New Schools + Class Expansions = Surplus students and Fewer Residency Slots

[FutureDO2016]

I have seen the number of DO schools increase and class size expansions grow tremendously in the past decade. There are 30 DO schools and branches now I believe with more coming in the next few years.

Eventually will there be a surplus of Osteopathic 4th years and Allopathic 4th years (not to mention the ~10,00 foreign medical graduates that fail to match yearly) compared to the number of first year residency positions offered in the AOA and NRMP match (Soon to merge between 2015-2020)?

I don't get what's the point of educating more students if the graduate training is not developed at the same rate...a medical school graduate without residency training is useless.

---

Members don't see this ad.

 

[TheBDP]

Preeeeeach

 

[Postictal Raiden]

Currently, there are about 31k pgy1 spots including AOA, ACGME, AUA, SF match, and the military. Last year DO schools enrolled about 6800 students in their 2018 class, and MD schools enrolled about 21k students. Assuming a 5% attrition rate across the board, in 2018 there will be about 26.5k US med grads. This leaves another 4.5k for IMGs and FMGs. Without the expansion of GME spots, It will take the opening of another 30 DO to have more US med grads than pgy1 positions.

The sky hasn't fallen yet.

 

[FutureDO2016]

So based on your numbers, there will be ~21,000 MDs and ~7,000 DOs leading to 28,000 American medical graduates and only 2-3,000 spots for foreign and Caribbean medical graduates.

I think based on this year's stats, there were ~500 unmatched DOs and couple hundred unmatched MDs as well as thousands of foreign medical graduates.

So I guess this won't be a problem until the next decade but I guess it will get harder for FMGs.

 

[FutureDO2016]

Unless they start expanding residency programs (I think they add a 100 or couple hundred new slots each year)...new schools each year add potentially 50( class side increase) to 450-500 (3 new DO schools) new graduates depending on the number of schools...

Eventually at what year will the number of 4th year MD and DO graduates surpass the number of residency slots (leading to very few FMGs getting residency or US grads with no residency)?

 

[Postictal Raiden]

No matter what, I don't think they should expand GME. This will flood the market and destroy the profession for good. At the current rate, the number of practicing physicians in the US will approach 1 million very soon, that's 2.5x the number of doctors existed in 1970. Meanwhile, the US population has only grown by 60% since that time. Add to that the increasing number of midlevel practitioners, you get the picture.

 

[midweststudent1]

No matter what, I don't think they should expand GME. This will flood the market and destroy the profession for good. At the current rate, the number of practicing physicians in the US will approach 1 million very soon, that's 2.5x the number of doctors existed in 1970. Meanwhile, the US population has only grown by 60% since that time. Add to that the increasing number of midlevel practitioners, you get the picture.

I wholeheartedly agree with this. If you want to pay off your massive loans, you need to be needed

 

[FutureDO2016]

So you guys think they should just stop GME growth even though enrollment continues to grow? That's not good for future medical students...I mean there will always be a need for doctors especially in rural and under-served areas, but no one wants to live major cities and suburbs...hence the oversaturation in some areas.

 

[YankeeCandle1141]

No matter what, I don't think they should expand GME. This will flood the market and destroy the profession for good. At the current rate, the number of practicing physicians in the US will approach 1 million very soon, that's 2.5x the number of doctors existed in 1970. Meanwhile, the US population has only grown by 60% since that time. Add to that the increasing number of midlevel practitioners, you get the picture.

........and since 1970 the average life expectancy has increased by almost a decade, the average BMI has probably doubled, and amount of knowledge gained in medical science has required sub-specialization.

There is not even a hint of risk for an oversaturation of doctors.

 

[Postictal Raiden]

........and since 1970 the average life expectancy has increased by almost a decade, the average BMI has probably doubled, and amount of knowledge gained in medical science has required sub-specialization.

There is not even a hint of risk for an oversaturation of doctors.

I agree, these things you mentioned are the very reason for why physicians are still in demand despite increasing the number of providers (doctors and midlevels) far beyond the increase in population. However, we also need to remember that it doesn't take much to saturate the market. A good example is pharmacy. In less than a decade, the job market for this profession went from red hot to near dead.

 

[NontradCA]

So you guys think they should just stop GME growth even though enrollment continues to grow? That's not good for future medical students...I mean there will always be a need for doctors especially in rural and under-served areas, but no one wants to live major cities and suburbs...hence the oversaturation in some areas.

You're being shortsighted about this.

 

[Bea5T]

I agree, these things you mentioned are the very reason for why physicians are still in demand despite increasing the number of providers (doctors and midlevels) far beyond the increase in population. However, we also need to remember that it doesn't take much to saturate the market. A good example is pharmacy. In less than a decade, the job market for this profession went from red hot to near dead.

But pharmacy is pretty much school --> retail. And if I'm not mistaken you only need 1 maybe 2 to run any given pharmacy. I don't think it's very comparable to medicine, especially since many physicians work part time once they get older and the need is substantially greater.

 

[Postictal Raiden]

But pharmacy is pretty much school --> retail. And if I'm not mistaken you only need 1 maybe 2 to run any given pharmacy. I don't think it's very comparable to medicine, especially since many physicians work part time once they get older and the need is substantially greater.

That's exactly what's shielding our profession from saturation. Residency functions as the bottleneck for practicing medicine in the US. Once you expand residency positions, you are pretty much disrupting this gradient.

Based on reading few sources, I found that on average, physicians work 30 years after completing residency. Some specialties have longer shelf live (like pathology and rads) while others have a shorter one (EM comes to mind). However, due to the decrease in reimbursement, many old timers have been delaying their retirement, and this has led to saturation in some fields such as radiology and pathology.

I admit that there are many other factors that play part of this demand and supply equation, but on the most basic level, it should be clear to everyone that increasing the number of practicing physicians will only lead to devaluing the profession.

 

[W19]

They probably need to add another 2k primary care spot cause I want to get a residency spot when I am applying.

 

[Postictal Raiden]

They probably need to add another 2k primary care spot cause I want to get a residency spot when I am applying.

If you are a US med grad with no serious red flags and apply broadly then you should get a spot somewhere.

 

[W19]

I will be a US grad, but it seems like the match is getting more and more competitive. It will get worst by the time I am applying in 2017... There is a thread floating somewhere in the residency forum where many US students failed to match this year in IM/FM.

 

[Postictal Raiden]

I will be a US grad, but it seems like the match is getting more and more competitive. It will get worst by the time I am applying in 2017... There is a thread floating somewhere in the residency forum where many US students failed to match this year in IM/FM.

The solution is simple. Just be among the top 98% and you will be fine

 

[W19]

The solution is simple. Just be among the top 98% and you will be fine

I certainly will try to be among these savants, but it seems there is no room for any mistake anymore like it was in past matches. Once one fails step1, you are toast.

 

[67552931811]

That's exactly what's shielding our profession from saturation. Residency functions as the bottleneck for practicing medicine in the US. Once you expand residency positions, you are pretty much disrupting this gradient.

Based on reading few sources, I found that on average, physicians work 30 years after completing residency. Some specialties have longer shelf live (like pathology and rads) while others have a shorter one (EM comes to mind). However, due to the decrease in reimbursement, many old timers have been delaying their retirement, and this has led to saturation in some fields such as radiology and pathology.

I admit that there are many other factors that play part of this demand and supply equation, but on the most basic level, it should be clear to everyone that increasing the number of practicing physicians will only lead to devaluing the profession.

Path isn't saturated. That statement gets slung around on SDN and it is not correct (source: numerous family members and or acquaintances who are pathologists, recently relocated, and discussed with me the current job market.)

 

[Postictal Raiden]

Path isn't saturated. That statement gets slung around on SDN and it is not correct (source: numerous family members and or acquaintances who are pathologists, recently relocated, and discussed with me the current job market.)

Good to know. I'm an optimist by nature, but reading all these doom and gloom posts eventually get you.

 

[67552931811]

Good to know. I'm an optimist by nature, but reading all these doom and gloom posts eventually get you.

I hear you, sir. I think the key take away is to read a lot of the info on here with a large grain of salt. After all, it is the internet...

 

[YankeeCandle1141]

Path isn't saturated. That statement gets slung around on SDN and it is not correct (source: numerous family members and or acquaintances who are pathologists, recently relocated, and discussed with me the current job market.)

And neither is radiology.

Idiots on here always try to make these claims. Frankly I cant believe nobody has tried to make the law school comparison yet.

There is a shortage of doctors. That shortage is increasing.

This isn't pharmacy, and its not law. This is medicine.

 

[Mad Jack]

No matter what, I don't think they should expand GME. This will flood the market and destroy the profession for good. At the current rate, the number of practicing physicians in the US will approach 1 million very soon, that's 2.5x the number of doctors existed in 1970. Meanwhile, the US population has only grown by 60% since that time. Add to that the increasing number of midlevel practitioners, you get the picture.

You do realize that we're not even in the top 10 in doctors per capita. Nor the top 20. Or 30. Or 40. Hell, we're 56th in the world in doctors per capita. That puts us near Uzbekistan, Slovenia, and Romania. Only two first world countries have less physicians than the United States- Canada and Japan. Canada has done this intentionally to limit access, but suffers from a lack of primary care services, while Japan has a potentially catastrophic physician shortage on the horizon, particularly when their aging physician workforce is taken into account.

http://gamapserver.who.int/gho/inte..._workforce/PhysiciansDensity_Total/atlas.html

The point is, there's plenty of room for more physicians. The only reason we have midlevels is because there weren't enough doctors to provide care in the first place- they were a solution to a problem created by the lack of medical schools and residency positions in the United States.

 

[QualityProcess]

I guarantee you when all the data comes out it will be clear that this year was no different than any other recent year. It gets marginally tougher by a slight percent every year and has for years; it does not magically change overnight.

yep. its never as bad as it seems, and its never as good as it seems...

 

[Goro]

I chatted up my clinical Dean the other day about this and he was quite matter-of-fact that new residency slots are coming. I didn't press him on AOA vs ACGME, but pretty soon there won't be a distinction.

I have seen the number of DO schools increase and class size expansions grow tremendously in the past decade. There are 30 DO schools and branches now I believe with more coming in the next few years.

Eventually will there be a surplus of Osteopathic 4th years and Allopathic 4th years (not to mention the ~10,00 foreign medical graduates that fail to match yearly) compared to the number of first year residency positions offered in the AOA and NRMP match (Soon to merge between 2015-2020)?

I don't get what's the point of educating more students if the graduate training is not developed at the same rate...a medical school graduate without residency training is useless.

 

[midweststudent1]

I chatted up my clinical Dean the other day about this and he was quite matter-of-fact that new residency slots are coming. I didn't press him on AOA vs ACGME, but pretty soon there won't be a distinction.

Did he give any indication where the money is going to come from? Because I just don't see the federal government spending any more at all ...

 

[xBODOMx]

I chatted up my clinical Dean the other day about this and he was quite matter-of-fact that new residency slots are coming. I didn't press him on AOA vs ACGME, but pretty soon there won't be a distinction.

I interviewed at quite a few osteopathic schools and all of them were pretty hush regarding the merger and did not have a plan for incoming students. Has your school said anything about this? My understanding is that the AOA residencies need to merge BY 2020. I'll be graduating in 2019, so what happens if there are barely any AOA left by 2019, still waiting to merge/meet ACGME accreditation standards? Will almost all students try to match ACGME then with the (hopefully few) unmatched students scramble for AOA spots? The merger is confusing to me.

 

[NurWollen]

Did he give any indication where the money is going to come from? Because I just don't see the federal government spending any more at all ...

My understanding is that the "freeze" on new Medicare funding for GME spots only applies to hospitals that have residency programs or have had residency programs in the past. Hospitals that have never had GME can get federal funding.

 

[Goro]

Nope. But I was just struck by how matter-of-factly he said that they were coming. He isn't a guy who would just rattle that out from wishful thinking. I'll have to pump our other Deans for their take

Did he give any indication where the money is going to come from? Because I just don't see the federal government spending any more at all ...

I think that they were hush-hush because no one really knows how the merger will affect things. At out school, our grads have a great track record of scoring ACGME residencies, much less, AOA one, so we're not worried. I don't know what the mindset is at, say, MUCOM or PCOM-GA. But to reiterate what I've heard previously by my AOA-connected colleagues, DO grads will be getting more out of the merger than the MD grads.

I interviewed at quite a few osteopathic schools and all of them were pretty hush regarding the merger and did not have a plan for incoming students. Has your school said anything about this? My understanding is that the AOA residencies need to merge BY 2020. I'll be graduating in 2019, so what happens if there are barely any AOA left by 2019, still waiting to merge/meet ACGME accreditation standards? Will almost all students try to match ACGME then with the (hopefully few) unmatched students scramble for AOA spots? The merger is confusing to me.

 

[midweststudent1]

Yes if you open a new program you can get funded. They then cap the new programs number of slots after five years.

I guess a main problem I see with this is that won't most of the new problems be in very small community hospitals? Most large hospitals or hospitals in large cities already have residencies in place

 

[Postictal Raiden]

You do realize that we're not even in the top 10 in doctors per capita. Nor the top 20. Or 30. Or 40. Hell, we're 56th in the world in doctors per capita. That puts us near Uzbekistan, Slovenia, and Romania. Only two first world countries have less physicians than the United States- Canada and Japan. Canada has done this intentionally to limit access, but suffers from a lack of primary care services, while Japan has a potentially catastrophic physician shortage on the horizon, particularly when their aging physician workforce is taken into account.

http://gamapserver.who.int/gho/inte..._workforce/PhysiciansDensity_Total/atlas.html

The point is, there's plenty of room for more physicians. The only reason we have midlevels is because there weren't enough doctors to provide care in the first place- they were a solution to a problem created by the lack of medical schools and residency positions in the United States.

I know. However, do you realize that these countries don't have 200K NPs, 100K PAs and 50K CRNAs? Do you also realize that physicians in this country work on average 1.5x the amount of hours worked by physicians in those countries?

 

[Mad Jack]

I know. However, do you realize that these countries don't have 200K NPs, 100K PAs and 50K CRNAs? Do you also realize that physicians in this country work on average 1.5x the amount of hours worked by physicians in those countries?

I'm a big believer in competition. I think we could out-compete midlevels in quality and services, so I'm honestly not all that concerned. I don't foresee physicians being unemployed or making less than 150k at any time in the near future, in any case. And I'm only going to get 27 years of practice max (and hopefully far less if my investments are wise), so it's not like things need to hold up all that long anyway.

 

[YankeeCandle1141]

I guess a main problem I see with this is that won't most of the new problems be in very small community hospitals? Most large hospitals or hospitals in large cities already have residencies in place

In order for any significant amount of new residency positions to open, a lot of rules would have to change.

 

[NurWollen]

Yes if you open a new program you can get funded. They then cap the new programs number of slots after five years.

This must be part of the reason why lately I've been seeing multiple AOA residencies popping up all at once at random community hospitals. There's no cap if they start all at once, but if they open an FM program then a few years later want to open a surgery program, they're outta luck.


Also, I have heard that there are a few other loopholes as well. For example, funding for pediatric residencies is separate and not subject to the current funding cap. Is this true?