It's a little easier to get into medical school these days, but a lot harder to pay tuition.
Competition peaked in 1974, when more than 42,000 applicants competed for about 15,000 places -- or 2.8 applicants for every spot. But with the baby boomers hitting middle age and federal subsidies drying up, the ratio has fallen to about 1.9 applicants per spot, and it's expected to drop to about 1.5 by the end of this decade.
Last fall, 16,963 students entered the nation's 127 medical schools, about a 2 percent drop from the peak enrollment in 1981.
"For the first time in 50 years, we have a downturn," said Dr. John A.D. Cooper, president of the Association of American Medical Colleges.
Fears in the 1960s and 1970s of an impending doctor shortage have given way in the 1980s to worries about an impending doctor glut. That shift, along with budget pressures, has led to cutbacks in federal subsidies for medical education, including tuition assistance.
Last year's medical school graduates had an average debt of nearly $30,000.
"We're facing a real financial crisis," said Jeffrey Stolz, president of the American Medical Student Association. Federal cuts won't limit the number of doctors, he said, but merely limit applicants to those who can afford the soaring medical school tuition.
"It's very scary," said Dr. Russell L. Miller, dean of Howard University College of Medicine. "I hope I don't live to see the day when cost will be the determining factor for people going into the field, but we're close to that now."
At Howard, one of four primarily black medical schools in the nation, nearly 75 percent of the students are American blacks and another 10 to 15 percent are African or Caribbean blacks. A key factor in selection of students, Miller said, is the likelihood of their taking a leadership role in a medically underserved community after graduation.
"At Howard, because of our mission and our very reason for being," Miller said, "we're more likely to take a chance on a student who we believe has the ability but has not had a chance to perform."
Besides Howard, with about 115 students per class and annual tuition of $5,700, the District's other two medical schools are: George Washington University, with about 150 students per class and a yearly tuition of $18,500, and Georgetown University, with about 205 per class and yearly tuition of about $21,000.
Medical school enrollments have changed since 20 years ago, when medical students were an almost exclusively white male group.
The percentage of women among medical students has risen steadily from 9 percent in 1965 to 35 percent today.
For blacks, the progress is more mixed. As recently as 1967-68, two schools -- Howard and Meharry Medical College in Nashville -- accounted for more than two thirds of all black first-year medical students in the nation. In all other medical schools combined, blacks accounted for less than 1 percent of students.
The percentage of blacks among medical students nationally rose gradually during the late 1960s and early 1970s. But after peaking at 7.8 percent in 1974-75, it fell to 5.8 percent this year.
"That's an alarming statistic when you consider it occurred at a time when white applicants declined by some 20 percent, medical school fees increased by $2,500 and black applicant performance on the Medical College Admission Test improved," said Joan Baratz, director of an Educational Testing Service study on minority enrollment in medical schools.
"What we're going to see -- what we're already seeing -- is a cut in minority access to the profession," said AMSA's Stolz.
The rising cost of medical education is undercutting efforts to improve medical care in rural and inner-city areas, where the most acute need is for general practitioners and other primary care doctors, Stolz said.
Students who go deeply into debt in medical school are more likely to go into higher-paying specialties or military medicine, he said, rather than returning to their home communities as general practitioners.