The American Medical Association reports that the number of applicants to US schools stood at 38 529 in 1999, a 6% decrease from 1998 and an 18% decline since 1996. Actual first-year enrolment remained relatively constant over this period, at around 17 000 students.

Data from the Association of Canadian Medical Colleges indicate that the number of applicants to Canadian faculties of medicine stood at 7575 in 1999, 8% fewer than in 1996.

Barbara Barzansky, secretary of the AMA's Council on Medical Education, attributes the steady decline in applications to a buoyant economy that offers more career options. She also cites difficulties in finding favourable medical employment, as well as fear of the perceived difficulties posed by managed care. "There is a lot of dissatisfaction among the established medical community that is getting passed on," she says.

Potential medical students may also be declining to assume the huge debts now associated with medical education. On graduating, the average US medical student now owes about US$93 000. With interest, that could easily grow to US$200 000, Barzansky notes.