Chicago Applications to the nation's medical schools fell 3.7 percent in 2000 in the fourth straight year of decline.
Attractive jobs in dot-coms and information technology, along with the prospect of big medical school debts, may be among the reasons for the decline, said Barbara Barzansky, secretary of the American Medical Assn.'s medical education council and author of the report.
Add the increased paperwork, regulations and concerns that have come with managed care and, she said, "it's not as friendly an environment as it used to be."
The applicant pool last year totaled 37,092. It included 17,274 women, a 0.9 percent drop from 1999, the report found. The number of minorities climbed 2 percent to 4,266.
Despite the drop in applicants, "there are still more than twice as many applicants as there are places" for them, said Dr. Jordan Cohen, president of the Association of American Medical Colleges.
The report, published in today's Journal of the American Medical Assn., also found that the number of patients available to participate in clinical teaching during 2000-01 decreased in almost half the nation's 125 medical schools.
Some experts say managed care is partly to blame. Insurance companies may be steering patients away from teaching hospitals because the care there can be more expensive, Barzansky said.
The shortage may help explain results of two other studies in the same journal that suggest some medical schools may not be adequately preparing students to deal with common problems and procedures.
One study, by Massachusetts General Hospital researchers and based on a 1998 survey of 2,626 students completing their residency assignments nationwide, found that more than one in 10 felt unprepared to handle certain treatments and procedures. Training in handling "nontraditional patients" such as those with AIDS, drug abuse and chronic pain was cited as particularly deficient.
The other study found a serious inability to perform an abdominal exam among first-year residents in internal medicine and pediatrics at two New York medical institutions.