Doctor Supply and Demand Statistics: Construing Misconceptions

[Excelsius]

Given all the rumors going around SDN about the pre-med pipeline “exploding,” I thought it would be a good idea to finally get some facts out. Below I am including a set of graph that are from AAMC itself. Here are some points:

International Medical Graduates (IMGs) are not at risk of losing all their residency spots any time soon. While some think that AAMC has this agenda to artificially eliminate all IMGs by turning over their residency spots to US graduates, here is what AAMC says:

• “…if the flow of IMGs slows significantly, then any shortages that develop may be even more severe than those described in this report.”
• “Thus the components of the projected 12% net growth in total number of active physicians from 2006 to 2025 includes an additional 28,900 USMDs (6% growth), 32,900 DOs (79% growth), and 18,900 IMGs (12% growth) (Figure 5).”

In other words, AAMC actually counts IMGs as part of its goal to increase med school graduates by 15% by 2015 or so.

In terms of residencies, AAMC gives two options: 1.if the residency programs expand in a “robust” manner, then the only decrease in spots will be in IMGs – from 6500 to 6000. 2. If the residency expansion is “moderate,” then IMG spots will decrease from 6500 to 4100 to give up those extra spots for the DOs. When you consider that most IMGs go into primary care, this makes you wonder whether DOs will be forced into these primary care residencies in the future. And by future, we’re talking about as early as 2016. Certainly, if this happens, it will be bad for both DOs and IMGs. Losing 40% of their residency spots might force many to reconsider going to the Caribbean schools.

I am not sure what is the likelihood of only moderate growth in residencies. While some think that AAMC doesn’t have any plans to increase the number of residencies, that is not true. If you look at Table 4, you’ll see that already 33% of medical schools are adding new residency programs. Given that the new medical schools are not even going to be operational since 2015, this 33% is very encouraging and might mean that the “robust” residency growth will occur, instead of the “moderate” one.

Also, while there are going to be about 10-15 new medical schools added by 2015, their average class size is going to be around 100 or less – not the 150 or more we might have assumed (Table 2).

Another thing to note is that unlike what is claimed in this forum, physician work hours have barely increasing (Figure 44). In fact, AAMC says that the newer doctors work less hours than the veterans because the newer generation has more interests and seeks a more balanced life.

Note also that since 1980 the number of medical graduates has not changed at all (Figure 2). Yet many students here claim that the number of med students has been steadily increasing. You will probably not see any real increases in number until 2007. Even then, it is not going to be much compared to historical data. If the numbers of graduates increased the same way as it did between 1960 and 1980, then today we would have to have over 40,000 med school graduates, not 17,000. Even after all the increases over the next 10-20 years, the number of graduates is still going to be less than half than what is was supposed to be had it continually grown from 1980 – yet the demand has been accelerating.

I hope the graphs below will speak for themselves and I hope some of the skeptics get to see them too. It’s hard to imagine any other profession having as much demand as the medical profession, no matter how pessimistic someone is.

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[Excelsius]

 

[Excelsius]

(I am trying this photo upload for the first time. The images are unintentionally too big. I tried resizing them in photobucket, but the images here did not get smaller.)

 

[Chemist0157]

So...much...data...





Good job!

 

[Alex0128]

Good info. I wish more people on SDN would backup their claims with evidence...

Thanks

 

[Law2Doc]

Good info. I wish more people on SDN would backup their claims with evidence...

Thanks

LOL -- as I stated on the other thread that this one is liked to:

"You've got some bad data on there, and you also keep resorting to putting tables from, and projections derived from past graduation rates, which don't tell you anything about what is going on now. (or that would be projected currently). Also your quote "In other words, AAMC actually counts IMGs as part of its goal to increase med school graduates by 15% by 2015 or so." is simply wrong because it's opposite of the actual charging orders given by the AAMC to US schools. The AAMC has stated that it wants US seats to meet US needs. It has also stated that US med schools should increase by 15% over the next few years (See eg. http://findarticles.com/p/articles/m..._/ai_n13790786). This is US students, not increases in IMG grads. So that's just wrong.

Additionally, your suggestion that numbers haven't gone up significantly still ignores what is happening presently in terms of record increases in folks in the pipeline. For instance, one article notes, "First-year enrollment at U.S. medical schools reached an all-time high this year as more than 18,000 first-year students enrolled in U.S. medical schools, increasing 2 percent over 2007, the Association of American Medical Colleges announced Tuesday." That's record numbers of first years in med school now. It's hard to imagine that this isn't going to translate to an increase in graduates in a few years. See http://www.diverseeducation.com/artm...le_11864.shtml.

Believe what you want, but the big increase in US graduates is coming up through the ranks. This increase, over time, will drive the 40% of FMGs that snare US residencies down to substantially worse odds. The elimination of vacancies starts in 2010, and will continue progressively."

 

[Fiko18]

actually this "projected shortage" is exactly what it is, a projection. Unfortunately for most forgein medical students the recent baby boom does not match those of the past and the need for doctors will actually not increase that much, AAMC knows this and will thus not increase residency programs by as much as u have just stated, US med schools are not only increasing in numbers but established schools are increasing their capacity. This equals one thing, less spots open for foreign grads. Which in my opinion the way it should be. I don't want a flux of physicians (especially forgein ones) in this country that will not only decrease market value of physician services but will decrease the quality of healthcare.

 

[Excelsius]

LOL -- as I stated on the other thread that this one is liked to:

"You've got some bad data on there, and you also keep resorting to putting tables from, and projections derived from past graduation rates, which don't tell you anything about what is going on now. (or that would be projected currently). Also your quote "In other words, AAMC actually counts IMGs as part of its goal to increase med school graduates by 15% by 2015 or so." is simply wrong because it's opposite of the actual charging orders given by the AAMC to US schools. The AAMC has stated that it wants US seats to meet US needs. It has also stated that US med schools should increase by 15% over the next few years (See eg. http://findarticles.com/p/articles/m..._/ai_n13790786). This is US students, not increases in IMG grads. So that's just wrong.

Additionally, your suggestion that numbers haven't gone up significantly still ignores what is happening presently in terms of record increases in folks in the pipeline. For instance, one article notes, "First-year enrollment at U.S. medical schools reached an all-time high this year as more than 18,000 first-year students enrolled in U.S. medical schools, increasing 2 percent over 2007, the Association of American Medical Colleges announced Tuesday." That's record numbers of first years in med school now. It's hard to imagine that this isn't going to translate to an increase in graduates in a few years. See http://www.diverseeducation.com/artm...le_11864.shtml.

Believe what you want, but the big increase in US graduates is coming up through the ranks. This increase, over time, will drive the 40% of FMGs that snare US residencies down to substantially worse odds. The elimination of vacancies starts in 2010, and will continue progressively."

I am familiar with the good advice that you usually give to students and you know a lot. That's why I am somewhat flummoxed by your reaction. We all make errors sometimes, but continuously reiterating the same points, making an argument for the sake of argument, is just something I don't understand. Even in the face of incontrovertible data, you choose to disagree.

For the sake of general knowledge, I will try once again to clarify, but this time I will break things down:

1. How can you say “you've got some bad data on there”? Your comment is not questioning my data (for the data is not mine), it is questioning AAMC. Here, go look at my source: AAMC Publications. My "wrong" data is coming directly from those two publications. Apparently a large scale publication directly from AAMC is not as good as the two small articles from some unknown websites that you provide, which, by the way, have been already taken down. Come on!
2. The projections are not based on old graduation data. Take a look at the publication dates – one was published this month and the other back in April. AAMC announced the new med student growth back in 2005. The notion that these publications are based on old data is just wrong.
3. There is also an irony here: most of the numbers that you mention are actually backed up by the publication. You provide a link to an article that says in 2008 there were over 18,000 matriculants. Did you look at Figure 2? It shows that for 2008 there ARE over 18,000 matriculants.
4. Regarding GME spots, you were claiming that there is no planned increase in residencies. Do you still believe that even after looking at Table 4, which says that 33% of medschools are increasing residency spots? Do you also believe that the average class size for the new medical schools is going to be over 150 (look at Table 2)? Frankly, if you don’t believe these simple facts given by AAMC – these are NOT projections – then you must have a better data than the source itself.
5. Let’s clarify something else: AAMC has NOT said it is trying to artificially decrease IMG or DO residencies. Did you read the exact quotes from AAMC I provided above? AAMC basically is saying that there are two scenarios: if the growth in residencies is only moderate, then it will decrease the IMG spots from 6600 to 4100. If you do the math, you’ll see that it’s a 38% decrease and actually SUPPORTS what you’re saying (again, apparently you didn’t read what I wrote). But the other scenario is that the growth in residencies may be robust, in which case the decrease in IMG GME spots will only be about 10%. By claiming that you know for sure that in the near future the decrease is going to be definitely 40%, you are definitely speculating. I argue that residency numbers have remained stagnant because the medical student graduates have remained stagnant for over 20 years (Figure 3). Sure, you can argue that it’s a speculation. I think it is a logical speculation. I hope you were not expecting the residency spots to go up when the student population was stagnant. That’s illogical. I also argue that instead of trying to articially decrease IMG spots, AAMC is saying that it will be an (unfortunate) by-product if residencies, for some unknown reasons, do not increase enough. If the residencies are privately or federally funded, AAMC doesn't have much say in mandating residency increases. If you can show me a single quote proving that AAMC is trying to purposely keep residency spots down, I will gladly concede this point.

I hope that you can pay more attention to the real data and see that some of what you are saying is actually backed up by the data. Other things that you say are just projections and speculations. AAMC projections may not be 100% accurate, but I’d sure expect it to be more accurate than what you or I could project.

I’ll reiterate that I am neither an IMG nor a DO. Nor do I plan on taking any of those routes. My argument is as a matter of principle to reveal the correct data, not to protect one route or the other. Certainly, if anything, the data shows that you should always try to go the MD route because even in the best case scenario (for now) IMGs maylose 10% of their residencies within the next five to ten years. Given that MD students will fill more and more MD residencies as their numbers increase, this means that DO students might be left out if DO residencies do not increase. Since AAMC is trying to solve that issue by simply decreasing the numbers of IMG residencies (which are overwhelmingly for primary care), the ramification is that more DO students will be forced into primary care. Now this is just a speculation and I wouldn’t want to make any final comments about this until we hear from some DO residents/attendings as well.

If you don’t believe the AAMC data, then there is nothing more I can say, except that using anecdotal evidence or reading one article here and one article there does not supersede AAMC’s own publication, especially when the data agree. Good luck.

 

[Excelsius]

actually this "projected shortage" is exactly what it is, a projection. Unfortunately for most forgein medical students the recent baby boom does not match those of the past and the need for doctors will actually not increase that much, AAMC knows this and will thus not increase residency programs by as much as u have just stated, US med schools are not only increasing in numbers but established schools are increasing their capacity. This equals one thing, less spots open for foreign grads. Which in my opinion the way it should be. I don't want a flux of physicians (especially forgein ones) in this country that will not only decrease market value of physician services but will decrease the quality of healthcare.

What are you talking about? What is your source? Are you now questioning the Census Bureau of The United States? The data says that US population growth is 26%. The growth of the elderly (65+) is 36%. That means that the elderly are growing faster than the general population, much less the population of medical graduates.

And there is only one "baby boom" that I am aware of.

 

[EpiPEN]

The only graph I trust

 

[Law2Doc]

[*] Let's clarify something else: AAMC has NOT said it is trying to artificially decrease IMG ... residencies.

Um, yeah, they did, although not in those words (and not relating to DO). If you look up speeches and statements made by AAMC Pres. Dr. Jordan Cohen in 2005-2006 (about the time not coincidentally when the AAMC articulated it's desire for US med schools to voluntarily increase their ranks), you will find him raising lots of questions about the quality control that happens offshore, and reiterating the need for US education to be increased to satisfy US healthcare needs. An example can be found here http://www.aamc.org/newsroom/reporter/march06/word.htm, but there are several other speeches/statements of his on the net. Although he does not come out and say it, his questioning of offshore quality control, statements like, "given the looming doctor shortage and the large number of well-qualified U.S. students who aspire to be physicians, our civic responsibility argues strongly that we increase substantially the number of graduates from accredited medical schools in the United States", and the fact that at the same time the AAMC requested US schools increase their numbers substantially (while there has been no such push for residency slot increases), I think common sense lets you connect the dots. So I think the AAMC's agenda has been made pretty clear. Looking back to old data and projections doesn't serve you well -- this all started happening in 2005-6.

Look, we are just going to have to agree to disagree. All I can tell you is that when you are in med school, you get a lot of info from pundits first-hand. And they pretty universally agree that the coming years will put the squeeze on the offshore crowd. You can disbelieve and hark back to old AAMC data if you prefer, feeling it is "incontrovertible". All I'm telling you is that folks in the know are "controverting" about this very frequently in this country's medical schools. But believe what you want. We will know in 5 years regardless.

 

[Excelsius]

Um, yeah, they did, although not in those words (and not relating to DO). If you look up speeches and statements made by AAMC Pres. Dr. Jordan Cohen in 2005-2006 (about the time not coincidentally when the AAMC articulated it's desire for US med schools to voluntarily increase their ranks), you will find him raising lots of questions about the quality control that happens offshore, and reiterating the need for US education to be increased to satisfy US healthcare needs. An example can be found here http://www.aamc.org/newsroom/reporter/march06/word.htm, but there are several other speeches/statements of his on the net. Although he does not come out and say it, his questioning of offshore quality control, statements like, "given the looming doctor shortage and the large number of well-qualified U.S. students who aspire to be physicians, our civic responsibility argues strongly that we increase substantially the number of graduates from accredited medical schools in the United States", and the fact that at the same time the AAMC requested US schools increase their numbers substantially (while there has been no such push for residency slot increases), I think common sense lets you connect the dots. So I think the AAMC's agenda has been made pretty clear. Looking back to old data and projections doesn't serve you well -- this all started happening in 2005-6.

Look, we are just going to have to agree to disagree. All I can tell you is that when you are in med school, you get a lot of info from pundits first-hand. And they pretty universally agree that the coming years will put the squeeze on the offshore crowd. You can disbelieve and hark back to old AAMC data if you prefer, feeling it is "incontrovertible". All I'm telling you is that folks in the know are "controverting" about this very frequently in this country's medical schools. But believe what you want. We will know in 5 years regardless.

Good. Here is a quote from the article you provided: "...the U.S. physician workforce will continue to rely on graduates of offshore (and other foreign) schools for the foreseeable future, no matter how quickly or how much LCME- and AOA-accredited schools expand their capacity." That's one. Here is another one: "....we need to explore whether some credible process can be devised to evaluate the educational programs of offshore schools and to help them improve if they are not meeting acceptable standards."

Sure, you can connect the dots your way. Another way to look at it is through the quotes above. I don't disagree that he is skeptical about some of the foreign schools, but he also realizes that we will be relying on them for the "foreseeable future," and that we should develop a process to evaluate these schools.

You keep calling the data old, yet I already showed to you that it is very current and conforms to almost all of your own projections. Yes, the changes started in 2005. The paper I used was published a few weeks ago... I hope that now you won't say that even though the paper was published this month, the data it represents is from 2004 or older.

We actually agree on several points. Our main difference is that you are adamant that there can be only one outcome. I think it would be respectable to at least accept that in matter of average class size and the assumption that there are no new residencies being planned, you were wrong. But it doesn't matter. This isn't about you or me.

 

[Law2Doc]

Good. Here is a quote from the article you provided: "...the U.S. physician workforce will continue to rely on graduates of offshore (and other foreign) schools for the foreseeable future, no matter how quickly or how much LCME- and AOA-accredited schools expand their capacity." That's one. Here is another one: "....we need to explore whether some credible process can be devised to evaluate the educational programs of offshore schools and to help them improve if they are not meeting acceptable standards."

Sure, you can connect the dots your way. Another way to look at it is through the quotes above. I don't disagree that he is skeptical about some of the foreign schools, but he also realizes that we will be relying on them for the "foreseeable future," and that we should develop a process to evaluate these schools.

You keep calling the data old, yet I already showed to you that it is very current and conforms to almost all of your own projections. Yes, the changes started in 2005. The paper I used was published a few weeks ago... I hope that now you won't say that even though the paper was published this month, the data it represents is from 2004 or older.

We actually agree on several points. Our main difference is that you are adamant that there can be only one outcome. I think it would be respectable to at least accept that in matter of average class size and the assumption that there are no new residencies being planned, you were wrong. But it doesn't matter. This isn't about you or me.

Again, this article, and others shortly preceded the AAMC requesting US med schools to increase enrollment. So an article suggesting that offshore schools need more acountability, or, as you concede, skeptical about foreign schools, paired with the last sentence AND shortly followed up by very real action of the AAMC to increase US student enrollment points a different direction that you suggest. We can bandy this about for hours -- no real point. I'm at ground zero of the increase (which has happened in a very real way), I see and hear about it frequently, and speak to tons of folks in the profession who have strong views on what is going on. You can disagree, but I'm telling you what is happening from the trenches. So you can say -- no this isn't happening, that's not what the AAMC site suggests, but we will see who was right in a few years. I think you'll be surprised to see who was wrong.

 

[Lukkie]

the graphs you posted are very narrow. here is a more encompassing one

 

[Excelsius]

Again, this article, and others shortly preceded the AAMC requesting US med schools to increase enrollment. So an article suggesting that offshore schools need more acountability, or, as you concede, skeptical about foreign schools, paired with the last sentence AND shortly followed up by very real action of the AAMC to increase US student enrollment points a different direction that you suggest. We can bandy this about for hours -- no real point. I'm at ground zero of the increase (which has happened in a very real way), I see and hear about it frequently, and speak to tons of folks in the profession who have strong views on what is going on. You can disagree, but I'm telling you what is happening from the trenches. So you can say -- no this isn't happening, that's not what the AAMC site suggests, but we will see who was right in a few years. I think you'll be surprised to see who was wrong.

Ok, I'll take you on that. Give me an approximate date by when you expect the IMG residencies to fall by 40%. My data already shows that 38% is a possibility by 2015. Will you commit to a definite 40% decrease before that date?

So give me a date and then we'll get back to this. I'll bring my lightsaber.

 

[Excelsius]

the graphs you posted are very narrow. here is a more encompassing one

Your data actually proves incontrovertibly that I am holistically correct.

Forgot to justify why I think so (before someone tells me I am wrong): I think that your graph support my points because it is discontinuous, smooth, and differentiable on all intervals.

 

[Law2Doc]

Ok, I'll take you on that. Give me an approximate date by when you expect the IMG residencies to fall by 40%. My data already shows that 38% is a possibility by 2015. Will you commit to a definite 40% decrease before that date?

So give me a date and then we'll get back to this. I'll bring my lightsaber.

As long as I don't have to lose my hand and call you father.
Currently 40% of non-US students land US residencies. I personally predict this will be below 30% by 2015. But it should fall even more rapidly once it gets to a percentage that folks feel is too much of a longshot to go offshore for school. Right now ample people go offshore for a 40% shot at a US residency. Will they be as quick to travel offshore for 30%? And will that 30% even hold up when the stats of offshore folks drop, as more folks manage to get into US schools (thanks to the enrollment increase)? Once it gets to a low enough a percentage, you will see a lot of offshore schools fold. Where this minimum percentage is set is a matter of risk aversion of FMGs, so individual attitudes toward risk will come into play.

 

[Excelsius]

As long as I don't have to lose my hand and call you father.
Currently 40% of non-US students land US residencies. I personally predict this will be below 30% by 2015. But it should fall even more rapidly once it gets to a percentage that folks feel is too much of a longshot to go offshore for school. Right now ample people go offshore for a 40% shot at a US residency. Will they be as quick to travel offshore for 30%? And will that 30% even hold up when the stats of offshore folks drop, as more folks manage to get into US schools (thanks to the enrollment increase)? Once it gets to a low enough a percentage, you will see a lot of offshore schools fold. Where this minimum percentage is set is a matter of risk aversion of FMGs, so individual attitudes toward risk will come into play.

That was hilarious. I promise, if you do that, your organism shall be saved.

So you are committing only to 30% decrease before 2015. Not much of a risk taker, eh? I think that by 2015 the decrease will be at most by 20%, though I do agree that if it reaches a certain number, you'll see a snowball effect. It might even affect DOs if that happens. So according to you there will be 4700 or less FMG spots by 2015 and I say it will be at least 5200 or more.

Given that the prediction has six years to materialize, I don't think either of us will be around this forum by then, but if we are and are studying in proximal locations, the loser must buy a big lunch for the winner and visibly wear a T-shirt to his residency/med school for at least one day with the following inscription: "Shamefully lost a MEDICAL bet to a PRE-MEDICAL student six years ago, when I was a MEDICAL student." If I lose, the quote can be modified.