do NOT go Caribbean + relevant statistics

[allantois]

1) Number of US graduates:

in 2015: 24,020 (18705 MD and 5314 DO)
in 2019: 26,760 (20630 MD and 7246 DO)
-based on the number of first year students enrolled in the fall of 2015 MINUS 4% attrition

2) Number of residencies:

in 2015: 29,428 PGY-1 positions
-27293 ACGME plus 2135 AOA
in 2019: ?
- We will have two trends at work here. First, is the natural expansion of ACGME residencies that has occurred every year. However, the second one is the loss of some AOA residencies that will occur due to GME merger. One thing is certain: due to AOA residency loss, the overall growth will be lower than usual and will probably increase only marginally, if at all.
______________________

What we have is a huge expansion of DO programs. AOA has not been able to accommodate for this growth by increasing their number of residencies. Their solution (and ultimately a bet) was to merge with ACGME with the hopes of increasing the prospects of matching osteopathic students by relying on the "gap" that exists between residency positions and number of US graduates (6300 in 2015). Going forward there will be even more US graduates as both LCME and especially COCA have a bunch of new schools seeking accreditation.

3) Citations
- Fall 2015 enrollement:
https://www.aamc.org/newsroom/newsreleases/446400/applicant-and-enrollment-data.html
http://www.aacom.org/docs/default-source/data-and-trends/2015prelimenrollrpt.pdf?sfvrsn=12
- Number of residencies:
http://www.nrmp.org/wp-content/uploads/2015/12/First-Year-GME-in-the-US-2015.pdf

TLDR - number of residencies is staying the same. By 2020, IMGs may very well find themselves with only half of today's positions that are left for them to fill.

EDITED to include received feedback

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[deleted731525]

Actually the number of residencies do increase every year. It still falls behind growth of students, but I dont think it will be as drastic of a change until around 2024. Also I think the surplus currently is only around 6000. Here is a link http://www.nejm.org/doi/full/10.1056/NEJMp1511707?query=TOC&&

 

[DetectiveAlonzo]

Oh great.... here we go again.

 

[IslandStyle808]

Oh great.... here we go again.

To be fair assessment of matching is better done by looking at the amount of spots to the amount of graduates. Better than showing the NRMP report that shows 50% of graduates from Caribbean schools match, which is pretty much useless in gauging the first time matching of FMGs/IMGs.

Unfortunately, this information is nothing new so I have to agree with you...

 

[allantois]

Actually the number of residencies do increase every year. It still falls behind growth of students, but I dont think it will be as drastic of a change until around 2024. Also I think the surplus currently is only around 6000. Here is a link http://www.nejm.org/doi/full/10.1056/NEJMp1511707?query=TOC&&

I don't like the article; the author basically argues that we don't need any more GME expansion (with which I agree). I think he overestimates GME growth and underestimates school expansion while totally ignoring the merger.

To be fair assessment of matching is better done by looking at the amount of spots to the amount of graduates. Better than showing the NRMP report that shows 50% of graduates from Caribbean schools match, which is pretty much useless in gauging the first time matching of FMGs/IMGs.

Unfortunately, this information is nothing new so I have to agree with you...

We always advice students to stay in the US because things are going to get worse. I wanted to put precise numbers on the problem, and what I found is different reports projecting different data.

However, the ACTUAL data is that in 2015 there were 29,428 PGY-1 positions for 24,019 graduates.

http://www.nrmp.org/wp-content/uploads/2015/12/First-Year-GME-in-the-US-2015.pdf

And in 2019, there will be 27,876 graduates (minus attrition)

 

[IslandStyle808]

I don't like the article; the author basically argues that we don't need any more GME expansion (with which I agree). I think he overestimates GME growth and underestimates school expansion while totally ignoring the merger.

We always advice students to stay in the US because things are going to get worse. I wanted to put precise numbers on the problem, and what I found is different reports projecting different data.

However, the ACTUAL data is that in 2015 there were 29,428 PGY-1 positions for 24,019 graduates.

http://www.nrmp.org/wp-content/uploads/2015/12/First-Year-GME-in-the-US-2015.pdf

And in 2019, there will be 27,876 graduates (minus attrition)

EDIT MADE: Made mistake on calculations have to divide by 10 for the years. The numbers come out accurately after this.

I actually agree with you more so than the article. In fact, that article is horribly written.

http://www.nejm.org/doi/full/10.1056/NEJMp1511707?query=TOC&&

First statement: "between 2004–2005 and 2013–2014, the number of filled entry-level GME positions grew from 24,982 to 28,962, an increase of 3980 positions, or a 1.66% annual rate of growth."

This sentence is wrong in a whole lot of ways. First off how is 24,982 to 28,962 an increase of 1.66%? Here is what a 1.66% growth rate looks like 24,982 * 1.0166 = 25,396 spots NOT 28,962. The second thing is that he is looking at spots filled and not total amount of spots. This tell us not much about the squeeze, because there are also spots that went unmatched.

Second statement: "During the same period, the number of U.S. graduates with M.D. and D.O. degrees grew from 18,542 to 22,960, an increase of 4418, or a 2.40% annual growth rate."

This sentence is also wrong. An increase of 18,542 to 22,960 graduates is not an increase of 2.40%, it is an increase of 24%. In 2014, there were 18,073 MD graduates and 5,263 DO graduates (23,336 total in 2014, not 18,542).

https://www.aamc.org/download/321532/data/factstableb2-2.pdf
https://www.osteopathic.org/inside-...014-osteopathic-medical-profession-report.pdf

Don't want to correct the entire article its just too much effort. How did this even get published.


In the end, it will be difficult to predict how many spots will survive this merger. Your right in that, at best the same amount of spots will still be there. However, GME could increase more to match this crunch. Only the future will tell.

 

[DetectiveAlonzo]

Let's just get @the argus in here for old times sake.

I love his opinions.

Jumpman jumpman jumpman that boy's up to somethin'!

 

[deleted731525]

Let's just get @the argus in here for old times sake.

I love his opinions.

Jumpman jumpman jumpman that boy's up to somethin'!

lol, SDN is a flat circle.

 

[deleted564680]

Real loss of AOA programs will be 40-50%. 30% is too low IMO. Only about ~170 of the ~860 programs have filed for pre-accreditation and they need to do so by Dec. 2017. Also, about 55 of those 170 programs have MD program directors now. Specialty loss will be > 50% in some fields. We will know that info this year since all 5 year programs need to submit by June 30th this year. 4 year programs will submit by Dec. 2016 and 3 year programs by Dec. 2017.

Also, not to burst any bubbles about the IMG/FMG thing, but just because there is a 3000-5000 "gap" between how many spots and how many applicants, doesn't mean that they fill preferentially MD > DO > FMG/IMG. There are a lot of programs (especially East Coast) that will fill IMG/FMG > DO. The AOA is in for an earful when the first combined match has a DO match rate ~85%.

The solution is not more GME. It is growing at a pace it needs to grow and continues to do so. The problem is DO schools opening up every other weekend in old strip malls while adding 50-100 students to current class sizes when they already had too many students to begin with.

 

[allantois]

Real loss of AOA programs will be 40-50%. 30% is too low IMO. Only about ~170 of the ~860 programs have filed for pre-accreditation and they need to do so by Dec. 2017. Also, about 55 of those 170 programs have MD program directors now. Specialty loss will be > 50% in some fields. We will know that info this year since all 5 year programs need to submit by June 30th this year. 4 year programs will submit by Dec. 2016 and 3 year programs by Dec. 2017.

Also, not to burst any bubbles about the IMG/FMG thing, but just because there is a 3000-5000 "gap" between how many spots and how many applicants, doesn't mean that they fill preferentially MD > DO > FMG/IMG. There are a lot of programs (especially East Coast) that will fill IMG/FMG > DO. The AOA is in for an earful when the first combined match has a DO match rate ~85%.

The solution is not more GME. It is growing at a pace it needs to grow and continues to do so. The problem is DO schools opening up every other weekend in old strip malls while adding 50-100 students to current class sizes when they already had too many students to begin with.

DO schools will graduate ~2000 more students in 2019 (for a total of over 7000) than they did in 2015, while AOA only has ~2000 non-prelim positions. They had no choice, but to merge with ACGME as they are obviously relying on MD residency programs to accommodate for their growth. Interestingly, if you look into AACOM reports, they've been very proud of this unprecedented growth in school enrollment and showing no signs of it slowing down.

 

[deleted564680]

Yeah well, they are wrong to tout the growth as success when many of these schools provide sub-standard education, especially during the clinical years. We would be much better off if they fixed the schools we have now and restricted class sizes to maintain quality. Some of the DO schools now are worse than caribbean schools with rotations and have curriculums solely focused on board exams. As a proud DO, this sickens me and just provides fodder to the MD side that we as a whole are not as well trained in medical school.

 

[TheaterOfTheme]

Good data. Thanks for the post. Boy...I am questioning DO more and more because of this merger.

 

[IslandStyle808]

Yeah well, they are wrong to tout the growth as success when many of these schools provide sub-standard education, especially during the clinical years. We would be much better off if they fixed the schools we have now and restricted class sizes to maintain quality. Some of the DO schools now are worse than caribbean schools with rotations and have curriculums solely focused on board exams. As a proud DO, this sickens me and just provides fodder to the MD side that we as a whole are not as well trained in medical school.

The way that DO schools do rotations have made me sick to my stomach. They don't pay for rotations and those attendings that teach for them are not always rewarded (no professorship, tenure, etc.). Its like volunteer work for them. Can you image what would happen with those osteopathic residency programs that become allopathic decide its not worth it to ally themselves with osteopathic schools. It would mean a loss of residency based rotations and would push osteopathic students further into preceptor based ones. This merger could be a nightmare.

 

[the argus]

this is not good data, it is riddled with errors and presumption based in nothing.

Let's just get @the argus in here for old times sake.

I love his opinions.

Jumpman jumpman jumpman that boy's up to somethin'!

Well, I guess since you asked for it...

1) Number of US graduates:

in 2015: 24,019 (18705 MD and 5314 DO)
in 2019: 27,876 (20630* MD and 7246** DO)
-based on the number of first year students enrolled in the fall of 2015

2) Number of residencies:

in 2015: 32,756 (fewer are PGY-1***)
-30,212 ACGME plus 2544**** AOA
in 2019: same or less
- As you probably know, AOA and ACGME are merging into one GME; in the process some AOA residencies will be lost (up to 30% by some estimates). Thus, the number of positions by 2020 will at best(!) stay at around current levels.
______________________

So, we have: 16% growth in the number of US medical graduates by the year 2019 (3857 more students), while the number of residencies will either stagnate or even contract. Currently, ~8600***** NRPM positions go to IMGs and FMGs. The only way for the system to accommodate the new-coming US graduates is to squeeze out foreign-trained students. Thus, the number of positions available to them will be ~half of what it is today in just 5 years (this affects anyone who hasn't started med school yet!).

My estimates are for the year 2019. However, going forward there will be even more US graduates; for instance COCA already accredited 1 more program to start this year and 2 next year (both are satellite campuses of existing schools). This is not even accounting for the increases in class sizes plus both LCME and especially COCA have a bunch of new schools seeking accreditation.

3) Citations:
https://www.aamc.org/newsroom/newsreleases/446400/applicant-and-enrollment-data.html
http://www.aacom.org/docs/default-source/data-and-trends/2015prelimenrollrpt.pdf?sfvrsn=12
http://www.nrmp.org/wp-content/uploads/2015/12/First-Year-GME-in-the-US-2015.pdf
http://www.aacom.org/docs/default-source/data-and-trends/2015-match-report.pdf
http://www.nrmp.org/press-release-n...ency-match-record-number-of-positions-filled/

TLDR - number of residencies is staying the same, while an increase of 4k US graduates is expected by 2020; think long and hard before deciding to attend med school offshore.

I don't even know where to start with this mess.

1) Number of US graduates. If you are gonna use the number enrolled in 2015 for the 2019 grad numbers, then you also have to use the enrolled in 2011 for the 2015 grad numbers, not the actual grad numbers. If you don't, you're being inconsistent with attrition, which is actually significant and matters.
in 2015: 25,018 = 19,230 USMD + 5,788 DO
in 2019: 27,850 = 20,631 USMD + 7,219 DO
So your actual increase in enrollment is 2,832, not 3,857. Off by 1,000. That's only an 11% increase, not 16%.
http://www.aacom.org/docs/default-source/data-and-trends/AppEnrollGrad2011-2016.pdf?sfvrsn=9
https://www.aamc.org/download/321462/data/factstablea4.pdf

2) This whole section is just basically nonsense and presumption. Saying 30% of DO residencies will be lost is based on nothing. And its ~6,300 NRMP positions currently going to IMGs, not ~8,600.

These estimates are based on a poor analysis of incorrect data and lots of presumptions not really based in anything. People are allowed to believe what they want to believe. Personally, I'll go with the authors published in the NEJM over random dude on SDN...

 

[the argus]

I actually agree with you more so than the article. In fact, that article is horribly written.

http://www.nejm.org/doi/full/10.1056/NEJMp1511707?query=TOC&&

First statement: "between 2004–2005 and 2013–2014, the number of filled entry-level GME positions grew from 24,982 to 28,962, an increase of 3980 positions, or a 1.66% annual rate of growth."

This sentence is wrong in a whole lot of ways. First off how is 24,982 to 28,962 an increase of 1.66%? Here is what a 1.66% growth rate looks like 24,982 * 1.0166 = 25,396 spots NOT 28,962. The second thing is that he is looking at spots filled and not total amount of spots. This tell us not much about the squeeze, because there are also spots that went unmatched.

Second statement: "During the same period, the number of U.S. graduates with M.D. and D.O. degrees grew from 18,542 to 22,960, an increase of 4418, or a 2.40% annual growth rate."

This sentence is also wrong. An increase of 18,542 to 22,960 graduates is not an increase of 2.40%, it is an increase of 24%. In 2014, there were 18,073 MD graduates and 5,263 DO graduates (23,336 total in 2014, not 18,542).

https://www.aamc.org/download/321532/data/factstableb2-2.pdf
https://www.osteopathic.org/inside-...014-osteopathic-medical-profession-report.pdf

Don't want to correct the entire article its just too much effort. How did this even get published.


In the end, it will be difficult to predict how many spots will survive this merger. Your right in that, at best the same amount of spots will still be there. However, GME could increase more to match this crunch. Only the future will tell.

Annual rate of growth man, annual. Those percentages are per year.

The authors are very correct with their math, something the OP can certainly not claim (not surprising he also liked your extremely error riddled post).

 

[IslandStyle808]

Annual rate of growth man, annual. Those percentages are per year.

The authors are very correct with their math, something the OP can certainly not claim (not surprising he also liked your extremely error riddled post).

You're correct.

 

[allantois]

this is not good data, it is riddled with errors and presumption based in nothing.

Well, I guess since you asked for it...

I don't even know where to start with this mess.

1) Number of US graduates. If you are gonna use the number enrolled in 2015 for the 2019 grad numbers, then you also have to use the enrolled in 2011 for the 2015 grad numbers, not the actual grad numbers. If you don't, you're being inconsistent with attrition, which is actually significant and matters.
in 2015: 25,018 = 19,230 USMD + 5,788 DO
in 2019: 27,850 = 20,631 USMD + 7,219 DO
So your actual increase in enrollment is 2,832, not 3,857. Off by 1,000. That's only an 11% increase, not 16%.
http://www.aacom.org/docs/default-source/data-and-trends/AppEnrollGrad2011-2016.pdf?sfvrsn=9
https://www.aamc.org/download/321462/data/factstablea4.pdf

2) This whole section is just basically nonsense and presumption. Saying 30% of DO residencies will be lost is based on nothing. And its ~6,300 NRMP positions currently going to IMGs, not ~8,600.

These estimates are based on a poor analysis of incorrect data and lots of presumptions not really based in anything. People are allowed to believe what they want to believe. Personally, I'll go with the authors published in the NEJM over random dude on SDN...

The 6300 IMG figure is correct, making my analysis even more dire

So while I might have not accounted for attrition (on which I later commented); I didn't quite notice the way NRPM reported the number of foreign students (absolute in terms of FMGs, but a percentage of US IMGs). The way all these organizations report data is so convoluted that I at least wanted to provide some starting point for people to start thinking about this issue. You know, many prefer raw data to personal anecdotes that get cited here.

And as this thread shows, how many AOA residencies survive the merger is a matter of belief and there is no analysis done by anyone on that. I stand by my assertion that things will get much worse for IMGs very fast and I think that point is very important to repeat as we are still getting threads from people asking whether they should go Caribbean every week.

 

[the argus]

The 6300 IMG figure is correct, making my analysis even more dire

So while I might have not accounted for attrition (on which I later commented); I didn't quite notice the way NRPM reported the number of foreign students (absolute in terms of FMGs, but a percentage of US IMGs). The way all these organizations report data is so convoluted that I at least wanted to provide some starting point for people to start thinking about this issue. You know, many prefer raw data to personal anecdotes that get cited here.

And as this thread shows, how many AOA residencies survive the merger is a matter of belief and there is no analysis done by anyone on that. I stand by my assertion that things will get much worse for IMGs very fast and I think that point is very important to repeat as we are still getting threads from people asking whether they should go Caribbean every week.

That's fine, you're allowed to believe what you wanna believe. You should just be very upfront that your assertions about DO residencies being lost are based on nothing but your gut feeling, with no data whatsoever to back it up.

It also just makes very little sense logically. The idea that US GME would actually DECREASE the number of physicians being trained is pretty unlikely. Yes, certain programs may close, but that doesn't mean those positions would be lost. The more likely scenario would be that they are folded into a pre-existing program, or a new program is created. Residents are usually integral to the functioning of a hospital, and it just wouldn't work to completely just lose those positions.

 

[deleted731525]

Actually the number of residencies do increase every year. It still falls behind growth of students, but I dont think it will be as drastic of a change until around 2024. Also I think the surplus currently is only around 6000. Here is a link http://www.nejm.org/doi/full/10.1056/NEJMp1511707?query=TOC&&

So since there was some debate about the accuracy of this projection, I thought I would look to see how accurate it has been so far with it's projected GME totals. The NRMP data for the 2016 match: http://www.nrmp.org/wp-content/uploads/2016/03/Advance-Data-Tables-2016_Final.pdf , shows a total pg1 of 27860. https://natmatch.com/aoairp/stats/2016prgstats.html shows 3229 osteopathic positions. That gives a total of 31,089. The article projected around 30,000(maybe a little bit under or over as far as I can tell from the graph) for this year. That being said the total number of osteopathic positions is probably off because the link I used doesnt differentiate between pg1 and pg2 positions as far as I can tell. Either way, given that the vast majority of DO programs are in primary care I dont think accounting for that would change things enough to alter the main point that it seems that so far the article is actually slightly underestimating GME growth.

Edit: Something else I just realized is that there are some dual accredited programs. Even if we only use the number of students "matched" via the osteopathic match which is 2255(which probably underestimates the projection?) we get a total of 30,115 which would put the author right on the money.

Im sure I messed up somewhere so feel free to point out any mistakes.