Do you want there to be more residencies?

[rekrul]

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I am personally in favor keeping the number of residencies stable or even decreasing them in some over-saturated specialties (path, optho, etc). It's simple supply and demand: the fewer physicians are out there, the more valuable they are and the harder it is for hospitals, insurers, and the government to railroad them into accepting low compensation and restrictions on patient care. Look at what happened to law for a lesson on what happens when a lid is not kept on supply.

I shudder to think what the consequences would be if the government decided to bite the bullet and double or triple the number of residencies in one fell swoop, filling the gap b/w the number of American grads and the number of open spots with Indians, as is currently the practice. Imagine taking this long road and making all the sacrifices for a decade only to finally become an attending and have that happen .

What are your thoughts?

 

[Leg]

Thank you for your pre-medical opinion on graduate medical education. We appreciate it.

 

[DrHart]

You're looking at the situation from a very "us vs. them" perspective. It isn't "us doctors" against "the world." It's important to keep in mind that the baby boomers are retiring and over the next 20 years the need for doctors will increase. When somebody tells you their husband died while waiting for a doctor's appointment, I sure hope you don't just say, "Hey, it's simple supply and demand."
If your goal is to find a career with a straight shot to a wealthy lifestyle, there have been plenty of warning signs to turn back now. You should judge your value on the people you help not the compensation you receive for doing so.

 

[ChillDawg]

Pathology is oversaturated? I've had path residents tell me that it's not very competitive of a residency because its more 'invisible' and thus, slots are usually still available after match.

 

[rekrul]

I'm simply curious where the prevailing opinion of my fellow premeds on this issue stands, that's all. I've given mine to launch the discussion, not because I profess to be an expert policymaker. Even so, I don't think your sentiment is very appropriate. I may be a pre-med, but considering that I'm about to make a huge commitment that will define my life going forward, if I don't have opinions on such topics then I'm just a ***** that doesn't know what he's getting into.

"Thank you for your pre-medical opinion on graduate medical education. We appreciate it."

 

[deleted393595]

What are your thoughts?

Get the government out of GME funding, and remove restrictions on the number of residencies.

 

[Leg]

I shudder to think what the consequences would be if the government decided to bite the bullet and double or triple the number of residencies in one fell swoop, filling the gap b/w the number of American grads and the number of open spots with Indians, as is currently the practice.

Perhaps inaccurate, racially biased sentiments are better off excluded when honestly attempting to solicit advice.

For one, unless Congress decides to repeal the Balanced Budget Act of 1997 or Medicare wins the lottery and decides to share, no one is "doubling or tripling" anything. Also, a great number of your concerns could have easily been addressed by utilizing the "search" function. Please visit the residency forums and inform yourself so that you can make the best possible decision regarding your future career.

 

[rekrul]

Perhaps inaccurate, racially biased sentiments are better off excluded when honestly attempting to solicit advice.

For one, unless Congress decides to repeal the Balanced Budget Act of 1997 or Medicare wins the lottery and decides to share, no one is "doubling or tripling" anything. Also, a great number of your concerns could have easily been addressed by utilizing the "search" function. Please visit the residency forums and inform yourself so that you can make the best possible decision regarding your future career.

I really don't understand the hostility you are displaying. Calling Indians Indians is now racist? What am I supposed to call them in that case? And I could have utilized the search function to address my "concerns," which are simply asking fellow premeds what their opinion on a topic is? All right...stepping slowly away from my keyboard..have a nice day bro.

 

[Law2Doc]

Pathology is oversaturated? I've had path residents tell me that it's not very competitive of a residency because its more 'invisible' and thus, slots are usually still available after match.

He means the job market is over saturated. Residency is but a gateway not a destination. And that btw is a big reason path is not currently competitive.

 

[ChillDawg]

He means the job market is over saturated. Residency is but a gateway not a destination. And that btw is a big reason path is not currently competitive.

Got it, thanks. Any source of info on saturation of various specialties? I hadn't really considered that in the past.

 

[Law2Doc]

Got it, thanks. Any source of info on saturation of various specialties? I hadn't really considered that in the past.

You'll have to glean stuff by word of mouth. Talk to residents in their later job seeking years as you get close to branches on your decision tree. Right now path, radiology and cardiology reportedly have very tight job markets. But things are always in flux.

 

[Dral]

Got it, thanks. Any source of info on saturation of various specialties? I hadn't really considered that in the past.

Check out the path forum. Half of the threads are about how there are no jobs. If you dig deep enough, you'll figure out why things are likely the way they are with path.

 

[Jimmy Jones]

i actually agree with you OP but most of the people on this forum are the "medicine is the best i would do it for $0/year its my callinggg" mentality

the prestige of doctors came in very large part due to the inaccessibility of becoming one

the increase in residency spots and explosion in growth of DO schools (+ recent expansion of MD schools) is fueled in no small part by corporate healthcare interests that wish to marginalize doctors and make them glorified techs - cogs in the system that have no say over business decisions

all about revenues in this world

 

[rekrul]

i actually agree with you OP but most of the people on this forum are the "medicine is the best i would do it for $0/year its my callinggg" mentality

the prestige of doctors came in very large part due to the inaccessibility of becoming one

the increase in residency spots and explosion in growth of DO schools (+ recent expansion of MD schools) is fueled in no small part by corporate healthcare interests that wish to marginalize doctors and make them glorified techs - cogs in the system that have no say over business decisions

all about revenues in this world

Completely agree. I think patients would see no benefit from this, either. I'm sure there are thousands of doctors out there who like the $$$, but at the end of they day they're in the trenches interacting with patients in an intimate, personal setting. It's hard to be a completely greedy bastard when you're dealing with these people on such a close, personal level.

But if you reduce doctors to "cogs in a machine" as you put it, no different from some assembly line worker at Ford, then you give all the power to some suits in the C-suites of large health systems and insurance companies. These guys don't have to interact with the patients, and its much easier for them to say "screw it, we're going to do the absolute minimum so that we can maximize the bottom line." Since they never get near the clinic floor, they don't have to see what effect that has on their customers...er patients.

 

[Jimmy Jones]

yea bro. look at how the "golden age of medicine" began to end and take note of 2 big things that sprung up during the same decade (surge in DO school seats and the emergence of HMOs)

i'm still interested in medicine because of a myriad other reasons but i've shadowed a lot of docs, from world renowned surgeon to family practice in the middle of nowhere and all i see is someone inhaling a sandwich in front of EMR while seeing their quality of life decrease my leaps and bounds over the past 2 decades

meanwhile i see smart premeds (aka, could get into med school) that purposely drop out and are pursuing MHAs. the salary cap is higher and the hospital bigwigs will lay off 1500 grunt staff (financial analysts, accountants, techs, nurses) before touching their own bonuses

 

[Midas Mulligan Magoo]

yea bro. look at how the "golden age of medicine" began to end and take note of 2 big things that sprung up during the same decade (surge in DO school seats and the emergence of HMOs)

i'm still interested in medicine because of a myriad other reasons but i've shadowed a lot of docs, from world renowned surgeon to family practice in the middle of nowhere and all i see is someone inhaling a sandwich in front of EMR while seeing their quality of life decrease my leaps and bounds over the past 2 decades

meanwhile i see smart premeds (aka, could get into med school) that purposely drop out and are pursuing MHAs. the salary cap is higher and the hospital bigwigs will lay off 1500 grunt staff (financial analysts, accountants, techs, nurses) before touching their own bonuses

Yeah, the transition medicine is undergoing is pretty sad. Still, the rest of the labor market is sinking even faster, so I guess in one sense, going into medicine has never been a better bet. What are the superior alternatives? I can think of only a couple: become a developer, but only if you've got the talent to be in the top 5th percentile, the type of dude that gets Google and Facebook into a bidding war over him out of college. If you're going to be average don't bother, you'll work in corporate IT and they'll outsource your ass before you hit 40, plus you'll struggle to break 6 figures.

Even better if you can get into front-office finance at bulge bracket banks and then step up to private equity. That path allows you to join the true global economic elite and decouple yourself from the fate of the US economy. I always get green with envy when I check with my buddy who managed to go that route. The flexibility itself is worth its weight in gold. He asked to be posted to the Tokyo office of his bank and voila, there he goes, right out of college, balling it up with Japanese babes and his 80K salary and 80K bonus as a 22 year old.

Other than that? Physician is still the best bet. Every other job involves far too much ass kissing to get ahead and has a lot of uncertainty anyway. These premeds who chose to get MHAs may well end up regretting their decision. An MHA is no more a guarantee of becoming a hotshot hospital administrator making the big $$$ than an MBA is of making you a CEO. Get an MD on the other hand and you're sure as hell gonna be a doctor.

 

[DrShephardWannabe]

Completely agree. I think patients would see no benefit from this, either. I'm sure there are thousands of doctors out there who like the $$$, but at the end of they day they're in the trenches interacting with patients in an intimate, personal setting. It's hard to be a completely greedy bastard when you're dealing with these people on such a close, personal level.

But if you reduce doctors to "cogs in a machine" as you put it, no different from some assembly line worker at Ford, then you give all the power to some suits in the C-suites of large health systems and insurance companies. These guys don't have to interact with the patients, and its much easier for them to say "screw it, we're going to do the absolute minimum so that we can maximize the bottom line." Since they never get near the clinic floor, they don't have to see what effect that has on their customers...er patients.

If you make it to medical school, you aren't a "cog in a machine," you're one of the brightest students in the entire country. I'm not going to comment on the residency shortage because as an undergraduate I can't possibly have a fully rounded view, but I have to disagree with your main point of it being a "more doctors less value." By your theory you should be against opening more medical schools since the current acceptance rate is ~45% rather than residencies where only a few thousand AMG's go unmatched out of 30,000.

 

[allantois]

It only takes a glance at pharmacy subforum, to see what oversaturation in a field leads to.

 

[Law2Doc]

Completely agree. I think patients would see no benefit from this, either. I'm sure there are thousands of doctors out there who like the $$$, but at the end of they day they're in the trenches interacting with patients in an intimate, personal setting. It's hard to be a completely greedy bastard when you're dealing with these people on such a close, personal level.

But if you reduce doctors to "cogs in a machine" as you put it, no different from some assembly line worker at Ford, then you give all the power to some suits in the C-suites of large health systems and insurance companies. These guys don't have to interact with the patients, and its much easier for them to say "screw it, we're going to do the absolute minimum so that we can maximize the bottom line." Since they never get near the clinic floor, they don't have to see what effect that has on their customers...er patients.

Sadly most of the customers/patients are totally on board with this absolute minimum approach -- it isn't a hard sell. If I had a nickel for every patient who told me how great their NP PCP was, I'd be pretty rich. CVS and Walmart are making some nice change off patients who take the "anyone in a white coat is fine" approach.

 

[Law2Doc]

Yeah, the transition medicine is undergoing is pretty sad. Still, the rest of the labor market is sinking even faster, so I guess in one sense, going into medicine has never been a better bet. What are the superior alternatives? I can think of only a couple: become a developer, but only if you've got the talent to be in the top 5th percentile, the type of dude that gets Google and Facebook into a bidding war over him out of college. If you're going to be average don't bother, you'll work in corporate IT and they'll outsource your ass before you hit 40, plus you'll struggle to break 6 figures.

Even better if you can get into front-office finance at bulge bracket banks and then step up to private equity. That path allows you to join the true global economic elite and decouple yourself from the fate of the US economy. I always get green with envy when I check with my buddy who managed to go that route. The flexibility itself is worth its weight in gold. He asked to be posted to the Tokyo office of his bank and voila, there he goes, right out of college, balling it up with Japanese babes and his 80K salary and 80K bonus as a 22 year old.

Other than that? Physician is still the best bet. Every other job involves far too much ass kissing to get ahead and has a lot of uncertainty anyway. These premeds who chose to get MHAs may well end up regretting their decision. An MHA is no more a guarantee of becoming a hotshot hospital administrator making the big $$$ than an MBA is of making you a CEO. Get an MD on the other hand and you're sure as hell gonna be a doctor.

Oh please. Only on SDN are software developer, investment banker and doctor the only three lucrative jobs out there. There are about a thousand types of jobs out there where pay is higher. Look around -- most of the products and services you use and businesses you frequent likely were at one time run by some twenty-something year old with a dream. Medicine is just a bad job if you are in it primarilly for the money. Your friend who opens a corner sandwich shop has a better chance of becoming a millionaire by thirty than you will.

 

[Law2Doc]

If you make it to medical school, you aren't a "cog in a machine," you're one of the brightest students in the entire country. I'm not going to comment on the residency shortage because as an undergraduate I can't possibly have a fully rounded view, but I have to disagree with your main point of it being a "more doctors less value." By your theory you should be against opening more medical schools since the current acceptance rate is ~45% rather than residencies where only a few thousand AMG's go unmatched out of 30,000.

You can be the brightest student in the country and still be a cog. As for "more doctors means less value," I think the point is that the basics of supply and demand will always come into play. In path, for instance, there are too many graduating residents as compared to good jobs, so employers get lots of resumes even for the most mediocre of positions, maybe pay a bit less, and people have no job security because you are so easily replaced. By contrast, derm has more carefully managed its spots, and so getting a good paying job, even one with cushy hours, is more doable. And this information trickles down to med students and rapidly you have some of the best and brightest med students competing to look at ugly rashes and skin cancers and dispense zit creams for a living.

Opening more med schools is the opposite issue. Med school doesn't make you a doctor. You can't get a license after med school, and honestly you still know very little. It just qualifies you to do a residency where you'll actually start to learn to be a doctor in a particular specialty. And it's a lifelong journey of learning where you'll never know all you need to know. That's what you guys are signing on for. If you want a job where you finish school and you're done with your education, many other paths will be more amenable to this approach. Anyway, it's residency, not medical school, that's the bottleneck. If there are only say, 30,000 funded residency slots out there it doesn't matter if med schools are graduating 30,000 people or 130,000. Still the same number of doctors. And it will still generally be the most competitive 30,000 people getting the spots. So it's irrelevant -- nobody who understands the system focuses in number of med schools -- the issue has to be residency spots because that's the gatekeeper for becoming a doctor.

Should there be more residency spots? (1) depends if you believe there's a doctor shortage, rather than a distribution problem (the latter being what most physicians believe), (2) depends if you care about salary and security (more cheap labor in your specialty means your boss can pay you less an fire you at a whim because you're easily replaceable (lawyers are a great example of how gluts can kill a job market). (3) Obviously if you are still at the premed/med school end of it, you want fewer impediments ahead, but you need to be careful -- this same impediment looming ahead of you is all that's going to save your job once you get past it.

 

[Petrichor1]

I agree that as doctors you may be taught abut caring for patient and providing them accessible healthcare. We are better than Canada though in that quick healthcare support is provided. Long periods of waiting is not needed. You try booking an appointment and you get scheduled quickly. The problem I concur with op is the corporate control of Medicine and almost anyone and everyone controlling the autonomy and value of a doctor. Rather than putting your arguments toward international importation, it would be worth your while in seeing how many new schools are opening each year with the excuse of baby boomer. That has been the catch phrase of pharmacy schools and look where they are now.

 

[DrShephardWannabe]

You can be the brightest student in the country and still be a cog. As for "more doctors means less value," I think the point is that the basics of supply and demand will always come into play. In path, for instance, there are too many graduating residents as compared to good jobs, so employers get lots of resumes even for the most mediocre of positions, maybe pay a bit less, and people have no job security because you are so easily replaced. By contrast, derm has more carefully managed its spots, and so getting a good paying job, even one with cushy hours, is more doable. And this information trickles down to med students and rapidly you have some of the best and brightest med students competing to look at ugly rashes and skin cancers and dispense zit creams for a living.

Opening more med schools is the opposite issue. Med school doesn't make you a doctor. You can't get a license after med school, and honestly you still know very little. It just qualifies you to do a residency where you'll actually start to learn to be a doctor in a particular specialty. And it's a lifelong journey of learning where you'll never know all you need to know. That's what you guys are signing on for. If you want a job where you finish school and you're done with your education, many other paths will be more amenable to this approach. Anyway, it's residency, not medical school, that's the bottleneck. If there are only say, 30,000 funded residency slots out there it doesn't matter if med schools are graduating 30,000 people or 130,000. Still the same number of doctors. And it will still generally be the most competitive 30,000 people getting the spots. So it's irrelevant -- nobody who understands the system focuses in number of med schools -- the issue has to be residency spots because that's the gatekeeper for becoming a doctor.

Should there be more residency spots? (1) depends if you believe there's a doctor shortage, rather than a distribution problem (the latter being what most physicians believe), (2) depends if you care about salary and security (more cheap labor in your specialty means your boss can pay you less an fire you at a whim because you're easily replaceable (lawyers are a great example of how gluts can kill a job market). (3) Obviously if you are still at the premed/med school end of it, you want fewer impediments ahead, but you need to be careful -- this same impediment looming ahead of you is all that's going to save your job once you get past it.

You're right, but my philosophy would be rather than making residency the bottleneck, it should be getting into medical school. If U.S. MD schools continue to grow every year without residency slots growing, then medical school becomes more and more of a gamble like the Caribbean. I fear a day where someone could get accepted into an MD/DO U.S. medical school and be worried about the six figure crushing debt that doesn't give them the current ~95% odds at getting a job (AKA law school). I'd much rather see the medical school acceptance rate go down than risk the medical school environment becoming even more cutthroat as many of my law friends note. Although for the next 5 years or so I'd imagine the match is just going to exclude more IMG/FMG's to make room for AMG'S, several years from now if the pattern continues then it could become an issue. I do think the entire problem is much more complicated than simply adding more residency spots though.

 

[Law2Doc]

You're right, but my philosophy would be rather than making residency the bottleneck, it should be getting into medical school. If U.S. MD schools continue to grow every year without residency slots growing, then medical school becomes more and more of a gamble like the Caribbean. I fear a day where someone could get accepted into an MD/DO U.S. medical school and be worried about the six figure crushing debt that doesn't give them the current ~95% odds at getting a job (AKA law school). I'd much rather see the medical school acceptance rate go down than risk the medical school environment becoming even more cutthroat as many of my law friends note. Although for the next 5 years or so I'd imagine the match is just going to exclude more IMG/FMG's to make room for AMG'S, several years from now if the pattern continues then it could become an issue. I do think the entire problem is much more complicated than simply adding more residency spots though.

Right now the AAMC wants US med school graduates to approximate residency slots so that in a few years we drive offshore schools out of the game. The notion is that US med schools should fill US needs, and we shouldn't have to import people whose education wasn't quality controlled by LCME. Once US med students approach the number of residency spots, a couple of non mutually exclusive things things may happen (1) the AAMC will put the brakes on med school expansion, (2) US schools struggling to get their candidates into residencies may close down, or (3) the AAMC will ask for more residency slots once offshore schools are out of the picture. So I'm not super concerned that there will be hordes of US grads with high debt and no prospects (although I suspect that's the future for Caribbean grads at some point -- it's a game of musical chairs and at some point that music stops and they won't find a chair). What I do see happening is lots of US grads having less control as to where they go in terms of specialty and geography. Ie if you want a job and you are in the bottom tenth of your class you might be going to Wyoming to do family med, even if your dream is doing IM in Atlanta. But no, I think keeping the bottleneck at residency is the more appropriate spot. Your fears of med schools cranking out students who have no place to go is premature and probably unfounded -- there is someone (AAMC) running the controls, it's not a runaway train like eg law schools were.

 

[Goro]

1000% agree with my learned colleague.

Right now the AAMC wants US med school graduates to approximate residency slots so that in a few years we drive offshore schools out of the game. The notion is that US med schools should fill US needs, and we shouldn't have to import people whose education wasn't quality controlled by LCME. Once US med students approach the number of residency spots, a couple of non mutually exclusive things things may happen (1) the AAMC will put the brakes on med school expansion, (2) US schools struggling to get their candidates into residencies may close down, or (3) the AAMC will ask for more residency slots once offshore schools are out of the picture. So I'm not super concerned that there will be hordes of US grads with high debt and no prospects (although I suspect that's the future for Caribbean grads at some point -- it's a game of musical chairs and at some point that music stops and they won't find a chair). What I do see happening is lots of US grads having less control as to where they go in terms of specialty and geography. Ie if you want a job and you are in the bottom tenth of your class you might be going to Wyoming to do family med, even if your dream is doing IM in Atlanta. But no, I think keeping the bottleneck at residency is the more appropriate spot. Your fears of med schools cranking out students who have no place to go is premature and probably unfounded -- there is someone (AAMC) running the controls, it's not a runaway train like eg law schools were.

 

[Baron Samedi]

So I'm not super concerned that there will be hordes of US grads with high debt and no prospects (although I suspect that's the future for Caribbean grads at some point

Last I saw, Carib schools already carry a dismal 50% match rate. Going to one of those is financial suicide. I recently met a guy who graduated from Ross now working as a scribe because he can't land a slot.

 

[kenjixshadow]

Last I saw, Carib schools already carry a dismal 50% match rate. Going to one of those is financial suicide. I recently met a guy who graduated from Ross now working as a scribe because he can't land a slot.