Am I crazy for not supporting this? (AAMC residency petition)

[Awared]

http://action.aamc.org/page/s/add-your-name?utm_medium=social&utm_source=facebook

It seems like half of my med school class has supported this petition. I don't know if I'm missing something, but it seems like expanding residency positions is the last thing that the AAMC should be lobbying for. Recently there have been many new for profit medical schools popping up and this move seems to only bring more incentive to create more and dilute the profession.

I am completely open to any ideas on topics that I'm currently ignorant to, but why not first work on prioritizing AMG>IMG/FMG and then improving PR for physicians and students?

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[jakeislove]

http://action.aamc.org/page/s/add-your-name?utm_medium=social&utm_source=facebook

It seems like half of my med school class has supported this petition. I don't know if I'm missing something, but it seems like expanding residency positions is the last thing that the AAMC should be lobbying for. Recently there have been many new for profit medical schools popping up and this move seems to only bring more incentive to create more and dilute the profession.

I am completely open to any ideas on topics that I'm currently ignorant to, but why not first work on prioritizing AMG>IMG/FMG and then improving PR for physicians and students?

AMGs already get first bite at the apple. Why build more protection into the system?

 

[Mad Jack]

AMGs already get first bite at the apple. Why build more protection into the system?

Because ew, Carib grads...

Seriously though, a US grads first policy would be the worst thing that ever happened to our medical system. We'd lose a lot of the top-notch grads and physician scientists that we attract from all over the world.

 

[Espadaleader]

I'm not for it. AMGs are not matching. IMGs are not priority

 

[Slack3r]

Here's a good rule of thumb: if the AAMC supports it, it's probably not in your best interest. If AMSA supports it, it's DEFINITELY not in your best interest.

Sign accordingly.

 

[deleted480308]

Here's a good rule of thumb: if the AAMC supports it, it's probably not in your best interest. If AMSA supports it, it's DEFINITELY not in your best interest.

Sign accordingly.

Yeah a student was pushing a "expand access to care" resolution lately. I was the only one yelling, "booooooo to more government"

 

[Psai]

US residency spots should be for US grads. Who cares about top notch foreigners? We should be doing a better job of training our physicians at home and making sure that their practice is relatively undisturbed by outside forces. Instead, the opposite is happening where physician training is being diluted and there is a massive influx of lesser trained "providers"

 

[Mad Jack]

US residency spots should be for US grads. Who cares about top notch foreigners? We should be doing a better job of training our physicians at home and making sure that their practice is relatively undisturbed by outside forces. Instead, the opposite is happening where physician training is being diluted and there is a massive influx of lesser trained "providers"

So your solution to our "diluted" physician training is to stop taking the best physicians that the rest of the 6 billion people in the world can offer us? Cool, we'll just leave them in other countries where they can innovate and save lives there instead, just so we can protect the bottom of the barrel American grads that can't beat them out in the match.

 

[Psai]

How do you know that the people who come here are the best physicians from those countries? What makes you so sure that they're better than what we produce here? And why do you think the best physicians should come to America? Why shouldn't they stay and innovate in their home countries? Also, what makes you so special that you can denigrate people as "bottom of the barrel" and say that these "best physicians" from abroad are better than them?

 

[operaman]

This is an issue on which I'm terribly ill informed. Health care is such a complex system that any change is sure to have unintended consequences both good and bad. I should read more about this issue though. My questions would be:

1) If government funding for GME were doubled tomorrow, how many current programs have enough volume/capacity to add more positions? I just wonder to what extent the money is the limiting factor in already-established programs.

2) Many places I've interviewed have added/are adding positions. Are they just funding this on their own, through the VA, or taking GME funds from another department? Just looking at spots available in charting the outcomes in 2011 vs 2013, there are many more total slots available; where are these coming from?

The numbers make it clear that we will have more grads than spots in the near future, but I wonder if money alone would fix it. I'd be curious to hear from program directors if/how many spots they would add if given double the current funding, and how else we might address other limiting factors.

 

[graviton]

Why shouldn't they stay and innovate in their home countries?

"Opportunity for each according to ability or achievement."

 

[SouthernSurgeon]

This is an issue on which I'm terribly ill informed. Health care is such a complex system that any change is sure to have unintended consequences both good and bad. I should read more about this issue though. My questions would be:

1) If government funding for GME were doubled tomorrow, how many current programs have enough volume/capacity to add more positions? I just wonder to what extent the money is the limiting factor in already-established programs.

2) Many places I've interviewed have added/are adding positions. Are they just funding this on their own, through the VA, or taking GME funds from another department? Just looking at spots available in charting the outcomes in 2011 vs 2013, there are many more total slots available; where are these coming from?

The numbers make it clear that we will have more grads than spots in the near future, but I wonder if money alone would fix it. I'd be curious to hear from program directors if/how many spots they would add if given double the current funding, and how else we might address other limiting factors.

If you have time, I'd suggest reading the IOM's report.

Their suggestions for how to reform GME are more than a little wonky, but the first 50 pages or so are a really nice review of how GME funding works, where the money comes from and goes, the political history of how it came to be, and some of the issues that residency programs are facing.

http://www.iom.edu/Reports/2014/Graduate-Medical-Education-That-Meets-the-Nations-Health-Needs.aspx

In ref to your #1 - (a) if anything funding is going to get cut, not increased; (b) most programs wouldn't be able to expand drastically. The hope would be that expansion could happen in ways that benefit areas of most need.

In ref to your #2 - most big academic centers are way, way over cap. They basically just bite the bullet on funding spots that are over the cap.

 

[AlmostAnMD]

I would rather support a measure to increase the salary of existing spots than more spots at the same salary

 

[chronicidal]

The gist of the IOM report is that, contrary to the agenda of the AAMC, increasing GME funding will not substantially address the physician workforce issues the country faces (e.g. insufficient primary care physicians, geographic maldistribution).

Data from the NRMP demonstrate that, contrary to what the AAMC wants you to believe, it is NOT increasingly difficult for US medical graduates to match to residency positions in recent years despite the increase in schools.

 

[Psai]

The gist of the IOM report is that, contrary to the agenda of the AAMC, increasing GME funding will not substantially address the physician workforce issues the country faces (e.g. insufficient primary care physicians, geographic maldistribution).

Data from the NRMP demonstrate that, contrary to what the AAMC wants you to believe, it is NOT increasingly difficult for US medical graduates to match to residency positions in recent years despite the increase in schools.

Why do I hear about people applying to increasingly larger numbers of residencies? I've heard of people applying to 80 programs for ENT and 30 for internal med

 

[Dave89]

Cool, we'll just leave them in other countries where they can innovate and save lives there instead...

[gasp!]

Perish the thought!

 

[Mad Jack]

[gasp!]

Perish the thought!

I put America's health and the freedom of talented physicians to come here if they choose above all else in regard to this topic. If a Nigerian doctor wants to gtfo of Africa and he's a fine researcher and talented physician, I'd rather him get a position than some bottom of the barrel applicant that failed his Steps a couple times and barely scraped by to pass medical school. Forcing PDs to accept worse applicants just because they're US educated is bad for the medical profession, bad for society, and bad for the talented people we force out of the process. The only people that win with US first match policies are the borderline applicants that they would protect. I don't give a damn about them, I want the best, most talented colleagues possible regardless of where they happen to have been educated.

 

[Psai]

your post is so delusional
"bottom of the barrel applicant that failed his Steps a couple times and barely scraped by to pass medical school. "
as if that happens on a daily basis

 

[Mad Jack]

your post is so delusional
"bottom of the barrel applicant that failed his Steps a couple times and barely scraped by to pass medical school. "
as if that happens on a daily basis

On most years, one in 20 US MD students fail Step 1 and one in 10 DOs fails the COMLEX. Given the choice between them and a high stat foreign applicant that blew the steps out of the water on the first try, I'm picking the foreign dude every single time. When I was working at a Top 10's teaching hospital, many of the best academic physicians we had were foreign and had resumes that would put 99% of US grads to shame. To push people like that out of the match just so we can take mediocre-to-poor US grads in their place is just bad policy all around.

 

[Dave89]

Oh, are we using anecdotes now?

I've met several foreign doctors who were worse than any US grad I've ever seen.

 

[chronicidal]

Why do I hear about people applying to increasingly larger numbers of residencies? I've heard of people applying to 80 programs for ENT and 30 for internal med

It depends on how you define competitiveness.

It is true that
1) Average boards scores are increasing.
2) Applicants are interviewing and ranking more places. The averaged matched applicant contiguously ranked 11.5 programs in their first choice specialty in 2014, up from 9.4 in 2009.
3) The proportion of applicants matching to their first rank is slightly decreasing. In 2014, 51.6% matched to their first rank, down from a high of 59.5% in 2000.

However,
1) The overall match rate (matched vs. unmatched to PGY-1 positions) is essentially unchanged.
2) The match rate for individual specialties (% of applicants to matched to their first choice specialty) is essentially unchanged for the vast majority of specialties.
3) The match rate for couples is unchanged.

What you might conclude is that applicants are gunning harder than ever (doing better on Step, applying to more places, ranking more reach programs), but there are enough positions for US MD students for the usual percentage (~94%) to get a PGY-1 position. Increasing residency positions will not address this flavor of competition.

(as long as there is favoritism towards US medical students over IMGs)

 

[jakeislove]

Because ew, Carib grads...

Seriously though, a US grads first policy would be the worst thing that ever happened to our medical system. We'd lose a lot of the top-notch grads and physician scientists that we attract from all over the world.

US MD grads is what they want to write, LOL!

 

[PL198]

Just because someone does well on step 1 doesn't mean they're going to be a good doctor. To be blunt, a lot of patients have problems communicating with foreign physicians. Someone that has a 260 step 1 but can't communicate well with patients is going to be a worse doctor than someone who got a 220 but patients can talk to. That doesn't solely mean verbal communication either.

 

[chronicidal]

Just because someone does well on step 1 doesn't mean they're going to be a good doctor. To be blunt, a lot of patients have problems communicating with foreign physicians. Someone that has a 260 step 1 but can't communicate well with patients is going to be a worse doctor than someone who got a 220 but patients can talk to. That doesn't solely mean verbal communication either.

So might you suggest that we have a communication test, maybe something that comes after Step 1, with a focus on skills more applicable to clinical interactions? Maybe it would involve talking to some patient actors given a standard story? And maybe passing this test would be a prerequisite to even applying to residency if you are a FMG?

 

[PL198]

So might you suggest that we have a communication test, maybe something that comes after Step 1, with a focus on skills more applicable to clinical interactions?

I don't know if you're joking or referring to step 2, which obviously doesn't work as well as one would think or there wouldn't be this problem.

 

[jakeislove]

So might you suggest that we have a communication test, maybe something that comes after Step 1, with a focus on skills more applicable to clinical interactions? Maybe it would involve talking to some patient actors given a standard story? And maybe passing this test would be a prerequisite to even applying to residency if you are a FMG?

Sucks that there isn't a test like that.

 

[PL198]

Sucks that there isn't a test like that.

except that this wouldn't be a problem if the test was efficacious at its purpose

 

[notbobtrustme]

How do you know that the people who come here are the best physicians from those countries? What makes you so sure that they're better than what we produce here? And why do you think the best physicians should come to America? Why shouldn't they stay and innovate in their home countries? Also, what makes you so special that you can denigrate people as "bottom of the barrel" and say that these "best physicians" from abroad are better than them?

It's such ****ing bull**** too. Pretty much the only reason people come to America is because our doctors make 3x to 10x as much as any other country in the world. There are world class facilities all around the world. People come here because CREAM, dolla dolla bill ya'll.

I have no problem letting 5 superstars stay in their ****hole country so that the US can train US MDs first. It's not like our system sucks because we don't have the proper treatments and protocols in place. There's really no need to add 3 weeks of ****ty life to a person in heart-failure by ****ing around with their meds.

 

[PL198]

It's such ******* bull**** too. Pretty much the only reason people come to America is because our doctors make 3x to 10x as much as any other country in the world. There are world class facilities all around the world. People come here because CREAM, dolla dolla bill ya'll.

I have no problem letting 5 superstars stay in their ****hole country so that the US can train US MDs first.

god forbid US schools would be more in touch with the US healthcare system and its delivery and would therefore be able to train its grads to function better in it. but naw, a physician trained in "insert random nation here" is automatically good to go for USA if they can pass steps. if that is true, then why isn't all of my training board specific b/c that's all an IMG would need?

 

[jakeislove]

except that this wouldn't be a problem if the test was efficacious at its purpose

Petition the NBME to add a skin color component.

That would solve everything!

 

[PL198]

Petition the NBME to add a skin color component.

That would solve everything!

yeah that's what I said

 

[notbobtrustme]

So might you suggest that we have a communication test, maybe something that comes after Step 1, with a focus on skills more applicable to clinical interactions? Maybe it would involve talking to some patient actors given a standard story? And maybe passing this test would be a prerequisite to even applying to residency if you are a FMG?

Step 2 CS is entirely game-able.

 

[alpinism]

So your solution to our "diluted" physician training is to stop taking the best physicians that the rest of the 6 billion people in the world can offer us? Cool, we'll just leave them in other countries where they can innovate and save lives there instead, just so we can protect the bottom of the barrel American grads that can't beat them out in the match.

Yes, because that sounds like a horrible plan especially with what's going on in Sierra Leone right now...

One of the main reasons why the ebola outbreak is still going strong is that so many local doctors have left Western Africa for the US and Europe.

God forbid any smart talented physicians actually stay there and research malaria/HIV/TB instead of coming here to work on diabetes and fibromyalgia.

 

[Desk_Jockey]

Yeah a student was pushing a "expand access to care" resolution lately. I was the only one yelling, "booooooo to more government"

Strongly correlated avatar and post-content.

 

[atomi]

On most years, one in 20 US MD students fail Step 1 and one in 10 DOs fails the COMLEX. Given the choice between them and a high stat foreign applicant that blew the steps out of the water on the first try, I'm picking the foreign dude every single time. When I was working at a Top 10's teaching hospital, many of the best academic physicians we had were foreign and had resumes that would put 99% of US grads to shame. To push people like that out of the match just so we can take mediocre-to-poor US grads in their place is just bad policy all around.

What the......
Are you in med school? Graduated and in residency? Taking the MCAT for the 4th time? I am confused where you are developing these opinions.

 

[slopes23]

If you look at 2013 performance data of the USMLE Step 1 95% of US/Canadian school MD degrees passed Step 1 (including repeat exams). With out repeat exams its 97% (1st attempt test takers only). For argument sake I think we can all agree 95% ~ 97%

1. 95% pass means 5% fail.
2. 5% in fractional expression is 1/20.
3. Voila.

Try not to be so rude about it next time. If you had actually taken the time to look you would have noticed what he was saying, from a mathematical perspective, was not wrong.

 

[Mad Jack]

What the......
Are you in med school? Graduated and in residency? Taking the MCAT for the 4th time? I am confused where you are developing these opinions.

I'm a medical student that worked at clinically at a big name teaching hospital for the better part of a decade previously. Many of our most innovative researchers where FMGs (NOT USIMGs, let me make that one clear right off the bat). Also, many of our most talented residents were IMGs that had groundbreaking previous research and we at the top of their class in big-name international schools, then annihilated the Steps on top of it. I'm advocating for these people because I can't imagine how much my hospital (and our major research projects) would have suffered in their absence, all because of some policy designed to protect less well qualified US graduates. Let the PDs pick the best possible people for their departments.

 

[Mad Jack]

Well those people clearly "made it" in spite of these policies. Which is probably intrinsically tied to why they are so successful (i.e. they are highly motivated and talented individuals).

They didn't make it in spite of any policies, as such laws do not yet exist. Or PDs are currently free to pick and choose applicants as they see fit. The policies I am referring to are possible US-grad first legislation that would tie Medicare reimbursement for residency slots to legislation that forces PDs to accept US graduates first, essentially pushing FMGs out of the match. If such legislation were to pass, it would be illegal for my institution to take such individuals over US graduates. The AOA had already officially endorsed such legislation, and I guarantee that as the residency crunch approaches, the AAMC will warm to such policies as well. Protectionist BS like that only serves to protect the weakest applicants while ultimately costing us the best and brightest the rest of the world has to offer.

 

[Mad Jack]

The AOA has a vested interest in such policies, as they are all about trying to get on the "inside" of the perceived residency crunch. Same rationale as the merger.

There is zero political traction for any such policy, just as there is little traction for the current reform proposals.

But this is a complex issue - you can very easily argue that the US has an obligation to their own students/trainees (since they are subsidizing their education and training with loans/GME funding), and that the US has an obligation to ensure trainees meet the US's future health needs and further that training FMGs who may very well take that training back home doesn't meet that obligation, and that the "brain drain" effect of pulling the best talent out of foreign countries is not in THOSE countries interests either.

Simply pulling out anecdotes about an FMG being a great resident or researcher doesn't address any of those complexities.

It's a complex issue, but I side on the freedom of people to choose. If a FMG wants to come to America and a PD wants to take them, that should remain possible.

I don't want to speculate too much b on the AAMC and AMA side of things. Some politicians could go right ahead and pass legislation on behalf of unmatched students if enough bad press results from it, with or without the AAMC getting involved, because "protecting the jobs of American doctors and the investments of taxpayers" looks fabulous on paper.

 

[Slack3r]

It's a complex issue, but I side on the freedom of people to choose. If a FMG wants to come to America and a PD wants to take them, that should remain possible.

I don't want to speculate too much b on the AAMC and AMA side of things. Some politicians could go right ahead and pass legislation on behalf of unmatched students if enough bad press results from it, with or without the AAMC getting involved, because "protecting the jobs of American doctors and the investments of taxpayers" looks fabulous on paper.

First of all, American PDs are perfectly free to choose whoever they wish as it currently stands. Many people don't want to deal with the hassles of visas and work permits and Yadda yadda, so it can limit the number of programs willing to take foreign docs. Also, in many competitive fields, there really isn't any reason to gamble on FMGs as there are a glut of perfectly qualified AMGs.

As to the "took er jerbs " but, you are aware this type of "protectionism" happens on every nation on the planet right? Try and get up after graduation and move to the UK to work for the NIH. Tell me how that works out for you. Nations have obligations to their citizens. And why should any country's taxes and resources be used to serve citizens of OTHER countries before taking care of their own first?

 

[Mad Jack]

First of all, American PDs are perfectly free to choose whoever they wish as it currently stands. Many people don't want to deal with the hassles of visas and work permits and Yadda yadda, so it can limit the number of programs willing to take foreign docs. Also, in many competitive fields, there really isn't any reason to gamble on FMGs as there are a glut of perfectly qualified AMGs.

As to the "took er jerbs " but, you are aware this type of "protectionism" happens on every nation on the planet right? Try and get up after graduation and move to the UK to work for the NIH. Tell me how that works out for you. Nations have obligations to their citizens. And why should any country's taxes and resources be used to serve citizens of OTHER countries before taking care of their own first?

I'm aware that they are free to currently. I was speaking in regard to the future. My program was a top IM program, but they always take a FMG or two because the caliber of person they select isn't a gamble, they have proven track records and the sorts of resumes that are so impressive you have to look them over a second time because they're damn near unbelievably good.

As to other countries- this is America. We're the land of opportunity, and the nation that is supposed to be the exception to many of the rules. I want the best doctors here, regardless of where they came from, and if they are out there and want to make a better life for themselves in our country and have the stats to earn a place, I'm all for letting them.

 

[IlDestriero]

This is an issue on which I'm terribly ill informed. Health care is such a complex system that any change is sure to have unintended consequences both good and bad. I should read more about this issue though. My questions would be:

1) If government funding for GME were doubled tomorrow, how many current programs have enough volume/capacity to add more positions? I just wonder to what extent the money is the limiting factor in already-established programs.

2) Many places I've interviewed have added/are adding positions. Are they just funding this on their own, through the VA, or taking GME funds from another department? Just looking at spots available in charting the outcomes in 2011 vs 2013, there are many more total slots available; where are these coming from?

The numbers make it clear that we will have more grads than spots in the near future, but I wonder if money alone would fix it. I'd be curious to hear from program directors if/how many spots they would add if given double the current funding, and how else we might address other limiting factors.

The increase in match spots was primarily due to changes forcing residency programs to go "all in" for the match. They can't hold back spots anymore for out of match applicants.
Wildly expanding spots is not a good idea and will decrease compensation. Of course each specialty will continue to police its numbers to maintain competition. We don't need any more anesthesia positions.

 

[Slack3r]

Which is the problem - you're railing against policies which don't exist and are extremely unlikely to ever exist, and which the AAMC aren't advocating for

Couldn't have said it better myself.

 

[Baller MD]

The increase in match spots was primarily due to changes forcing residency programs to go "all in" for the match. They can't hold back spots anymore for out of match applicants.
Wildly expanding spots is not a good idea and will decrease compensation. Of course each specialty will continue to police its numbers to maintain competition. We don't need any more anesthesia positions.

You da man.

 

[Meh.meh]

I'm aware that they are free to currently. I was speaking in regard to the future. My program was a top IM program, but they always take a FMG or two because the caliber of person they select isn't a gamble, they have proven track records and the sorts of resumes that are so impressive you have to look them over a second time because they're damn near unbelievably good.

As to other countries- this is America. We're the land of opportunity, and the nation that is supposed to be the exception to many of the rules. I want the best doctors here, regardless of where they came from, and if they are out there and want to make a better life for themselves in our country and have the stats to earn a place, I'm all for letting them.

I've been confused by this thread for the last few days, so maybe I'm one of the "bottom of the barrel" people.

To me, your argument seemed to focus on not introducing protectionist laws, which is only perpipherally related to opposing expansion of residencies. I don't think anyone here wants the worst students from US allopathic schools to out-compete the "best and brightest" of other countries.

So far as I know, that situation is complete fiction. I don't think there are many people at Harvard who got a 200 step 1 and all passes, then out-competed a nobel laureate from Africa. I don't think that situation will ever exist.

If you previously worked for a top institution, maybe the FMGs were so amazing because the top institutions can afford to sort through the best applications in the world. They can also afford the risk of a few bad apples. The FMGs you saw are probably not represenative of the whole pool. It would be like taking AMGs stats from Yale and extrapolating that all AMGs are amazing.

I'm not a fan of mindlessly expanding residency positions because we have historically been poor at predicting scarcity in medicine. It seems like every few years we have an "oversupply" of nurses, GI docs, (insert position here), followed by an extreme "shortage."

If we're going to expand things, I'd prefer to be overly cautious about expansion. Having too much work is better than being unemployed.

 

[Mad Jack]

I've been confused by this thread for the last few days, so maybe I'm one of the "bottom of the barrel" people.

To me, your argument seemed to focus on not introducing protectionist laws, which is only perpipherally related to opposing expansion of residencies. I don't think anyone here wants the worst students from US allopathic schools to out-compete the "best and brightest" of other countries.

So far as I know, that situation is complete fiction. I don't think there are many people at Harvard who got a 200 step 1 and all passes, then out-competed a nobel laureate from Africa. I don't think that situation will ever exist.

If you previously worked for a top institution, maybe the FMGs were so amazing because the top institutions can afford to sort through the best applications in the world. They can also afford the risk of a few bad apples. The FMGs you saw are probably not represenative of the whole pool. It would be like taking AMGs stats from Yale and extrapolating that all AMGs are amazing.

I'm not a fan of mindlessly expanding residency positions because we have historically been poor at predicting scarcity in medicine. It seems like every few years we have an "oversupply" of nurses, GI docs, (insert position here), followed by an extreme "shortage."

If we're going to expand things, I'd prefer to be overly cautious about expansion. Having too much work is better than being unemployed.

I was on a tangent.

As to residency expansion, I'm all for it. I believe that everyone deserves a physician, and that the rise of midlevels is largely a result of a lack of physician care being available. That isn't to say they don't have their place, but rather that the places they are currently taking over (primary care, mostly) would never have seen a need for their services had enough physicians been available to provide necessary PCP services to begin with. More physicians leads to more high quality care for patients, and would serve to interrupt the expansion of midlevel providers (which use "lack of physicians to provide necessary care" as their banner for their ever expanding scope of practice) and secure a stronger place for physicians in the future market.

 

[FIREitUP]

So your solution to our "diluted" physician training is to stop taking the best physicians that the rest of the 6 billion people in the world can offer us? Cool, we'll just leave them in other countries where they can innovate and save lives there instead, just so we can protect the bottom of the barrel American grads that can't beat them out in the match.

except the purpose of 'lobbying' for some sort of change is not so much to make the country a better place as a whole, but instead to make the country a better place for the special interest you are a part of. as a parallel, do you think nurses lobbying for more autonomy is really in the best interest of the country (despite what they might claim, I think we can agree that it isn't)?

 

[Slack3r]

I was on a tangent.

As to residency expansion, I'm all for it. I believe that everyone deserves a physician, and that the rise of midlevels is largely a result of a lack of physician care being available. That isn't to say they don't have their place, but rather that the places they are currently taking over (primary care, mostly) would never have seen a need for their services had enough physicians been available to provide necessary PCP services to begin with. More physicians leads to more high quality care for patients, and would serve to interrupt the expansion of midlevel providers (which use "lack of physicians to provide necessary care" as their banner for their ever expanding scope of practice) and secure a stronger place for physicians in the future market.

Let's not conflate things here. The nursing organizations have used the maldistribution of physicians as a cover to expand their scope of practice with savvy lobbying, nothing more. We do not, and likely will not have a "physician shortage", but a disproportionate amount of sub specialized physicians in large cities and "desirable locales". How expanding mid level provider scope is meant to alleviate this shortage is beyond me, since last I checked, most nurses want to make the most money in desirable areas also. Go figure.

 

[Mad Jack]

Let's not conflate things here. The nursing organizations have used the maldistribution of physicians as a cover to expand their scope of practice with savvy lobbying, nothing more. We do not, and likely will not have a "physician shortage", but a disproportionate amount of sub specialized physicians in large cities and "desirable locales". How expanding mid level provider scope is meant to alleviate this shortage is beyond me, since last I checked, most nurses want to make the most money in desirable areas also. Go figure.

I agree with you. I'm just saying, most expansion efforts are pushing for most new residencies to be in FP, peds, and IM. If we have enough physicians trained in primary care fields, some of them will have to start taking jobs farther out as markets saturate. Once people can actually find physicians that are willing to take them due to us having enough PCP docs available, the nurses won't be able to push their BS excuse of "not enough providers" anymore, and will have to take a stand on pushing for expanded scope based on their training and experience, which is something that is much less likely to fly.

If you think we don't have a shortage of primary care physicians, try finding a FM or IM physician to see you in the next week. There was one PCP in my entire county that was taking new patients- every other provider that was taking people on was an NP or PA. If you want to see a physician for primary urgent primary care services (being sick or whatever), it's pretty damn hard to arrange.

If we've got way more PCP residency positions (due to a residency expansion bill) than we have fellowship positions for those IM grads to match into afterward, then being a specialist in a desirable locale won't be an option. It'll be hospitalist or PCP for all but the most competitive applicants, and eventually the hot markets will saturate for those fields and you'll have to go elsewhere if you want a job, just like damn near every other career available in the country.

 

[Greenberg702]

http://action.aamc.org/page/s/add-your-name?utm_medium=social&utm_source=facebook

It seems like half of my med school class has supported this petition. I don't know if I'm missing something, but it seems like expanding residency positions is the last thing that the AAMC should be lobbying for. Recently there have been many new for profit medical schools popping up and this move seems to only bring more incentive to create more and dilute the profession.

I am completely open to any ideas on topics that I'm currently ignorant to, but why not first work on prioritizing AMG>IMG/FMG and then improving PR for physicians and students?

I would never support this simply because all of the blustering about a doctor shortage is a myth. There is a maldistribution of physicians, not a shortage. This is just the lobby's way of making things easier for itself in the short term, but completely dicking over our profession in the long term. What will happen when the demand levels out or begins to drop (e.g the baby boomers die)? This is exactly what happened with radiology. Everyone was screaming shortage, residency spots were drastically increased in expectation of higher demand, and now voila they're left with a horrific job market and a collapse in competitiveness. Btw, good luck closing residency programs once they're up and running. We need to learn from the mistakes of other specialties and not simply listen to people screaming shortage without researching all of the facts.

Liberal pharmacy organizations were also screaming shortage just a couple of years ago. Now look where they are. Residency spots are the last "barrier" before practice. We should not demolish it so easily.