AAMC Endorses Resident Physician Shortage Reduction Act of 2021

[Ho0v-man]

AAMC Endorses Resident Physician Shortage Reduction Act of 2021

Newly reintroduced bill would increase federal support for physicians’ graduate medical education programs to increase access to care for patients nationwide

www.aamc.org

I feel like this needs its own thread. Given what we’ve seen in just the past few years with rad onc and EM, there’s no doubt this would decimate every field. Is there anything we can do as med students/residents? It seems like our professional societies don’t care.

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[Lem0nz]

Maybe I'm being a jaded jerk, but I feel like this is what happens when the younger generation makes a lot of noise without thinking or understanding the consequences of their actions. The only people I hear pushing for this are residents who are not close to graduation and loud medical students who say the match isn't fair. Anyone else feel similar or strongly the opposite? If so, why?

 

[jambro]

It'd be nice if more residents = more practicing physicians, but our ridiculous system would probably just give us more unemployed residency-trained physicians and more midlevel "physician extenders" at the same time. And physicians that do have jobs would have less ability to negotiate.

 

[Rekt]

It'd be nice if more residents = more practicing physicians, but our ridiculous system would probably just give us more unemployed residency-trained physicians and more midlevel "physician extenders" at the same time. And physicians that do have jobs would have less ability to negotiate.

This. NPPs are flourishing in EM still. Don't think for any second you're safe. Medicine is a dump. Get out asap.

 

[jambro]

This. NPPs are flourishing in EM still. Don't think for any second you're safe. Medicine is a dump. Get out asap.

I don't think any specialty is really safe but I'm happy that right now I'm thinkng diagnostic rads which I think is safer than other specialties for various reasons

 

[Ho0v-man]

I don't think any specialty is really safe but I'm happy that right now I'm thinkng diagnostic rads which I think is safer than other specialties for various reasons

Nothings safe at all if this bill passes. If distributed evenly, this would be an almost 50% increase in spots in every field.

 

[Lawpy]

Maybe I'm being a jaded jerk, but I feel like this is what happens when the younger generation makes a lot of noise without thinking or understanding the consequences of their actions. The only people I hear pushing for this are residents who are not close to graduation and loud medical students who say they match isn't fair. Anyone else feel similar or strongly the opposite? If so, why?

I feel the same way and i'm not even in residency. And i'm already jaded

 

[Lawpy]

I blame the destruction of medicine on dysfunctional capitalism and idiot med students parroting ignorance and delusions on social media

 

[Lawpy]

AAMC Endorses Resident Physician Shortage Reduction Act of 2021

Newly reintroduced bill would increase federal support for physicians’ graduate medical education programs to increase access to care for patients nationwide

www.aamc.org

I feel like this needs its own thread. Given what we’ve seen in just the past few years with rad onc and EM, there’s no doubt this would decimate every field. Is there anything we can do as med students/residents? It seems like our professional societies don’t care.

@NotAProgDirector @operaman @Med Ed how do you respond to this news?

 

[DOVinciRobot]

Maybe I'm being a jaded jerk, but I feel like this is what happens when the younger generation makes a lot of noise without thinking or understanding the consequences of their actions. The only people I hear pushing for this are residents who are not close to graduation and loud medical students who say they match isn't fair. Anyone else feel similar or strongly the opposite? If so, why?

You essentially just summed up Med Twitter in a nutshell lol.

It’s all virtue signaling.

 

[Type2Fiber]

It'd be nice if more residents = more practicing physicians, but our ridiculous system would probably just give us more unemployed residency-trained physicians and more midlevel "physician extenders" at the same time. And physicians that do have jobs would have less ability to negotiate.

Anyone who doesn't understand that the bolded is what drives legislation like this is naive. This is nothing more than an attempt to further turn physicians into widgets

 

[Heart of the Cards]

To put this in perspective, the 2019 match cycle had 35,185 positions. This bill would add 14,000 new positions or a 40% increase. The AHA has endorsed this (they would get cheap labor out of this), but the AMA has also endorsed this bill.

 

[order66.exe]

This bill gets reintroduced and endorsed every year to no avail. AANP and AAPA strongly lobby against it as you can imagine. If there are a ton of physicians then what is the point of physician extenders.

 

[Rekt]

This bill gets reintroduced and endorsed every year to no avail. AANP and AAPA strongly lobby against it as you can imagine. If there are a ton of physicians then what is the point of physician extenders.

Is there any point to them now?

 

[Kardio]

Nothings safe at all if this bill passes. If distributed evenly, this would be an almost 50% increase in spots in every field.

I haven’t read the bill. Are they endorsing a total increase of 14k residents over the next 7 years, followed by a return to baseline - or do they want to bring the number up by 14k and keep it there going forward?

The latter scenario (the ‘+50%’ one), honestly seems so ridiculous I don’t even think the naive would advocate for it. The former, while debatable, is far less egregious.

 

[order66.exe]

Also wouldn't this be 14,000 positions total? Assuming the average residency is about 4 years in length this would actually only increase spots the number of year graduating docs by about 3500. Hardly apocalyptic especially if concentrated in FM, IM and Psych which have huge demand and multiple avenues to practice.

 

[GreenDuck12]

Keep in mind that residency positions are filled for multiple years- this will not be a 40% increase in residency positions. If there are 35,0000 residency positions currently each year, and it increases by 14,000 over 7 years, that would increase the total positions offered during that time period from 245,000 to 259,000 - hardly the end of the world.

 

[emergentmd]

Med students and residents are likely screwed. There are so much different headwinds and the question is not if but when most fields will be oversupplied.

Increased residency spots and single payer is what will eventually screw most fields. Supply & Demand and economic forces eventually wins out and they all point to increased residencies at all costs to drive down the cost of healthcare/increase profit for VC/Hospital systems.

If diagnostic rad thing they are protected, guess what will happen when HCA/Nighthawk opens up 500 spots each year. There will be carribean grads lining up to fill them.

Even if this does not happen, we will get a single payer system in some form with payments likely pegged to Medicare rates. I would be shocked if this doesn't happen in the next 10 yrs given our current political push to the left. For all here who disliked Trump, you will be in for a rude awakening with some form of universal healthcare.

Most new grads will not be making 400K+ for 30 yrs like the fore fathers.

 

[Heart of the Cards]

Keep in mind that residency positions are filled for multiple years- this will not be a 40% increase in residency positions. If there are 35,0000 residency positions currently each year, and it increases by 14,000 over 7 years, that would increase the total positions offered during that time period from 245,000 to 259,000 - hardly the end of the world.

I think you've misunderstood the proposal. The bill says the number of residency spots will be expanded by 2000 each year. So it would be 35k before the bill passes then 37k the next year, then 39k.... and at the end of the seventh year it would be 49k. I also doubt it would drop back to baseline so it would be the full 40% increase from then on.

 

[Lawpy]

This bill gets reintroduced and endorsed every year to no avail. AANP and AAPA strongly lobby against it as you can imagine. If there are a ton of physicians then what is the point of physician extenders.

Wow, finally something i can agree with the midlevel lobbying groups!

 

[order66.exe]

I think you've misunderstood the proposal. The bill says the number of residency spots will be expanded by 2000 each year. So it would be 35k before the bill passes then 37k the next year, then 39k.... and at the end of the seventh year it would be 49k. I also doubt it would drop back to baseline so it would be the full 40% increase from then on.

If it’s like the act that was passed last year then this isn’t true. It’s 14,000 people total supported. Again assuming the average physician is in residency for four years that’s 3500 new pgy-1 spots not 14,000 pgy-1 spots.

it’s the appropriation difference between 14 billion dollars per years versus 56 billion dollars per year (assuming 14,000 new pgy1 spots and an avg length of training of 4 years)

Hard to say though without having the text

 

[GreenDuck12]

I think you've misunderstood the proposal. The bill says the number of residency spots will be expanded by 2000 each year. So it would be 35k before the bill passes then 37k the next year, then 39k.... and at the end of the seventh year it would be 49k. I also doubt it would drop back to baseline so it would be the full 40% increase from then on.

Expanded each year by 2000 spots. Assuming a static 35k spots per year, it increases to 37k the next year. However, because those slots are filled for multiple years, the next cycle would have 35k and increase by 2k. Not 37k + 2K, which is your assumption. Even taking your assumption to be true, that would be 2+4+6+8+10+12+14 for a total increase of 56k. With that same baseline of 245k positions over those 7 years, an increase of 56k would be a 22% increase. Hardly the end of the world with most of those positions going to primary care.

 

[order66.exe]

Expanded each year by 2000 spots. Assuming a static 35k spots per year, it increases to 37k the next year. However, because those slots are filled for multiple years, the next cycle would have 35k and increase by 2k. Not 37k + 2K, which is your assumption. Even taking your assumption to be true, that would be 2+4+6+8+10+12+14 for a total increase of 56k. With that same baseline of 245k positions over those 7 years, an increase of 56k would be a 22% increase. Hardly the end of the world with most of those positions going to primary care.

This would actually be pretty massive given that physician jobs are only expected to increase mildly over the next few years per BLS.

but again I don’t think there are going to be 56,000 more docs in the system. There are going to be 14,000 more docs in the system with only 3500 more graduating per year which is basically an appropriate increase.

That said this bill never passes because of midlevel and nursing opposition so I wouldn’t lose too much sleep over it.

 

[ace_inhibitor111]

This would actually be pretty massive given that physician jobs are only expected to increase mildly over the next few years per BLS.

but again I don’t think there are going to be 56,000 more docs in the system. There are going to be 14,000 more docs in the system with only 3500 more graduating per year which is basically an appropriate increase.

That said this bill never passes because of midlevel and nursing opposition so I wouldn’t lose too much sleep over it.

This assumes steady state, but there is already an approx. 2.5% increase in doctors per year according to the AAMC workforce report even without the bill. Compare that with the annual 0.5% increase in the US population a year and I think we’d reach saturation relatively quickly if the bill passes. I mean sure, the aging baby boomers may require a temporary increase in healthcare in the future, but there is evidence to show that we may be halfway past that hump. A permanent large increase in number of doctors is not the solution to this problem.

 

[Ho0v-man]

I haven’t read the bill. Are they endorsing a total increase of 14k residents over the next 7 years, followed by a return to baseline - or do they want to bring the number up by 14k and keep it there going forward?

The latter scenario (the ‘+50%’ one), honestly seems so ridiculous I don’t even think the naive would advocate for it. The former, while debatable, is far less egregious.

Also wouldn't this be 14,000 positions total? Assuming the average residency is about 4 years in length this would actually only increase spots the number of year graduating docs by about 3500. Hardly apocalyptic especially if concentrated in FM, IM and Psych which have huge demand and multiple avenues to practice.

That’s the thing, I can’t find the actual text of the bill to verify this. I hope you’re right. 3,500 wouldn’t be as bad. But if we concentrate that in specialties where programs are easiest to open up (IM/FM/EM), that’s still pretty disruptive.

 

[VA Hopeful Dr]

Maybe I'm thinking about this wrong, but FM spots are already increasing a fair bit. Clearly lots of hospitals can afford to just cover the costs themselves. Seems like this bill is most likely to just give new programs funding.

 

[Med Ed]

@NotAProgDirector @operaman @Med Ed how do you respond to this news?

Call me when the president's ink pen touches it.

 

[Redpancreas]

AAMC Endorses Resident Physician Shortage Reduction Act of 2021

Newly reintroduced bill would increase federal support for physicians’ graduate medical education programs to increase access to care for patients nationwide

www.aamc.org

I feel like this needs its own thread. Given what we’ve seen in just the past few years with rad onc and EM, there’s no doubt this would decimate every field. Is there anything we can do as med students/residents? It seems like our professional societies don’t care.

It's kind of a damned if you don't, damned if you do... situation. I'm still against it.

1) Bill passes and physicians double? Expect decrease in standards, salary, etc. Degree mills like the notorious D.O schools will be validated and more new schools will open.

2) Bill doesn't pass? Expect NPPs/Administrators to collaborate to find workarounds to our limited supply. This, however, still allows physician to uphold standards/salary, but will involve more NPP involvement in direct aspects of patient care.

 

[Neopolymath]

Also wouldn't this be 14,000 positions total? Assuming the average residency is about 4 years in length this would actually only increase spots the number of year graduating docs by about 3500. Hardly apocalyptic especially if concentrated in FM, IM and Psych which have huge demand and multiple avenues to practice.

I came here to say this and also that this will probably just be funding absorbed by programs footing the bill themselves currently. If it even passes, I doubt it's the big change initially thought.

 

[ace_inhibitor111]

I came here to say this and also that this will probably just be funding absorbed by programs footing the bill themselves currently. If it even passes, I doubt it's the big change initially thought.

Imagine it financing HCA’s current programs, freeing up their funding to create even more residency programs

 

[Dral]

• 40% of the country’s practicing physicians felt burnt out at least once a week before the COVID-19 crisis began—and the issue of increased clinician burnout has only been intensified by the pandemic—which could cause doctors and other health professionals to cut back their hours or even accelerate their plans for retirement.

Instead of relying on ways to address this directly, let's just make more doctors!

 

[efle]

Are they expecting US MD/DO spots to also keep expanding at a similar rate? Aren't we already only filling like 2/3rds of our residency seats with US grads despite very high match rates, so won't this only impact the match for the international crowd?

Edit - And beyond the match impacts, I imagine job market effects will completely depend on what specialties they open the new spots in

 

[Heart of the Cards]

If it’s like the act that was passed last year then this isn’t true. It’s 14,000 people total supported. Again assuming the average physician is in residency for four years that’s 3500 new pgy-1 spots not 14,000 pgy-1 spots.

it’s the appropriation difference between 14 billion dollars per years versus 56 billion dollars per year (assuming 14,000 new pgy1 spots and an avg length of training of 4 years)

Hard to say though without having the text

You're right and I was mistaken. This AMA page from a previous (failed) attempt explains it more clearly.

4 things students should know about the new GME bill

Graduate medical educations slots will increase 15,000 if a new bill for Medicare-funded residency positions is adopted. Med students should know the bill’s provisions about the new residency slots and funding.

www.ama-assn.org

It'd be 14,000 cumulative spots and the yearly slots would go from 35k to 37k. Honestly that's not so bad.

 

[SurfingDoctor]

 

[Neopolymath]

Imagine it financing HCA’s current programs, freeing up their funding to create even more residency programs

They are not eligible thankfully.

 

[Maimonides1]

To put this in perspective, the 2019 match cycle had 35,185 positions. This bill would add 14,000 new positions or a 40% increase. The AHA has endorsed this (they would get cheap labor out of this), but the AMA has also endorsed this bill.

You mean the new American Midlevel Association that I gave up long time ago..?

 

[NotAProgDirector]

The full text of the bill is here: BILLS-117s834is.pdf (congress.gov)

It's the same bill that's been submitted annually for he last few years, and so far has died in committee every time.

Already discussed is that it's not 14K PGY-1 positions -- you need a funding slot for each PGY year.

The bill allocates 10% of the slots each year to:
1. Rural hospitals
2. Hospitals over their cap (but they can't use the increase to cover their cap, they need to increase their number of residents
3. Hospitals in states with new medical schools and new branch campuses
4. Hospitals in shortage areas.

There's nothing in the bill that allocates these spots for primary care. Could just increase ortho spots by 400 every year.

Seems like a financial windfall for big hospitals that are over their caps, and for those states with new medical schools. The "new medical school" is backdated to 2000.

And this was news back in March. No idea why it's getting press now. The initial link was from March also.

 

[operaman]

@NotAProgDirector @operaman @Med Ed how do you respond to this news?

Yeah I don't think it's that big of a deal personally. The increase seems fairly small, and surely a number of those positions would just go to fund already existing spots somehow. Also, just because they're funded doesn't mean they will magically exist. Some fields could probably expand without compromising education, but most procedural fields would struggle to expand without also growing their faculty and overall case volume. The individual fields can also exert some influence on this since new programs and positions have to be approved. We added a single resident to each year during my training and it was actually extremely challenging even in a big busy program to make sure people kept getting adequate training. We also grew our faculty quite a bit in that same period so there were increasing coverage needs, but even this wasn't straightforward. You still have to consider fixed things like clinic space, OR space and staff and time, etc. Basically this isn't a Field of Dream "if you build it, they will come" sort of situation.

In the end, I would guess that most slots go to primary care fields and the net effect will be decreased salaries and poor job markets in those fields, but probably not the doomsday impact it would appear at first glance. It also won't do squat for physician shortages since all these new grads will also want to end up working in larger cities and other desirable areas .

 

[Maimonides1]

The old AMA and the politics of Medical Education in the US!

Following Dr. Gibson Columbia 1938

69 Medical schools
165K practicing physicians in US
Cost of Medical education $15K
Women are rarity in medicine..!

 

[Cornfed101]

They should just increase the pay for residents by 50% and keep the number of residency slots the same. Maybe I’ll go lobby that

 

[catnip12]

The old AMA and the politics of Medical Education in the US!

Following Dr. Gibson Columbia 1938

69 Medical schools
165K practicing physicians in US
Cost of Medical education $15K
Women are rarity in medicine..!

Great post! Thanks for linking this video

 

[Rekt]

The full text of the bill is here: BILLS-117s834is.pdf (congress.gov)

It's the same bill that's been submitted annually for he last few years, and so far has died in committee every time.

Already discussed is that it's not 14K PGY-1 positions -- you need a funding slot for each PGY year.

The bill allocates 10% of the slots each year to:
1. Rural hospitals
2. Hospitals over their cap (but they can't use the increase to cover their cap, they need to increase their number of residents
3. Hospitals in states with new medical schools and new branch campuses
4. Hospitals in shortage areas.

There's nothing in the bill that allocates these spots for primary care. Could just increase ortho spots by 400 every year.

Seems like a financial windfall for big hospitals that are over their caps, and for those states with new medical schools. The "new medical school" is backdated to 2000.

And this was news back in March. No idea why it's getting press now. The initial link was from March also.

These points don't even make sense. The reason residencies don't exist in rural areas is because they don't provide adequate training.

 

[Skullcutter69]

Yeah I don't think it's that big of a deal personally. The increase seems fairly small, and surely a number of those positions would just go to fund already existing spots somehow. Also, just because they're funded doesn't mean they will magically exist. Some fields could probably expand without compromising education, but most procedural fields would struggle to expand without also growing their faculty and overall case volume. The individual fields can also exert some influence on this since new programs and positions have to be approved. We added a single resident to each year during my training and it was actually extremely challenging even in a big busy program to make sure people kept getting adequate training. We also grew our faculty quite a bit in that same period so there were increasing coverage needs, but even this wasn't straightforward. You still have to consider fixed things like clinic space, OR space and staff and time, etc. Basically this isn't a Field of Dream "if you build it, they will come" sort of situation.

In the end, I would guess that most slots go to primary care fields and the net effect will be decreased salaries and poor job markets in those fields, but probably not the doomsday impact it would appear at first glance. It also won't do squat for physician shortages since all these new grads will also want to end up working in larger cities and other desirable areas .

This is an incredibly salient point and one that I’m going to add to my AMA thread on neurosurgery. I’ve gotten quite a few messages about the nuances surrounding the job market and supply/demand in different specialties. I think it’s important to realize that the number of residency slots is driven by several different factors. First and foremost is funding, which is why legislation like this is making people nervous. Most specialties could increase the number of trainees in many programs, but are really limited by funding (or some programs will blame lack of federal funding as a reason for not expanding). Surgical subspecialties, however, have a whole additional layer of protection that is inherent to the fields themselves and not just stemming from a desire to limit supply. In order to be a neurosurgeon, you have to be able to do a lot of different, complex operations. This means being able to hit your ACGME minimums, which necessitates having enough brain tumors, aneurysms, pediatric trauma, ACDFs, etc. available for trainees under a single program. These are relatively rare problems, and it’s actually a huge feat to have a) the faculty who are able to draw these cases to their practice, b) the infrastructure to successfully treat them, and c) a willingness to train residents in doing them.

Case in point, the Mayo Clinic in Arizona is rolling in millions of dollars (the 100K Medicare funding/ resident was not a factor holding them back) and had been trying to start a residency for the good part of a decade. They’ve only just been able to open a 1 resident/year program last year, mostly due to the factors I listed above. All in all, at least in surgery, funding is only 1 part of the equation. The nature of the training means that even well-funded programs have difficulty opening or expanding spots while maintaining adequate skill levels.

 

[Postictal Raiden]

The old AMA and the politics of Medical Education in the US!

Following Dr. Gibson Columbia 1938

69 Medical schools
165K practicing physicians in US
Cost of Medical education $15K
Women are rarity in medicine..!

15k in 1938 is equivalent to 280k in 2021.

Also the US population at that time was about a third of what it is today. But the number of practicing physicians today is 6x that of 1938. However people nowadays seek medical attention a lot more frequently than they did in the past.

 

[outtadisworld]

Maybe I'm being a jaded jerk, but I feel like this is what happens when the younger generation makes a lot of noise without thinking or understanding the consequences of their actions. The only people I hear pushing for this are residents who are not close to graduation and loud medical students who say the match isn't fair. Anyone else feel similar or strongly the opposite? If so, why?

I think you are being a jerk. The younger generation has inherited a medical system that puts graduates (and sometimes patients) into hundreds of thousands of dollars into debt, midlevel encroachment, healthcare consolidation, and admin bloat.

The younger generation is at least trying to come up with solutions. We won't know if they will work until they are put into action, but at least they are trying.

Don't blame the younger generation for brainstorming how to fix these issues.

Instead, maybe the older generation can ask themselves how to fix the problem that they made?

 

[VA Hopeful Dr]

I think you are being a jerk. The younger generation has inherited a medical system that puts graduates (and sometimes patients) into hundreds of thousands of dollars into debt, midlevel encroachment, healthcare consolidation, and admin bloat.

The younger generation is at least trying to come up with solutions. We won't know if they will work until they are put into action, but at least they are trying.

Don't blame the younger generation for brainstorming how to fix these issues.

Instead, maybe the older generation can ask themselves how to fix the problem that they made?

What does any of that have to do with increasing residency spots?

 

[Ho0v-man]

I think you are being a jerk. The younger generation has inherited a medical system that puts graduates (and sometimes patients) into hundreds of thousands of dollars into debt, midlevel encroachment, healthcare consolidation, and admin bloat.

The younger generation is at least trying to come up with solutions. We won't know if they will work until they are put into action, but at least they are trying.

Don't blame the younger generation for brainstorming how to fix these issues.

Instead, maybe the older generation can ask themselves how to fix the problem that they made?

What are you talking about? We’ve literally seen other fields destroyed by residency expansion. And residency expansion has nothing to do with the other things you just mentioned. Furthermore, that poster is a fellow. So hasn’t contributed to the systems dysfunction at all.

 

[ohmanwaddup]

Hard for me to care enough to oppose this is when people's main concern with this is that salaries might go down.

Pay just really is not a pressing issue to me past a certain point

 

[efle]

Hard for me to care enough to oppose this is when people's main concern with this is that salaries might go down.

Pay just really is not a pressing issue to me past a certain point

Do you consider unemployment a salary reduction lol

 

[ohmanwaddup]

Do you consider unemployment a salary reduction lol

Unemployment seems a bit dramatic