This means that those who replied, at the end of their tenth year of graduation, had earned during that year: in law, an average of over $5,000, and in medicine, less than $4,000. From the small number of replies which had been received from the ten year men in law, one may be led to infer that perhaps neither the less successful lawyers nor those who had given up law for business answered the inquiries. These tables are more suggestive than informing, since in either case they represent returns only from fractions of the groups studied.

The average full-time pay of all the male teachers in the high schools of cities having over 250,000 of population was $1,839 in 1912. While it is true that many persons in the public-school service later take up medicine, comparatively few doctors leave their profession to enter teaching, although a change from medical practice to some departments of educational work is quite easy in most of the cities. This means that the practice of medicine brings more satisfying rewards than this other line of public service of which we have definite information regarding the monetary returns and that taking the country as a whole we would expect for the fairly well-established physician, in country districts and villages, net earnings of from $1,000 to $3,000; in the smaller cities, from $1,000 to $2,000; in the larger cities, from $1,500 to $4,000; with much larger returns for the unusually successful men.

Approaching this problem from another side, we note the age distribution of physicians and surgeons, as given in the census, indicates that the proportion of physicians over forty-five years of age is larger than the proportion of such persons in other professions. This means that

a large proportion of those who enter upon the practice of medicine remain in the profession, although from the very nature of the physician's position in society and his opportunity to become acquainted with men of affairs one would think that it would be as easy for him to make profitable business connections as it is for lawyers.

According to a very careful study made by the Journal of the American Medical Association, the 2,205 physicians whose death was noted in the columns of that periodical for 1914 had attained an average age of between sixty and sixty-one years and their average number of years of practice was nearly thirty-four. This means that they entered upon practice at about the age of twenty-six, and assuming $3,000 as the cost of their medical education, it would seem that if, during each year of their productive period, they had laid aside $200 the principal and the interest on their outlay would have been more than repaid. Taking this amount out of their earnings it is more than likely that the average net earnings of physicians as a class will for this productive period of thirty-four years still be double the net earnings of the man who spent about as much time in learning one of the skilled trades and whose productive period is very much shorter.

It will be claimed that the physician has many expenses. Unlike the lawyers most of the physicians have their offices in their own homes. Their travelling expenses are much smaller than those of the men engaged in the engineering professions. While it must be conceded that the law offers more large prizes than medicine it is doubtful whether any of the scientific professions offer more opportunities for securing unusual financial rewards.

CHAPTER VI.

PROSPECTS.

Certain economists claim that before any man undertakes to invest time and money in securing his special training for any vocation he should make sure that the particular vocation is not overcrowded and that there is a public demand for the services of one more trained man or woman in the field which he is thinking of entering. On the other hand it must be noted that very few persons who prepare themselves for gainful occupations or incur expenses for engaging in producing marketable commodities have any assurance in advance of a demand for their services or a market for their products.

It is well enough however to try to find out what statistics have to say about the prospects for remunerative service in this profession. For the entire United States there were in 1890, 167 physicians and surgeons per each 100,000 of population; in 1900, 174; in 1910, 165. For the ten largest cities in the country taken together there were in 1906, 236; and in 1910, 210 male and female physicians per 100,000 of population. Compared with 100 or less for most of the European countries, and 142 registered physicians per 100,000 for London in 1911, there seem to be indications that the current notion that the field is oversupplied is well founded. This disparity in the number of physicians in different countries may be partially explained by the methods of the census takers of this country, who enroll

every person who reports himself as a physician, as such, without considering whether he is actually engaged in practice, or duly licensed and registered. More care has been observed in this respect in the last census.

In determining whether the number of physicians is greater than the actual needs of the country, several things must be taken into consideration. A careful observer with a large acquaintance among medical men is of the opinion that in this country 20 per cent. of those who graduate never practice medicine; some, because they entered upon their preparation without any appreciation of the real significance of medicine as a career; others, because they early discovered that medicine is not a get-rich-quick enterprise if practiced according to sound ethical standards, nor even an easy way of making a living. Some, even, if they take up other callings retain the title of doctor and are classed. In determining the chances for success in a given locality, it must be considered that from 10 to 20 per cent. of the registered physicians have retired from practice or are among those who while not actively so engaged, minister to the wants of a few families or patients of many years of standing.

After making due allowance for all these factors, a full consideration of these statistics would seem to force us to the conclusion that on account of the activities of the too numerous medical colleges the number of graduates has been in excess of the normal demands; this is reflected in the decrease of the enrollment in the medical colleges in recent years although a part of the decrease must be attributed to the higher requirements for admission. This tendency is to be noticed in the following table:

The apparent oversupply, as compared with other countries, has been due to the greater freedom which persons of all classes have in taking up this work, and the oversupply had led to such competition for business as to make of our people probably the best served nation in the world in this respect. We may conclude that for the ordinary normal demands of the well-organized and prosperous large city or the smaller city with its contiguous country population, a ratio of from 150 to 180 per 100,000 of population is not excessive.

From 1902 to 1912 the average death rate among physicians was 15.93 per 1,000; so that, according to these figures, approximately 2,500 new medical graduates are needed each year to take the places of those who drop out of the ranks on account of death. Considering also the growth of the population and the larger needs of the under-supplied communities as they become more prosperous and considering particularly the increased demand by the industries for the medical supervision of workers and the rapidly growing movement for organized public-health service we must conclude that the present output of 3,500 medical graduates every year is

not excessive.

By personal interviews with many physicians in several of our large cities some very conflicting testimony on this point was collected. While the committees of medical societies agree generally that there is an over