Bad Outlook for Future Foreign Grads

[Westardly]

I recently sat in with a few of the deans from my school when the issue of future physician shortages was brought up and what was being done to address this issue. US schools have been asked to increase their admissions by up to 30% over the next few years. When asked about training positions for the increase in new US graduates, they said the initial plan is to replace spots filled by foreign graduates in existing US residencies with US grads. This would be the first step until more residency programs can be created. Of course the physician shortage problem will not be solved until PG training positions are increased, however this was stated as the overall plan.

I personally dont think this is the best plan. I would hope for more training positions to open before increasing admission, but this is not the case. Apparently there is a lot that goes into to creating residencies and this process will take more time than simply upping admission.

If I were considering foreign med school, I would certainly look into this. A person would probably be safe this year since I don't think the schools have increased admissions yet, but this could be a potential issue in the very near future.

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[SabaMed]

Yeah I agree if your in now as a FMG your safe.

 

[utorontograd]

Looks like a bottleneck is on it's way. What school are you at westwardly?

 

[oldpro]

I recently sat in with a few of the deans from my school when the issue of future physician shortages was brought up and what was being done to address this issue. US schools have been asked to increase their admissions by up to 30% over the next few years. When asked about training positions for the increase in new US graduates, they said the initial plan is to replace spots filled by foreign graduates in existing US residencies with US grads. This would be the first step until more residency programs can be created. Of course the physician shortage problem will not be solved until PG training positions are increased, however this was stated as the overall plan.

I personally dont think this is the best plan. I would hope for more training positions to open before increasing admission, but this is not the case. Apparently there is a lot that goes into to creating residencies and this process will take more time than simply upping admission.

If I were considering foreign med school, I would certainly look into this. A person would probably be safe this year since I don't think the schools have increased admissions yet, but this could be a potential issue in the very near future.

This is old news, it was put out over a year ago and yes there are 2 new schools that will be built.

Premeds tend to panic over these things, and yes US Medschools love to "Pick on FMG's but the truth is good residencies are going to FMG's too, it's not simply go to a US school and you will get any resedency you want, you also have to do well on the steps and present your self well too. Some US students do not do well at both.

Also the shortage shows no end in sight, as far as programs they will increase the spots if they can fill them, for now some of the residency programs still go unfilled.

 

[McGillGrad]

What you really mean to say is that the outlook is not good for sub par foreign grads that have managed to score residency positions that would otherwise go unfilled. This is good news for good Carib graduates because it helps to remove the small percentage of awful physicians that make the rest look bad.

Now if we could only weed them out of US med schools, too. There are far more 'dangerous' MD's coming from US/Canadian medical schools and there always will be because medical school attracts these types of people. This is the same reason why only 99% of lawyers give the rest a bad name.

 

[erichaj]

First I just want to say that this myth about a shortage of doctors is just a myth.

It should be stated that there is a shortage of doctors in Rural areas. There is not shortage of doctors around the corner from me in a big city.

Rural and inner city areas have always had a shortage of doctors. Increasing the number of medical students will not solve this problems. If someone does not want to go to a rural area, they won't.

By increasing the number of medical school slots in the US they will decrease the number of FMGs going to Ross, SGU, or AUC.

Those so called "Good" FMG students will not have to be FMGs becasue they will get into a US program.

When I went to Ross there was alway a fear that somehow the US would decrease the number of residency slots overall. This never happened. I will won't happen because the popullation of the United States is rising and the baby boomer are starting to peek.

Some of those rural areas will no longer be so rural in a few years. I can see that happening in my area. What used to be farmland 10 years ago, is now a full on city.

So, If you can take the MCAT and do relatively well or if your grades are good enough you will get into a medical school. If you are planning to go to an offshore school you better do it in the next year or so.

Anyway, The more doctors that are out there, the less mid-levels we will need. This will make it better for doctors and raise the level of care.

 

[oldpro]

First I just want to say that this myth about a shortage of doctors is just a myth.

It should be stated that there is a shortage of doctors in Rural areas. There is not shortage of doctors around the corner from me in a big city.

Rural and inner city areas have always had a shortage of doctors. Increasing the number of medical students will not solve this problems. If someone does not want to go to a rural area, they won't.

By increasing the number of medical school slots in the US they will decrease the number of FMGs going to Ross, SGU, or AUC.

Those so called "Good" FMG students will not have to be FMGs becasue they will get into a US program.

When I went to Ross there was alway a fear that somehow the US would decrease the number of residency slots overall. This never happened. I will won't happen because the popullation of the United States is rising and the baby boomer are starting to peek.

Some of those rural areas will no longer be so rural in a few years. I can see that happening in my area. What used to be farmland 10 years ago, is now a full on city.

So, If you can take the MCAT and do relatively well or if your grades are good enough you will get into a medical school. If you are planning to go to an offshore school you better do it in the next year or so.

Anyway, The more doctors that are out there, the less mid-levels we will need. This will make it better for doctors and raise the level of care.

Shortage of DOctors is not a myth, it has been documented??? Why do you say there is not a shortage? I know of thousands of nurses and yet there is a nursing shortage??? You can't live in your little world thinking thats how the rest of the world is. Have you ever changed health plans and try to sign up with a new Doc? Well in some areas it's next to impossible to find one that takes "New Patients" I really think you should do research before you post such uninformed opinion. One more note, the average age of the largest portion of the population of the USA is getting older, that means soon the elderly, IE: retired nonworking folks, will keep getting larger, so Practicing Physicians are older and getting older, most do not practice till 70 they retire younger, whats going to happen when they do?

 

[erichaj]

Shortage of DOctors is not a myth, it has been documented??? Why do you say there is not a shortage? I know of thousands of nurses and yet there is a nursing shortage??? You can't live in your little world thinking thats how the rest of the world is. Have you ever changed health plans and try to sign up with a new Doc? Well in some areas it's next to impossible to find one that takes "New Patients" I really think you should do research before you post such uninformed opinion. One more note, the average age of the largest portion of the population of the USA is getting older, that means soon the elderly, IE: retired nonworking folks, will keep getting larger, so Practicing Physicians are older and getting older, most do not practice till 70 they retire younger, whats going to happen when they do?

I have done my research. I'm also in it not standing outside making opinions. As I understand it you were kicked out of your program. So maybe you can get out of your little world. But I did not write the post to get into a pissing match with some guy on the net.

If you go to any large city, you will see that there are plenty of doctors taking new patient.

They may not be taking the new patients your thinking off. Like, Medicare and medicaid. They may be Selective of the health plans they are taking.
This is done because many insurance companies don't pay very well. So, it's not the shortage of Doctors, it's the decrease in availabilty and distribution of doctors.

When the older physicians retire the younger ones will take their place. The number of physicians finishing medical school and those retiring is about the same.

I believe Jama had an article several months ago on this topic.

It is supply and demand. Just because some people have to wait to see a doctor does not mean that there is a shortage. It means the supply and demand curve of economics is working.

One more important note. We have one of the best, tehcnologically advanced healthcare systems in the world, but We have one of the worst delivery systems.

Which means that increasing the number of doctors will not change the delivery sytem. Improving reimbursement rates will. If a primary care doctor gets 20 dollars to see a complicated medicaid patient, he won't want to see many of them. He won't be able to keep his practice open.

 

[oldpro]

I have done my research. I'm also in it not standing outside making opinions. As I understand it you were kicked out of your program. So maybe you can get out of your little world. But I did not write the post to get into a pissing match with some guy on the net.

If you go to any large city, you will see that there are plenty of doctors taking new patient.

They may not be taking the new patients your thinking off. Like, Medicare and medicaid. They may be Selective of the health plans they are taking.
This is done because many insurance companies don't pay very well. So, it's not the shortage of Doctors, it's the decrease in availabilty and distribution of doctors.

When the older physicians retire the younger ones will take their place. The number of physicians finishing medical school and those retiring is about the same.

I believe Jama had an article several months ago on this topic.

It is supply and demand. Just because some people have to wait to see a doctor does not mean that there is a shortage. It means the supply and demand curve of economics is working.

One more important note. We have one of the best, tehcnologically advanced healthcare systems in the world, but We have one of the worst delivery systems.

Which means that increasing the number of doctors will not change the delivery sytem. Improving reimbursement rates will. If a primary care doctor gets 20 dollars to see a complicated medicaid patient, he won't want to see many of them. He won't be able to keep his practice open.

Man you really need to get things straight! I WAS NOT KICKED OUT OF ANY PROGRAM EVER. I'm a second year MD student.

I have exams this week and have no time to post the proof but there is a Physcian shortage in the USA and you are just making yourself look bad here.

You are the one who posted the blinded: "in my city there are lots of Doctors" post.

I have worked as a an RN in over 5 cities in over 4 states and RURAL and I can tell you the shortage in real. By the way I'm reporting your attack on me it is unfounded and not very Mature. Good tactic to sling mud though to take people off the facts.

Better check your sources

 

[erichaj]

Man you really need to get things straight! I WAS NOT KICKED OUT OF ANY PROGRAM EVER. I'm a second year MD student.

I have exams this week and have no time to post the proof but there is a Physcian shortage in the USA and you are just making yourself look bad here.

You are the one who posted the blinded: "in my city there are lots of Doctors" post.

I have worked as a an RN in over 5 cities in over 4 states and RURAL and I can tell you the shortage in real. By the way I'm reporting your attack on me it is unfounded and not very Mature. Good tactic to sling mud though to take people off the facts.

Better check your sources

Report it. All they have to do is look at your post to me.

By the way, since you are a MEDICAL "STUDENT", you ignorance is forgiven.

 

[Methodnike]

When the older physicians retire the younger ones will take their place. The number of physicians finishing medical school and those retiring is about the same.

.

Exactly. If it is about the same number, the shortage of physicians will be astronomical. We need A LOT MORE new physicians finishing medical school than those retiring because of the aging population and the increase of the overall population.

 

[erichaj]

Exactly. If it is about the same number, the shortage of physicians will be astronomical. We need A LOT MORE new physicians finishing medical school than those retiring because of the aging population and the increase of the overall population.

I did a yahoo search on articles about "physician shortage". All the articles I read are titled physician shortage. However, when you start reading the articles they all fall back and state that the so called shortage is more of a maldistribution.

Two issues kept coming up.

1. The maldistribution of physicians. Few in inner cities and rural areas and too many in big cities etc.

2. The physicians that do exist in any area seem to not want to accept insurance providers that have poor reimbursements. Like: Medicare, Medicaid, and some private insurance. Due this fact, many people that are insured can't find a physician that takes their insurance. so this is not really a shortage of the overall number of physicians.

To be fair the articles did state that there will be a shortage of some specialties BUT again they went on to state that this "shortage" is becasue of the above problems. For example some docs are not taking call in the ER so ER docs have a hard time finding a specialist when they need one.

This is a reflection of the bigger problem with healthcare in the United States.

So, creating a ton of more doctors will not solve the real problem in healthcare. We need some new doctors, but what we really need is to correct the pay schedules and the malpractice problems.

If you have a bunch of new doctors that don't take the same insurance companies in thier office you end up with the same problems of maldistribution but you now have more doctors doing the same thing.

Physican Shortage is a poor choice of wording. It masks the real problems.

 

[oldpro]

I did a yahoo search on articles about "physician shortage". All the articles I read are titled physician shortage. However, when you start reading the articles they all fall back and state that the so called shortage is more of a maldistribution.

Two issues kept coming up.

1. The maldistribution of physicians. Few in inner cities and rural areas and too many in big cities etc.

2. The physicians that do exist in any area seem to not want to accept insurance providers that have poor reimbursements. Like: Medicare, Medicaid, and some private insurance. Due this fact, many people that are insured can't find a physician that takes their insurance. so this is not really a shortage of the overall number of physicians.

To be fair the articles did state that there will be a shortage of some specialties BUT again they went on to state that this "shortage" is becasue of the above problems. For example some docs are not taking call in the ER so ER docs have a hard time finding a specialist when they need one.

This is a reflection of the bigger problem with healthcare in the United States.

So, creating a ton of more doctors will not solve the real problem in healthcare. We need some new doctors, but what we really need is to correct the pay schedules and the malpractice problems.

If you have a bunch of new doctors that don't take the same insurance companies in thier office you end up with the same problems of maldistribution but you now have more doctors doing the same thing.

Physican Shortage is a poor choice of wording. It masks the real problems.

SO what you are saying is if you are rich and have the right kind of insurance then there are plenty of Doctors and no shortage, but if you live in the rural areas, ( about 80% of the area of the USA) and or you do not have the RIGHT kind of insurance then you do see a shortage. Huh seems very unethical and unprofessional to me, we are to treat regardless of ability to pay.

This is why I'm going rural and I will make a good living seeing the needy, it's the best reason to become a Doc I can think of. BTW you still made my point there is a shortage, if there are Docs unwilling to do a job there is a shortage in that area, hence a shortage, I love the logic SDN people use to win an argument. A shortage is a shortage no matter how you try to ignor it, BTW Medicare and Medicaid is a significant number of people along with the underinsured, in fact it may be in numbers reaching over half the people in the USA. So you are telling me that Doctors are only treating half the population of the USA? WOW.

 

[erichaj]

SO what you are saying is if you are rich and have the right kind of insurance then there are plenty of Doctors and no shortage, but if you live in the rural areas, ( about 80% of the area of the USA) and or you do not have the RIGHT kind of insurance then you do see a shortage. Huh seems very unethical and unprofessional to me, we are to treat regardless of ability to pay.

This is why I'm going rural and I will make a good living seeing the needy, it's the best reason to become a Doc I can think of. BTW you still made my point there is a shortage, if there are Docs unwilling to do a job there is a shortage in that area, hence a shortage, I love the logic SDN people use to win an argument. A shortage is a shortage no matter how you try to ignor it, BTW Medicare and Medicaid is a significant number of people along with the underinsured, in fact it may be in numbers reaching over half the people in the USA. So you are telling me that Doctors are only treating half the population of the USA? WOW.

Where does it say "we are to treat regardless of ability to pay". I did not see that in US constitution. Did I miss something. Can someone point out that statement in the constitution.

Your statement implies that we are obligated to do that. WE CHOOSE TO DO IT.

A Shortage is only a shortage when there is not enough doctors available.

Don't blame is not the doctors. stop being a victim. the blame is the insurance companies and what they do to cause physicians to not work with them. then the victims become doctors and patients.

Maldistribution Oldpro, not shortage.

PS. 80% of doctors are not in 20% of the US like you are suggesting.

 

[McGillGrad]

Don't blame is not the doctors. stop being a victim. the blame is the insurance companies and what they do to cause physicians to not work with them. then the victims become doctors and patients.

The insurance companies are not to blame (excluding HMOs) because there is room for insurance companies to make money while providing physicians with a financial impetus for 11-15 years of post-secondary education to earn 150k per year.

The blame is mostly upon trial lawyers (due to a lack of tort reform) and venomous patients that blame physicians for their in/actions. High malpractice insurance premiums caused by the fear of frivolous litigation are the culprit.

Even though the US may have 2.7 practicing physicians per 1000 people, the number of primary care physicians is far below sustainable levels. We have plenty of specialists in the large cities (mainly in the northeast) but there will be a shortage of PC physicians as the large baby boomer cohort of doctors retire and the rest of the baby boomer cohort require more and more medical attention as they near their 60s-70s.

All in all, this topic is far too premature for anyone entering medical school for the next 5-10 years due to the lag in entering medical school and finishing residency.

Residency spots will only be affected in a decade (if they will be affected at all), so I do not see what the big hoopla is all about.

 

[rahulazcom]

Yes, new schools will open but more residency positions will be created too. I have read about the need for more primary care residencies to open especially in underserved areas. Also, consider there are many primary care residencies that go unfilled every year. I wouldn't be too worried for the near future. There are enough spots to go around. I myself am very interested in primary care so this is good news for me.

 

[oldpro]

Where does it say "we are to treat regardless of ability to pay". I did not see that in US constitution. Did I miss something. Can someone point out that statement in the constitution.

Your statement implies that we are obligated to do that. WE CHOOSE TO DO IT.

A Shortage is only a shortage when there is not enough doctors available.

Don't blame is not the doctors. stop being a victim. the blame is the insurance companies and what they do to cause physicians to not work with them. then the victims become doctors and patients.

Maldistribution Oldpro, not shortage.

PS. 80% of doctors are not in 20% of the US like you are suggesting.

Are you or have been to medschool? ETHICS! Where does it say only treat the RICH?
What kind of a person thinks that only the right kind of people should be cared for? Right insurance, RIght social status ect? This is not political but man, we are supposed to be a caring group. We all deserve care and have a right to it, I see where you are going but you are blind to reasons to be a Doctor, We can aurge till the cows come home but a healthy nation is a strong nation, right now there is a major crisis in America and it needs to be fixed as I said the Elderly are going to increase about 3 fold in just a couple of years. Then they will not have health insurance but medicare. We are going to have people clogging the ER's due to no Doctors to care for them.

I'm not a victim I will help in the solution. People who believe this dribble that its someone elses fault for not having the the right social status or the right job or the right IQ (how many below 80 people are in the high paying jobs?) deserve the good health care? WHO MADE US GOD?

PS the major cities are only 20 to 30% of the USA? How do you think it's more than that? (I'm counting the metero ares too)
Are you trying to say that 50% of the USA is a city/metro area?

 

[erichaj]

Are you or have been to medschool? ETHICS! Where does it say only treat the RICH?
What kind of a person thinks that only the right kind of people should be cared for? Right insurance, RIght social status ect? This is not political but man, we are supposed to be a caring group. We all deserve care and have a right to it, I see where you are going but you are blind to reasons to be a Doctor, We can aurge till the cows come home but a healthy nation is a strong nation, right now there is a major crisis in America and it needs to be fixed as I said the Elderly are going to increase about 3 fold in just a couple of years. Then they will not have health insurance but medicare. We are going to have people clogging the ER's due to no Doctors to care for them.

I'm not a victim I will help in the solution. People who believe this dribble that its someone elses fault for not having the the right social status or the right job or the right IQ (how many below 80 people are in the high paying jobs?) deserve the good health care? WHO MADE US GOD?

PS the major cities are only 20 to 30% of the USA? How do you think it's more than that? (I'm counting the metero ares too)
Are you trying to say that 50% of the USA is a city/metro area?

I'm a board certified physician that is WAY ahead of you. Lets see 2 more years left in medical school then residency and then you will still be new.

But to get to your points. I did not say don't treat them and I did not say only the rich should get treated. YOU keep stating that I said those things.

I feel that there is a better way to bring healthcare to people than simply increase the numbers of doctors. It's called efficiency.

I know you were a nurse for several years, but just like you said that medical school is not like nursing school, medical school is not real life either.

Its important that you are formulating ideas and trying to come up with solutions, but first of all insulting me is not going to help you, next your only solution to the problem so far has been:

1. More docotors
2. See all the patients.

Neither of the above will improve healthcare as a system. They may help. But you can only see so many patients (remember you have to pay the bills to keep a practice open). AND, the lower the reimbursements are from insurance the more you will have to see. What are you going to do, have 50 office visits per day.

As I understand it, you don't even want to do that, you want to work for a hospice doing palliative care. That kind of takes out of the mix.

We can have this debate all day long and you can make accusation all day long. But if you open you eyes and stick to the facts you will see that you
simple answer to a complex problem is not going to work.

 

[oldpro]

While I understand your points, I do not agree with all that you have said, I do like discussions though and thank you for making it clear what you are posting here, I try to do the same, it's the only way to change and grow ideas. It is better if we debate and not always agree to stimulate new ideas. ( just no mud slinging) SO I'm sorry iask if you went to medschool I did not mean to insult you, I didn't know.

One thing I think we both agree on is the system is broken.

I'm not very liberal in most areas except this one. My feeling on this is very vry controversal. I think we need to throw out Medicalre, Medicaid and HMO's and primary insurance. Then install unversal insurance, allow private supplemental policies and for Physcians to choose to accept both. My wife and I lived in the UK for a year and she did get supplemental Health insurance besides the "Free" health care we got. Taxes? Why would they be more? This supplemental would cost the same or less than it does now. Medicare is filled with fraud as is Medicade and overspending on administration and underspending on the real care. I think the proganda machine in the USA is alive and well telling Americans it cant work? Why could it not?
If they would consult Physicians in helping and we embrace this and help set the fess to realistic levels why would it not be a good thing?
The working could pay more into the system as a sliding scale based on such a Tax I think you would pay less for the premiums than now.

It's just my Idea and I know it's imperfect but so is the mess we are in now.

 

[erichaj]

While I understand your points, I do not agree with all that you have said, I do like discussions though and thank you for making it clear what you are posting here, I try to do the same, it's the only way to change and grow ideas. It is better if we debate and not always agree to stimulate new ideas. ( just no mud slinging) SO I'm sorry iask if you went to medschool I did not mean to insult you, I didn't know.

One thing I think we both agree on is the system is broken.

I'm not very liberal in most areas except this one. My feeling on this is very vry controversal. I think we need to throw out Medicalre, Medicaid and HMO's and primary insurance. Then install unversal insurance, allow private supplemental policies and for Physcians to choose to accept both. My wife and I lived in the UK for a year and she did get supplemental Health insurance besides the "Free" health care we got. Taxes? Why would they be more? This supplemental would cost the same or less than it does now. Medicare is filled with fraud as is Medicade and overspending on administration and underspending on the real care. I think the proganda machine in the USA is alive and well telling Americans it cant work? Why could it not?
If they would consult Physicians in helping and we embrace this and help set the fess to realistic levels why would it not be a good thing?
The working could pay more into the system as a sliding scale based on such a Tax I think you would pay less for the premiums than now.

It's just my Idea and I know it's imperfect but so is the mess we are in now.

I have given much thought to universal insurance. AND believe me I'm not in any way a fan of Private insurance or medicare or medicaid. Just read some of my other posts about them.

I just wonder if we do univeral insurance if it won't just turn out to be another medicare. Lots of room for corruption there.

I don't think it cant be done. It very possible, the only thing we have to make sure of is that this time, ITS THE DOCTORS THAT MAKE THE CHOICES NOT THE MBAs AND THE GOVT. BULL SH ** T.

I like the sliding scale idea. If you could set a minimum standard of care and set a fee for that then anything else would be like buying a car or going out to eat. If you want air conditioning then you pay more. But the basic part should be able to take care of things like major hospital stays and a heart attack to name a couple. the sliding scale part comes in when you want for example all of your office visits covered.

I don't know if you agree with this but I believe that the majority of the cost of medicine in the US is not from doctor OFFICE visits. It's from hospital stays and the cost of certain treatments like chemotherapy and things like that. So, if we focous on changing that and reducing that cost, the 65 dollar office visit every couple of months is not going to break the bank.

 

[oldpro]

I have given much thought to universal insurance. AND believe me I'm not in any way a fan of Private insurance or medicare or medicaid. Just read some of my other posts about them.

I just wonder if we do univeral insurance if it won't just turn out to be another medicare. Lots of room for corruption there.

I don't think it cant be done. It very possible, the only thing we have to make sure of is that this time, ITS THE DOCTORS THAT MAKE THE CHOICES NOT THE MBAs AND THE GOVT. BULL SH ** T.

I like the sliding scale idea. If you could set a minimum standard of care and set a fee for that then anything else would be like buying a car or going out to eat. If you want air conditioning then you pay more. But the basic part should be able to take care of things like major hospital stays and a heart attack to name a couple. the sliding scale part comes in when you want for example all of your office visits covered.

I don't know if you agree with this but I believe that the majority of the cost of medicine in the US is not from doctor OFFICE visits. It's from hospital stays and the cost of certain treatments like chemotherapy and things like that. So, if we focous on changing that and reducing that cost, the 65 dollar office visit every couple of months is not going to break the bank.

Also it is from the cost of Covering you r A$$ its all I heard of through out my nursing career, and I already know about the pain in the a$$ chart review Nurses "Quality review" they call It LOL, there's so much I would cut it's not funny.

 

[flighterdoc]

Are you or have been to medschool? ETHICS! Where does it say only treat the RICH?
What kind of a person thinks that only the right kind of people should be cared for? Right insurance, RIght social status ect? This is not political but man, we are supposed to be a caring group. We all deserve care and have a right to it, I see where you are going but you are blind to reasons to be a Doctor, We can aurge till the cows come home but a healthy nation is a strong nation, right now there is a major crisis in America and it needs to be fixed as I said the Elderly are going to increase about 3 fold in just a couple of years. Then they will not have health insurance but medicare. We are going to have people clogging the ER's due to no Doctors to care for them.

I'm not a victim I will help in the solution. People who believe this dribble that its someone elses fault for not having the the right social status or the right job or the right IQ (how many below 80 people are in the high paying jobs?) deserve the good health care? WHO MADE US GOD?

PS the major cities are only 20 to 30% of the USA? How do you think it's more than that? (I'm counting the metero ares too)
Are you trying to say that 50% of the USA is a city/metro area?

I've been to med school (and honored ethics, BFD). Have you ever been to the REAL WORLD? Are you prepared to live up to your idealism? To go $150+K in debt, and not get paid? EM physicians are not paid by anybody for approximately 30% of the people they treat, yet they accept the liability of every patient contact.

If you are forced (either by the state, or your own morals) to provide the benefit of your effort to others for no compensation, you're either a Saint, or a slave.

Even the hippocratic oath only says that you work on patients, not everyone ("...into who's house I go...."). You are not obliged to work on everybody, under any circumstances.

 

[oldpro]

I've been to med school (and honored ethics, BFD). Have you ever been to the REAL WORLD? Are you prepared to live up to your idealism? To go $150+K in debt, and not get paid? EM physicians are not paid by anybody for approximately 30% of the people they treat, yet they accept the liability of every patient contact.

If you are forced (either by the state, or your own morals) to provide the benefit of your effort to others for no compensation, you're either a Saint, or a slave.

Even the hippocratic oath only says that you work on patients, not everyone ("...into who's house I go...."). You are not obliged to work on everybody, under any circumstances.

Yep I been there done that, Worked as a Hospice RN for 9 years and RN 17 years total. Plan on Rural practice FP already have an offer. Who said anything about no compensation? The discussion was over the Rich and tha poor INSURED. The other Doc does not like Medicare nor Medicaid reimbersment. Still get paid just not what you would like. I do agree the reimbersment should be the average for the service and if not then that is wrong but fewe people have no payor source. I worked in the public health side of this I really do know about insurance and you are right they are messed up.

But to not accept Medicare and Medicaid patients is just not what I will do in my practice. It is just not right in my opinion. I will still get paid just not as much as some insurance company, I'm not becoming a Doctor to become wealthy.

 

[DiverDoc]

Ericaj, your ignorance terrifies me.

 

[erichaj]

Ericaj, your ignorance terrifies me.

If your going to make some stupid comment at least have the balls to back it up with something. It is obvious that you are some first year med student who does not know sh ** t.

 

[rahulazcom]

Based on what I have read in this thread, I tend to side with Dr.Raj. I think it's easy to label people as being uncompassionate but I would ask people to show patience. I'm sure your views will change as your progress through your medical career. I have a long way to go still and my views have drastically changed in the last 2 years alone.

Yes, I understand that it is our obligation to treat people in need. At the same time, medicare has an obligation to fairly compensate a physician based on his or her services and can't simply pay whatever they feel like which is the current case. A physician's only real defense against medicaid is to refuse to accept their patients until they make improvements to their system. There will never be any motivation to improve their system if every physician willingly accepts whatever medicaid pays and sees anyone. Furthermore, we all assume people who are on medicare can't afford health insurance when the reality is that many people don't put an emphasis on their health care in lieu of other expenditures such as entertainment. So where doe the patient's responsibility lay in regards to providing their health insurance? It's just too easy to assume that every uninsured person is someone who can't afford health insurance.

I don't think it's a black or white issue and I can understand how many physicians would choose not to deal with medicaid patients for reasons other than lower reimbursement such as the hassles endured in collections, the uncompliant patient populations, the abusers of the system etc.

 

[rahulazcom]

Based on what I have read in this thread, I tend to side with Dr.Raj. I think it's easy to label people as being uncompassionate but I would ask people to show patience. I'm sure your views will change as your progress through your medical career. I have a long way to go still and my views have drastically changed in the last 2 years alone.

Yes, I understand that it is our obligation to treat people in need. At the same time, medicare has an obligation to fairly compensate a physician based on his or her services and can't simply pay whatever they feel like which is the current case. Furthermore, we all assume people who are on medicare can't afford health insurance when the reality is that many people don't put an emphasis on health care in lieu of other expenditures such as entertainment. So where doe the patient's responsibility lie in regards to providing their health insurance?

I don't think it's a black or white issue and I can understand how many physicians would choose not to deal with medicaid patients for reasons other than lower reimbursement such as the hassles endured in collections, the uncompliant patient populations, the abusers of the system etc. Personally, I don't know what I will do. I wrestle with this idea from time to time. I didn't enter medicine to make money. I had a great job prior to medical school so the idea of selectively treating sets of people disturbs me. But as previously mentioned, I'm still young and naive in my training and I may feel drastically different as I experience and learn more information regarding a career in medicine.

 

[erichaj]

I've been to med school (and honored ethics, BFD). Have you ever been to the REAL WORLD? Are you prepared to live up to your idealism? To go $150+K in debt, and not get paid? EM physicians are not paid by anybody for approximately 30% of the people they treat, yet they accept the liability of every patient contact.

If you are forced (either by the state, or your own morals) to provide the benefit of your effort to others for no compensation, you're either a Saint, or a slave.

Even the hippocratic oath only says that you work on patients, not everyone ("...into who's house I go...."). You are not obliged to work on everybody, under any circumstances.

In a family practice office, even with A GOOD INSURANCE BASE you end up writing off a substantial part of your billings. The insurance companies denies your charges just so that they can force you to work harder to get the money for the the patients you have seen.

Imagine showing up to work, working and then your boss tells you, buddy you worked for 8 hours but today I'm only going to pay you for 6. When you ask why, you get no answer. Really, thats what happens with insurance companies. that is the what all you pre meds and medical students are heading towards. I'm not making any of this up.

So, I feel deeply for someone who has cancer (or something similar) and has to mortgage his house just to pay for his treatment. That is not right. But at the same time, if I can't keep my practice open because I work 60 hours per week and still can't make the payments to keep a practice going, that is not right either. (That last statement is true for soooo many doctors right now as I write this post). It is a fact.

So we can talk about all these issues, but the bottom line is that even the guy with cancer want to be paid when he goes to work.

 

[TexasFool]

This 30% increase will fall short of maintaining the current shortage levels. In about 10 years after the increases are in effect (most schools will take 10 years to get there) the need for doctors will have increased by more then 30% and I bet anything residency programs will be pulling in FMG without any trouble.

 

[oldpro]

Based on what I have read in this thread, I tend to side with Dr.Raj. I think it's easy to label people as being uncompassionate but I would ask people to show patience. I'm sure your views will change as your progress through your medical career. I have a long way to go still and my views have drastically changed in the last 2 years alone.

Yes, I understand that it is our obligation to treat people in need. At the same time, medicare has an obligation to fairly compensate a physician based on his or her services and can't simply pay whatever they feel like which is the current case. A physician's only real defense against medicaid is to refuse to accept their patients until they make improvements to their system. There will never be any motivation to improve their system if every physician willingly accepts whatever medicaid pays and sees anyone. Furthermore, we all assume people who are on medicare can't afford health insurance when the reality is that many people don't put an emphasis on their health care in lieu of other expenditures such as entertainment. So where doe the patient's responsibility lay in regards to providing their health insurance? It's just too easy to assume that every uninsured person is someone who can't afford health insurance.

I don't think it's a black or white issue and I can understand how many physicians would choose not to deal with medicaid patients for reasons other than lower reimbursement such as the hassles endured in collections, the uncompliant patient populations, the abusers of the system etc.

Thing is this boiled down to the biggest Shortage of Physicians being in the area where Medicare and Medicaid and HMO insurance is for most of the Patient base. It bloomed out of the 1st post on the thread the commented that Phsycian shortage is misslabeled, while I still think there is a shortage, nether the less this is a real issue and I think on topic.

As physicians do we and must we accept all payer sources for our care?

For me, my personal belief is YES I Will. But this is the USA and we all have a right to practice the way we want to and I do understand that insurance payments limit how a Patient is treated, and Patients just about never want to spend a dime on extra and at times HMO's will not allow the "Extra" if you want to be paid by them. Yes it's not right, thats why the system is broken! Medicare has rules about extra too. So what do we do? I do not have an easy answer, but I do know if you do not do something to rectify it soon, all he$$ is going to break loose with the baby boomers all over 65!

 

[CatsandCradles]

If I were considering foreign med school, I would certainly look into this. A person would probably be safe this year since I don't think the schools have increased admissions yet, but this could be a potential issue in the very near future.

Well, hold on a minute there. I've been floating around on SDN for sometime now, so I reading that about 15-20% of FP positions go unfilled each year. And I would still think that there are plenty of unfilled IM positions as well. Further more the population of America is growing, we passed 300,000 million this month. There is going to be a physician shortage. And not to long ago this country had to get nurses from South Korea and Eastern Europe, so that's a growing need as well.

Also bear in mind that it may take several years, actually many years before the US schools can make that 30%. It takes a whole lot of work to accredit a school or secure an expansion of class size of a school. By that time things are going to change and I wouldn't be suprised if we still had a sizeable number of unfilled seats even.

 

[cooldreams]

This 30% increase will fall short of maintaining the current shortage levels. In about 10 years after the increases are in effect (most schools will take 10 years to get there) the need for doctors will have increased by more then 30% and I bet anything residency programs will be pulling in FMG without any trouble.

we should be expanding, and becoming more efficient. the mayo is a GREAT example of doing more work with few docs... more efficent....

 

[///M5]

I heard that PAs are going to pick up the slack for some of the underserved areas, ie FP, rural, inner cities, CAID/CARE can abuse them easier. But theyve porably been saying that for years.

whats everyones opinion on this?

 

[oldpro]

I heard that PAs are going to pick up the slack for some of the underserved areas, ie FP, rural, inner cities, CAID/CARE can abuse them easier. But theyve porably been saying that for years.

whats everyones opinion on this?

PA's and NP's are not MD or DO and care must be overseen by these professionals since they are the only ones Licensed to Practice Medicine at a High level.

 

[sbturnisback]

Follow your dream. Nothing can stop you! Best wishes!

 

[neurodoc]

The main "problem" with US medical education is that it does not graduate enough US MDs/DOs to fill the annual needs of US residency programs, not to mention the general US need for physicians. That's why we have so many residency positions "left over" that must be matched with FMGs. That's also why we have so many NPs/PAs that need to serve as "physician extenders" (makes me think of "Hamburger Helper").

The best way to fix this "problem" would be to drastically increase US med school enrollment. It is a shame that we can't become "self-sufficient" by training enough physicians for owr country's needs. Of course we could, if we had the political will to do so. Don't count on that happening any time soon.

 

[2easy]

You can see quite easily who the medical students are and the practicing physicians in this thread.

The medical students want to save the world. Idealistic. Unrealistic. Ignorant.

Talk to you losers in a couple years, after you've been sued, after you've seen your 600th non paying scumbag in the ER who want more narcotics, after you've received dozens and dozens of checks from insurance with $0.00 in it, after your malpractice carrier informed you they are raising your premiums by 75% next year.........

Bwahahahahahaha!

 

[Faebinder]

There is no shortage of physicians... don't fool yourselves.... There is a shortage of physicians who are willing to get paid 90k and 80k a year for doing a job that requires medical school and residency training.

If I offered you 100k a year to work full time as an FM doc and do the entire scope from top to bottom of what an FM doc does and even take calls and everything else.... would anyone take it after all this training? Well I guess we are short on physicians then who would take this job. (plenty of low paying jobs out there for licensed physicians looking for a taker.

Erichaj is correct... don't be quick to dismiss someone telling you their experience..

Everyone here is probably too early in their career to go look at www.nrmp.org last year match statistics... go see how residency spot numbers did not change but US seniors, DO docs both increased. Last year was the worst match season ever..... this year is predicted to be worse. Less and less spots are open post match every year indicating there is an intense fight for the positions available.. Just go scan the SDN forums down below and look at the sub-spedcialties... go look at Radiology and EM and see how the program directors tell you that they have 20-40 applicants more than last year. Go see nrmp positions and you will note that the overall number is not changing.

 

[billydoc]

There is no shortage of physicians... don't fool yourselves.... There is a shortage of physicians who are willing to get paid 90k and 80k a year for doing a job that requires medical school and residency training.

If I offered you 100k a year to work full time as an FM doc and do the entire scope from top to bottom of what an FM doc does and even take calls and everything else.... would anyone take it after all this training? Well I guess we are short on physicians then who would take this job. (plenty of low paying jobs out there for licensed physicians looking for a taker.

Erichaj is correct... don't be quick to dismiss someone telling you their experience..

Everyone here is probably too early in their career to go look at www.nrmp.org last year match statistics... go see how residency spot numbers did not change but US seniors, DO docs both increased. Last year was the worst match season ever..... this year is predicted to be worse. Less and less spots are open post match every year indicating there is an intense fight for the positions available.. Just go scan the SDN forums down below and look at the sub-spedcialties... go look at Radiology and EM and see how the program directors tell you that they have 20-40 applicants more than last year. Go see nrmp positions and you will note that the overall number is not changing.

Yep, I totally agree with you. The shortage is to find "suckers" who would do more for less. BTW as an RN I see the same thing. After "downsizing" all these health conglamirates want you to do the job of what four ppl used to do. So the shortage is to fill the place long enough before one quits, and to eplace it with another sucker, who idealistically thinks it's going to be different for him/her. If some supplemental tax-free / deferred system of medical saving / spending accounts is not implemented, and some kind of a tort reform is not done....I'm afraid we aint seen nothing yet They gonna bring Hillary as a "savior" of the healthcare, and then Hello Socialism. But she won't pick up the tab for your med school debt.

 

[Faebinder]

They gonna bring Hillary as a "savior" of the healthcare, and then Hello Socialism. But she won't pick up the tab for your med school debt.

And that scares the living crap out of me....

 

[oldpro]

You can see quite easily who the medical students are and the practicing physicians in this thread.

The medical students want to save the world. Idealistic. Unrealistic. Ignorant.

Talk to you losers in a couple years, after you've been sued, after you've seen your 600th non paying scumbag in the ER who want more narcotics, after you've received dozens and dozens of checks from insurance with $0.00 in it, after your malpractice carrier informed you they are raising your premiums by 75% next year.........

Bwahahahahahaha!

Yes there are many problems I say "KILL THE LAWERS!" the system needs an overhaul and Docs need to get together and practice as "FIRMS ie: Clinics" not on there own, insurance companies give better rates to groups then individuals. But we need Caps on suits, there is a limit to how much an injury is worth, and many times Jury awards to a case cause of emotion not to facts.

 

[SabaMed]

There is no shortage of physicians... don't fool yourselves.... There is a shortage of physicians who are willing to get paid 90k and 80k a year for doing a job that requires medical school and residency training.

If I offered you 100k a year to work full time as an FM doc and do the entire scope from top to bottom of what an FM doc does and even take calls and everything else.... would anyone take it after all this training? Well I guess we are short on physicians then who would take this job. (plenty of low paying jobs out there for licensed physicians looking for a taker.

Erichaj is correct... don't be quick to dismiss someone telling you their experience..

Everyone here is probably too early in their career to go look at www.nrmp.org last year match statistics... go see how residency spot numbers did not change but US seniors, DO docs both increased. Last year was the worst match season ever..... this year is predicted to be worse. Less and less spots are open post match every year indicating there is an intense fight for the positions available.. Just go scan the SDN forums down below and look at the sub-spedcialties... go look at Radiology and EM and see how the program directors tell you that they have 20-40 applicants more than last year. Go see nrmp positions and you will note that the overall number is not changing.

This is a semi-serious question, are you on crack? Because that's the only way I can figure how you interputed the matching as of recently. There were actually 100's of spots that went UNFILLED last year. Thats correct UNFILLED! Now your saying that Rads and EM had more applicants than spots? YES, always more applicants than spots for those, been that way for years, those are some of the most sought after specialties. I'm talking about overall spots, FM, IM, Psyc and Peds had a ton of openings. Maybe take another look or put down the pipe?

 

[oldpro]

.......... the only way I can figure how you interputed the matching as of recently. There were actually 100's of spots that went UNFILLED last year. Thats correct UNFILLED! Now your saying that Rads and EM had more applicants than spots? YES, always more applicants than spots for those, been that way for years, those are some of the most sought after specialties. I'm talking about overall spots, FM, IM, Psyc and Peds had a ton of openings. Maybe take another look or put down the pipe?

I support this ( except for the first part but it made me laugh)

 

[Faebinder]

This is a semi-serious question, are you on crack? Because that's the only way I can figure how you interputed the matching as of recently. There were actually 100's of spots that went UNFILLED last year. Thats correct UNFILLED! Now your saying that Rads and EM had more applicants than spots? YES, always more applicants than spots for those, been that way for years, those are some of the most sought after specialties. I'm talking about overall spots, FM, IM, Psyc and Peds had a ton of openings. Maybe take another look or put down the pipe?

Do you always talk without evidence?

Here lemme slap some reality for you...

Here are the nrmp statisitics... Let us examine them...

Last year there was a total of 21,659 PGY 1 positions (forget the PGY 2 cause obviously you still need a PGY 1 to go into 2)...

Flip to page 3.... at the bottom

TOTAL APPLICANTS = 33,534 (lets take out the people who withdrew)
TOTAL ACTIVE APPLICANTS for 2006.. 26,715

DO YOU SEE A PROBLEM? Do you just like arguing? There are effectively 5,000 people extra applying over the total number of PGY-1 positions in 2006.

All these people passed Step 1 and 2 and are eligible to work in the US.

Lets look at how many unmatched people total in 2006... right underneath it.

Total is 6,643 people... of that 949 are US students and 658 are US physicians that graduated last year but didnt match or maybe decided to change careers... effective is 1,607 US students/graduates (no these are not the IMGs or FMGs or the DOs or the Fifth Pathways).

So what did all the 1,607 US MDs and 5,036 FMG+IMG+DO+FifthPathway try to scramble for? Scroll down to page 7... it's at the bottom.. there was 620 PGY-1 spots open after the 2006 match for all applicants..

Translation.... 1 position for each 10 scrambling applicants.

Next time you want to talk crap to someone bring some evidence.

 

[SabaMed]

Do you always talk without evidence?

Here lemme slap some reality for you...

Here are the nrmp statisitics... Let us examine them...

Last year there was a total of 21,659 PGY 1 positions (forget the PGY 2 cause obviously you still need a PGY 1 to go into 2)...

Flip to page 3.... at the bottom

TOTAL APPLICANTS = 33,534 (lets take out the people who withdrew)
TOTAL ACTIVE APPLICANTS for 2006.. 26,715

DO YOU SEE A PROBLEM? Do you just like arguing? There are effectively 5,000 people extra applying over the total number of PGY-1 positions in 2006.

All these people passed Step 1 and 2 and are eligible to work in the US.

Lets look at how many unmatched people total in 2006... right underneath it.

Total is 6,643 people... of that 949 are US students and 658 are US physicians that graduated last year but didnt match or maybe decided to change careers... effective is 1,607 US students/graduates (no these are not the IMGs or FMGs or the DOs or the Fifth Pathways).

So what did all the 1,607 US MDs and 5,036 FMG+IMG+DO+FifthPathway try to scramble for? Scroll down to page 7... it's at the bottom.. there was 620 PGY-1 spots open after the 2006 match for all applicants..

Translation.... 1 position for each 10 scrambling applicants.

Next time you want to talk crap to someone bring some evidence.

Here's the data for ALL applicants page 7.
TOTAL - PGY1 3382 21659 195967 9 20072 92.7 620
21659 positions were offered to ALL APPLICANTS! 20072 were filled and accepted and 620 were left unfilled. You reading this or smoking on that pipe again? 7.3% were still left unfilled even after all the FMG's got matched, now isn't that something? What's the reason why some grads didn't get matched, it might be because #1 they picked the wrong specialty and #2 didn't have the scores to get a residency. The simple fact is if you have the scores you can get a residency and from my school there hasn't been anyone that didn't get a residency.
NOW PUT DOWN THAT PIPE!

 

[Faebinder]

Here's the data for ALL applicants page 7.
TOTAL - PGY1 3382 21659 195967 9 20072 92.7 620
21659 positions were offered to ALL APPLICANTS! 20072 were filled and accepted and 620 were left unfilled. You reading this or smoking on that pipe again? 7.3% were still left unfilled even after all the FMG's got matched, now isn't that something? What's the reason why some grads didn't get matched, it might be because #1 they picked the wrong specialty and #2 didn't have the scores to get a residency. The simple fact is if you have the scores you can get a residency and from my school there hasn't been anyone that didn't get a residency.
NOW PUT DOWN THAT PIPE!

After all the foreign graduates matched? Obviously you ignored the fact on page 3 that said half the US foreign graduates didn't match.. those 1204 people gonna scramble on 620 spots vs 5439 people, of which more than a thousand are new US MD.

Scores will definitely make you one of the 50% that matched if you apply to the right specialty for your score... but it aint getting better that's for sure... look at the trend ... more and more people are unmatched in every catagory including US foreign grads... it's only a matter of time before the US med schools push towards accepting their grads first before accepting foreigns..

You can keep hoping it's rosey and pretty all you want... the data is there.. and if you are scrambling... you better have some damn good scores.

I'm gonna quit arguing with you.. the data is there... the link is there.. you can chose to ignore what I said all you want.. it doesn't matter. I am sure you will pick your career regardless of the data.

 

[oldpro]

The only point I have is the Grads have to qualify also, some do not US and FMG, some have lousy scores and cannot get the residency they want in the places they want, some programs DO go unfilled I know of many FP programs that cut positions because year after year there are no grads to fill them.