Thank you! If I'm reading the data correctly, there were 40,000 total applicants for 27,000 places. 17,000 senior us med student applicants, plus various re-applicants, FMGs and IMGs, some DOs. Result: 26,000 matches, 1000 empty spots, presumably because there weren't enough qualified FMG/IMGs to fill the remaining slots. So, residency spots are not yet the bottleneck.
As for your second point, forcing physician salaries down to the point that they must take very low-paying jobs in undesirable areas does not seem like a particularly well thought-out plan.
That's not
my plan. I'm just suggesting that sooner or later, if there are enough doctors, economics will force doctors to fill any and all available slots.
This has not been shown to be true. Physicians increase demand even in low demand geographies and will accept lower pay to stay in them!
More doctors might mean more expenditures now, but that will peak eventually also. Lets look at ER docs. People know that ER waits are long, so they don't go. but then Urgent care clinics open, and people go there. More docs work in the urgent cares, and so there are more doctor visits. But now ERs are competing and adding more doctors to decrease wait times. So now the ERs need more docs. But once all the ERs have a zero wait time, and there's an Urgent care on every street corner, and every Walgreens and Walmart and Costco has a walk-in doc in the box ( maybe all board certified in ER medicine ) then ER salaries will stagnate and then decrease. Sooner or later, that rural 24 hour spot will be filled, because there's no other job available.
That's why doctors join IPOs and PPOs. The insurers say, " you want our patients, give us a discount". That only works if there are doctors willing to agree. If the doctors all had a 3 month waiting list of patients waiting to be seen, they won't take the bait. The reason they agree is because there aren't enough patients to go around, and the more doctors, the worse it is.
Look at Lasik. At first, when a few doctors did it, it was a few thousand dollars an eye. Now it's a commodity, every ophthalmologist does it, and it's a couple of hundred an eye. Supply and demand. It's new technology, and a new procedure, and more utilitzation, but with more supply than demand, the price came down, and there's less income for the doctors.
This simply isn't true because people aren't widgets and aren't only motivated by money. Physicians generally have to live where they work. They often have spouses, children, other family members. There are quality of life issues. Physicians are highly educated and tend to seek out cultural and social experiences that match their background and training. When you have children you worry about the quality of schools they are in, the diversity of their experiences. When you are married, you want your spouse to be happy and content and to have access to the activities and work opportunities that line up with those offered by your own work location. There is a dollar amount that I personally would sacrifice to assure that everyone in my home life is happy, and that dollar amount is high. They don't say "Happy wife/happy life" for nothing.
It's got to be at least part of the reasoning for focusing on med school applicants from rural and underserved areas. If your family is from an underserved area, it seems more likely that you will return to the area where your family is from when you have your own family. Blood is thicker than water (and dollars, sometimes).
I know a couple of newly minted doctors who took jobs in primary care fields in crazy places (very rural Alaska and New Mexico) for crazy pay. Both lasted 2 years and then moved closer to family to raise their families at a close to 50% pay cut.
The UAE actively recruits American-trained physicians to practice in the UAE at crazy, tax-free salaries way above what physicians make here in the US with all kinds of perks. Supply and demand says new physicians should be flocking over there, but they don't. You want to move your family to the UAE? Think your wife will want to live there no matter how much extra money you're making?
If/when I become a physician I would like to serve in an underserved area for some period of time. But by then my husband will likely be retired and my kids will be in college. I would have had a very different answer for you if I was 15 years younger.
I agree completely with everything you wrote.
"Happy wife, happy life" indeed, but if the wife needs food on the table in order to be happy, living in rural Alaska or in the UAE will look a lot more attractive than being unemployed in Manhattan.
All I'm saying is, that if there are enough more doctors, all those empty residency slots will be filled, and all those rural jobs will be taken. It might take 1,000 more doctors a year, or maybe 100,000 more, but at some point, if the rate of medical school formation exceeds the rate of population growth, then sooner or later every doctor's job will be filled, there will be unemployed doctors, and salaries will come down. Doctors are not immune from the laws of supply and demand.
