Are the best and brightest going into medicine?

That rather depressing perception is shared not only by a hefty majority of the survey's 7,700 respondents but also by a number of high-profile physicians: "We all worry that American medicine may no longer be the magnet it has been for America's best and brightest," AMA Past President Yank D. Coble Jr. said last year in sizing up the profession.

National Institutes of Health Director Elias A. Zerhouni has also fretted that many promising students may be shying away from careers in medicine and medical research.

Some of the more vocal among today's practicing physicians have lamented the transformation of their beloved profession into what they view as a trade. In short, maybe prospective doctors-if they're listening to those elders-are reluctant to come in for the same reasons doctors at midcareer are trying to get out. As one young doctor groused, "MBA graduates with six years of post-high school education may start for nearly the same compensation as physician residents with 12 years of post-high school education. This does not even begin to assess other factors such as lifestyle, indebtedness, and liability."

The uneasiness is not exclusive to medicine. "Science as a profession isn't particularly honored," said Cornell University physicist and Nobel Laureate Robert C. Richardson in an interview with The New York Times in July. Richardson was talking primarily about PhD careers in the sciences and engineering.

In 1975, the US ranked No. 3 in the world in the percentage of 18-24-year-olds who earned degrees in the natural sciences and engineering. Today our country has dropped to No. 17, and half of the engineers graduating from US schools were born in other countries. "The glamorous degree these days," Richardson concluded, "is the MBA."

Putting the grumbles in perspective Just how legitimate is the "best and brightest" gripe? How much reality is in the perception? Any concerns about the Doctors of the Future must be put in context. Consider that average MCAT scores for both medical school applicants and matriculants have steadily increased over the past decade. Applicants' mean MCAT verbal reasoning score rose from 8.3 in 1992 to 8.8 in 2003. Mean scores in the physical sciences portion jumped from 8.1 to 9.0, and in biological sciences from 8.2 to 9.3. We're not sending schlubs to med school these days.