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By Patrick Neustatter, MD

There's a lot to being a good doctors.

Desirable attributes include problem solving, empathy, being respectful, a good listener /communicator, conscientiousness, emotionally stable, able to work in a team and of course the smarts to learn about illnesses and what to do about them.

To get to be a doctor however, you have to get accepted to medical school - and from what I gather from talking to the pre-med students we've had volunteering at the Moss Clinic, that is a punishing and wildly competitive business that seems to select for dogged determination and an ability to pass exams, rather than these touchy-feely attributes that are so important once you get there.

Herculean Labor To get into medical school you have to have an above average GPA. Do well in the MCATS (medical college admission testing). Then apply to between 15 and 25 "carefully selected schools" which requires going through the AMCAS (American Medical College Application Service) application process submitting your work and activity record. A record that needs to include clinical exposure, non-clinical community work, and ideally other hobbies like playing an instrument to show you are a well-rounded person, several letters of recommendation. And the all-important autobiographical personal statement. You may also be asked to write individualized essays for specific schools.

Currently we have Cameron, a pre-med student at Germanna who has been shadowing me as I see patients (so having to put up with my pontificating about medical "fascinoma's"). And Ravi, a student from University of Mary Washington, working as a scribe (needed because we dinosaurs of the medical world are incapable of learning to navigate the not-very user-friendly, Allscripts, electronic medical records program that we have). Both are doing this as part of their clinical exposure.

Then Ravi is doing an extra postgraduate year in college and Cameron applying to join the rescue squad - to further "buff" his resumes.

The Irony The real irony is that all these dedicated, bright, wannabe's would be wonderful doctors so far as I can see. But only about a third will get into medical school (in 2021, admission rate was 36 percent according to AAMC data).

This, in a country that has a drastic shortage of doctors of all kinds, where the population is growing (it has gone up 21percent since 1997) and the gray revolution of people living longer is providing greater need.

AAMC predicts a likely shortfall of up to 122,000 by 2032 - "at least half of that shortage is expected to be among primary care physicians" notes the Washington Post (graduating doctors are gravitating toward well-paying specialties like orthopedics and interventional radiology to pay off the crippling debt they accumulate - average for 2020 was $207,000 and change).

The bottle neck seems to be residency programs - as the number of residency programs determines how many medical students can enter the system.

The Centers for Medicare and Medicaid Services pays hospitals to hire residents. But in 1997 Congress passed a Balanced Budget Act and that froze funding for residency programs at 1996 levels.

You may have experienced this doctor shortage by finding it is virtually impossible get to see an actual doctor instead you get an appointment with a physician's assistant or nurse practitioner "extender."

So, part of it is a political problem. But there's still the issue of people getting in to medical school will be those who are dogged, and good exam takers - not necessarily the characteristics to make the best doctors.

All further arguments for being an emancipated patient, and being able to be in charge of your own healthcare.

Patrick Neustatter, MD is the Medical Director of the Moss Free Clinic