Both the AACOM and AAMC know that residency is NOT currently a bottleneck they way they like to suggest it is, but that they will have to make it one. Let me expand. And this is me expanding in the most superficial way possible since I could discuss many elements of this AT LENGTH. Everyone constantly bitches to congress that residency is a bottleneck, that there isnt enough specialties, that they need to cough up more money to make more spots, that they need to add spots here*-here**-and-here***. But congress has the numbers, they know the truth. Residency is not a bottle-neck and all and there are thousands of more spots than their are graduates. That with very few exceptions there is an *excess* of specialists over what is needed (every number you hear about specialists shortages is presuming that the existing specialists arent going to redistribute themselves. So its effectively measuring the deficit in middle america and ignoring an excess on the coasts. Excess > deficit in this case). That they have no need to create more spots for American students at the cost of the american taxpayer when we have american tax-funded spots going to non-americans. And that they really need to add spots there^-there^^-and-there^^^
*= NYC or Boston
** = Chicago or LA
*** = Warm major cities with close access to beaches
^ = The applachian mountains
^^ = The ozarks
^^^ = Places with perpetual winters and entire communties with only dial-up internet.
This wont stop the people with vested interests (AACOM, AAMC, ACGME, AOA, AMA) from fighting the good fight over and over by ramming their head against the wall of resitance in the government and hoping for a different outcome... but they also arent idiots. The writing is on the wall. All the involved groups know that the US wont act *until* there is either a true calamity that is truly imminent, or until US students are actually going to these primary care programs in undesirable locations. That everyone says they want to do primary care doesnt help the cause. So the second-level game is that IF the government isnt going to budge on the number of spots available until the extant ones are better utilized, then this is a land grab. There is *possiby* a finite number of residency spots in the immediate future. The AAMC wants to expand to force the issue with the governmental powers that be. The AOA wants to expand because this is its time to increase its hold on the overall medical numbers. To avoid calamity, the "n" of students will only appoximate the "x" of residency spots. Never meet. Never exceed. Even in a theoretical world devoid of incredibly qualified foreign applicants. So the AOA wants to fill as much of the "n" as possible and are willing to cut corners because they see this as a "move it or lose it" situation for the degree's future.
I may be a DO, but my experience is at the AMA end. The AMA is in no way shape or form open about their feeligns on this. Their stance is residency should be expanded, the end, period, full stop. But every member talks quite openly with other members about 1) how its pretty obvious that forcing the issue by expanding medical education without expanding residency is going to be the only way and 2) Its pretty obvious, and the DOs who are sent from the AOA admit it openly too, that this is a land-grab by the AOA trying to make sure they have a higher representaiton once the roster fills up in this attempt to push the issue.
