Is pathology at an all time low?

[Guest8]

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You're right, this doesn't make any sense. The vast majority of people who finish residency in the US are going to work in the US and thus pay (a lot of) taxes. The vast majority of medical students either don't work before school or work such low-paying jobs that their tax contribution is minimal. So then who is acceptable for residency by those standards? Only non-traditionals or people whose parents who worked here and made enough to contribute a meaningful tax burden? What about a recent immigrant who gets admitted to a US med school but didn't pay any taxes beforehand? What about a US citizen whose parents paid a lot of taxes, but s/he went to an offshore school and came back for residency? What about the kid of a single mom who lived on welfare who beat the odds and got into a US med school?

There's no valid reason to limit residency spots to US grads, foreign grads, grads whose parents paid US taxes their whole lives, or whatever. I want residencies taking the best candidates for the jobs. Does Path need to do better at recruiting the best candidates? For sure. Should we cut some spots to do so? For sure. But should we in any way pretend that only US-born, children of US-taxpaying parents deserve to be MDs in America? Absolutely not.

 

[Spikebd]

There's no valid reason to limit residency spots to US grads, foreign grads, grads whose parents paid US taxes their whole lives, or whatever. I want residencies taking the best candidates for the jobs. Does Path need to do better at recruiting the best candidates? For sure. Should we cut some spots to do so? For sure. But should we in any way pretend that only US-born, children of US-taxpaying parents deserve to be MDs in America? Absolutely not.

I don’t think it’s so simple. It seems undisputed that individuals on H1-B visas depress salaries for American workers. I’m not blaming any individual who is coming here on these programs. I believe most of them are smart and very hardworking. I’m just trying to point out the reality in pathology seems to be that there exists a relatively tight job-market. The FMG issue is a significant one in my opinion. It’s not the only issue, but still a significant one that warrants being addressed and studied further. I also believe preference should be given to American graduates first.

I think PSLF is the governments way of softening the blow for current residents and medical students who will be practicing in a new “Medicare for all” health system in the next decade or so.

And as I said, there are a lot of issues in this field (consolidation, low reimbursement, advancing technology, etc) this is just one of them.

 

[Vicinal]

You're right, this doesn't make any sense. The vast majority of people who finish residency in the US are going to work in the US and thus pay (a lot of) taxes. The vast majority of medical students either don't work before school or work such low-paying jobs that their tax contribution is minimal. So then who is acceptable for residency by those standards? Only non-traditionals or people whose parents who worked here and made enough to contribute a meaningful tax burden? What about a recent immigrant who gets admitted to a US med school but didn't pay any taxes beforehand? What about a US citizen whose parents paid a lot of taxes, but s/he went to an offshore school and came back for residency? What about the kid of a single mom who lived on welfare who beat the odds and got into a US med school?

Based on your comment you imply that having over 300 unfilled positions is justified. You are very generous indeed. I did not realize that going 200-300K US Med school debt and then competing with people without educational debt from other countries and predominantly from well to do families with means for jobs was an inherent intent of the system. (US medical students have educational debt. This includes offshore US citizen grads, DOs and the like. Most foreign grads do not.) So I appreciate that FMGs pay taxes and live in the US after training but they can tolerate less pay and saturate a crappy market ultimately contributing to a less desirable field overall. Half of positions need to be cut immediately if not sooner.

 

[y2k_free_radical]

Based on your comment then you feel that having over 300 unfilled positions are justified because of these reasons. You are very generous indeed. I did not realize that going 200-300K in debt for going to Med school in the US then having to compete with people with no debt from other countries and predominantly from well to do families with means for jobs that pay less was the intent. US medical students have educational debt. This includes offshore US citizen grads, DOs and the like. Most foreign grads do not. So I appreciate that they pay taxes and live in the US but they can take less pay and saturate a crappy market and make the field less desirable overall. Half of positions need to be cut immediately if not sooner.

And their forebears paid taxes for decades and some defended our country,but patriotism is coached as xenophobia and politically incorrect in the recent years.Most of these other countries would not extend the same courtesy to U S applicants.

 

[jupiterianvibe]

It'd be nice if the match was fluid enough to allow a redistribution of spots each cycle. For example, the 400 spots left unfilled this year in path would be redistributed to other specialties with an overabundance of applications, such as derm or plastics

 

[ScubaV]

Based on your comment you imply that having over 300 unfilled positions is justified. You are very generous indeed.

300 unfilled positions? Where's the data for this? Unless you mean residency spots going to FMG's means they're unfilled, which is ridiculous. I am starting to think there are probably too many pathology residency spots, but I haven't seen much good data to support either side of the argument. Being imprecise with terminology at best, or intentionally spreading misinformation at worst, does not help matters.

I did not realize that going 200-300K US Med school debt and then competing with people without educational debt from other countries and predominantly from well to do families with means for jobs was an inherent intent of the system. (US medical students have educational debt. This includes offshore US citizen grads, DOs and the like. Most foreign grads do not.)

How does debt have anything to do with competition for residency spots? You were arguing that residency spots should only go to those who've adequately "paid into the system" (i.e. taxes for Medicare, due to it's eventual insolvency). I countered with some examples highlighting the flaws of that argument, unless "paying into the system" is really a coded phrase for "US citizen for more than one generation", which is moot anyway because according to the most recent match data only ~200 US seniors applied for ~600 open PGY1 pathology spots. FMG's aren't taking away spots from US MD's.

Half of positions need to be cut immediately if not sooner.

I don't inherently disagree with this. There probably do need to be cuts, but there has to be well-reasoned arguments with good data to determine how many spots should be cut, and then to convince the various regulatory agencies to actually do it. Cutting spots because you think there's too many FMG's and you don't like them/they don't deserve it/dey took er jerbs! is not going to convince anyone. Cutting spots because there's too many pathologists and salary is going down out of proportion to other specialties/lots of unemployed or underemployed pathologists would be a convincing argument but also has nothing to do with FMG vs. US MD. It's irrelevant. Like I said above if the problem is too many graduating trainees would that really be solved by changing the ratio of US MD:FMG from 1:1 or 1:2 to 1:0?

By all means, argue to cut residency spots and let the best medical students win what's left. All I'm saying is that artificially trying to factor in FMG status or taxpayer status or whatever else is unhelpful as a practical matter and hints at ulterior motives.

 

[Vicinal]

300 unfilled positions? Where's the data for this? Unless you mean residency spots going to FMG's means they're unfilled, which is ridiculous. I am starting to think there are probably too many pathology residency spots, but I haven't seen much good data to support either side of the argument. Being imprecise with terminology at best, or intentionally spreading misinformation at worst, does not help matters.



How does debt have anything to do with competition for residency spots? You were arguing that residency spots should only go to those who've adequately "paid into the system" (i.e. taxes for Medicare, due to it's eventual insolvency). I countered with some examples highlighting the flaws of that argument, unless "paying into the system" is really a coded phrase for "US citizen for more than one generation", which is moot anyway because according to the most recent match data only ~200 US seniors applied for ~600 open PGY1 pathology spots. FMG's aren't taking away spots from US MD's.



I don't inherently disagree with this. There probably do need to be cuts, but there has to be well-reasoned arguments with good data to determine how many spots should be cut, and then to convince the various regulatory agencies to actually do it. Cutting spots because you think there's too many FMG's and you don't like them/they don't deserve it/dey took er jerbs! is not going to convince anyone. Cutting spots because there's too many pathologists and salary is going down out of proportion to other specialties/lots of unemployed or underemployed pathologists would be a convincing argument but also has nothing to do with FMG vs. US MD. It's irrelevant. Like I said above if the problem is too many graduating trainees would that really be solved by changing the ratio of US MD:FMG from 1:1 or 1:2 to 1:0?

By all means, argue to cut residency spots and let the best medical students win what's left. All I'm saying is that artificially trying to factor in FMG status or taxpayer status or whatever else is unhelpful as a practical matter and hints at ulterior motives.

Please calm down.... ulterior motives can be read into anything....

there were spots initially created to serve US grads and US taxpayers historically. Then hospitals got greedy because of the CMS funding of graduate medical education.... lots of changes happened in pathology including CP being automated, PAs being hired etc... and programs did not cut numbers of spots. Now more than half of the CMS funded programs are not filling by the intended trainees.

 

[Vicinal]

Does anyone know a number of residents per accessions that seems reasonable. Something like 1 per 10-12K? How does the ACGME empirically justify residency spots and fellowship positions?