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[deleted630732]

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Good discussion

 

[cbrons]

Its either that or they'll fill it with mid-levels. So which one do you want?

 

[DocWinter]

There are 5 new DO schools planned for 2018. There have been about 5 or 6 added since 2013. The crap of all that aside, there is a physician shortage and there will soon be fewer residencies than graduating medical students. It has to happen.

15K does seem excessive but its headed in the right direction.

 

[PL198]

There are 5 new DO schools planned for 2018. There have been about 5 or 6 added since 2013. The crap of all that aside, there is a physician shortage and there will soon be fewer residencies than graduating medical students. It has to happen.

15K does seem excessive but its headed in the right direction.

the fact that DO schools are popping up like crazy doesn't mean anything about the number of residency slots there should be

 

[pacman2018]

Its either that or they'll fill it with mid-levels. So which one do you want?

Then let them dilute their salaries... same thing happened with pharmacy. It's not what you want. Also, that's 15k new physicians that couldn't "make it" before adding these new positions which is only further diluting the profession of doctors

 

[DrBowtie]

I interpreted this as 3k extra slots per year for 5 years for 15000 total funded years.

 

[deleted564680]

15000 is a lot of spots. MD + DO spots extrapolated out to 2020 even with new campuses opening still amounts to about 5000 less graduates than residency spots. We actually have enough residency spots. The hospitals have been footing the bill since the halting of new programs over a decade ago. I'm assuming hospitals would like to have that money back so they can build more cancer centers/etc. The amount of money a big academic center gets and makes from residents is astounding.

 

[Stagg737]

I'm not opposed to more positions, but I do think 15k is quite excessive. The other issue is that adding more residency slots isn't going to fix the issue with physician shortage in underserved areas since no one is forcing physicians to practice in those areas. It'll just worsen the issues with saturation in the more desirable areas and create them in the moderately desirable areas.

There are 5 new DO schools planned for 2018. There have been about 5 or 6 added since 2013. The crap of all that aside, there is a physician shortage and there will soon be fewer residencies than graduating medical students. It has to happen.

15K does seem excessive but its headed in the right direction.

the fact that DO schools are popping up like crazy doesn't mean anything about the number of residency slots there should be

It's not just DO schools, there have also been around 15 new MD schools pop up in the past 10 years. Either way, it's just furthering the modern perspective that higher education's primary goal is now business and not education.

 

[cbrons]

Also, that's 15k new physicians that couldn't "make it" before adding these new positions which is only further diluting the profession of doctors

Or it could be 15k new unsupervised PAs or NPs who never went to med school. Which do you prefer?

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Edit: See this eloquently worded response from a thread in General Residency Issues:

"From a boots on the ground perspective, there aren't enough MDs to provide that amount of care that our population is currently demanding. That gap is not going to be bridged by graduating more physicians due to lack of funding for expanding number of resident slots so it's going to fall to the NPs and PAs by default. This isn't an issue that needs to be settled in JAMA or NEJM. This is an issue that's already been settled based on the decisions made over the last decade. The only question to be decided now is what role physicians have going forward. Are we going to be supervisors deciding (or just endorsing) care provided by teams of midlevels, boutique specialists only available to the well-to-do, or some other model that allows us to provide value to the system while still retaining our profession's mission?<br /> <br />Nursing has already provided a model for the NPs moving forward where less experienced personnel are placed into de-skilled positions supported by automated safety systems and a robust layer of semi-clinical QA/QI managers"

https://www-forums.studentdoctor.net/index.php?posts/17746887

 

[cbrons]

Then let them dilute their salaries..

Theyre going to dilute your salary too since they are being given essentially identical roles and responsibilities. You are just another "provider."

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[DocWinter]

the fact that DO schools are popping up like crazy doesn't mean anything about the number of residency slots there should be

As someone said the MD schools have been increasing too. With the merger at a head it will affect everyone. I think it's a perfectly good reason to create more slots.

 

[PL198]

As someone said the MD schools have been increasing too. With the merger at a head it will affect everyone. I think it's a perfectly good reason to create more slots.

my argument is no different. just because new schools are popping up does not mean more slots are needed. schools trying to make more money says nothing about the supply of physicians

 

[Mad Jack]

I recently read this article about the residency cap and the push to expand GME funding

https://www.doximity.com/doc_news/v2/entries/6273238

Apparently there is a bill to increase GME funding through the following mechanism:

"The addition of 3,000 new residency slots annually for five years for a total of 15,000 by end the end of the period. Around half of those slots would be dedicated to students practicing in “high demand” areas such as primary care."

While I'm sure that there is a shortage specifically in primary care and a few other fields, wouldn't an extra 15,000 spots be incredibly excessive? That's almost a 50% increase in the number of doctors being pumped out each year. Where would we even begin to fill these spots? Only 42,000 people applied for 31,000 spots last year. We would literally have to accept everyone who passed step 1 and wanted to practice in the US. Not to mention, even if we did fill these spots we would see an incredible saturation of doctors in the US in a matter of years.

Thoughts?

It's 3,000 per year, and only for 5 years, for a total of 15,000 residents. In other words, let's say there's 22,000 residency positions today (as an example). This bill ups that number to 25,000 for the next five years, after which it drops back to 22,000. That doesn't mean 22,000>25,000>28,000>etc. That isn't some huge increase, it's a temporary bump.

And this bill has been on the table in some form or another since 2010, it never passes, so don't count on it now.

 

[NotAProgDirector]

It also depends upon what you mean by a "slot". If I have an IM residency program that is 3 years long with 10 residents per year, I need a cap of 30. If the bill increases the number of slots by 5000, I need 3 of those to hire one extra resident. And a surgical program would need 5. So I think this number looks 3-5x bigger than you think.

That said, I'm not sure it's a great idea for many other reasons.

 

[Psai]

This.

Every so often someone writes up a hair-pulling article about this bill like it's a new thing.

It's a DOA bill that gets recycled every year.

All of this has happened before and will happen again.

 

[Mad Jack]

All of this has happened before and will happen again.

Like URM threads, it is destined to be an annual issue that churns itself out again and again, with people getting their panties in a bunch over what amounts to nothing one way or another.

 

[Goro]

Three to six new MD schools coming soon too! This is just off the top of my head with only one cup of tea this AM.

WSU
Arrowhead
Kaiser-SoCal
UNLV
TCU
Seton Hall (maybe)

There are 5 new DO schools planned for 2018. There have been about 5 or 6 added since 2013. The crap of all that aside, there is a physician shortage and there will soon be fewer residencies than graduating medical students. It has to happen.

15K does seem excessive but its headed in the right direction.

 

[Mad Jack]

Three to six new MD schools coming soon too! This is just off the top of my head with only one cup of tea this AM.

WSU
Arrowhead
Kaiser-SoCal
UNLV
TCU
Seton Hall (maybe)

Here is the current list of developing medical schools that are out there. Some are DOA, but many will likely open:

State School City Degree Anticipated Inaugural Class
Alaska University of Alaska at Fairbanks Fairbanks MD Under discussion[63]
Arizona Mayo Medical School - Arizona Scottsdale MD 2017[64]
Arkansas Arkansas State University Jonesboro DO 2016[65][66]
California California University of Science and Medicine Colton MD "Applicant status" per LCME[67]
California Southern California College of Osteopathic Medicine Los Angeles DO "Applicant status"[68] as of 2011
California Kaiser Permanente School of Medicine Pasadena MD 2019[69]
California University of California, Merced School of Medicine Merced MD Under discussion[70]
Florida Center for Allied Health Nursing Education TBD DO "Applicant status"[68] as of 2011
Florida Larkin College of Osteopathic Medicine South Miami DO "Applicant status"[68][71] as of 2013
Florida Palm Beach Medical College Palm Beach MD Under discussion[72]
Florida Nova Southeastern University College of Allopathic Medicine North Miami MD Proposed start for 2018[73]
Idaho Idaho State University-Idaho College of Osteopathic Medicine Meridian, Idaho DO Under discussion (2018)[74]
Illinois University of Illinois at Urbana-Champaign Urbana, Champaign MD Under discussion (2017)[75][76]
Indiana Indiana University School of Medicine - Evansville Evansville MD 2017[77]
Kansas Indiana Wesleyan University TBD (possibly Overland Park) DO "Applicant status"[68][78] as of 2011
Louisiana Louisiana State University Lafayette MD Under discussion[79]
Minnesota Minnesota College of Osteopathic Medicine Gaylord DO 2018[80]
Missouri Homer G. Phillips College of Osteopathic Medicine St. Louis DO "Applicant status"[68] as of 2010
Missouri Kansas City University of Medicine and Biosciences Joplin DO 2017[81]
Montana Montana College of Osteopathic Medicine Missoula DO (Under discussion) 2017[82]
Nevada Roseman University of Health Sciences Henderson MD 2018[83]
New Jersey Seton Hall University South Orange, New Jersey MD 2018
New York Syracuse University Syracuse, New York MD proposed[84]
Ohio Heritage College of Osteopathic Medicine Warrensville Heights DO 2015[85]
Oklahoma OU - TU School of Community Medicine Tulsa MD 2014[86]
Pennsylvania Southwestern Pennsylvania (school name TBD) Beaver DO "Applicant status"[68] as of 2010
Pennsylvania Temple University School of Medicine at Allegheny Health Network Pittsburgh MD originally 2013;[87] postponed. Regional clinical campus created for years 3 and 4.
Texas University of Houston Houston MD Under discussion[88]
Texas University of North Texas Health Science Center - Texas Christian University Fort Worth MD 2018[89]
U.S. Virgin Islands University of the Virgin Islands Christiansted & Charlotte Amalie MD 2017[90]
Utah Rocky Vista University College of Osteopathic Medicine-Southern Utah Ivins DO 2017[91][92]
Virginia College of Henricopolis School of Medicine Martinsville MD 2016[93]
Virginia King School of Medicine Abingdon MD In development[94]
Wisconsin Osteopathic Medical College of Wisconsin Jefferson DO 2018[95]

 

[Psai]

It's obvious what's going on. This has already happened to nursing, pharmacy and law. The glut in the law market has been particularly prominent in the past few years. When things are good, people want to enter the field and demand increases. To meet that demand, new schools open up and pump out graduates of dubious quality. Things stay stable for a while but then there's a point where there are more grads than jobs.

When the job market starts to suck, employers start to not give a **** about the employees because they have their pick of replacements. Signing bonuses become a thing of the past, annual raises are but a memory and treatment of staff becomes steadily worse.

There is no shortage of physicians. The midlevel revolution will happen whether or not our numbers grow. All this nonsense about providers and midlevel "residents" and fellows" is an attempt to blur the lines. Patient satisfaction serves only to decrease pay. And increasing spots will only lead to diluted training for residents.

 

[postbacpremed87]

It's obvious what's going on. This has already happened to nursing, pharmacy and law. The glut in the law market has been particularly prominent in the past few years. When things are good, people want to enter the field and demand increases. To meet that demand, new schools open up and pump out graduates of dubious quality. Things stay stable for a while but then there's a point where there are more grads than jobs.

When the job market starts to suck, employers start to not give a **** about the employees because they have their pick of replacements. Signing bonuses become a thing of the past, annual raises are but a memory and treatment of staff becomes steadily worse.

There is no shortage of physicians. The midlevel revolution will happen whether or not our numbers grow. All this nonsense about providers and midlevel "residents" and fellows" is an attempt to blur the lines. Patient satisfaction serves only to decrease pay. And increasing spots will only lead to diluted training for residents.

The name of the game is to choose a specialty where you can make good money for the shortest length of training and start making that money as soon as possible before conditions change.

 

[PL198]

It's obvious what's going on. This has already happened to nursing, pharmacy and law. The glut in the law market has been particularly prominent in the past few years. When things are good, people want to enter the field and demand increases. To meet that demand, new schools open up and pump out graduates of dubious quality. Things stay stable for a while but then there's a point where there are more grads than jobs.

When the job market starts to suck, employers start to not give a **** about the employees because they have their pick of replacements. Signing bonuses become a thing of the past, annual raises are but a memory and treatment of staff becomes steadily worse.

There is no shortage of physicians. The midlevel revolution will happen whether or not our numbers grow. All this nonsense about providers and midlevel "residents" and fellows" is an attempt to blur the lines. Patient satisfaction serves only to decrease pay. And increasing spots will only lead to diluted training for residents.

nothing really to stop it from happening though as long as these schools keep popping up like weeds.

I also don't understand the logic behind it. if for sake of argument we say we need more docs, I'd rather schools with successful track record have more spots and branch out their affiliated institutions, than to have med schools in montana or idaho

 

[AlbinoHawk DO]

Its either that or they'll fill it with mid-levels. So which one do you want?

I rather have the mid levels than to have more people with our level of expertise being railroaded with garbage salaries. No matter how many mid-levels you add, the need of having a physician won't disappear.

I seriously doubt Trump will be spending on getting 15k new slots when he's trying to kill obamacare.

 

[cbrons]

I rather have the mid levels than to have more people with our level of expertise being railroaded with garbage salaries. No matter how many mid-levels you add, the need of having a physician won't disappear.

The whole expansion of midlevel practice rights/scope is to serve in place of physicians.

I seriously doubt Trump will be spending on getting 15k new slots when he's trying to kill obamacare.

Don't count on it. He is very willing to spend tax payer dollars on government boondoggles like walls and bridges to nowhere. Repealing obamacare =/= halting pre-planned expansion of GME.

 

[Anicetus]

nothing really to stop it from happening though as long as these schools keep popping up like weeds.

I also don't understand the logic behind it. if for sake of argument we say we need more docs, I'd rather schools with successful track record have more spots and branch out their affiliated institutions, than to have med schools in montana or idaho

Why shouldn't we have more schools in those areas? It will force people to spread out in the country since the coastal "popular" cities are too populated.

Some people are saying even if you send a doc to train in Montana for residency, a lot of the time it's too hard to move after they have settled and are being handled a deal too good to turn down after being there for 3+ years.

This is what is best for our nation at the end of the day. We needed a distribution of doctors. The downside is that obviously the people who go to these areas will be those who were worse test takers.

 

[Stagg737]

The whole expansion of midlevel practice rights/scope is to serve in place of physicians.

There's also still a very significant percentage of patients who will demand to see a physician over a mid-level, and when it comes to the serious issues a physician is still the go-to. As long as mid-levels don't get independent prescribing rights, I think physicians will be fine in terms of demand.

 

[IlDestriero]

They can increase the residency cap, but specialties will continue to evaluate and control the number of spots in the match to control the number of graduates. Nobody benefits from saturated markets.
The Peds Anesthesia field is evaluating this right now and considering decreasing the number of fellowship positions offered.


--
Il Destriero

 

[Peach Newport]

I don't understand why they want to make the new PGE spots in primary care. It seems to me that if they just keep a good range of specialties, BUT ONLY FUND NEW PGE SPOTS IN GEOGRAPHICALLY UNDERSERVED AREAS, most of these problems we see could be avoided.

 

[cbrons]

There's also still a very significant percentage of patients who will demand to see a physician over a mid-level, and when it comes to the serious issues a physician is still the go-to. As long as mid-levels don't get independent prescribing rights, I think physicians will be fine in terms of demand.

They have independent prescribing rights in like 24 states.

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[Etorphine]

it'll be tougher to become a specialist in the future, that's for sure

 

[aalamruad]

it'll be tougher to become a specialist in the future, that's for sure

Is this just because they're safe from mid level encroachment and will maintain relatively good salaries so more people will be competing for those fields?

Also, are most surgical fields safe from most of the problems being discussed in this thread?

 

[Spectre of Ockham]

Thoughts?

Given the fact that there's a global shortage of doctors it's a good move , seriously this planet desperately needs a lot more doctors. How many of our peers do we have to see jumping out the window before we do something ? How many neurons do we have to loose to the stress of over a 70+ hour minimum work week ?

IDK about you but about 40% of doctors I know smoke due to stress , another 30% is obese due to stress , 10% is stressed beyond belief and 10% are attending that seem to superhumanly float above this sea of misery 95% and throw the patients to the lower ranks when they had too much.

Also at the current burnout rate your can bet that at least 10% of those if they are poorly trained will throw in the towel.

 

[Psai]

Given the fact that there's a global shortage of doctors it's a good move , seriously this planet desperately needs a lot more doctors. How many of our peers do we have to see jumping out the window before we do something ? How many neurons do we have to loose to the stress of over a 70+ hour minimum work week ?

IDK about you but about 40% of doctors I know smoke due to stress , another 30% is obese due to stress , 10% is stressed beyond belief and 10% are attending that seem to superhumanly float above this sea of misery 95% and throw the patients to the lower ranks when they had too much.

Also at the current burnout rate your can bet that at least 10% of those if they are poorly trained will throw in the towel.

We need fewer doctors and the ability to tell people that no, their 90 year old grandma does not need to be full code do everything doctor. She has a nonreversible illness, time to say goodbye.

 

[SurfingDoctor]

The Resident Physician Shortage Reduction Act was proposed by two Democrats in the House and taps the Medicare budget (where most GME support comes from by the way). Considering the current Speaker of the House is interested in eliminating Medicare, the chance of this getting passed... I think you have a better chance of winning the lottery.

One should be more concerned about the privatization of Medicare. Are insurance companies interested in supporting GME education? I don't know the answer to that, but I can see them saying that it's not their problem. They are in the business of acting as financial intermediaries to obtain profit, not supporting doctors in training, at least not to the magnitude that it would impact their bottom line.

 

[caffeinemia]

The Resident Physician Shortage Reduction Act was proposed by two Democrats in the House and taps the Medicare budget (where most GME support comes from by the way). Considering the current Speaker of the House is interested in eliminating Medicare, the chance of this getting passed... I think you have a better chance of winning the lottery.

One should be more concerned about the privatization of Medicare. Are insurance companies interested in supporting GME education? I don't know the answer to that, but I can see them saying that it's not their problem. They are in the business of acting as financial intermediaries to obtain profit, not supporting doctors in training, at least not to the magnitude that it would impact their bottom line.

This here is scary as hell...as far as the insurance companies are concerned, they want you to see the cheapest, least invasive "provider" ever. If they could have you only see the mortician, they would.

 

[DoctwoB]

The real question is not whether we should fund more residency slots but truly whether there should even BE more residency slots. In most fields, we have a physician maldistribution, not a shortage, and making more docs won't suddenly make everyone want to practice in Montana. Additionally, where are these slots going to come from. Pretty much every major academic affiliated hospital already has residents. To add more spots you're either opening up marginal programs at Podunk community hospital or diluting the training of residents at existing programs.

 

[Spectre of Ockham]

We need fewer doctors and the ability to tell people that no, their 90 year old grandma does not need to be full code do everything doctor. She has a nonreversible illness, time to say goodbye.

 

[kamakazi5]

We need fewer doctors and the ability to tell people that no, their 90 year old grandma does not need to be full code do everything doctor. She has a nonreversible illness, time to say goodbye.

This is one thing I have wondered since I started working in the ICU. Doctors explain the situation but when it comes down to it they never say no to these families. Is it just due to how they were trained or do they legally have to continue doing everything possible for these poor people? I'm sure it's more nuanced than this but I have become very curious about it.

 

[Psai]

This is one thing I have wondered since I started working in the ICU. Doctors explain the situation but when it comes down to it they never say no to these families. Is it just due to how they were trained or do they legally have to continue doing everything possible for these poor people? I'm sure it's more nuanced than this but I have become very curious about it.

It's up to the families. Right now, our role is to recommend and guide, not to make the final decision. Unfortunately that leads to many cases of people who should have gone comfortably a while ago now suffering through everything we do to them, long after they've lost what made them people.

 

[Azete]

It's up to the families. Right now, our role is to recommend and guide, not to make the final decision. Unfortunately that leads to many cases of people who should have gone comfortably a while ago now suffering through everything we do to them, long after they've lost what made them people.

I agree 100%, and our system would be far better off if physicians had the final say, but that's a pretty big burden some people might not be comfortable with (me included). Having the kids of a 90 yr old patient I pulled the plug on call me a murderer, etc. wouldn't be an easy thing to endure.

Not to mention the particularly unhappy family members that happen to be lawyers and decide to make an ordeal out of it.