Great read-Residency Shortages

[JDMcNugent]

Hey all, this article was posted in my local newspaper e-column and is definitely worth a read: http://www.omaha.com/article/201311...y-positions-to-intensify-for-medical-students

It is something most already know about the increased competition for residency slots in the U.S. and how the steep increase in enrollment, lack of medicare funding etc. contributes to this problem. There is a slight emphasis on nebraska & iowa but I think it creates a big picture snapshot of how this shortage is projected.

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[rdk322]

Great read. Thanks for sharing. I feel like FMGs looking for residency positions in the States would be most heavily affected if residency shortage problem gets bigger. What does everyone think about the outlook for residency placements for DO's? Will they ever face residency shortage?

 

[deleted307836]

Great read. Thanks for sharing. I feel like FMGs looking for residency positions in the States would be most heavily affected if residency shortage problem gets bigger. What does everyone think about the outlook for residency placements for DO's? Will they ever face residency shortage?

From what I've read, the number of American medical graduates is expected to exceed the number of residency positions starting in 2019. So yes, DO's (and MD's alike) will face residency shortages in the relatively near future unless significant action is taken (which is extremely unlikely given the government's inability to spend even more on GME).

 

[GUH]

There are still thousands of unfilled residency positions each year. If your goal is to become a physician, it's still eminently doable.
If your goal is to match something like neurosurgery at an academic research center (the example given in the article), you're going to have to work for it.

 

[darklabel]

From what I've read, the number of American medical graduates is expected to exceed the number of residency positions starting in 2019. So yes, DO's (and MD's alike) will face residency shortages in the relatively near future unless significant action is taken (which is extremely unlikely given the government's inability to spend even more on GME).

Actually those numbers are deceiving. I believe the article assumes all DO and MD students will be part of the ACGME match (Which isn't true). When you factor in the DO match then we're not exactly sure when it will happen.

The primary care fields will always be available to AMGs in the foreseeable future, but the competitive specialties will become even more difficult to match into. As for IMGs, I just say tough **** because with the opportunities of SMP and grade replacement, theres no reason to go IMG unless you just don't want to work hard to get into a US school. I do feel bad for FMGs, but it is more difficult for a US grad to get into a residency (or residency-like) in other countries and to set up a practice there.

 

[Temperature101]

I am not too concerned yet since I am 99.99% interested in family medicine...Lol. However, I feel bad for people who are gunning for competitive residency spots.

 

[68quebec]

I am not too concerned yet since I am 99.99% interested in family medicine...Lol. However, I feel bad for people who are gunning for competitive residency spots.

I'm with you. Family Medicine is my favorite one too.

 

[JDMcNugent]

Yeah pretty tough if you can't match. Especially with (more than likely) $200,000+ in debt from school and it has to be a crushing feeling seeing almost all of your classmates find out that they got a job and you didn't.

 

[sazerac]

There are still thousands of unfilled residency positions each year. If your goal is to become a physician, it's still eminently doable.
If your goal is to match something like neurosurgery at an academic research center (the example given in the article), you're going to have to work for it.

[citation needed]

There were 402 unfilled PGY1 positions in the NRMP match of 2013. Family Medicine, for example, had less than 60 positions unfilled. That's like one (maybe two) per state.

Google "main residency match data" for the details.

 

[GUH]

[citation needed]

There were 402 unfilled PGY1 positions in the NRMP match of 2013. Family Medicine, for example, had less than 60 positions unfilled. That's like one (maybe two) per state.

Google "main residency match data" for the details.

That is the number of unfilled programs, not the number of unfilled positions. You are also excluding AOA positions. Try again.

 

[sazerac]

That is the number of unfilled programs, not the number of unfilled positions. You are also excluding AOA positions. Try again.

Well I'll be.

929 unfilled positions.
123 were in family med.

My mistake.

Still doesn't seem like "thousands" though.

 

[notbobtrustme]

For MDs, the competitiveness only increases slightly since the class sizes for MD is increasing at the slowest pace. DOs will be in the same place as IMGs are right now while less competitive MD applicants will be in the position where DOs are now.

 

[DrBowtie]

That is the number of unfilled programs, not the number of unfilled positions. You are also excluding AOA positions. Try again.

Then 878 were filled in the SOAP, 595 of those by US MDs. Not exactly huge surplus.

 

[bcurtis]

Hey all, this article was posted in my local newspaper e-column and is definitely worth a read: http://www.omaha.com/article/201311...y-positions-to-intensify-for-medical-students

It is something most already know about the increased competition for residency slots in the U.S. and how the steep increase in enrollment, lack of medicare funding etc. contributes to this problem. There is a slight emphasis on nebraska & iowa but I think it creates a big picture snapshot of how this shortage is projected.

Good find, though a bit disheartening lol

 

[darklabel]

Yeah no. What you aren't taking into account is the HUGE drop off for residency placement between DO and IMG. MD only makes you moderately more competitive for residencies than DO, while DO makes you A LOT more competitive for residencies than IMG. So being a DO will make you a bit less competitive in the coming years, but you'd still be plenty better off than IMGs are now.

And people always forget the AOA match like it doesn't have any competitive residencies and sends you in the middle of nowhere FM/IM spots that not even IMGs will want .

I think this is like pharmacy was a decade ago. Many of them saw the rapid increase in schools as a major problem in the future and now the # of graduates != number of jobs available and its only getting vastly worse. I think entering students of DO schools will be fine for the next few years, but in a decade I definitely see a negative impact on new entering DO students and even MDs (for competitive residencies) if the number of schools continue to increase like they do.

COCA is on a power binge and accrediting any school with a building and allowing satellite sites to open like theres no tomorrow. There always seems to be a disconnect between academia and real world need....

 

[cliquesh]

Then 878 were filled in the SOAP, 595 of those by US MDs. Not exactly huge surplus.

Yep, the nrmp data, as well as the natmatch data, is PRE-scramble/SOAP.

 

[Postictal Raiden]

And people always forget the AOA match like it doesn't have any competitive residencies and sends you in the middle of nowhere FM/IM spots that not even IMGs will want .

I think this is like pharmacy was a decade ago. Many of them saw the rapid increase in schools as a major problem in the future and now the # of graduates != number of jobs available and its only getting vastly worse. I think entering students of DO schools will be fine for the next few years, but in a decade I definitely see a negative impact on new entering DO students and even MDs (for competitive residencies) if the number of schools continue to increase like they do.

COCA is on a power binge and accrediting any school with a building and allowing satellite sites to open like theres no tomorrow. There always seems to be a disconnect between academia and real world need....

As long as the number of residency spots remain the same, or at most increases at a rate that is less than that of the population growth, the medical profession will be fine. The medical profession will be ruined for good if one of two things happen. 1) The government starts allowing foreign trained docs to practice in the US without completing an American residency or 2) The number of residency position increase dramatically. Neither I can foresee happening.

 

[darklabel]

As long as the number of residency spots remain the same, or at most increases at a rate that is less than that of the population growth, the medical profession will be fine. The medical profession will be ruined for good if one of two things happen. 1) The government starts allowing foreign trained docs to practice in the US without completing an American residency or 2) The number of residency position increase dramatically. Neither I can foresee happening.

Whole heartedly agree, but I'm worried that in the future (not near, but maybe a decade or so out) that DO students from new schools will fail to match. I would rather be rejected from medical school than have 200k+ in debt and have no residency after medical school.

 

[Postictal Raiden]

Whole heartedly agree, but I'm worried that in the future (not near, but maybe a decade or so out) that DO students from new schools will fail to match. I would rather be rejected from medical school than have 200k+ in debt and have no residency after medical school.

This is going to happen eventually, to DO grads and to a lesser extent to MD grads. The fittest will survive. Period. Those who chose the easy way out (Carib grads) are going to suffer the most. At least one third of DO's can match into AOA residencies without any competition. From what I remember, there were 300+ FM pgy1 AOA positions were left unfilled.

 

[darklabel]

This is going to happen eventually, to DO grads and to a lesser extent to MD grads. The fittest will survive. Period. Those who chose the easy way out (Carib grads) are going to suffer the most. At least one third of DO's can match into AOA residencies without any competition. From what I remember, there were 300+ FM pgy1 AOA positions were left unfilled.

Pfft yeah, whatever. We got into medical school now so we'll let them worry about it

 

[Postictal Raiden]

Pfft yeah, whatever. We got into medical school now so we'll let them worry about it

Yeah. I worried too much about getting into med school to worry now about getting into residency. I will do my best and will worry about it when time comes.

 

[guylewis]

I think we are losing sight of the major problem: there's a huuuuge shortage of primary care doctors and not enough residency spots to educate the graduates to satisfy this demand. There isn't a surplus of doctors like there is a surplus of pharmacy graduates or lawyers, so I think we are going to be fine. We, as future medical students, are fortunately in heavy demand, and for us we will likely still be able to match. I'm not sure about what the future holds for med students 15 years down the line but we don't have to worry about that, yayyyy! and future/recent IMGs are apparently totally out of luck. it was a good idea to do IMG a few years ago but that is no longer true today. That ship has sailed. DO and US MD graduates will be fine (this is what I've been told by many DOs, MDs, and professors)

 

[touchpause13]

There have been proposals to increase funding for GME and create more residency spots but I think medical education is pretty dang low on the priority list.

 

[guylewis]

Also, call me over sensitive but I'm not thrilled with how the author of this paper implies that DO school isn't medical school. Just sayin...

e.g.:
"New medical schools and colleges of osteopathic medicine also opened. In the last three years alone, eight new medical schools and six new osteopathic colleges opened, pumping hundreds of more students into the pipeline."

 

[touchpause13]

Also, call me over sensitive but I'm not thrilled with how the author of this paper implies that DO school isn't medical school. Just sayin...

e.g.:
"New medical schools and colleges of osteopathic medicine also opened. In the last three years alone, eight new medical schools and six new osteopathic colleges opened, pumping hundreds of more students into the pipeline."

Yeah I see where you are going there. It seems a bit biased

 

[costales]

I doubt that was his intention. That's how the schools are named.

 

[guylewis]

I doubt that was his intention. That's how the schools are named.

whether you get an M.D. or your D.O. affixed to the end of your name, you went to a medical school and you are a physician. that's what I'm trying to say. this author is stating that you either go to medical school or you go to study at a college of osteopathic medicine as if they are mutually exclusive terms, and that is where I am at odds with his improper characterization of DOs. both are medical schools

 

[JDMcNugent]

I suppose I missed the authors subtle bias. I was more so interested because other than sdn, I hear nothing in the news regarding this issue and its always about how some stupid website doesnt work for people to enroll in health insurance. The DO i shadow here in Omaha is a pretty big advocate for increasing awareness on this issue and actually encouraged me to write our congressman to address it. I decided against it seeing as how our elected and appointed officials are worthless and they have a tendency to miss the big picture.

 

[JDMcNugent]

Yeah I see where you are going there. It seems a bit biased

It is more than likely biased due to the fact that this was written in Omaha, Nebraska where we do not have many osteopathic physicians. The only 2 medical schools in the state are located in Omaha and are both allopathic schools. I frankly don't care that the author is biased or even goes as far to imply that osteopaths < allopaths, it is great that something like this makes the news and can maybe help bring awareness to this looming issue. Although I highly doubt that many people care outside of pre-meds, med students, and physicians/health care practitioners.

 

[notbobtrustme]

Yeah no. What you aren't taking into account is the HUGE drop off for residency placement between DO and IMG. MD only makes you moderately more competitive for residencies than DO, while DO makes you A LOT more competitive for residencies than IMG. So being a DO will make you a bit less competitive in the coming years, but you'd still be plenty better off than IMGs are now.

I think we are talking about two different things.

Take average MD, average DO and average IMG applicants. The average MD applicant will be more competitive for more residencies than the DO applicant who will be more competitive than the IMG. Now, say we have 1000 residency spots. In any given year, 600 MDs, 200 DOs and 400 IMGs enter the match. Given that only 1000 people can enter ACGME training, the breakdown might look like 500 MD, 150 DOs and 250 IMGs. Now what happens if there are 1000 MDs, 400 DOs and 400 IMGs? Now the situation gets much trickier for DOs and IMGs. The breakdown might be 850 MDs and 150 between DOs and IMGs. That's what I mean by DOs being in the same spot as IMGs are today. That's because the number of average MD applicants is going up.

 

[darklabel]

It is more than likely biased due to the fact that this was written in Omaha, Nebraska where we do not have many osteopathic physicians. The only 2 medical schools in the state are located in Omaha and are both allopathic schools. I frankly don't care that the author is biased or even goes as far to imply that osteopaths < allopaths, it is great that something like this makes the news and can maybe help bring awareness to this looming issue. Although I highly doubt that many people care outside of pre-meds, med students, and physicians/health care practitioners.

Actually, health care practitioners such as NPs and PAs love the fact that theres a supposed shortage of family physicians. It allows them to assume the role without having to go through the rigors of medical school or even the long training that occurs. Even PharmD's are trying to cash in and fill in the role of a family practitioner (Though with Pharmacy school almost equal in price of a medical school, I don't see the point).

While we sit here complaining about the residency shortage, we should also shift our attention to other positions that are trying to encroach in MD/DO territory and trying to play family doctor without actually putting in the long hours and training, which can lead to disastrous results for health care as a whole.

 

[costales]

It is more than likely biased due to the fact that this was written in Omaha, Nebraska where we do not have many osteopathic physicians.

The 2010 AOA census showed only 206 DOs in Nebraska. Next door in Iowa: 1,319 - one out of every 5 physicians was a DO, and the current governor ran the DO school.

 

[bionerd89]

Actually, health care practitioners such as NPs and PAs love the fact that theres a supposed shortage of family physicians. It allows them to assume the role without having to go through the rigors of medical school or even the long training that occurs. Even PharmD's are trying to cash in and fill in the role of a family practitioner (Though with Pharmacy school almost equal in price of a medical school, I don't see the point).

While we sit here complaining about the residency shortage, we should also shift our attention to other positions that are trying to encroach in MD/DO territory and trying to play family doctor without actually putting in the long hours and training, which can lead to disastrous results for health care as a whole.

Has there been any changes to the situation? Are NP and PA now legally allowed to assume the role of a family physician without an actual physician overseeing them?

 

[darklabel]

Don't know, it varies per state. However, both organizations representing their respective professions are making a strong push. In FL (My home state), the Medical board tried to limit who can be called a doctor in a medical setting (and rightfully so). I remember how during my fiancee's time in nursing school, they advocated so that this law wouldn't pass because the idea that a nurse can bypass medical school and be called a doctor is such a great one .

http://www.clinicaladvisor.com/stat...imit-who-can-be-called-doctor/article/284167/

 

[notbobtrustme]

I seriously doubt MD and DO applicant numbers will double in just a few years. And besides that, DOs have their own residency programs, so they'll be fine. IMGs will be the first to be driven out.

US MDs and ACGME slots are expected to be 1:1 in less than a decade. That's been the stated goal of the AMA and LCME.

 

[darklabel]

US MDs and ACGME slots are expected to be 1:1 in less than a decade. That's been the stated goal of the AMA and LCME.

Source? I know Class of 2017-18 will have total number of MD and DO graduates equal to number of ACGME slots, but I haven't read anywhere of parity with only USMD graduates.

 

[Postictal Raiden]

US MDs and ACGME slots are expected to be 1:1 in less than a decade. That's been the stated goal of the AMA and LCME.

In 2012, the number of first year enrollment at US MD schools was 20050. There are currently around 26K ACGME slots available. If I understand you correctly, you are suggesting that in six years (not ten because it takes 4 years to graduate), the number of first year enrollment should increase by 30% (6000 seats). That's a 1000 seat/year increase, which is equivalent to opening ~7 new MD programs every year.

 

[Postictal Raiden]

Source? I know Class of 2017-18 will have total number of MD and DO graduates equal to number of ACGME slots, but I haven't read anywhere of parity with only USMD graduates.

This is true. However, we still haven't factored in ~5% attrition and the number of pgy1 slots that aren't ACGME (Urology, Ophth, military, and AOA) which could easily add another 3500 positions.

 

[JDMcNugent]

The 2010 AOA census showed only 206 DOs in Nebraska. Next door in Iowa: 1,319 - one out of every 5 physicians was a DO, and the current governor ran the DO school.

Not surprising at all seeing as how Iowa just has the University of Iowa and DMU for it's medical schools.

 

[QueenJames]

Sooo... pretty much bad news for caribbean grads (Ross, SGU, etc.)?

 

[JDMcNugent]

Sooo... pretty much bad news for caribbean grads (Ross, SGU, etc.)?

I personally would be anxious if I were a current caribbean student planning on matching in the U.S. but I don't know how that will shake out. I would hope that students who want to go to medical school and practice in the U.S. will do their homework and find out that it's really not a good option.

Now, this clearly is a convoluted issue that isn't as black and white as the article may suggest. But, what do you all think about the possibility of this issue getting fixed? i.e., medicare funding to pay for residency slots, medical school enrollment issues, etc.

 

[touchpause13]

US MDs and ACGME slots are expected to be 1:1 in less than a decade. That's been the stated goal of the AMA and LCME.

I'm sorry but that would be a good thing why?

 

[GUH]

I'm sorry but that would be a good thing why?

It's inefficient to have empty residency slots

 

[darklabel]

I'm sorry but that would be a good thing why?

Its not, but since the AOA isn't playing nice with the AMA or ACGME, than Osteo's aren't being considered whenever these schools think about expansion. All of these organizations have called for an increase in the number of medical schools (MD, I doubt they meant DO) because of the perceived notion of there not being enough primary care physicians, when really that is dictated by the number of residencies available.

Think about it, only way to increase primary care physicians is by opening residencies and allowing more DOs and IMGs/FMGs take those positions, not increase medical school enrollment. So really, when it comes to increase USMD school enrollment, its just so that there are more USMDs in ACGME positions.

 

[touchpause13]

It's inefficient to have empty residency slots

But there are still IMGs that could fill the gaps. There is a problem of not enough primary care docs in rural areas, I think squeezing out folks who would be willing to do that kinda work is a bad call

 

[68quebec]

This is going to happen eventually, to DO grads and to a lesser extent to MD grads. The fittest will survive. Period. Those who chose the easy way out (Carib grads) are going to suffer the most. At least one third of DO's can match into AOA residencies without any competition. From what I remember, there were 300+ FM pgy1 AOA positions were left unfilled.

WOW 300+ positions left unfiled? that's hugh number lol

 

[Postictal Raiden]

WOW 300+ positions left unfiled? that's hugh number lol

Yup. Between IM and FM, there were over 500 positions left unfilled. Check out for yourself.

https://natmatch.com/aoairp/stats/2013prgstats.html

 

[Postictal Raiden]

I'm really baffled about the 4 ENT and the 6 GS slots that were left unoccupied.

 

[68quebec]

Yup. Between IM and FM, there were over 500 positions left unfilled. Check out for yourself.

https://natmatch.com/aoairp/stats/2013prgstats.html

thank you very much.

 

[DrBowtie]

Yup. Between IM and FM, there were over 500 positions left unfilled. Check out for yourself.

https://natmatch.com/aoairp/stats/2013prgstats.html

I'm really baffled about the 4 ENT and the 6 GS slots that were left unoccupied.

You guys are acting like they never actually fill those spots.

I'm sure most of them were scooped up by people who tried the ACGME match only, didn't match and scrambled into them.

There aren't tons of funded spots going to waste each year, the data sets we have show 3 months before the real deadline to find a warm body.