An idea to solve the physician shortage problem

[gettheleadout]

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This. OP: do you really think 45,000 more people are going to go into FP just because you offer them another $10-20k/yr? That might cause one to choose one program over another buy not one specialty over another.

Is anything really worth not aiming for the career you think will satisfy you the most?

 

[Morsetlis]

^ The answer would be different for different people.

 

[45408]

TheProwler you still have to admit there would most likely be people who aren't competitive enough coming out of medical school to get into a specialty slot who would choose an unpaid specialty spot if it meant they could get into the specialty they wanted.

I don't think it would dilute the specialty significantly, there are already many highly qualified medical students who're just faced with too tight a window for things like radiology or derm.

No, this really still makes NO SENSE AT ALL. Now you want to make paid specialty slots and unpaid specialty slots in the same specialty?

And yes, residency would suck, but thinking long term if you come out making $300,000 it would only realistically take 3 years tops to pay off accumulated debt.

Pre-med math never fails to fail me.

Obviously something would need to be done to cover living expenses in the absence of student loans.

Here's the part where you suggest the government funds that, even though the government didn't have enough money to pay the residents...

Agree. People know what they want to become and will not let debt get in their way. I'll gladly take the hit in order to one day be a urologist.

It's people like you who just hand away everything we've got. Strong work. "Future cuts to specialists? Sure, take all my residency stipend too!"

 

[45408]

You laugh, but there's some thought somewhere (sorry I can't be specific) of allocating funds for 100% paid for medical education and having MDs and DOs pay for residency training by the year with the hope more people will take on less debt and go into the primary care specialties.

I've had 2 attendings mention this to me. I haven't looked for any sources regarding it.

Just because some attendings have supported this idea (which they have) doesn't mean it's not a stupid idea.

 

[gettheleadout]

Just because some attendings have supported this idea (which they have) doesn't mean it's not a stupid idea.

I seriously hope (however unrealistically) that all of this is held at bay until my class is safely finished with residency...

 

[NeuroChris]

According to the AAMC, America faces a shortage of roughly 90,000 physicians in the next 10 years. Roughly half that number in family practice physicians. https://www.aamc.org/download/150584/data/physician_shortages_factsheet.pdf

The government hasn't raised the funding for residencies in the past decade, and it does not seem that will change.

So how does one increase the number of residency slots without increasing the funding?

Well, since the majority of the physician shortage will be concentrated in family practice, the government should work to reverse this trend by reallocating current funds to boost family practice residency salaries. What the number should be I don't know, but above 70,000/year sounds nice enough incentive.

Now for specialty residency slots, since these students will presumably go on to make 2-3 times that of a family practice physician in the private sector, I think it's reasonable to cut the salaries of specialty residencies to zero. Therefore, this should accomplish two things, one it should provide enough funding to boost family practice residency salaries, and it should also allow teaching hospitals to boost the number of slots.

The cost of a specialty residency slot would then be the cost of teaching + educational supply costs. Current funding should presumably then be able to reallocate funds from specialty residency salaries to pay for more teachers + equipment to boost specialty residency slots. The amount of growth might not be explosive, but it should provide at least a few thousand more specialty residency slots a year.

According to AAMC, we need about 9,000 more slots a year over the next ten years to keep up with demand.

So this idea would provide more incentive to students to pursue family practice, and in addition it should create more slots in specialties, thus addressing both issues without increasing government funding for residency slots.

Really this is an issue that needs to be taken up in the 2012 election. Presumably health care is going to be a major issue, and as of yet, I've not heard any candidate talk about how they're going to address the physician shortage.

, You want specialty residents to work for free? wow, what the hell are you smokin?. thats the stupidest thing ive ever heard.👎

 

[UrshumMurshum]

, You want specialty residents to work for free? wow, what the hell are you smokin?. thats the stupidest thing ive ever heard.👎

Ok, then how would you solve the physician shortage crisis? Ideally the straightforward way would be to have the government increase residency funding. They spend roughly in the neighborhood of 8.4 billion dollars annually and this supports the teaching hospital + resident salaries. If you take 3 years being the average residency duration, and roughly 25,000 residents per year, this funding is sufficient to fund roughly 75,000 residents. If you do a proportional increase, 2 billion additional dollars a year should theoretically support roughly 93,000 total residency slots for an increase from 25,000 residency slots to 31,000 residency slots a year. This increase in 6,000 residency slots would be close to covering the 9,000 needed to keep up with the physician shortage.. Really all that's needed from politicians is to approve anywhere in the neighborhood of 2+ billion dollars in increased funding. But then the question becomes, how does this happen? Medicare is already getting cut, and the special committee was designated to cut the government budget. Added to this, there doesn't seem to be any political awareness of the supply side of healthcare.

This. OP: do you really think 45,000 more people are going to go into FP just because you offer them another $10-20k/yr? That might cause one to choose one program over another but not one specialty over another.

No keep in mind that number 45,000 deficient is over a decade long period, so it would actually result in a deficit of 4,500 a year. Even that is a substantial number to cover given the current residency data, but it's not intractable like 45,000 would be.

 

[Bacchus]

Just because some attendings have supported this idea (which they have) doesn't mean it's not a stupid idea.

I know. I think its an awful idea as do these two attendings. Just throwing it out there. Have you heard about it on the "main circuit" at all?

 

[Jarudy]

NP's/PA's seem like a logical way to contribute to a broader solution involving loan forgiveness and possibly increased pay(?) if the problem is as severe as it's made out to be. Couldn't existing loan forgiveness programs be beefed up a bit to compensate? Just a thought

 

[45408]

Ok, then how would you solve the physician shortage crisis? Ideally the straightforward way would be to have the government increase residency funding. They spend roughly in the neighborhood of 8.4 billion dollars annually and this supports the teaching hospital + resident salaries. If you take 3 years being the average residency duration, and roughly 25,000 residents per year, this funding is sufficient to fund roughly 75,000 residents. If you do a proportional increase, 2 billion additional dollars a year should theoretically support roughly 93,000 total residency slots for an increase from 25,000 residency slots to 31,000 residency slots a year. This increase in 6,000 residency slots would be close to covering the 9,000 needed to keep up with the physician shortage.. Really all that's needed from politicians is to approve anywhere in the neighborhood of 2+ billion dollars in increased funding. But then the question becomes, how does this happen? Medicare is already getting cut, and the special committee was designated to cut the government budget. Added to this, there doesn't seem to be any political awareness of the supply side of healthcare.

No keep in mind that number 45,000 deficient is over a decade long period, so it would actually result in a deficit of 4,500 a year. Even that is a substantial number to cover given the current residency data, but it's not intractable like 45,000 would be.

I haven't read a single compelling reason that explains why physicians should be the ones that take all these pay cuts.

Here's a novel idea: if they want more doctors, they can pay for them. Otherwise, they get what they pay for.

 

[Wisdomphilia]

Pre-med math never fails to fail me.

👍

 

[235788]

I haven't read a single compelling reason that explains why physicians should be the ones that take all these pay cuts.

Here's a novel idea: if they want more doctors, they can pay for them. Otherwise, they get what they pay for.

I personally think the pay cuts will trickle down (nurses, na's, etc). Yes the doctors will take a hit, but it wont be as bad as further down the totem pole.

 

[gettheleadout]

I haven't read a single compelling reason that explains why physicians should be the ones that take all these pay cuts.

Here's a novel idea: if they want more doctors, they can pay for them. Otherwise, they get what they pay for.

👍 x 1000

I personally think the pay cuts will trickle down (nurses, na's, etc). Yes the doctors will take a hit, but it wont be as bad as further down the totem pole.

That doesn't at all address the point of his post which was WHY should physicians take the pay cuts? So what if they trickle down to others, when you admit it would be worst for physicians anyway?

 

[45408]

I personally think the pay cuts will trickle down (nurses, na's, etc). Yes the doctors will take a hit, but it wont be as bad as further down the totem pole.

They won't. Cutting nurse wages is like cutting firefighter wages, and you won't cut a nurse's aide's salary. There's no blood in turnips.

 

[BirdIsTheWord]

Or they couldn't match into anything else.

Unfortunately... this is most likely the case. However, family medicine can be very lucrative and rewarding if done in a certain way.

Even if they didn't match into what they wanted, it would still be a great option for them. All physicians share the same goal of helping people, no matter the specialty. Its like playing shortstop when you wanted to play catcher. Either way you are playing the sport you love

 

[Morsetlis]

You don't cut nurses' salaries. There's more of them, and they will strike 😉

 

[JonnyL]

I think not paying residents would actually exacerbate the shortage.

 

[UnclePhil]

And yes, residency would suck, but thinking long term if you come out making $300,000 it would only realistically take 3 years tops to pay off accumulated debt.

Do you actually believe this bull**** that you are writing? 3 years? LOL

 

[deleted390966]

I think it's reasonable to cut the salaries of specialty residencies to zero.

I think you're joking.

Well, even if you have a workable solution, you'll still have make it past your opponents.

 

[gettheleadout]

Even if they didn't match into what they wanted, it would still be a great option for them. All physicians share the same goal of helping people, no matter the specialty. Its like playing shortstop when you wanted to play catcher. Either way you are playing the sport you love

But A) That's your opinion and B) That wasn't the point you made initially which was they are likely satisfied with what they'll make because they knew what they were getting into, which is very clearly not the case 100% of the time.

 

[UnclePhil]

Even if they didn't match into what they wanted, it would still be a great option for them. All physicians share the same goal of helping people, no matter the specialty. Its like playing shortstop when you wanted to play catcher. Either way you are playing the sport you love

It's not really the same thing.

 

[NickNaylor]

Even if they didn't match into what they wanted, it would still be a great option for them. All physicians share the same goal of helping people, no matter the specialty. Its like playing shortstop when you wanted to play catcher. Either way you are playing the sport you love

No, sorry, you're not going to be satisfied with any field of medicine just because you want to help people. That's an incredibly naive way of looking at things.

 

[CodeBlu]

No, sorry, you're not going to be satisfied with any field of medicine just because you want to help people. That's an incredibly naive way of looking at things.

This x1000

 

[BirdIsTheWord]

No, sorry, you're not going to be satisfied with any field of medicine just because you want to help people. That's an incredibly naive way of looking at things.

Okay, so if you wanted to become a cardiologist but instead had no other matches except into FM, you would just be like "you know what, f*ck this. Ima go be a janitor".

Really?

I understand that this is my opinion but would you really hate your job and be that unsatisfied if you did not match into what you wanted?

 

[Charles_Carmichael]

Okay, so if you wanted to become a cardiologist but instead had no other matches except into FM, you would just be like "you know what, f*ck this. Ima go be a janitor".

Really?

I understand that this is my opinion but would you really hate your job and be that unsatisfied if you did not match into what you wanted?

Yes. I would absolutely hate it if I didn't match into the field I wanted to match into. If you don't match into the field you want to match into, you're not still "playing the sport that you love."

 

[gettheleadout]

Okay, so if you wanted to become a cardiologist but instead had no other matches except into FM, you would just be like "you know what, f*ck this. Ima go be a janitor".

Really?

I understand that this is my opinion but would you really hate your job and be that unsatisfied if you did not match into what you wanted?

Being unsatisfied doesn't equate to quitting. Yes, most people will take what they match with, but that absolutely does not mean they will be happy with it.

 

[NickNaylor]

Okay, so if you wanted to become a cardiologist but instead had no other matches except into FM, you would just be like "you know what, f*ck this. Ima go be a janitor".

Really?

I understand that this is my opinion but would you really hate your job and be that unsatisfied if you did not match into what you wanted?

Yes, ignoring your obvious hyperbole. IM isn't surgery isn't dematology isn't radiology. While all specialties fall under the broad umbrella of "medicine," by no means does that mean that the skills required and/or nature of the work are similar.

It's like saying you would be satisfied with a job as a McDonald's "cook" when in reality you want to be a five star chef (or vice versa) because you "like cooking." The two jobs really aren't comparable though they might have some very broad similarities. Maybe an even more apt comparison is being a public defender vs. a prosecuting attorney vs. a defense attorney vs. a high-flying corporate attorney. Sure, they're all lawyers, but their jobs really aren't comparable. If you wanted to be a prosecuting attorney, would you really be happy as a defense attorney?

Most people obviously wouldn't quit because they've spent so much time and money into getting whether they are. But if there were no repercussions for leaving the profession if you didn't want to go into a field you matched in I imagine at least some people would do so.

 

[BirdIsTheWord]

I guess it is just my opinion then which is understandable that you'll have the views that you have. To me, I'm not going go through 4 years or more of undergrad, hundreds of hours studying for tests, spending more than 1000 dollars on the AMCAS in hopes that I get into somewhere, (hopefully) going to a med school of my choosing, spending even more time and money studying and preparing for Step I and other med schools tests, just to be unsatisfied when I don't match into my top choice and regret the rest of my career as a physician

But thats just me

 

[gettheleadout]

I guess it is just my opinion then which is understandable that you'll have the views that you have. To me, I'm not going go through 4 years or more of undergrad, hundreds of hours studying for tests, spending more than 1000 dollars on the AMCAS in hopes that I get into somewhere, (hopefully) going to a med school of my choosing, spending even more time and money studying and preparing for Step I and other med schools tests, just to be unsatisfied when I don't match into my top choice and regret the rest of my career as a physician

But thats just me

You may not know it until it's too late though... You go through rotations and clerkships, fall in love with some field, and if you fail to match into it you end up heartbroken because by that point you could only see yourself there.

 

[BirdIsTheWord]

Thats true, but isn't that why you don't put all of your eggs into one basket?

Like I said, this may be me, but if/when I get to that portion I would probably make a list of my most desired specialties to match (I'm assuming it could work like that. If not, someone please let me know).

 

[Bacchus]

Thats true, but isn't that why you don't put all of your eggs into one basket?

Like I said, this may be me, but if/when I get to that portion I would probably make a list of my most desired specialties to match (I'm assuming it could work like that. If not, someone please let me know).

You can rank multiple specialties, but only if you like them equally. All of it rests on one exam, the COMLEX or USMLE, and that's hard to swallow. The score you receive decides your entire future and its best to make the most of what you can apply to but sometimes the specialties don't just jive with you. There's plenty of reason to be upset. Surgery doesn't equal anesthesiology doesn't equal cardiology doesn't equal family medicine doesn't equal internal medicine. It just doesn't.

 

[NickNaylor]

Thats true, but isn't that why you don't put all of your eggs into one basket?

Like I said, this may be me, but if/when I get to that portion I would probably make a list of my most desired specialties to match (I'm assuming it could work like that. If not, someone please let me know).

You don't (not because it's not possible, but because it's just a bad idea) apply to many different specialties when applying for residency. Our physician advisers, for example, recommend that people apply to only two, MAYBE three (rarely) specialties depending upon the competitiveness of the fields you're interested in; most people only apply to one. In short, it's a very real possibility that you simply may not be able to practice in a field that you're interested in.

 

[235788]

Even if they didn't match into what they wanted, it would still be a great option for them. All physicians share the same goal of helping people, no matter the specialty. Its like playing shortstop when you wanted to play catcher. Either way you are playing the sport you love

haha or your interest lies in human physiology and solving complex issues that are academically stimulating. If I wanted to "help" people i'd become a social worker.

 

[Wolfman89]

sure, but will your family?

You say this now, but when you need to fix your car, and it costs $5000, and you need to pay taxes, health insurance... You'd want to have money no?

You're all saying, you'd be happy with making $0 until you're 30-32 years old....

No one ever said go into medicine for the money, but there's nothing wrong with getting paid to do what you love.

+1000

yes, ignoring your obvious hyperbole. Im isn't surgery isn't dematology isn't radiology. While all specialties fall under the broad umbrella of "medicine," by no means does that mean that the skills required and/or nature of the work are similar.

It's like saying you would be satisfied with a job as a mcdonald's "cook" when in reality you want to be a five star chef (or vice versa) because you "like cooking." the two jobs really aren't comparable though they might have some very broad similarities. Maybe an even more apt comparison is being a public defender vs. A prosecuting attorney vs. A defense attorney vs. A high-flying corporate attorney. Sure, they're all lawyers, but their jobs really aren't comparable. If you wanted to be a prosecuting attorney, would you really be happy as a defense attorney?

Most people obviously wouldn't quit because they've spent so much time and money into getting whether they are. But if there were no repercussions for leaving the profession if you didn't want to go into a field you matched in i imagine at least some people would do so.

+1

 

[235788]

👍 x 1000

That doesn't at all address the point of his post which was WHY should physicians take the pay cuts? So what if they trickle down to others, when you admit it would be worst for physicians anyway?

They shouldn't. Physicians are underpaid. Unfortunately, our buddies across the sea get paid in peanuts and popcorn, and the general public blames our (american) health care system for their poor health and cite their success (limited imo) as reason for reform.

 

[BirdIsTheWord]

You don't (not because it's not possible, but because it's just a bad idea) apply to many different specialties when applying for residency. Our physician advisers, for example, recommend that people apply to only two, MAYBE three (rarely) specialties depending upon the competitiveness of the fields you're interested in; most people only apply to one. In short, it's a very real possibility that you simply may not be able to practice in a field that you're interested in.

Ah, so then (assuming again) I guess if you don't get your favorited match, you can't really apply again. Or can you?

 

[Bacchus]

Ah, so then (assuming again) I guess if you don't get your favorited match, you can't really apply again. Or can you?

If you match you're contractually bound to the program. The only way you "apply again" is if you do a 1-year transitional year or have to scramble because you didn't match.

 

[gravitywave]

it's also worth bearing in mind that no one goes into FM because it was their only option. every US grad has several options to choose from, no matter what their academic record was. I don't care who you are, FM/IM/Peds/Psych/OB are always options for anyone.

so it's a real misrepresentation to say, as several have in this thread, that some go into FM because they had no other choice. it's possible to wind up in a position where some doors are closed to you, yes. but IM for example is an option for everyone, and there's such a huge range of options under the IM umbrella alone that if you can't find one to suit you, then I'd have to wonder about your fitness for medicine to begin with.

 

[gettheleadout]

it's also worth bearing in mind that no one goes into FM because it was their only option. every US grad has several options to choose from, no matter what their academic record was. I don't care who you are, FM/IM/Peds/Psych/OB are always options for anyone.

so it's a real misrepresentation to say, as several have in this thread, that some go into FM because they had no other choice. it's possible to wind up in a position where some doors are closed to you, yes. but IM for example is an option for everyone, and there's such a huge range of options under the IM umbrella alone that if you can't find one to suit you, then I'd have to wonder about your fitness for medicine to begin with.

For the record, when I said earlier that someone may have wound up in a specialty they don't like because they couldn't match into anything else, I wasn't referring specifically to FM.

 

[CodeBlu]

For the record, when I said earlier that someone may have wound up in a specialty they don't like because they couldn't match into anything else, I wasn't referring specifically to FM.

Sounded like you were.

 

[gettheleadout]

Sounded like you were.

For the post I was responding to, yes, but I intended that as a generalization to all less-competitive specialties (FM, IM, Psych) where the pay/lifestyle/etc may not be what the student expected from the specialty they actually wanted.

 

[DoctwoB]

Just because some attendings have supported this idea (which they have) doesn't mean it's not a stupid idea.

Of course the specialty attendings support the idea. It doesn't affect them. The much more likely alternative, that specialty salaries will trend downwards and primary care will either stagnate or trend downwards is much worse for them.

 

[DoctwoB]

they should just pay FP more than specialists through medicare etc. What an FP does is more valuable in my opinion since it's prevention and real health..not open heart bypass. w\e though lol rant

Nevermind the fact that specialists get 1-7 additional years of residency training w/ extremely hard work at low salary. Just from this, specialists deserve to be paid more, though the gap should be less than what it is today.

 

[45408]

they should just pay FP more than specialists through medicare etc. What an FP does is more valuable in my opinion since it's prevention and real health..not open heart bypass. w\e though lol rant

Even if it is more valuable, it doesn't mean they should get paid more. Doing open heart surgery is more stressful, more technically demanding, and requires a lot more training than managing hypertension in an outpatient.

It's more valuable to keep the oil changed regularly in your car for a few bucks here and there, but it doesn't mean that you won't have to pay $3000 to re-build your engine if your engine seizes when there's a problem with the oil.

 

[Alejandro]

It's the diamond water paradox-for those of you who studied econ...Even though something like water is so important to our health and survival, a diamond has a market value that is ridiculously higher than water.

I think I made some rough calculations about a state-supported loan forgiveness program for GPs: I think to fund that would require every citizen in my state to pay 7 dollars/year. For Alabama, the number was like 4 dollars/year.

Small amount relative to a paycheck, but still nobody is willing to pay for it nonetheless.

I would argue that even if you had more providers, the funding mechanism is still too poor to produce comprehensive care for patients. I doubt having more doctors will disincentify them to take less appointments per day. the payment scheme is so inadequate that doctors will still take like 20+ appts a day + 7-15 minute appointments...so YES you've solved a physician shortage, but i wouldn't argue that you've IMPROVED CARE.

People still need to make money.

Though I do have a question: Do you think this could be improved by better selecting individuals to serve in underserved areas? Like those who have a sincere interest in rural/urban medicine? Yes there are program out there, but it's debatable on how effective they are, depending on the school.

 

[theseeker4]

It's the diamond water paradox-for those of you who studied econ...Even though something like water is so important to our health and survival, a diamond has a market value that is ridiculously higher than water.

I think I made some rough calculations about a state-supported loan forgiveness program for GPs: I think to fund that would require every citizen in my state to pay 7 dollars/year. For Alabama, the number was like 4 dollars/year.

Small amount relative to a paycheck, but still nobody is willing to pay for it nonetheless.

I would argue that even if you had more providers, the funding mechanism is still too poor to produce comprehensive care for patients. I doubt having more doctors will disincentify them to take less appointments per day. the payment scheme is so inadequate that doctors will still take like 20+ appts a day + 7-15 minute appointments...so YES you've solved a physician shortage, but i wouldn't argue that you've IMPROVED CARE.

People still need to make money.

Though I do have a question: Do you think this could be improved by better selecting individuals to serve in underserved areas? Like those who have a sincere interest in rural/urban medicine? Yes there are program out there, but it's debatable on how effective they are, depending on the school.

Anyone who has been paying attention to the medical school applications process for any time should realize how easy it is to fake interest in rural/urban medicine/primary care etc. Combine that with how many people change their minds through the 4 years of medical school and 3-10 years post-graduate training, and there is no entry-level method for getting more doctors to go into primary care. After eating **** for the better part of a decade during their education and training, who here can blame doctors for wanting to go into a specialty they are most interested in, and getting paid well for it too? If you want more primary care physicians, you have to pay them more. If reimbursements continue to be cut, you will continue to see less doctors interested in it.

 

[Handinhand]

It scares me how naive the majority of pre-med & even med students are when it comes to the business/economic side of medicine. Maybe we should start requiring pre-meds work for 2-3 years after undergrad before coming to medical school so they can develop some economic understanding and see how the real world works.

There's really only one option that will solve the physician shortage. The general public actually taking a positive interest in the medical field. You'd think that peoples' health would be the absolute most important thing to someone, but that's hardly how it is. Nobody wants to think about giving any kind of stimulus to physicians because those greedy bastards already make $1 million a year and all drive porsches, right? If anything, the general opinion of the public is to cut physician reimbursement year after year, all the while it costs more and more every year to actually become a physician.

 

[sanityonleave]

random blathering

Pre-meds: can you guys pretty, pretty please stop trying to "fix" the healthcare system until you're actually working and have the faintest clue what you're talking about? Thanks!

 

[IlDestriero]

Pre-meds: can you guys pretty, pretty please stop trying to "fix" the healthcare system until you're actually working and have the faintest clue what you're talking about? Thanks!

Yes. Let the politicians handle it. They're the real experts.

 

[BirdIsTheWord]

Yes. Let the politicians handle it. They're the real experts.

And why not! They have done a great job already