The current system will not change until there is a fundamental realignment towards neutrality in the supply-demand equation. Until then, the providers hold the proverbial cards.

Your sarcasm – not – aside, you didn’t answer the question I posed – would you leave a rural area if you were the sole or second trauma surgeon? And think before you pontificate with your clueless sarcasm – rural areas can’t afford to pay “princely” sums, no one else besides your delusional mind thinks that doctors lord it over others, and no one is extorting the patient population no matter what you may think. Answer the question – would you stay or go? Leave the sarcasm out of your answer.

With all your hyperbole about Flexner and your rants about patient abandonment, let’s ask you the real question – if you were a trauma doc in a rural area, on call every or every other night, with no life to speak of, wouldn’t YOU want to leave and go elsewhere? Or would your beneficent and altruistic spirit keep you in the boondocks?

The Flexner model is based, in part, on the antecedent German medical education model of the time. In looking at Flexner, there were two groups of suggestions made. The first deals with the nature of the education required. I find it to be a bit much with the “basic sciences” emphasis to be a bit drawn out. The curriculum is something that can be tweaked but should stay relatively intact. The second deals with restricting supply. Closing over half of the existing schools at the time, coupling schools to large research institutions, precluding for profit schools, etc. are all for the sole purpose of restricting supply. If it were up to me, I would remove all of the supply limiting portions and let the weeding out occur via the USMLE and the residency process. If the USMLE is worth anything when it comes to weeding out the incompetents then there should be no complaint against this. Foreign schools that do not follow one, some, many or all of the supply side restricting tenets of Flexner produce graduates that can and do pass the USMLEs (while being held to a higher standard than their domestic counterparts) thereby showing the fallacy of the overtly restrictive nature of the supply side restriction segments of Flexner.

For any new schools opening that don’t meet current CME guidelines but that can obtain regional accreditation, I would suggest following the California legal model. License to practice in their state of training but without comity to obtain licensure in other states.

The current system places the restriction on those that can enter medical school. Once in, a C average (pass) is sufficient to make it through. Once licensed, any discussions of “quality” go out the door as it is virtually impossible to remove licensure from even the most derelict of providers. The level of “quality” that is tolerated from the licensed providers is not commensurate with the level of purported quality demanded of students applying for entry into the domestic medical schools.

I would rather see a system based on the free market when it comes to providers. Those, that through their skill, excel should be compensated to the degree that the market will bear. Those that do not should not. Under the current system, the most hack of quacks is guaranteed a high after expense compensation rate and it has nothing to do with his/her skills but instead has everything to do with a marketplace in which supply is restricted.

By definition, there is no monopoly.

Add to that the expansion of practice rights for nurses, naturopaths, chiropractors, optometrists, dentists, posiatrists, the whole argument for monopoly is rather silly, to put it mildly.