are only the latest in a decades-long series of tough talk that changed little or nothing. So far, he has not proceeded beyond the talking stage, and there's no certainty that his health-care reform proposals will get any further than that.
Like animals that can sense the imminence of an earthquake, students tend to be instinctively sensitive to signs of economic ups and downs, as evidenced by declines in applications for business schools -- formerly the doorway to golden careers in the corporate world. But now that big companies are shedding staff and cutting back or eliminating new hires, medicine has regained its economic and social luster.
Motivations vary for undertaking the rigors of medical education, a process that requires four years of post-college schooling that leaves many students personally indebted for $100,000 or more. The first round of medical education is followed by three years of residency training, notable for modest wages and hours so cruel that some states have imposed limits on residents' work schedules. After completing their residencies, many young physicians undergo several years of specialty training, again with low pay and long hours.
With all due allowance for the humanitarian aspects of medicine, must be noted that the profession is at the top of America's biggest and fastest-growing industry. While virtually every other major sector of the economy has been experiencing deliberate, painful shrinkage, the health-care industry has been booming. It now accounts for some 10 million jobs. And, as a glance at the help-wanted ads in almost any city, large or small, reveals, it aims to fill many more if it can find the right people.
While medicine's professional societies regularly gripe that doctors' incomes aren't growing as lustily as they did in the past, medicine retains a lofty place on the American income scale. Though it can't compete with the gargantuan remuneration that corporate executives reap through stock options and other devices for rewards, average income for physicians is well over $150,000 a year, while many specialists earn over $500,000 a year.
The figures are complicated by regional differences and marked differences between incomes of general practitioners and specialists. But, with rare exceptions, physicians are well paid for the skills they acquired over many years of training. Unemployment is virtually nil in the medical profession in the U.S.
Are President Clinton's health-care reforms likely to curb the earning power of medicine? Probably not. With doctors' income accounting for about 20 percent of national health-care expenditures, restraints will be required to achieve the savings needed to provide coverage for the uninsured. The Medicaid and Medicare programs are natural targets for cost cutting, since they're both tied to Washington. At this point, however, the White House is merely aiming for modest reductions in their rate of growth over the next five years.
In seeking all the support it can muster for health-care reform, the Clintons have turned from bashing to wooing organized medicine. And, on the subject of doctors' incomes, the American Medical Association and other medical organizations are dug in and ready to fight.
For the young shopping around for a well-paid, secure career, clairvoyance is not needed to home in on medicine. The conditions of practice may change, with major shifts from solo to group settings, and Washington will surely tighten the rules on services and spending. But compared to other career prospects in the economy, medicine is hard to beat -- which accounts for the big surge in applications to medical school.
Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.