More with less - THES reporters describe efforts around the world to meet the rising demand for trained medical staff without compromising quality
The American medical system is lurching towards yet another crisis - a steady decline in applications to medical schools.
It is already shouldering the burden of a growing elderly population, rocketing costs for drugs and equipment, and increased pressure to reduce fees.
The number of applications fell by 6 per cent this year, and a total of 30 per cent compared with the 1996 peak.
There are twice as many applicants as places, but officials are beginning to worry about a shortage of doctors in some specialties.
In some western states, hospitals are closing trauma centres due to a lack of doctors, and many doctors are moving because of the high cost of malpractice insurance in many areas.
Prospective medical students are also keenly aware of the average debt burden of $104,000 (£68,000) that awaits them after four years of classes, which are followed by three to seven years in a residency programme.
Eric Hodgson, president of the American Medical Student Association, said finance was partly to blame for the fall in numbers.
He added: "The lifestyle of a physician in America is not good. There are the hours one works in a residency, and limited opportunity to spend time with family. As more women enter medicine, family priorities become more important."
Residents work an average 60-90 hours a week, depending on their specialty, but earn a comparatively low $30,000 (£19,000) to $35,000 a year, less than many plumbers. Dr Hodgson, who plans to specialise in obstetrics and gynaecology, faces a 91-hour week in his impending residency.
The residency programme coincides with the requirement to begin repaying tuition loans. Accrediting bodies are trying to cut residents' hours to 80 a week, mainly out of concern about risks to patients from overtired doctors.
Meanwhile, applications to graduate programmes in law and business are soaring, which cost less, take less time and lead to jobs that pay as much as, or more than, those in medicine.
But there are signs that the decline in applications is reversing. The number of students who took the Medical College Admission Test rose by 6 per cent this autumn.
A career in medicine is seen as stable compared with those in law and business. As the job market becomes squeezed, more people may choose medicine.