Is the "residency shortage" false?

[AnatomyGrey12]

Maybe it just comes down to picking the right people in admissions.

Just my 2 cents but I honestly think this plays a big part of it these days. The current system of admissions selects for individuals who have a higher propensity and desire to be a super specialized left breast surgeon in Boston/LA/NY... Honestly I do feel that sometimes the way DO schools approach admissions is more effective if your goal is to produce PC physicians. the truly mission driven DO schools really do have a knack for selecting people who want to practice in the underserved locations. A lot of DO grads self select for primary care. IMO that some MD schools could do the same thing, and some do, but some definitely don't.

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[wizzed101]

Just my 2 cents but I honestly think this plays a big part of it these days. The current system of admissions selects for individuals who have a higher propensity and desire to be a super specialized left breast surgeon in Boston/LA/NY... Honestly I do feel that sometimes the way DO schools approach admissions is more effective if your goal is to produce PC physicians. the truly mission driven DO schools really do have a knack for selecting people who want to practice in the underserved locations. A lot of DO grads self select for primary care. IMO that some MD schools could do the same thing, and some do, but some definitely don't.

http://gomerblog.com/2014/01/match-...ed-school-personal-statement-legally-binding/

That will work for sure!

 

[Mansamusa]

Just my 2 cents but I honestly think this plays a big part of it these days. The current system of admissions selects for individuals who have a higher propensity and desire to be a super specialized left breast surgeon in Boston/LA/NY... Honestly I do feel that sometimes the way DO schools approach admissions is more effective if your goal is to produce PC physicians. the truly mission driven DO schools really do have a knack for selecting people who want to practice in the underserved locations. A lot of DO grads self select for primary care. IMO that some MD schools could do the same thing, and some do, but some definitely don't.

The DO system doesn't necessarily select for future PC physicians. Carib schools produce a lot of PC physicians, but they don't select for that. It happens as a result of other factors (perhaps in addition to school's purposeful selection process). If most DO schools had the option of accepting all 3.7/40 applicants, they would. Alternatively, many people don't select DO, but have it as their only option. Plus students interested in primary care may be more willing to attend DO schools rather then reapply MD. DO students may be less likely to have many residency prospects outside of PC. They may attend IM residencies that do not set them up for fellowships. DO students on this forum also get excited each time a new bar in set in terms of getting competitive specialty residencies, which means they are trying to branch out of PC, etc. There are a lot of factors that go into it rather than simply schools selecting for certain factors that MD schools are ignoring

And the major issue is distributing physicians. Having more PC physicians doesn't fix the distribution issue. Getting better at selecting students who may choose to practice in rural areas is a good thing to do, but the more educated a person is the less likely they are to stay in a rural area no matter their background. It's a hard thing to predict.

If someone is pursuing a fellowship in "left breast surgery" it is because there are jobs calling for it and a market available. Those people are still meeting a demand and filling a needed niche. Specialists are needed and when a job market no longer exists for a field, people back off (look at rads and gas). Additionally, "It can be argued that specialization improves outcomes due to greater patient volume, enhanced technical ability, more integrated multimodality treatment, use of advanced techniques, and enhanced patient satisfaction." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266785/ (paper talking specifically about breast surgery fellowships)


(The best way to increase PC physician would probably be CMS reforms and addressing the complaints of PC physicians)

 

[AnatomyGrey12]

http://gomerblog.com/2014/01/match-...ed-school-personal-statement-legally-binding/

That will work for sure!

599 pediatric neurosurgeons. That killed me, I literally laughed out loud here at work

 

[Giovanotto]

You are required to involuntary relocate in several South American countries. It's literally called "doing a rural", just a stepping stone in one's career like any other.

It costs more to train a physician than it costs for you to pay your medical education dollar for dollar. I'll concede the very poor might not pay taxes but you don't have to be in grinding poverty to be underserved, as is the case for many rural populations. In any case, I don't expect people to share my view on this but I think serving the neediest is more important than serving the wealthy and better for society if our system were structured to be accessible to everyone, everywhere, and better positioned to actually prevent the problems that cost our society so much down the line.

Ah, the voice of reason. Very refreshing.

 

[TaupePremed]

Look at the number of residency slots and the number of US MDs granted each year - these is absolutely not a shortage of residency slots.

18,705 MD degrees were granted by US schools in 2015. There were about 30,000 residency slots at that time to accommodate them. Also look at the match rates - very near 100% for US MDs.

That said, Caribbean graduates are probably screwed, have always been screwed, and will get progressively more screwed.

Getting into medical school is the big hurdle, the big question mark. It would take many, many years for the job market for US MDs to be as bad as it is for US lawyers. Law schools rake in cash, law schools are fairly easy to get into, and a lot of college graduates who can't think of anything better to do apply to and get accepted to law school. Med schools do NOT rake in cash (most of them), they are hard to get into, and people who are applying to med school for lack of a better idea generally get rejected.

Law schools have very different problems than med schools.

Caribbean medical schools, on the other hand, share many of the dastardly traits of US law schools.

 

[Law2Doc]

Do you guys think the next generation of doctors are going to get shafted by this increase in med school/residency spots? For the current generation doctors/med students, there seems like there will be a large demand for doctors, especially as the baby boomer generation is aging (I think someone mentioned this earlier in the thread). However after that the population seems a lot smaller. The US has the benefit of immigration (vs Japan which is shrinking significantly) but it seems the demand for doctors will decrease in the future. There might be too many doctors and too little demand although I don't have time to pull the numbers for this (so someone who knows could step in here)

There isn't going to be a big increase in residency slots, so no. Taxpayers aren't going to pay millions to subsidize the training of more "rich" doctors. So I don't see a big jump occurring. Med schools can increase enrollment all they want but that won't impact the number of new doctors, the bottleneck is at residency slots. Increase in US med school spots just means fewer residency slots to non US grads, not more doctors in total.

 

[Mansamusa]

There isn't going to be a big increase in residency slots, so no. Taxpayers aren't going to pay millions to subsidize the training of more "rich" doctors. So I don't see a big jump occurring. Med schools can increase enrollment all they want but that won't impact the number of new doctors, the bottleneck is at residency slots. Increase in US med school spots just means fewer residency slots to non US grads, not more doctors in total.

Question: Is there anything stopping unpaid residencies or residencies where students pay from opening up (besides PR)? I think that residencies were made an exception to minimum hourly wages laws (might be making that up?), but would that allow no-pay residencies or is that too far?

(I know people debate whether residents generate profit for a hospital or if they are net neutral, but assuming a hospital system's calculation favored it, would there be anything stopping a hospital from exploiting the overabundance of grads for free residency labor or charging for educational experience of residency?)

 

[Law2Doc]

Question: Is there anything stopping unpaid residencies or residencies where students pay from opening up (besides PR)? I think that residencies were made an exception to minimum hourly wages laws (might be making that up?), but would that allow no-pay residencies or is that too far?

(I know people debate whether residents generate profit for a hospital or if they are net neutral, but assuming a hospital system's calculation favored it, would there be anything stopping a hospital from exploiting the overabundance of grads for free residency labor or charging for educational experience of residency?)

It's not so much a question of legality although I could make a pretty good argument on public policy grounds that it's illegal. Pretty sure the ACGME doesn't allow its accredited programs to do this. There have definitely been non ACGME non funded fellowships though. But if you need ACGME accredidition of a residency to sit for your boards, you really have to go through the hoops. And programs that want to keep their accreditation need to go through their own hoops.

And there isn't much debate about whether residents make or lose money -- the six digit stipend was attached to residents precisely because they are such a cost center. The later year residents start becoming profitable just before they leave but the interns slow attendings down more than enough to offset that.

 

[jqueb29]

As someone who spent my whole life prior to college in an underserved rural hellhole, you could NEVER make me live in such a place again. Like others said earlier, you solve the problem with creativity, not force. Rural life is miserable.

 

[Goro]

My Dean likes to crow about how our grads are ending up practicing in rural/underserved areas, so I think you're on to something. My kids definitely do self-select for PC.

Just my 2 cents but I honestly think this plays a big part of it these days. The current system of admissions selects for individuals who have a higher propensity and desire to be a super specialized left breast surgeon in Boston/LA/NY... Honestly I do feel that sometimes the way DO schools approach admissions is more effective if your goal is to produce PC physicians. the truly mission driven DO schools really do have a knack for selecting people who want to practice in the underserved locations. A lot of DO grads self select for primary care. IMO that some MD schools could do the same thing, and some do, but some definitely don't.

 

[sharpstickie]

599 pediatric neurosurgeons. That killed me, I literally laughed out loud here at work

"My hero Ben Carson"

 

[Lawpy]

Just my 2 cents but I honestly think this plays a big part of it these days. The current system of admissions selects for individuals who have a higher propensity and desire to be a super specialized left breast surgeon in Boston/LA/NY... Honestly I do feel that sometimes the way DO schools approach admissions is more effective if your goal is to produce PC physicians. the truly mission driven DO schools really do have a knack for selecting people who want to practice in the underserved locations. A lot of DO grads self select for primary care. IMO that some MD schools could do the same thing, and some do, but some definitely don't.

I dont think DO schools have much of an option in pursuing other missions besides primary care. And even then, the DO graduates that end up in primary care usually don't do it because they actually want to (although some certainly do and are passionate about it)

I'd argue that mission-based MD schools, especially Rush and its heavy service requirements, do a more effective job in addressing the need for primary care physicians. Same with the HBCUs and many state schools

 

[AnatomyGrey12]

I dont think DO schools have much of an option in pursuing other missions besides primary care. And even then, the DO graduates that end up in primary care usually don't do it because they actually want to (although some certainly do and are passionate about it)

Well yeah because they have always had the mission of primary care... And a lot of the schools live by that motto when it comes to admissions.

I really disagree with the bolded. I don't know why it's so hard to understand but a large chunk (read:majority) of incoming DO students have already self selected for primary care. That is just what they want to do. Are there some who wanted something else and ended up in PC? Absolutely, but not as many as you would think. There are a decent number of specialties that are DO friendly that even the most average DO can get, so usually the ones on PC chose to be there.

Yes some of the mission based schools do help that mission but not nearly as many as you would think. For an example my state school has a large number of grads that never come to the state again. There really aren't that many that do actually. Seeing as DO schools are the #1 provider of PC physicians they are way more effective than most MD schools in that regard. Even the mission based schools and state schools churn out a ton of specialists. Just look at any match list.