DO Residency Shortage

[GypsyHummus]

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Hello everyone,
I am trying to get a better grip on the DO residency placement rates and where medical graduates end up.
I know that many of the AOA residencies have some negatives, mostly from what I have heard are locations and quality, but at least they are residencies.
But I have found out something that worries me
It looks like there are not enough DO residencies to fulfill the amount of students graduating. I know that this is a legitimate problem for other health professionals such as International med grads and podiatry students, but will DO students have to worry about finding a job after medical school?
I personally have a friend who went podiatry and she is graduating this year. She is worried that she wont match, and this is after 200K worth of debt. Will that ever happen to DO grads?
I know that if you graduate from an MD school, if you pass everything you are guaranteed a residency. Granted it might be in an undesirable location or specialty, but you are able to have a job. Is this the same for DOs, and if so, will it change?

 

[Flemon]

DOs do very well in the match, I think ~90% match while 94% of MDs match (Not 100% sure on those numbers and they don't include the scramble. Based on HockeyDr09's data.). As they are able to both apply to ACGME (MD) and AoA (DO) residencies it is not that big of a deal for DOs. I think, in the future the problems will fall on international and Carib grads, as US grads will be more preferred as the number of available residency spots decreases. As for the claim that AoA residencies are not on par with ACGME I am not sure how valid that is, but I am sure one of the super DO students on this board can answer that for you. Good luck with your choices.
Just my 2 cents I may be wrong.
http://forums.studentdoctor.net/showthread.php?t=813819&page=6 (Scroll half way down the page for DO match data)

 

[SoulinNeed]

The future will be hard for FMG and IMG graduates. Things will get a bit tougher for DO's, as well, but DO's currently have about a 90% match rate (DO+ACGME residency). As far as the shortage of DO spots, yeah it's there, but a good chunk go unfilled every year, and I think people should wait to see what happens, before worrying. Especially since the ACGME seems to be looking to implement a new system that may make residencies shorter.

 

[Wolverines83]

The future will be hard for FMG and IMG graduates. Things will get a bit tougher for DO's, as well, but DO's currently have about a 90% match rate (DO+ACGME residency). As far as the shortage of DO spots, yeah it's there, but a good chunk go unfilled every year, and I think people should wait to see what happens, before worrying. Especially since the ACGME seems to be looking to implement a new system that may make residencies shorter.

You can't just throw that in there at the end and not elaborate....

 

[SpecterGT260]

I believe that is referring to the system where you graduate based on merit rather than time. I don't know how seriously that is being considered....

 

[LesBois88]

Hello everyone,
I know that if you graduate from an MD school, if you pass everything you are guaranteed a residency. Granted it might be in an undesirable location or specialty, but you are able to have a job. Is this the same for DOs, and if so, will it change?

this is not technically correct.

 

[Drrrrrr. Celty]

this is not technically correct.

I believe last year a few people failed to even scramble. So, you're not guaranteed anything, but as a graduate or a US MD or DO school it is unlikely you'll fail to match.

 

[Oo Cipher oO]

You can't just throw that in there at the end and not elaborate....

click here for the info on the new accreditation system.

 

[Dharma]

Especially since the ACGME seems to be looking to implement a new system that may make residencies shorter.

Specter hit it on the head. The new accreditation standards seem to be geared toward maximizing quality of training and implementing methods of accountability that will allow for a higher degree of transparency. I just read the NEJM special report on this, and there was not any mention of making residencies shorter. Regarding financial burden the following was mentioned:

Finally, although accreditation must be sensitive to the burden it creates on programs, institutions, and individuals, it would be dangerous to expect accreditation to reduce its expectations to accommodate the host of other pressures on the system of physician training. Any move to create a reductionist model of accreditation to avoid burdening the system may further erode public support for physician education and public trust in the physicians the system produces.

As an aside (and not in reference to the above posts but rather to the general fears that many a premed/med student seem to exude) the worry of there not being enough residencies for American grads in the near future stems from a realistic possibility of GME funding cuts, but it's certainly been laced with a bit of Doom-n-Gloom (an SDN favorite). Yeah, you may end up at a family medicine residency in the middle of Central Wherethehellami, when you started school with the dream of becoming Dr. Uptown Baller, CT surgeon, aka Poppa Madchicksonmyshoulder. If that doesn't sit right with a student, it may be time to reconsider one's path.

Work hard, stay informed, get involved, and stay realistic. Anything else is beyond control.

 

[DrMediterranean]

Specter hit it on the head. The new accreditation standards seem to be geared toward maximizing quality of training and implementing methods of accountability that will allow for a higher degree of transparency. I just read the NEJM special report on this, and there was not any mention of making residencies shorter. Regarding financial burden the following was mentioned:



As an aside (and not in reference to the above posts but rather to the general fears that many a premed/med student seem to exude) the worry of there not being enough residencies for American grads in the near future stems from a realistic possibility of GME funding cuts, but it's certainly been laced with a bit of Doom-n-Gloom (an SDN favorite). Yeah, you may end up at a family medicine residency in the middle of Central Wherethehellami, when you started school with the dream of becoming Dr. Uptown Baller, CT surgeon, aka Poppa Madchicksonmyshoulder. If that doesn't sit right with a student, it may be time to reconsider one's path.

Work hard, stay informed, get involved, and stay realistic. Anything else is beyond control.

SoulinNeed is actually right. Here you go:

http://www.ama-assn.org/ama/pub/meded/2012-march/2012-march.shtml

"For physicians, one of the attractive features of the milestones concept and the focus on outcomes is the possibility of more flexibility in residency length. If, say, a family medicine resident can meet all the milestones in two years rather than three, there's no reason the doctor could not complete the residency and enter into practice.

AMA policy supports such flexibility, which could have the added benefit of allowing young physicians the opportunity to begin to pay back medical school debt by entering into practice that much sooner. For example, the AMA's Principles of Graduate Medical Education state that "[t]he time required for an individual resident physician's education might be modified depending on the aptitude of the resident physician and the availability of required clinical experiences."

I think the focus on outcomes and the milestones concept is awesome. Thoughts?

 

[cougardiver]

I think the focus on outcomes and the milestones concept is awesome. Thoughts?

Some value can be derived from time in the saddle. No amount of completing milestones will allow a student doctor to assimilate this information faster.

That said, I am very much on board with the idea of allowing residents to work harder and graduate sooner. This could not only reduce the debt load for medical students who work hard and enter into practice sooner, but this could also contribute to fixing the shortage of residencies that is often mentioned. Shorter time per residency + no changes in funding = more people allowed in residency 🙂

 

[cliquesh]

Some value can be derived from time in the saddle. No amount of completing milestones will allow a student doctor to assimilate this information faster.

That said, I am very much on board with the idea of allowing residents to work harder and graduate sooner. This could not only reduce the debt load for medical students who work hard and enter into practice sooner, but this could also contribute to fixing the shortage of residencies that is often mentioned. Shorter time per residency + no changes in funding = more people allowed in residency :)

It may, however, lead to job shortages and/or decreased salaries. In 2005, I believe, pathology reduced its residency from 5 years to 4 years and, since then, the pathology job market has become increasingly saturated and finding a job as a new pathologist can be difficult. The pathology job market was tight before the change in 2005, though, so what happened to pathology may not happen to an in-demand field, like FP.

 

[Dharma]

SoulinNeed is actually right. Here you go:

http://www.ama-assn.org/ama/pub/meded/2012-march/2012-march.shtml

"For physicians, one of the attractive features of the milestones concept and the focus on outcomes is the possibility of more flexibility in residency length. If, say, a family medicine resident can meet all the milestones in two years rather than three, there's no reason the doctor could not complete the residency and enter into practice.

AMA policy supports such flexibility, which could have the added benefit of allowing young physicians the opportunity to begin to pay back medical school debt by entering into practice that much sooner. For example, the AMA's Principles of Graduate Medical Education state that "[t]he time required for an individual resident physician's education might be modified depending on the aptitude of the resident physician and the availability of required clinical experiences."

I think the focus on outcomes and the milestones concept is awesome. Thoughts?

I'm not trying to be a nit picker, but in the actual ACGME report released by the NEJM there wasn't any much of shorter residencies. Your quote comes from the AMA. The AMA are most definitely powerful stakeholders in the ACGME, but they are not one and of the same. Regardless, according to the AMA site, it looks like they (the AMA) are in favor of reducing training time. Add in any projected calculations of how much money it will save, and I'm sure those outside of the field looking for public support will be shouting their endorsement from the hilltop.

In regards to the FM quote from the AMA website, I doubt we will see a reduction in residencies that are already only 3 years in length. Go to the FM threads and ask them if 2 years is enough time to train a competent FP. (Scratch that, I just did). I doubt the AAFP would agree with such a reduction in training either. If anything, the breadth of knowledge and skill necessary to become a competent generalist requires equally diversified training that may be tough to accomplish in two years and should make it the last place to start implementing reductions.

 

[DrMediterranean]

I'm not trying to be a nit picker, but in the actual ACGME report released by the NEJM there wasn't any much of shorter residencies. Your quote comes from the AMA. The AMA are most definitely powerful stakeholders in the ACGME, but they are not one and of the same. Regardless, according to the AMA site, it looks like they (the AMA) are in favor of reducing training time. Add in any projected calculations of how much money it will save, and I'm sure those outside of the field looking for public support will be shouting their endorsement from the hilltop.

In regards to the FM quote from the AMA website, I doubt we will see a reduction in residencies that are already only 3 years in length. Go to the FM threads and ask them if 2 years is enough time to train a competent FP. (Scratch that, I just did). I doubt the AAFP would agree with such a reduction in training either. If anything, the breadth of knowledge and skill necessary to become a competent generalist requires equally diversified training that may be tough to accomplish in two years and should make it the last place to start implementing reductions.

Semantics. Just like SoulinNeed said MAYBE the residency lengths can be reduced. This is the whole point of outcomes based education - it is not dependent on time spent learning but rather if you can meet certain core competencies. You cannot argue against the fact that this opens the possibility for it. And why are you so sure 3 year residencies can't be reduced? In Canada, FM is 2 years. Just sayin.

 

[Dharma]

Semantics. Just like SoulinNeed said MAYBE the residency lengths can be reduced. This is the whole point of outcomes based education - it is not dependent on time spent learning but rather if you can meet certain core competencies. You cannot argue against the fact that this opens the possibility for it. And why are you so sure 3 year residencies can't be reduced? In Canada, FM is 2 years. Just sayin.

My point is that the AMA statement is simply a speculation of certain possibilities that the new ACGME accreditation standards could eventually lead to. There are no proposals currently on the table for reductions in the length of residencies. The primary focus is improvement in quality and transparency in performance of GME programs with a focus on outcomes. Anyhow, being that the AMA is mentioning reductions, it's obvious that someone is considering it. No one is doubting the possibility.

Can residencies be shortened? Of course. Should they be? Maybe. Maybe not. But that's an answer that will certainly take time and resources to arrive at. How are they to know if 2 years is enough to accomplish these milestones in a manner that does not compromise quality of training along with reducing the exposure time necessary to become a competent attending. Quality is important, but quantity is as well, regardless of the skill at hand; repetition is your friend. How much is enough though? Will they run pilot programs first and set up studies to determine efficacy? If they can determine that less time yields similar results, then by all means, it should be done. A distillation down to the essentials should be a goal without a doubt.

All of this said, any speculation of cuts go beyond the statement made in the NEJM; the focus of the new standards is not to reduce the duration of years in residency, although it certainly could lead to this point eventually. Regardless of speculation, the ACGME's new standards do sound like a step in the right direction, that being one of improvement with a focus on quality and concrete results. Hopefully other GME entities will follow their lead in this pursuit of improvement and accountability.

 

[DrMediterranean]

My point is that the AMA statement is simply a speculation of certain possibilities that the new ACGME accreditation standards could eventually lead to. There are no proposals currently on the table for reductions in the length of residencies. The primary focus is improvement in quality and transparency in performance of GME programs with a focus on outcomes. Anyhow, being that the AMA is mentioning reductions, it's obvious that someone is considering it. No one is doubting the possibility.

Can residencies be shortened? Of course. Should they be? Maybe. Maybe not. But that's an answer that will certainly take time and resources to arrive at. How are they to know if 2 years is enough to accomplish these milestones in a manner that does not compromise quality of training along with reducing the exposure time necessary to become a competent attending. Quality is important, but quantity is as well, regardless of the skill at hand; repetition is your friend. How much is enough though? Will they run pilot programs first and set up studies to determine efficacy? If they can determine that less time yields similar results, then by all means, it should be done. A distillation down to the essentials should be a goal without a doubt.

All of this said, any speculation of cuts go beyond the statement made in the NEJM; the focus of the new standards is not to reduce the duration of years in residency, although it certainly could lead to this point eventually. Regardless of speculation, the ACGME's new standards do sound like a step in the right direction, that being one of improvement with a focus on quality and concrete results. Hopefully other GME entities will follow their lead in this pursuit of improvement and accountability.

While I appreciate your contribution, I am not trying to argue with you whether or not residency lengths should be shortened or not. I am trying to show you that this is a possibility, which a couple posts back you did not even acknowledge and then a couple posts later you mention "Can residencies be shortened? Ofcourse." as if you had acknowledged it from the beginning. I understand you read the NEJM article, I did too. I just wanted to show people on this forum that this is a possibility (clearly there was a poster before me that knew about this too - I'm not making this up) and shared information about it through the AMA page.

You keep bringing up the point that the AMA and ACGME are two different entities, certainly. But the AMA has a huge stake in the ACGME, it retains a large portion of control, so you can bet that if the AMA wants something and tries to lobby for it --- there is a decent possibility it could happen. And YES I understand the whole shift to outcomes is to improve education and quality rather than shorten residency -- I never said that the point was to shorten the residency, it would be absurd to think that thats the point of it. Maybe you misunderstood my previous post when I said that TIME spent in residency is not as important as meeting core competencies in the milestones system. I wasn't saying the point of these changes was to make residency length shorter at all.

As I stated before, the whole reason I posted was to spread information and clarify some points made in this thread. Do not take it personally as it was not an attack on you, I was only pointing out that in fact people ARE talking about the possibility of residency lengths being shortened, which you contradicted in your original post when talking about SoulinNeed's statement regarding this.


Here is the NEJM article Dharma mentioned before in case anyone wants to read it:

http://www.acgme-nas.org/assets/pdf/NEJMfinal.pdf

 

[Dharma]

While I appreciate your contribution, I am not trying to argue with you whether or not residency lengths should be shortened or not. I am trying to show you that this is a possibility, which a couple posts back you did not even acknowledge and then a couple posts later you mention "Can residencies be shortened? Ofcourse." as if you had acknowledged it from the beginning. I understand you read the NEJM article, I did too. I just wanted to show people on this forum that this is a possibility (clearly there was a poster before me that knew about this too - I'm not making this up) and shared information about it through the AMA page.

You keep bringing up the point that the AMA and ACGME are two different entities, certainly. But the AMA has a huge stake in the ACGME, it retains a large portion of control, so you can bet that if the AMA wants something and tries to lobby for it --- there is a decent possibility it could happen. And YES I understand the whole shift to outcomes is to improve education and quality rather than shorten residency -- I never said that the point was to shorten the residency, it would be absurd to think that thats the point of it. Maybe you misunderstood my previous post when I said that TIME spent in residency is not as important as meeting core competencies in the milestones system. I wasn't saying the point of these changes was to make residency length shorter at all.

As I stated before, the whole reason I posted was to spread information and clarify some points made in this thread. Do not take it personally as it was not an attack on you, I was only pointing out that in fact people ARE talking about the possibility of residency lengths being shortened, which you contradicted in your original post when talking about SoulinNeed's statement regarding this.

Oh nothing personal at all. My comment was geared towards the situation in general and not totally directed at you in particular. I just wanted to offer a perspective and throw some food for thought into the mix. Me thinks you took at is if I were just addressing you... My bad.

 

[DrMediterranean]

Oh nothing personal at all. My comment was geared towards the situation in general and not totally directed at you in particular. I just wanted to offer a perspective and throw some food for thought into the mix. Me thinks you took at is if I were just addressing you... My bad.

internet hugs. love you dharma

 

[Dharma]

internet hugs. love you dharma

Hahaha! It's all good.

 

[Furballer]

you can't just throw that in there at the end and not elaborate....

+1,000,000

 

[scpod]

The thing none of you has even thought of is that board certification still requires the same number of years. It is doubtful that they will ever change those requirements. And you have to be board certified, or at least board eligible, to get any decent position these days. One further thought, I believe there are a couple of states that require three years of post grad training for licensure. Couldn't work in any of those with less than three years of residency.

 

[SoulinNeed]

The thing none of you has even thought of is that board certification still requires the same number of years. It is doubtful that they will ever change those requirements. And you have to be board certified, or at least board eligible, to get any decent position these days. One further thought, I believe there are a couple of states that require three years of post grad training for licensure. Couldn't work in any of those with less than three years of residency.

I'm sure that can change, as well. Either way, I believe they are already implementing pilot programs to try this new system out next year. Of course, the ACGME is not going to come out and say that the purpose of this is to reduce residencies. That's not the main point, and this is honestly a better system, imo. Either way, however, it does raise the possibility of shorter residencies, which it seems is what the AMA want (the AMA is also a political organization, and I'm sure this is appealing to politicians), so there's a decent chance of that happening.

 

[GypsyHummus]

I have heard from numerous MD students that DOs are being pushed out of the MD residencies, is that true?

One example that the student gave was the residency program in my town. They accept ten people a year, 5 MD 5 DO for family practice. This year they took only two DOs and 8 MDs, and no FMG.

Are DOs feeling a crunch? And is it going to get worse?

 

[donkeykong1]

I have heard from numerous MD students that DOs are being pushed out of the MD residencies, is that true?

One example that the student gave was the residency program in my town. They accept ten people a year, 5 MD 5 DO for family practice. This year they took only two DOs and 8 MDs, and no FMG.

]

Are DOs feeling a crunch? No And is it going to get worse? Possibly in 5-6 years from both US MD/DO will feel some "crunch"

 

[SoulinNeed]

I have heard from numerous MD students that DOs are being pushed out of the MD residencies, is that true?

One example that the student gave was the residency program in my town. They accept ten people a year, 5 MD 5 DO for family practice. This year they took only two DOs and 8 MDs, and no FMG.

Are DOs feeling a crunch? And is it going to get worse?

The number of DO's applying to MD residencies is increasing, but at the same time, the match rate is increasing. Thus, the numbers don't support that theory. Here's something you need to remember, the vast majority of people unfortunately don't know what they're talking about.

 

[Drrrrrr. Celty]

The number of DO's applying to MD residencies is increasing, but at the same time, the match rate is increasing. Thus, the numbers don't support that theory. Here's something you need to remember, the vast majority of people unfortunately don't know what they're talking about.

And I'm going to say that your defense has more holes than swiss chess. The simple answer to why the match rate likely increased is that people probably ranked residencies more realistically for themselves. Simple as that, if you know are realizing that the competition at the top is too heavy you'll intelligently move down and go for a more uncompetitive residency and avoid taking a transitional year or etc. This has major implications because competition will eventually push into formerly uncompetitive and undesired residencies leading to a "crunch" and people, FMG's first and then USDO's from ACGME residencies. Which is a reason why the AOA needs to start funding and opening strong specialty residency programs because inevitably DO's will feel the crunch and get screwed out of practicing in their desired field.

 

[cliquesh]

I think we are going to have to see the specific NRMP data before we can make a judgement, Serenade.

 

[Wolverines83]

The number of DO's applying to MD residencies is increasing, but at the same time, the match rate is increasing. Thus, the numbers don't support that theory. Here's something you need to remember, the vast majority of people unfortunately don't know what they're talking about.

So true 👍👍👍

 

[SoulinNeed]

And I'm going to say that your defense has more holes than swiss chess. The simple answer to why the match rate likely increased is that people probably ranked residencies more realistically for themselves. Simple as that, if you know are realizing that the competition at the top is too heavy you'll intelligently move down and go for a more uncompetitive residency and avoid taking a transitional year or etc. This has major implications because competition will eventually push into formerly uncompetitive and undesired residencies leading to a "crunch" and people, FMG's first and then USDO's from ACGME residencies. Which is a reason why the AOA needs to start funding and opening strong specialty residency programs because inevitably DO's will feel the crunch and get screwed out of practicing in their desired field.

How does my theory have holes in it? The guy said that MD residencies are pushing DO's out, when in reality, more DO's are applying to MD residencies, and yet, the match rate is higher. That's all I said. That's it. And that's true. BTW, you're the one making complete assumptions about people's desires, without anything to back it up.

http://www.nrmp.org/data/resultsanddata2011.pdf

72% match rate (higher than last year's 71%), despite the fact that more DO's applied than the year before.

 

[cliquesh]

How does my theory have holes in it? The guy said that MD residencies are pushing DO's out, when in reality, more DO's are applying to MD residencies, and yet, the match rate is higher. That's all I said. That's it. And that's true. BTW, you're the one making complete assumptions about people's desires, without anything to back it up.

http://www.nrmp.org/data/resultsanddata2011.pdf

72% match rate (higher than last year's 71%), despite the fact that more DO's applied than the year before.

It was about 75% this year.

 

[SoulinNeed]

It was about 75% this year.

2012 ACGME DO match rate? My number was from 2011.

 

[Wolverines83]

2012 ACGME DO match rate? My number was from 2011.

yeah this year (2012) was like 74.9% or something. It's gone up for four of the the last 5 years or so despite more applicants.

I gotta say I agree with what soulinneed said....we can't know why people are/aren't entering either match. the only thing we know is that a higher percentage of those applying matched...can't really see a downside to it.

EDIT: Page four has the osteo info. just ctrl+f "osteo"

http://www.nrmp.org/data/datatables2012.pdf

 

[SoulinNeed]

yeah this year (2012) was like 74.9% or something. It's gone up for four of the the last 5 years or so despite more applicants.

I gotta say I agree with what soulinneed said....we can't know why people are/aren't entering either match. the only thing we know is that a higher percentage of those applying matched...can't really see a downside to it.

EDIT: Page four has the osteo info. just ctrl+f "osteo"

http://www.nrmp.org/data/datatables2012.pdf

Thank you very much for the data. Well, there you go then.