ACGME says more grads than residency slots by 2015

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futuredoc15

futuredoc15

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Because of the cap on Medicare's payments, the expanding number of U.S. medical school graduates, and the continuing influx of some 7000 international medical graduates in search of GME posts every year, before long there will be too few positions to train them all. Currently, about 25% of practicing physicians in the United States are graduates of international medical schools. The slow growth in GME positions — an annual rate of 0.9% over the past decade (Nasca T: personal communication) — contrasts with the increases in enrollment that have occurred in 100 of the 125 allopathic medical schools and a doubling of enrollments in osteopathic medical schools. By 2015, combined first-year enrollment in allopathic and osteopathic schools is projected to reach 26,403, an increase of 35% over 2002 numbers. Eight new allopathic schools and nine osteopathic schools or branch campuses have enrolled their first classes or soon will do so (for details, see Table 1 in the Supplementary Appendix, available with the full text of this article at NEJM.org).
In an interview, Dr. Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education, expressed concern over the narrowing gap between the number of entry-level GME posts and the growing number of medical school graduates. Nasca said, "We estimate that we will see domestic production of medical school graduates functionally surpass our current total number of GME postgraduate year-one pipeline positions [posts that lead to initial specialty certification] by 2015 or sooner
Given the current concern over the federal deficit, the likelihood that Congress will remove the cap on Medicare's GME support is nil. Indeed, holding on to existing GME support may be the best outcome medical educators can hope to achieve.
Nasca added, "In the absence of congressional action to lift the cap, or the unlikely prospect of securing other sources of GME support, we face the risk of graduating physicians in the United States who will be unable to obtain the training required to obtain a license to practice independently."



http://www.nejm.org/doi/full/10.1056/NEJMhpr1107519
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futuredoc15 said:
Because of the cap on Medicare's payments, the expanding number of U.S. medical school graduates, and the continuing influx of some 7000 international medical graduates in search of GME posts every year, before long there will be too few positions to train them all. Currently, about 25% of practicing physicians in the United States are graduates of international medical schools. The slow growth in GME positions — an annual rate of 0.9% over the past decade (Nasca T: personal communication) — contrasts with the increases in enrollment that have occurred in 100 of the 125 allopathic medical schools and a doubling of enrollments in osteopathic medical schools. By 2015, combined first-year enrollment in allopathic and osteopathic schools is projected to reach 26,403, an increase of 35% over 2002 numbers. Eight new allopathic schools and nine osteopathic schools or branch campuses have enrolled their first classes or soon will do so (for details, see Table 1 in the Supplementary Appendix, available with the full text of this article at NEJM.org).
In an interview, Dr. Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education, expressed concern over the narrowing gap between the number of entry-level GME posts and the growing number of medical school graduates. Nasca said, “We estimate that we will see domestic production of medical school graduates functionally surpass our current total number of GME postgraduate year-one pipeline positions [posts that lead to initial specialty certification] by 2015 or sooner
Given the current concern over the federal deficit, the likelihood that Congress will remove the cap on Medicare's GME support is nil. Indeed, holding on to existing GME support may be the best outcome medical educators can hope to achieve.
Nasca added, “In the absence of congressional action to lift the cap, or the unlikely prospect of securing other sources of GME support, we face the risk of graduating physicians in the United States who will be unable to obtain the training required to obtain a license to practice independently.”



http://www.nejm.org/doi/full/10.1056/NEJMhpr1107519
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The COCA and LCME need to cap enrollment, and the COCA especially needs to crack down on the standards for opening new schools.

I do not think the number of GME spots should be increased, nor do I think it will. Obviously the percentage of spots filled by US grads will increase, which is probably a good thing.
 
I think that the only thing that's going to restrain the growth of new med schools is when finally there are a significant number of people graduating medical school and not being able to get a residency. Then the news will filter down to the general public that med school is not a golden ticket to riches and applications will drop. This is basically what has already been happening with law schools (thanks to the uncontrolled growth in the number of law schools, there are too many law students graduating for the number of lawyer jobs out there, and just recently there has finally been a drop in law school apps as word has gotten out to the general public about that). I've seen rumblings on here that other health care careers like Pharmacy are also in a similar boat.

Until the consequences of an oversupply of med students become unavoidable, I expect we will keep seeing more med schools open. Schools want the tuition money and prestige that comes with opening a med school, and there are plenty of people who will jump at the chance to go to med school obviously.
 
peppy said:
I think that the only thing that's going to restrain the growth of new med schools is when finally there are a significant number of people graduating medical school and not being able to get a residency. Then the news will filter down to the general public that med school is not a golden ticket to riches and applications will drop. This is basically what has already been happening with law schools (thanks to the uncontrolled growth in the number of law schools, there are too many law students graduating for the number of lawyer jobs out there, and just recently there has finally been a drop in law school apps as word has gotten out to the general public about that). I've seen rumblings on here that other health care careers like Pharmacy are also in a similar boat.

Until the consequences of an oversupply of med students become unavoidable, I expect we will keep seeing more med schools open. Schools want the tuition money and prestige that comes with opening a med school, and there are plenty of people who will jump at the chance to go to med school obviously.
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this is exactly right. local politicians see med schools as the golden ticket.

Rural good ole boy country redneck politicans love med schools: "Hey we can open this school up in bumble**** arkansas with our population of 300. then we'll be rolling in those NIH dollars baby! Hollaa!!!"

Feel good liberals also love med schools: "in our racist society we need more URMs, so therefore opening up this med school in this city which already has 10 med schools is a good idea because we can recruit URMs exclusively"
 
Socrates25 said:
Rural good ole boy country redneck politicans love med schools: "Hey we can open this school up in bumble**** arkansas with our population of 300. then we'll be rolling in those NIH dollars baby! Hollaa!!!"

Feel good liberals also love med schools: "in our racist society we need more URMs, so therefore opening up this med school in this city which already has 10 med schools is a good idea because we can recruit URMs exclusively"
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Why don't the same politicians and feel-good liberals open more res. programs and residency spots?
 
No surprise here. People had predicted this years ago on Studentdoctor, when all these schools were in the planning stages. Everyone knows residency slots don't increase. Looks like "the squeeze" is finally coming to pass.
 
VA Hopeful Dr said:
Because those cost money, schools make money.
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True, schools can make money. But opening schools costs too: land, infrastructure, faculty/employee, systems, lots more.

If some grads can't get a res. spot, what's the use? The bottleneck of producing independent, licensed doctors is the residency stage, especially if spots don't keep up.

Depending on specialty, "MD" is closer to a 7-11year long degree (3 to 7 years of res). Getting 4 years of school but no spot is useless, if one wants to do clinical work.
 
Shoushu said:
True, schools can make money. But opening schools costs too: land, infrastructure, faculty/employee, systems, lots more..
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all of those things represent an inflow of money to the local economy, not a cost.

The AAMC has made it clear that US schools should fill US healthcare needs (ie residency slots). That's the way every other country does it. That is the reason for the push in increased enrollment of US allo class size. Primarilly it started as a non confrontational way to drive the cottage industry of Caribbean schools which cater to US nationals out of business, but will have impact on IMGs and others. I don't really see a big risk of having US schools exceed residency slots in the near term. As you get closer to that number people will stop finding desirable slots, and fewer people will enter the pipeline knowing that their cousin/uncle/brother graduated last year and the only thing they could match into was a malignant surgery prelim slot in booneysville Nebraska. At the same time it will have a disproportionate impact on DO than Allo grads, since they are the outsiders in the allo match, so that should put the brakes on opening new osteopathic schools even before there is an allopathic impact. It's kind of the story of the golden goose -- if med schools get too piggy they can kill it for everyone, but if played right it can simply drive one segment of the market (offshore MD mills) out of business.
 
Law2Doc said:
(offshore MD mills)
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That's a bit of a cheap shot. One of the biggest complaints against Caribbean schools is that they'll take anyone who can pay but then have a very high drop-out and failure rate. If they were really "MD mills", their students would all get what they paid for.
 
KeyzerSoze said:
That's a bit of a cheap shot. One of the biggest complaints against Caribbean schools is that they'll take anyone who can pay but then have a very high drop-out and failure rate. If they were really "MD mills", their students would all get what they paid for.
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They do get what they paid for. All the students get a chance to become doctors. Nothing stops you from failing out in US MD versus Caribbean MD, other than that the school tries to select for people that it believes will make it and helps them out if they start to fail.
 
Paine said:
They do get what they paid for. All the students get a chance to become doctors. Nothing stops you from failing out in US MD versus Caribbean MD, other than that the school tries to select for people that it believes will make it and helps them out if they start to fail.
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Right... which is why they're not degree mills.
 
Paine said:
Hah. I misunderstood what you said. Yeah, I don't consider the Caribbean as the University of Phoenix of med schools.
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I do.

While they may not be, strictly speaking, "diploma mills," many offshore schools only care that the tuition check clears. High graduation and match rates are nice to have but not critical to the business model. They're more "matriculation mills."

And if things really do change dramatically in the next couple of years WRT AMGs meeting the needs residency program slots it will still take a generation or so before the offshore schools disappear simply because of the "my dad/uncle/cousin went offshore and he matched ophtho/rads/gas" effect that these schools rely on to fill their rosters.

As for the DO grads, they've got their own residencies...not enough to take in all the graduates of their rapidly proliferating class sizes and numbers but enough to buffer things for awhile. The IMGs are the ones who are going to get the most hosed.
 
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This is good news. This will pressure Congress to raise the cap on residency positions. I believe that this is one of the reasons why the AAMC pushed for bigger class sizes. In the financial crisis we're in, who knows how long it will take before Congress acts.

This sucks for the FMG but good for the US citizen who won't get fleeced by those Carib schools. Even US grads need to be careful. The worst US grads won't get residency positions either.
 
Taurus said:
This is good news. This will pressure Congress to raise the cap on residency positions.
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Doubtful. When all the talk is about cutting the CMS budget, things are more likely to go the other direction. Less (or perhaps no) CMS funding of residency slots.

I anticipate this idea being floated by some Tea Party congressional whackjob soon.
 
I highly doubt that congress will be lifting the cap anytime soon. Medicare cuts seem much more likely.

However, we might see residency spots increase anyway, without increased funding. As the new duty hour rules are enforced, programs will find that more people are needed to cover the same work. Programs will need to either hire more residents, or PA/NP's, or evolve more faculty coverage models. It's not clear which of these will win out in the end. Unfunded positions are probably the cheapest option in the long run. Faculty are the "easiest" and most flexible (i.e. you don't need to worry about training needs). Midlevels are highly dependent on supply and skills. Whether these forces will ultimately increase or decrease total spots remains to be seen.
 
Taurus said:
This is good news. This will pressure Congress to raise the cap on residency positions. I believe that this is one of the reasons why the AAMC pushed for bigger class sizes. ...
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Nah. I agree with gutonc and aPD that Congress isn't going to pony up more money to fund more residency slots. Telling the voting public that they are going to spend more money on this aspect of healthcare isn't politically salable. As for the reason the AAMC pushed for bigger class sizes, you can look back to the original press releases (2005?) and see that this has NOTHING to do with increasing residency slots. Actually the converse. The AAMC is very clear that US med schools should be filling all US needs. They are also clear in the same releases that offshore programs not governed by the LCME are a great concern to them, and that by increasing US class sizes we can keep more US residents from traveling elsewhere for their education, which means the LCME can assure the quality of their education. That this is a nonconfrontational means of attack on caribbean schools by the AAMC wasn't particularly veiled.
 
I didn't say that Congress will increase the cap anytime soon. But it will pressure them to when you have a bunch of residency-less medical school grads complaining about it on TV.

Increasing the class sizes was a very smart move by the AAMC. Let's not forget that before the change the NP's were lobbying hard to be allowed to take the unfilled FP and IM positions. So, if you had a bunch of unfilled FP or IM positions today, a (D)NP who did not go through medical school and got an online degree could have been your co-resident.

By filling every spot mostly with US grads, you effectively block out the NP's. Of course, the NP's are now talking about creating their own nursing residencies but at least they can't claim to have completed a medical residency.
 
Taurus said:
... the NP's are now talking about creating their own nursing residencies but at least they can't claim to have completed a medical residency.
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I think they've gone beyond the "talking about it stage". And these "residencies" tend to be less than a year in length. And the government and public are buying into the equivalency. I'm not sure not forcing them to do the 3+ year path wasn't a better deterrent to what they are doing now.
 
How does it work right now when new residencies are created? Do the programs get no compensation at all from Medicare? For instance, my home ENT program is graduating its first residency class this year, so the program was obviously created subsequent to the cap being put into place. I've also heard speculation that my med school hospital is thinking about creating other, new residencies or expanding existing programs. My wife's peds intern class is now 12 (from 8 in all previous years). Are the hospitals just eating the costs?
 
physicsnerd42 said:
How does it work right now when new residencies are created? Do the programs get no compensation at all from Medicare? For instance, my home ENT program is graduating its first residency class this year, so the program was obviously created subsequent to the cap being put into place. I've also heard speculation that my med school hospital is thinking about creating other, new residencies or expanding existing programs. My wife's peds intern class is now 12 (from 8 in all previous years). Are the hospitals just eating the costs?
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There are several possibilities.

One is that they are just eating the costs, generally split somehow between the department and the hospital.

It's also possible that spots have been re-distributed between programs within the hospital. GME funded spots are not handed from CMS to individual programs, they go to the institution as a whole so they can be re-distributed between programs although this is generally a huge political clusterf*** at the department/program head level.

There's also the possibility that they were funded for positions that they haven't been using although I'm not sure if CMS allows that.
 
Shoushu said:
True, schools can make money. But opening schools costs too: land, infrastructure, faculty/employee, systems, lots more.
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I sat in on a presentation directed at faculty of a hospital where a new medical school campus is opening this year. The faculty were told that tuition and fees, which are of course close to $40,000/year, will ensure coverage of the school's start-up expenses and have the new campus turning a profit within 4 years of opening. I personally believe that medical schools and GME funding are cash cows for some institutions, particularly schools without large academic components, and residency programs that work residents to the limits and provide minimal education.

That said, if fill rates for US seniors fall as growth of graduates outpaces new residency positions, some percentage of graduates will not have jobs. A medical degree without board eligibility/board certification is practically worthless. Yes, there are a few jobs thrown around on these forums occasionally, for MDs without residency completion, but these are few and far between, and will likely not grow. Thus, all of these graduates of new lower tier medical school programs without residency opportunities will have no way to pay off their loans. It will create high rates of loan defaults for new graduates. This will be bad for a lot of people, and I suspect may even be a main contributor to the expected burst of the "student loan bubble". At a minimum, if docs start to default on their loans, it may drive up loan interest rates even further and make it harder to obtain loans.

Thus, assuming residency positions do not increase at the necessary rate to provide positions for graduating medical students or provide primary care providers given the expected shortage, I propose we look back at an unpopular proposal. I think medical school graduates out of medical school or out of internship should be allowed to practice with supervision similar to a NP or PA. If there truly is a shortage of primary care physicians being filled by midlevels, then medical school graduates are just as qualified to fill these positions. Medical school graduates could then apply for residency at a later date after working as a midlevel provider for some period of time.
 
Before we get all "Doom and Gloom" on this thread, let's make sure we are all talking about the same thing.

There are currently ~23,000 residency spots in the match. This ignores spots given outside the match, and spots in the AOA match. It also ignores the 1 year prelim spots that don't lead to final training, but I also ignored the PGY-2 spots. So, for the sake of argument, let's say there are 25K spots.

There are currently 16K allopathic grads each year, before the increase. Medical schools have increased class size from 10-20%, with most in the 10-15% range. Assuming 15%, that's another 2500 students, so we are at 18.5K allo grads.

There are 8-10 new schools opening. Assume 100 students per year (although most of these schools are planned at 60-80). That's 1000 new students, likely less, and it will take many years before these students are in the pipeline -- a few schools are actually up and running, many are still on the drawing board.

That brings the total to 19.5K allopathic students, and 25K spots. That still leaves 5K spots for DO students and IMG/FMG's. I don't see allo grads in unemployment lines -- assuming they apply intelligently. If you're not competitive for ortho but aim your entire application in that direction anyway, and get nothing, that's simply poor planning in my book. Will every DO student have a spot? Probably. Even if you look at the graph in the article, there will be enough spots as long as spots don't decrease, which seems very unlikely.

There is no question that there will be more competition for spots. And, someone will get squeezed out -- but that's likely to be IMG's and not US allo grads. DO's might feel the squeeze also, but that can be "fixed" by decreasing the number of IMG's allowed into spots.

Last, let's not forget that as class sizes are increased, more people can go to US schools. There is a good chance that many of these people were those that were headed to offshore schools. Someone has to be the "last kid picked", and if you're name is next on the list, you don't get a spot. But, once schools increase class size, the students who "just missed out" will get into a US school instead. So, although there may be a decrease in the number of offshore grads who get into residency spots, there also will be a shift of students from offshore to onshore schools.
 
aPD, while your logic seems sound, I don't understand how it correlates with this quote in the article:

In an interview, Dr. Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education, expressed concern over the narrowing gap between the number of entry-level GME posts and the growing number of medical school graduates. Nasca said, "We estimate that we will see domestic production of medical school graduates functionally surpass our current total number of GME postgraduate year-one pipeline positions [posts that lead to initial specialty certification] by 2015 or sooner, and this does not include some 10,000 non–U.S.-citizen international medical graduates and about 3700 U.S.-citizen international medical graduates who seek GME posts in U.S. teaching hospitals."
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I am thus basing my "gloom and doom" on the head of the ACGME's "gloom and doom".
 
aProgDirector said:
Before we get all "Doom and Gloom" on this thread, let's make sure we are all talking about the same thing.

There are currently ~23,000 residency spots in the match. This ignores spots given outside the match, and spots in the AOA match. It also ignores the 1 year prelim spots that don't lead to final training, but I also ignored the PGY-2 spots. So, for the sake of argument, let's say there are 25K spots.

There are currently 16K allopathic grads each year, before the increase. Medical schools have increased class size from 10-20%, with most in the 10-15% range. Assuming 15%, that's another 2500 students, so we are at 18.5K allo grads.

There are 8-10 new schools opening. Assume 100 students per year (although most of these schools are planned at 60-80). That's 1000 new students, likely less, and it will take many years before these students are in the pipeline -- a few schools are actually up and running, many are still on the drawing board.

That brings the total to 19.5K allopathic students, and 25K spots. That still leaves 5K spots for DO students and IMG/FMG's. I don't see allo grads in unemployment lines -- assuming they apply intelligently. If you're not competitive for ortho but aim your entire application in that direction anyway, and get nothing, that's simply poor planning in my book. Will every DO student have a spot? Probably. Even if you look at the graph in the article, there will be enough spots as long as spots don't decrease, which seems very unlikely.

There is no question that there will be more competition for spots. And, someone will get squeezed out -- but that's likely to be IMG's and not US allo grads. DO's might feel the squeeze also, but that can be "fixed" by decreasing the number of IMG's allowed into spots.

Last, let's not forget that as class sizes are increased, more people can go to US schools. There is a good chance that many of these people were those that were headed to offshore schools. Someone has to be the "last kid picked", and if you're name is next on the list, you don't get a spot. But, once schools increase class size, the students who "just missed out" will get into a US school instead. So, although there may be a decrease in the number of offshore grads who get into residency spots, there also will be a shift of students from offshore to onshore schools.
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I think Dr. Nasca is correct. He is talking about "pipeline positions" meaning ones that lead to board certification. There are a ton of non-pipeline Preliminary Surgery postions that do not lead to board certification except for those who make the cut and get a categorical position. There are also a ton of non-pipeline one year DO internships.

Also about the allopathic grads: There were over 17000 allopathic grads in 2011 and on the way to planned 21K allopathic grads in a few years.
https://www.aamc.org/download/251636/data/enrollment2011.pdf
https://www.aamc.org/data/facts/
 
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There may be hope yet for those concerned. No one seems to have made mention of the "Resident Physician Shortage Reduction Act of 2011" which was a bill recently introduced by several senate Democrats. It proposes to increase the number of Medicare-funded GME positions for by "15 percent (approximately 15,000 slots) over five years". On the other hand, hope and Congress probably do not belong in the same sentence (paragraph or page for that matter). I'm no political expert but Republicans, I believe, have historically been the more pro-physician party. I know there have been several leading Republicans leading the charge in the past to delay the SGR-induced cuts in reimbursements to providers/hospitals. So maybe there is a chance that both sides can agree on at least this part of the Medicare budget.

https://www.aamc.org/newsroom/newsreleases/2011/260830/110923.html
 
wooster201106 said:
There may be hope yet for those concerned. No one seems to have made mention of the "Resident Physician Shortage Reduction Act of 2011" which was a bill recently introduced by several senate Democrats. It proposes to increase the number of Medicare-funded GME positions for by "15 percent (approximately 15,000 slots) over five years". On the other hand, hope and Congress probably do not belong in the same sentence (paragraph or page for that matter). I'm no political expert but Republicans, I believe, have historically been the more pro-physician party. I know there have been several leading Republicans leading the charge in the past to delay the SGR-induced cuts in reimbursements to providers/hospitals. So maybe there is a chance that both sides can agree on at least this part of the Medicare budget.

https://www.aamc.org/newsroom/newsreleases/2011/260830/110923.html
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It's got some important sponsors (like the Senate majority leader) but I wouldn't hold my breath for this bill to pass. With the current mood of Congress, these extra ~3,750 slots (0.15*25,000 = 3,750, so where the 15,000 comes in, I'm not sure) would have to be paid for by cutting something else. 3,750 new slots would cost ~$400,000,000 per year which, by the way these things are advertised, means this bill would cost about $4 billion over 10 years. Where do they propose finding that money? Congress can't even agree on whether to give FEMA roughly that amount of money and I guarantee you that most random people on the street think FEMA is more important than GME.
 
Ok. So I just skimmed through NRMP data which may help the discussion here.

Following are numbers of medical students who applied to Match program (Page 9 of NRMP Result and Data ). I hope it may be considered a good reflection of number of medical school seats in general.

Seniors of US Allopathic Medical School

2007 - 15,667
2008 - 15,692
2009 - 16,008
2010 - 16,427
2011 - 16,893
2012 - ?

Students/Graduates of Osteopathic Medical Schools

2007 - 2,398
2008 - 2,711
2009 - 2,875
2010 - 2,965
2011 - 3,142
2012 - ?

So any views on how these numbers reflect all the discussion going on here and an guesses on 2012 numbers based on all the increase in past years ?
 
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cyneuron said:
Ok. So I just skimmed through NRMP data which may help the discussion here.

Following are numbers of medical students who applied to Match program (Page 9 of NRMP Result and Data ). I hope it may be considered a good reflection of number of medical school seats in general.

Seniors of US Allopathic Medical School

2007 - 15,667
2008 - 15,692
2009 - 16,008
2010 - 16,427
2011 - 16,893
2012 - ?

Students/Graduates of Osteopathic Medical Schools

2007 - 2,398
2008 - 2,711
2009 - 2,875
2010 - 2,965
2011 - 3,142
2012 - ?

So any views on how these numbers reflect all the discussion going on here and an guesses on 2012 numbers based on all the increase in past years ?
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It is not a good reflection of the number of med school seats in general. Urology has their own match through the AUA and does not participate in the NRMP. Plastic Surgery and Ophthalomology use the San Francisco match. The military services have their own match. Many DOs participate in the osteopathic match.

wooster201106 said:
There may be hope yet for those concerned. No one seems to have made mention of the "Resident Physician Shortage Reduction Act of 2011" which was a bill recently introduced by several senate Democrats. It proposes to increase the number of Medicare-funded GME positions for by "15 percent (approximately 15,000 slots) over five years". On the other hand, hope and Congress probably do not belong in the same sentence (paragraph or page for that matter). I'm no political expert but Republicans, I believe, have historically been the more pro-physician party. I know there have been several leading Republicans leading the charge in the past to delay the SGR-induced cuts in reimbursements to providers/hospitals. So maybe there is a chance that both sides can agree on at least this part of the Medicare budget.

https://www.aamc.org/newsroom/newsreleases/2011/260830/110923.html
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I think that bill has as much chance of passing as this one:
http://thomas.loc.gov/cgi-bin/bdquery/D?d111:21:./temp/~bdwoGA::
and this one:
http://www.opencongress.org/bill/111-h2251/show
 
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Neuronix said:
aPD, while your logic seems sound, I don't understand how it correlates with this quote in the article:

(quote removed)

I am thus basing my "gloom and doom" on the head of the ACGME's "gloom and doom".
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futuredoc15 said:
I think Dr. Nasca is correct. He is talking about "pipeline positions" meaning ones that lead to board certification. There are a ton of non-pipeline Preliminary Surgery postions that do not lead to board certification except for those who make the cut and get a categorical position. There are also a ton of non-pipeline one year DO internships.

Also about the allopathic grads: There were over 17000 allopathic grads in 2011 and on the way to planned 21K allopathic grads in a few years.
https://www.aamc.org/download/251636/data/enrollment2011.pdf
https://www.aamc.org/data/facts/
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I hadn't actually read the AAMC summary until you posted, so thank you for that. I think the real question is whether medical schools are going to stop at the 10% increase that they currently have, or keep pushing to the 20% increase called for by the AAMC. Medical schools are discovering (like mine) that it's easy to teach another 10% of students biochemistry, but it's difficult to generate another 10% more clerkship slots, or another 10% preceptors for a continuity experience.

It also depends on how many of these new medical schools get going, and how big they are. To be honest, I wasn't aware that so many of them actually have started enrolling students, and that there were even more on the drawing board.

The AAMC is targeting 21K graduating allopathic grads. That's still quite a bit less than the 25K spots available. Combined with the growth of osteo schools, it could easily fill the entire array of positions.

So, in summary, I am happy to stand corrected. Both of my assumptions -- that medical school class sizes were increasing by about 10% and that about 8 new schools were being started -- appear to be off by 50%. Regardless, the total number of allopathic grads will continue to be far less than the total number of slots, so allo grads are not going to end up squeezed. The DO and IMG's will get squeezed -- again assuming slots don't increase, which might happen even without additional funding.

Of note, we may run into the problem that programs decide to take the "best" DO's and IMG's, and those allo grads in the bottom 20% of their classes find there are no spots. Should that happen, you can be certain that the match would be tweaked such that allo grads would get priority treatment / first shot in some way.
 
Even if there are enough categorical spots for everyone to get *a* spot, I don't think that necessarily means things are okay if in fact that ends up meaning large numbers of US med students are forced into specialties or locations they aren't really happy about.
At least as things currently stand, most people (except for those with very serious application problems) can have some flexibility about specialty and location even if not everyone can get derm. However, why would someone want to invest the time, debt, and effort in med school if there was a good chance they would end up forced into family medicine in North Dakota?

If it becomes normal for the lower achieving American med students to be forced into accepting undesirable residency spots, wouldn't it make a lot more sense for intelligent folks to aim for being a PA or NP instead? Those careers at least give you some flexibility about what specialty you work in.
 
You're talking about things that are personal choices. Med school is not a promise of the residency of one's choosing. If "someone" doesn't want to invest in becoming a med student if it means chancing a FM residency in ND, then "someone else" certainly will, as we still have far more applicants than we do spots at US allopath schools. Responsible pre-meds research the field enough to know the situation they are getting themselves into. If they do not like the situation, no one is forcing them to apply, and they're free to pursue another career, such as NP or PA. If that were to occur to the point that US allopath schools (and residency programs) were unable to find enough qualified students to fill their programs, then I think we'd see tweaking of the system to ensure that enough bright young adult choose medicine as their career. But again, there's no evidence that we're anywhere near that problem in 2011. Rather, we seem to have a shortage of primary care physicians, especially in certain "less desireable" locations.

peppy said:
Even if there are enough categorical spots for everyone to get *a* spot, I don't think that necessarily means things are okay if in fact that ends up meaning large numbers of US med students are forced into specialties or locations they aren't really happy about.
At least as things currently stand, most people (except for those with very serious application problems) can have some flexibility about specialty and location even if not everyone can get derm. However, why would someone want to invest the time, debt, and effort in med school if there was a good chance they would end up forced into family medicine in North Dakota?

If it becomes normal for the lower achieving American med students to be forced into accepting undesirable residency spots, wouldn't it make a lot more sense for intelligent folks to aim for being a PA or NP instead? Those careers at least give you some flexibility about what specialty you work in.
Click to expand...
 
mlw03 said:
You're talking about things that are personal choices. Med school is not a promise of the residency of one's choosing. If "someone" doesn't want to invest in becoming a med student if it means chancing a FM residency in ND, then "someone else" certainly will, as we still have far more applicants than we do spots at US allopath schools. Responsible pre-meds research the field enough to know the situation they are getting themselves into. If they do not like the situation, no one is forcing them to apply, and they're free to pursue another career, such as NP or PA. If that were to occur to the point that US allopath schools (and residency programs) were unable to find enough qualified students to fill their programs, then I think we'd see tweaking of the system to ensure that enough bright young adult choose medicine as their career. But again, there's no evidence that we're anywhere near that problem in 2011. Rather, we seem to have a shortage of primary care physicians, especially in certain "less desireable" locations.
Click to expand...

I agree that it's not at that point yet. I'm just saying that the strategy of wanting to fill every residency with an AMG by flooding the system with so many AMGs that the AMGs spill into even the less competitive residencies may end up backfiring at some point. I just don't think it's enough that everyone gets *something*. The spots should be things that people actually want to do to attract the best quality talent.
Most of the people who currently go to med school are bright enough to be capable of doing a lot of careers. I think most wouldn't want to give up that much control over their fate.
 
peppy said:
Most of the people who currently go to med school are bright enough to be capable of doing a lot of careers. I think most wouldn't want to give up that much control over their fate.
Click to expand...

I'll agree with the first statement, but respectfully disagree with the second. I think most of the people who apply and matriculate to med school want to be doctors very, very badly - at least at that point in their lives. I think they want it bad enough to say to themselves, "I'd rather be a doctor of a specialty not my choosing than not a doctor." I think you're right for some, but I would estimate that to be a small percentage (< 20%).
 
Still, desire shouldn't blind one to reality. With the cuts and all, things doesn't look too good especially for the folks studying for their MDs abroad. A while back I almost became one, until I considered the possibility of debt and residency options back home. Increasingly there are no backup options in the host country either, eg, Caribbean/Australia.
 
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mlw03 said:
I'll agree with the first statement, but respectfully disagree with the second. I think most of the people who apply and matriculate to med school want to be doctors very, very badly - at least at that point in their lives. I think they want it bad enough to say to themselves, "I'd rather be a doctor of a specialty not my choosing than not a doctor." I think you're right for some, but I would estimate that to be a small percentage (< 20%).
Click to expand...


qft.

Pre meds simply are not able to understand this. Like all humans they are terrible at statistics and probability. I have claimed on other posts that if med school tuition was, tomorrow, raised to 1 million bucks and you had to do a year of free service in a free clinic, every spot at every school would still fill as long as they could get loans.
 
wooster201106 said:
There may be hope yet for those concerned. No one seems to have made mention of the "Resident Physician Shortage Reduction Act of 2011" which was a bill recently introduced by several senate Democrats. It proposes to increase the number of Medicare-funded GME positions for by "15 percent (approximately 15,000 slots) over five years". On the other hand, hope and Congress probably do not belong in the same sentence (paragraph or page for that matter). I'm no political expert but Republicans, I believe, have historically been the more pro-physician party. I know there have been several leading Republicans leading the charge in the past to delay the SGR-induced cuts in reimbursements to providers/hospitals. So maybe there is a chance that both sides can agree on at least this part of the Medicare budget.

https://www.aamc.org/newsroom/newsreleases/2011/260830/110923.html
Click to expand...

I'm sure I'll get a lot of flames for this, but... I don't want this to pass.

Why would I? I'd much rather have to work my ass off in medical school and compete harder for the spot/specialty I want -- at least that's something that is within my control. OTOH, if we start training a lot more docs... my reimbursement and salary go down, essentially no matter what I do. I can't work harder against simple economics. Reimbursement is already going to get chopped pretty hardcore in the next 4-5 years based on the current political environment -- why would I want to further endanger my future earning potential?

As has been pointed out in many, many other threads -- there is an issue of physician maldistribution, but the jury is still out on whether or not there's a true physician shortage. I don't believe there is, and I don't think minting a whole bunch more MDs so they can move to NYC/SF/LA/Boston and drive salaries down further is the right move. Instead, let's take the theoretical money we would put into training more grads via GME and use it to create incentives to redistribute physicians to high-need areas.

(dons flame-******ant suit)
 
You're probably right, but we're talking about educated young adults in their early 20s. I would argue they ought to be responsible for the decisions they make. This isn't a group of neglected and taken-advantage-of people who have no other choices and are being forced into medicine. They apply willingly, and in my opinion, should be accountable for those choices.

danzman said:
qft.

Pre meds simply are not able to understand this. Like all humans they are terrible at statistics and probability. I have claimed on other posts that if med school tuition was, tomorrow, raised to 1 million bucks and you had to do a year of free service in a free clinic, every spot at every school would still fill as long as they could get loans.
Click to expand...
 
mlw03 said:
You're probably right, but we're talking about educated young adults in their early 20s. I would argue they ought to be responsible for the decisions they make. This isn't a group of neglected and taken-advantage-of people who have no other choices and are being forced into medicine. They apply willingly, and in my opinion, should be accountable for those choices.
Click to expand...

I agree with you completely. I was only pointing out an obvious flaw in our system. Students have almost no power in any of this as the market is shifted to favor schools so much. I have no idea how to fix any of this but would hope that current pre meds would educate themselves about it as I don't see it changing anytime soon.
 
physicsnerd42 said:
It's got some important sponsors (like the Senate majority leader) but I wouldn't hold my breath for this bill to pass. With the current mood of Congress, these extra ~3,750 slots (0.15*25,000 = 3,750, so where the 15,000 comes in, I'm not sure) would have to be paid for by cutting something else. 3,750 new slots would cost ~$400,000,000 per year which, by the way these things are advertised, means this bill would cost about $4 billion over 10 years. Where do they propose finding that money? Congress can't even agree on whether to give FEMA roughly that amount of money and I guarantee you that most random people on the street think FEMA is more important than GME.
Click to expand...

4 billion over 10 yrs is not a lot of money if we consider that at least 5 billion per month is spent on the war.
 
TTPHUS said:
4 billion over 10 yrs is not a lot of money if we consider that at least 5 billion per month is spent on the war.
Click to expand...

I don't think it's a lot of money compared to the federal budget. I'm just saying it sounds like a lot of money, which makes it difficult to pass.
 
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physicsnerd42 said:
It's got some important sponsors (like the Senate majority leader) but I wouldn't hold my breath for this bill to pass. With the current mood of Congress, these extra ~3,750 slots (0.15*25,000 = 3,750, so where the 15,000 comes in, I'm not sure) would have to be paid for by cutting something else. 3,750 new slots would cost ~$400,000,000 per year which, by the way these things are advertised, means this bill would cost about $4 billion over 10 years. Where do they propose finding that money? Congress can't even agree on whether to give FEMA roughly that amount of money and I guarantee you that most random people on the street think FEMA is more important than GME.
Click to expand...

The bottleneck effect is at the residency stage. So even if more schools are opened, it doesn't solve the problems of physician shortage in some areas/fields. Unless we increase residency too, by 1000s of slots, like the good bill suggests.

But like you suggest, maybe GME doesn't have enough power, political capital, and "political clout" to wrangle a bill through. Congress cares more about using the money on economy or war.
 
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So the number of med schools are gonna have to stop decreasing at some point because of the fixed number of residency spots right? What keeps the number of spots constant; the amount of funding available?
 
How were residencies funded prior to medicare? I'm assuming the hospital foot the bill. Is a resident productive enough that a hospital could profit without medicare funding? It seems like it would be better if the market set the number of residencies instead of an arbitrary number funded by govt.
 
Indybailey said:
How were residencies funded prior to medicare? I'm assuming the hospital foot the bill. Is a resident productive enough that a hospital could profit without medicare funding? It seems like it would be better if the market set the number of residencies instead of an arbitrary number funded by govt.
Click to expand...

can_of_worms_ahead.jpg


This has been discussed extensively on SDN and a search is probably in order.

However...the short-ish (and more than likely not completely correct) answer to your question is that prior to CMS funding residencies, hospitals hired the residents and they were able to bill directly for their services (at a reduced rate compared to attendings). This of course led to all kinds of supervision issues (i.e. surgery attendings would have 3 or 4 cases going at one time with a senior/chief resident actually doing the case while the attending bopped back and forth between rooms).

Once CMS started to pay for residents, they decided residents could no longer bill (double dipping). Private insurance companies soon followed suit. In the interim, supervision requirements have been increased (attending has to be in the room for the entirety of a case or procedure or it can't be billed for, etc.). So yes, it is theoretically possible for residents to do the work, bill for it and make up for the money lost by direct GME funding. But it's going to be a massive hassle and a lot of federal, state and local laws as well as institutional policies are going to have to change to make it work.
 
They need to stop the proliferation of med schools (lots of the newer ones seem to be DO but not all), many of them for profit. A lot of them seem to be basically the equivalent of international schools in that they have to contract with large private or public hospitals for clinical year training. These schools are for the most part not filling up with the cream of the crop. But they are filling up with people who will accumulate monstrous debt and thus all of whom will want to be specialists.
 
lipomas said:
They need to stop the proliferation of med schools (lots of the newer ones seem to be DO but not all), many of them for profit. A lot of them seem to be basically the equivalent of international schools in that they have to contract with large private or public hospitals for clinical year training. These schools are for the most part not filling up with the cream of the crop. But they are filling up with people who will accumulate monstrous debt and thus all of whom will want to be specialists.
Click to expand...

There is one for profit medical school in the US. That institution is Rocky Vista. One!

The recent matriculants at allopathic medical schools are statistically better than the matriculants in the period between 1999 and 2006 because the number of applicants has increased significantly. In 2002 there were 33,625 applicants to US allopathic schools. In 2009 there were 42,269. The bigger the applicant pool the better the matriculants. The median MCAT among allopathic matriculants in the fall of 2010 was a 32. It's never been higher.

The growth of allopathic slots should also improve the the clinical education of new grads because the LCME is there to examine their education.:)
 
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