Matched transitional year without advanced year

[HopefullyGas]

I just got into a transitional year without getting into an advanced program for anesthesia. My board scores were 233 step 1 and 250 step 2, I did research, and I was in Anesthesia extracurriculars. One red flag in the form of a remediate rotation. I am not sure what exactly happened to me. What are my chances of being able to match into a physician only (R) program for anesthesia next year, and how do I best prepare for that?

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[chromuffin]

Next year reapply to both PGY1 and PGY2/CA1 positions in the hopes of scoring the latter. Why risk just PGY2 if this is your dream? You should match with those stats. Mine were worse and I matched.

 

[nimbus]

You got the hard part done! SOAP site up yet?

 

[chocomorsel]

Damn. People with >230 can’t match into anesthesia anymore? Are you serious?
Glad I am older and matched easily with worse stats 15 years ago.
Did you apply broadly OP or only to the top tier programs thinking you would match easily?

 

[abolt18]

Any open anesthesia spots this year to even SOAP into? Or did they all fill.

 

[AquaRegia241]

also in the same position as the OP. 238/229 on steps and 622/613 on comlex (am DO). had 12 interviews with 14 ranks and only partially matched to a TY but no advanced. Interviews were at a good mix of university hospitals and community (HCA) programs. No red flags that I know of other than drop in step 2. Perhaps I interview poorly or just bad luck but with no anesthesia programs available in the SOAP I'm just trying to mentally prepare myself to reapply during my TY (will dual apply with categorical IM).

virtual hugs to you OP. I'm grateful we both have a TY to fall back on but I know what you're going through and I hope we both have a successful cycle next year.

 

[abolt18]

2 Categorical, 0 Advanced, 1 R spots

That's wild.

 

[Justice4all]

Sorry to hear OP. Does your TY program have ansthesia program?

 

[GassYous]

Reddit said there were 2 spots open in the country. I saw a guy with 240s from a decent school not match.

Worries me because EM was popping a few years ago and had no open spots in the country but look now. I've been telling people that anesthesia is getting more competitive. It was noticeably worse last year but people are still giving the same advice.

 

[chocomorsel]

Reddit said there were 2 spots open in the country. I saw a guy with 240s from a decent school not match.

Worries me because EM was popping a few years ago and had no open spots in the country but look now. I've been telling people that anesthesia is getting more competitive. It was noticeably worse last year but people are still giving the same advice.

The question is, WHY is it getting more competitive? What has changed? More money? Less call? Less CRNAs? More respect? Someone please enlighten me. I couldn't match by today's standards.

 

[izchief360]

Similar story here. USMD 223/239. 12 anesthesia interviews, 16 anesthesia ranks. Only landed a prelim IM (rank 17). I'd like to apply again next year, but it seems like the competition jumps noticeably every year and I feel like I'd be at a baseline disadvantage applying as a PGY1. I guess I'll see how the next 6 months or so pan out...

 

[nimbus]

The question is, WHY is it getting more competitive? What has changed? More money? Less call? Less CRNAs? More respect? Someone please enlighten me. I couldn't match by today's standards.

More med school grads, not enough GME spots overall. Residencies haven’t kept up with med school expansions. It’s unethical in my view. The numbers should be linked. If you open a new medical school or expand class size, you should be required to expand residency programs or start new ones. Medical schools shouldn’t pump out new grads with no place to go.

Medical school enrollments grow, but residency slots haven’t kept pace

The AAMC’s annual survey shows student body growth won’t alleviate physician shortage unless residency and clinical training site shortfalls also are addressed.

www.aamc.org

 

[Ronin786]

2 Categorical, 0 Advanced, 1 R spots

That is wild. So far away from the norm. My best bet is it has a trickle down effect from candidates being able to zoom interview and use anesthesia as a backup to their failed surgical dreams. I bet there's gonna be a lot of unhappy interns.

 

[izchief360]

That is wild. So far away from the norm. My best bet is it has a trickle down effect from candidates being able to zoom interview and use anesthesia as a backup to their failed surgical dreams. I bet there's gonna be a lot of unhappy interns.

I believe this is the 'new normal' for anesthesia. As if we hadn't heard that term enough in 2020...

 

[aneftp]

More med school grads, not enough GME spots overall. Residencies haven’t kept up with med school expansions. It’s unethical in my view. The numbers should be linked. If you open a new medical school or expand class size, you should be required to expand residency programs or start new ones. Medical schools shouldn’t pump out new grads with no place to go.

Medical school enrollments grow, but residency slots haven’t kept pace

The AAMC’s annual survey shows student body growth won’t alleviate physician shortage unless residency and clinical training site shortfalls also are addressed.

www.aamc.org

Tons of lawyers graduate with no job prospects. This is the same thing happening to medical school graduates.

We all know residencies are tied into Medicare spending and very little change since the Clinton administration with residency funding.

Pretty soon. Residents may have to work for “free” like srna. I’m not kidding. It sucks.

but we have 20 new medical schools (lcme) since year 2000? Prior to that. It was 24 years in between university of south florida (1976). Plus new DO schools.

 

[bigfootisreal]

As a 2022 applicant with similar stats, this is slightly terrifying.

 

[chromuffin]

More med school grads, not enough GME spots overall. Residencies haven’t kept up with med school expansions. It’s unethical in my view. The numbers should be linked. If you open a new medical school or expand class size, you should be required to expand residency programs or start new ones. Medical schools shouldn’t pump out new grads with no place to go.

Medical school enrollments grow, but residency slots haven’t kept pace

The AAMC’s annual survey shows student body growth won’t alleviate physician shortage unless residency and clinical training site shortfalls also are addressed.

www.aamc.org

Might be repeating what is already known, but it’s a challenge adding spots to established residencies. With added spots comes decreased learning potential and ultimately a less-prepared physician. One example that I can share at my institution is the peds experience. If we had more residents, then there would be issues getting case numbers and residents may not feel competent managing peds patients.

 

[Neopolymath]

That is wild. So far away from the norm. My best bet is it has a trickle down effect from candidates being able to zoom interview and use anesthesia as a backup to their failed surgical dreams. I bet there's gonna be a lot of unhappy interns.

BINGO.

Similar situation happened in radiology this year. The number of actual slots (not weird foreign funded slots no one is eligible for but still listed on soap stats) was tiny. It's almost certainly due to dual-applying surgical sub applicants falling down their rank list into anesthesiology and radiology.

 

[secretasianman]

What a joke.

 

[Man o War]

More med school grads, not enough GME spots overall. Residencies haven’t kept up with med school expansions. It’s unethical in my view. The numbers should be linked. If you open a new medical school or expand class size, you should be required to expand residency programs or start new ones. Medical schools shouldn’t pump out new grads with no place to go.

Medical school enrollments grow, but residency slots haven’t kept pace

The AAMC’s annual survey shows student body growth won’t alleviate physician shortage unless residency and clinical training site shortfalls also are addressed.

www.aamc.org

We need a major overhaul in the student lending industry, for any higher education. Government backed student loans shouldn’t be given to questionable medical schools for tuition. I believe I saw that IMGs overall have a 50% match rate. Why should American taxpayers be on the hook for these scam schools? (Yes, I think it’s a scam when only half your graduates can match a residency).

 

[Gern Blansten]

The question is, WHY is it getting more competitive? What has changed? More money? Less call? Less CRNAs? More respect? Someone please enlighten me. I couldn't match by today's standards.

As someone else stated, new med schools are popping up everywhere, with class sizes ranging from 50 to 200 in number. The rare times you hear about new residency programs or expansion of existing ones, it is only a handful of positions. So you have hundreds (thousands soon?) of additional med school grads coming out from new schools, and only the previously existing residency spots plus a handful of new spots.
It is a math problem and anesthesiology is not the only specialty affected. Imagine the med school landscape in a few years when a few thousand graduating students will have no residency spot when they graduate. Students graduating in the fourth quartile (maybe even some in the third) who have any blemish on their transcript (a step failure, a shelf exam failure, any behavioral issue on the dean's letter, a remediation of any kind, or, heaven forbid, a DUI arrest) will be in serious trouble. After accumulating $200K-$400K of debt and no prospects to finish their training, what do we expect to occur for these unfortunate students? It is not a minor problem and we have seen it coming for the past decade and nothing has been done to fix it. IMO, it is the biggest problem that we face in medical training at the time.
Yet, for profit schools continue to open with seemingly no limits.
Those who have been at this a while know all of the medical school's tricks. They disguise their worst students by intentionally obfuscating their statistics that program directors rely upon when trying to match the best students. Gone are class rank and meaningful Dean's Letters. Gone are numeric step scores (one down and the other likely to follow soon). Some still provide quartile information or code words to signify relative class rank, but even that is becoming more rare.

 

[GaseousClay]

aren't they removing usmle step 1 scoring and changing to pass/fail? then the flood gates will really open and how will DOs/FMG be able to distinguish themselves when applying?

 

[nimbus]

For now there will be one less for-profit, PE owned medical school.

Billings Clinic ends talks with proposed medical school citing derogatory comments and previous commitments

Billings Clinic announced Wednesday that it will "end conversations with Medforth Global Healthcare Education" after two separate executive representatives of the medical school made comments that are "inconsistent with Billings

billingsgazette.com

 

[BLADEMDA]

As someone else stated, new med schools are popping up everywhere, with class sizes ranging from 50 to 200 in number. The rare times you hear about new residency programs or expansion of existing ones, it is only a handful of positions. So you have hundreds (thousands soon?) of additional med school grads coming out from new schools, and only the previously existing residency spots plus a handful of new spots.
It is a math problem and anesthesiology is not the only specialty affected. Imagine the med school landscape in a few years when a few thousand graduating students will have no residency spot when they graduate. Students graduating in the fourth quartile (maybe even some in the third) who have any blemish on their transcript (a step failure, a shelf exam failure, any behavioral issue on the dean's letter, a remediation of any kind, or, heaven forbid, a DUI arrest) will be in serious trouble. After accumulating $200K-$400K of debt and no prospects to finish their training, what do we expect to occur for these unfortunate students? It is not a minor problem and we have seen it coming for the past decade and nothing has been done to fix it. IMO, it is the biggest problem that we face in medical training at the time.
Yet, for profit schools continue to open with seemingly no limits.
Those who have been at this a while know all of the medical school's tricks. They disguise their worst students by intentionally obfuscating their statistics that program directors rely upon when trying to match the best students. Gone are class rank and meaningful Dean's Letters. Gone are numeric step scores (one down and the other likely to follow soon). Some still provide quartile information or code words to signify relative class rank, but even that is becoming more rare.

For the match this I suspect/hypothesize the following:

1. This was a "stats match" as the lack of in person interviews led to PDs using the hard data to match applicants.

2. ZOOM- This HURT a lot of applicants in my opinion. You can't get the feel for a person over the internet/zoom. So, if your stats are average or below average then you need that personal interview to move you up.

3. More and more applicants- the numbers go up every single year. Any spot in any field is now somewhat competitive.

4. Any "blemish" on your record in 2021 was likely a red flag. Without the personal interview the applicant couldn't explain it well enough to most PDs.
This will continue in 2022 match so be aware of that fact.

For 2022 applicants need to INTERVIEW at programs with lower stats than they have on paper. For example, if you are a top tier candidate throw in 5 midtier interviews.

 

[Gern Blansten]

For now there will be one less for-profit, PE owned medical school.

Billings Clinic ends talks with proposed medical school citing derogatory comments and previous commitments

Billings Clinic announced Wednesday that it will "end conversations with Medforth Global Healthcare Education" after two separate executive representatives of the medical school made comments that are "inconsistent with Billings

billingsgazette.com

The article is good because it points out the fallacy that having a med school there will solve the physician shortage, since there are hardly any residency positions for the grads to join after med school and most will stay near where they did their final training, which won't be in Montana.

When you see the for profit schools open up in multiple states with the same name, it seems very questionable to me that the school has your best interest in mind. They farm you out to wherever they can and the students often have to come up with their own electives, or sometimes even clerkships. They get no guidance because they have no mentors like they would in a traditional academic center. If you are at a school with the name of a city or state in the name of the school, and you have never stepped foot in the city or state that is in the name of the school, you are likely at a school looking to make a quick buck. If your school has two or more of the following: a generic directional name (Northern, Southern, Eastern, Western or a mountain range/ocean), is less than 15 years old, and has campuses in more than one state (for example, California, Nevada, and New York), you are likely at a school in it for profit only. If you are at a new school that went from zero students directly to 200 per class, you are likely at a school in it for the money. If you choose one of these schools, be prepared to get your mentorship on Student Doctor Network and not from a faculty advisor and you better make sure you are in the top half of your class.

 

[abolt18]

The article is good because it points out the fallacy that having a med school there will solve the physician shortage, since there are hardly any residency positions for the grads to join after med school and most will stay near where they did their final training, which won't be in Montana.

When you see the for profit schools open up in multiple states with the same name, it seems very questionable to me that the school has your best interest in mind. They farm you out to wherever they can and the students often have to come up with their own electives, or sometimes even clerkships. They get no guidance because they have no mentors like they would in a traditional academic center. If you are at a school with the name of a city or state in the name of the school, and you have never stepped foot in the city or state that is in the name of the school, you are likely at a school looking to make a quick buck. If your school has two or more of the following: a generic directional name (Northern, Southern, Eastern, Western or a mountain range/ocean), is less than 15 years old, and has campuses in more than one state (for example, California, Nevada, and New York), you are likely at a school in it for profit only. If you are at a new school that went from zero students directly to 200 per class, you are likely at a school in it for the money. If you choose one of these schools, be prepared to get your mentorship on Student Doctor Network and not from a faculty advisor and you better make sure you are in the top half of your class.

Listen, I went to the "OG" of DO schools and I still got 100% of my mentorship from SDN.

 

[chocomorsel]

The article is good because it points out the fallacy that having a med school there will solve the physician shortage, since there are hardly any residency positions for the grads to join after med school and most will stay near where they did their final training, which won't be in Montana.

When you see the for profit schools open up in multiple states with the same name, it seems very questionable to me that the school has your best interest in mind. They farm you out to wherever they can and the students often have to come up with their own electives, or sometimes even clerkships. They get no guidance because they have no mentors like they would in a traditional academic center. If you are at a school with the name of a city or state in the name of the school, and you have never stepped foot in the city or state that is in the name of the school, you are likely at a school looking to make a quick buck. If your school has two or more of the following: a generic directional name (Northern, Southern, Eastern, Western or a mountain range/ocean), is less than 15 years old, and has campuses in more than one state (for example, California, Nevada, and New York), you are likely at a school in it for profit only. If you are at a new school that went from zero students directly to 200 per class, you are likely at a school in it for the money. If you choose one of these schools, be prepared to get your mentorship on Student Doctor Network and not from a faculty advisor and you better make sure you are in the top half of your class.

Yeah, Tuoro is a crappy school system. I know people who went there and they would agree. You fend for yourself.
That being said, I did not know they were a Jewish entity. Interesting.

 

[chessknt]

It will be interesting to see the nrmp stats of number of list positions this year. I think the financial barrier to interviewing was nonexistent so you had people doing far more interviews resulting in much deeper pulls on match lists. You would think it is a net positive to reduce financial barriers to residency matching but reading this thread I'm not so sure.

 

[austintr]

It will be interesting to see the nrmp stats of number of list positions this year. I think the financial barrier to interviewing was nonexistent so you had people doing far more interviews resulting in much deeper pulls on match lists. You would think it is a net positive to reduce financial barriers to residency matching but reading this thread I'm not so sure.

Obviously n=1 but I initially thought doing interviews from home via zoom was gonna be great. It was convenient for sure, but looking back I think it hurt my app quite a bit. I applied to anesthesia this year with an app that was competitive for mid-low tier programs, or so I've been told the last few years. However, I only got a handful of interviews. I typically interview pretty well and have had no issues in the past at all with connecting with interviewers, etc. But with this cycle, I think a lot of extra competitive applicants took more interviews than usual and probably ended up matching farther down their lists into programs they would normally turn down an IV for in a normal year.

This is just based on my experience though, and that of my classmates'. A guy I would consider an absolute beast as far as board scores, intelligence and likeability goes ended up pretty far down his match list. I for one hope to be able to have in-person interactions during the next cycle when I'll already be at a significant disadvantage being a reapplicant.

 

[chessknt]

Obviously n=1 but I initially thought doing interviews from home via zoom was gonna be great. It was convenient for sure, but looking back I think it hurt my app quite a bit. I applied to anesthesia this year with an app that was competitive for mid-low tier programs, or so I've been told the last few years. However, I only got a handful of interviews. I typically interview pretty well and have had no issues in the past at all with connecting with interviewers, etc. But with this cycle, I think a lot of extra competitive applicants took more interviews than usual and probably ended up matching farther down their lists into programs they would normally turn down an IV for in a normal year.

This is just based on my experience though, and that of my classmates'. A guy I would consider an absolute beast as far as board scores, intelligence and likeability goes ended up pretty far down his match list. I for one hope to be able to have in-person interactions during the next cycle when I'll already be at a significant disadvantage being a reapplicant.

I hope that for you too. Soldier on and reach out to resources while you're still a student to figure out what you can/should do to be more competitive. Find your local PDs in anesthesia and IM and get their opinions too. It isn't fair that you're gonna have to work your ass off double time and have so much uncertainty but once you make it you'll have a much better appreciation for it and ultimately make you a stronger doctor.

 

[BLADEMDA]

I’m looking forward to seeing the match stats this year. Maybe, more applicants had anesthesiology as their second choice or backup and with the zoom interviews programs took the best stats they could get.

 

[tinyhandsbob]

More med school grads, not enough GME spots overall. Residencies haven’t kept up with med school expansions. It’s unethical in my view. The numbers should be linked. If you open a new medical school or expand class size, you should be required to expand residency programs or start new ones. Medical schools shouldn’t pump out new grads with no place to go.

Medical school enrollments grow, but residency slots haven’t kept pace

The AAMC’s annual survey shows student body growth won’t alleviate physician shortage unless residency and clinical training site shortfalls also are addressed.

www.aamc.org

Tell that to the other advanced fields where grads have no guarantee of a job/training and often don't end up working in their field but yea, in a civilized world, all educational programs would be linked to available training opportunities/jobs and schools would not be allowed to expand/open when too many grads are being produced relative to opportunities.

 

[Big Swinging Doc]

More med school grads, not enough GME spots overall. Residencies haven’t kept up with med school expansions. It’s unethical in my view. The numbers should be linked. If you open a new medical school or expand class size, you should be required to expand residency programs or start new ones. Medical schools shouldn’t pump out new grads with no place to go.

Medical school enrollments grow, but residency slots haven’t kept pace

The AAMC’s annual survey shows student body growth won’t alleviate physician shortage unless residency and clinical training site shortfalls also are addressed.

www.aamc.org

Hol up.

You are suggesting that when unscrupulous, money-grabbing for profit medical schools open up to fleece desperate pre-meds out of hundreds of thousands of federally guaranteed loan dollars (that most of their customers couldn't afford without the guarantee), that the medical school should also be able to line its pockets with the discount-labor-cartel that is ACGME-approved residencies?

You know that no (ZERO!!) residency programs train doctors out the goodness of their hearts, correct? They do it because they make money. The Feds pay the residency programs (on average) over $150k per trainee (it's probably more, since those figures are from 2015). The programs get to bill for everything the residents do. Then the programs unclench their fists to the tune of ~$50,000/year, which equates sometimes to an hourly rate of LESS THAN MINIMUM WAGE once you divide it by the actual hours worked...and all this for licensed professionals who have done four years of graduate school.

And you think inviting Prem Reddy and other bean counters behind these MD diploma mills to abuse the ACGME racket is a good idea??

I think that's a terrible, terrible idea. But I'm happy to hear arguments in favor.

 

[nimbus]

Hol up.

You are suggesting that when unscrupulous, money-grabbing for profit medical schools open up to fleece desperate pre-meds out of hundreds of thousands of federally guaranteed loan dollars (that most of their customers couldn't afford without the guarantee), that the medical school should also be able to line its pockets with the discount-labor-cartel that is ACGME-approved residencies?

You know that no (ZERO!!) residency programs train doctors out the goodness of their hearts, correct? They do it because they make money. The Feds pay the residency programs (on average) over $150k per trainee (it's probably more, since those figures are from 2015). The programs get to bill for everything the residents do. Then the programs unclench their fists to the tune of ~$50,000/year, which equates sometimes to an hourly rate of LESS THAN MINIMUM WAGE once you divide it by the actual hours worked...and all this for licensed professionals who have done four years of graduate school.

And you think inviting Prem Reddy and other bean counters behind these MD diploma mills to abuse the ACGME racket is a good idea??

I think that's a terrible, terrible idea. But I'm happy to hear arguments in favor.

Believe it or not, I was a resident once so I know the deal. I’m just saying we shouldn’t be creating more med school grads without also increasing residency slots. Do you disagree?

 

[Big Swinging Doc]

I guess I do disagree.

I "disagree" with the wisdom of going to the Caribbean for medical school. But I don't think it's any legislator's prerogative to eliminate such a long-shot (and expensive) bid for a career in medicine.

I "disagree" with Prem Reddy when he says he can educate medical students as well as established medical schools can. But I see no legal or justifiable way to keep him from hanging up his shingle and cashing tuition checks. Caveat emptor, and all that.

But just because Prem Reddy is able to find saps to pay hundreds of thousands of dollars for a medical degree offered from an institution one tiny sliver above a correspondence school does not mean that all of a sudden the federal government is under obligation to train another 200 "doctors."

If we extend your logic, it seems to me that any time a Caribbean Medical School Diploma mill increases its student body, then the American taxpayer is under some obligation to pay for more post graduate education. Can you help me understand that?

What about dental programs and chiropractors? We all know some of them who slipped into desperate residency programs. Is the ACGME supposed to guarantee a certain percentage of slots for them, whenever a new dental or chiropractic school comes on-line or expands the student body?

What is your expected conversion for osteopathic programs? 50%? 75%? 100%?

What do we do when a graduate from a foreign medical school matches into a US-based residency? Is some other program under obligation to accept another trainee, because Prem Reddy vaguely hinted at the promise that everybody who gets a participation MD ribbon in 2021 is somehow guaranteed a residency spot?

Listen, I'm no fan of the GME. I think that every time the government steps in to try to do by administration what the free market will do with cold efficiency, the government screws it up. With the backing of the AMA, government has throttled the supply of physicians. It'd be disingenuous of me, a member of the guild whose paycheck reflects the inefficiencies of governmental overreach, to complain too loudly about it. But it is clear that into the the void created by a scarcity of MDs has marched a steady stream of DOs, NPs, PAs, CRNAs, and others.

CRNAs can be churned out in 18 months. And they are doing their best to erode the trust surgeons and patients have in the generic "anesthesia provider." Anytime things start looking up for our field, the CRNA schools open the taps. But now you want the government to be under obligation to offer residency training to as many poorly-educated physicians as crooks like Prem Reddy can pin a diploma on? I hope you are just teasing me.

If you are serious--if you think that society at large or government in particular has an obligation to make sure that every student who (for whatever reason) was passed over for admission into a legitimate medical school has a soft place to land--are you going to similarly make sure that jobs exist for every ITT graduate, every cosmetic school graduate, every clown college graduate, every law school graduate, every Masters of Fine Arts?

If not, why not?

Medical school used to be a pretty safe bet to get reliably into the top 10%. And, if you stick to the main routes (University-associated allopathic programs), it still is. But just like there are cheap imitations of every other sought-after good on the planet (timepieces, iPhones, jewelry...) we now live in a world where there are cheap (in quality, though obviously not cheap in cost) imitations to medical education. I know, I know, we've all worked with colleagues who came from the Caribbean who were "just as good as any doc," but more and more, those are the exceptions, and the rule is that they paid close to half a million dollars for a worthless degree. I feel sorry for them. I really do. But making it easier for Prem Reddy and St. George's to fleece students (by being able to promise that the US taxpayer is under obligation to pay to train them upon graduation) is only going to make things worse.

I'm happy to have you change my mind.

 

[nimbus]

I guess I do disagree.

I "disagree" with the wisdom of going to the Caribbean for medical school. But I don't think it's any legislator's prerogative to eliminate such a long-shot (and expensive) bid for a career in medicine.

I "disagree" with Prem Reddy when he says he can educate medical students as well as established medical schools can. But I see no legal or justifiable way to keep him from hanging up his shingle and cashing tuition checks. Caveat emptor, and all that.

But just because Prem Reddy is able to find saps to pay hundreds of thousands of dollars for a medical degree offered from an institution one tiny sliver above a correspondence school does not mean that all of a sudden the federal government is under obligation to train another 200 "doctors."

If we extend your logic, it seems to me that any time a Caribbean Medical School Diploma mill increases its student body, then the American taxpayer is under some obligation to pay for more post graduate education. Can you help me understand that?

What about dental programs and chiropractors? We all know some of them who slipped into desperate residency programs. Is the ACGME supposed to guarantee a certain percentage of slots for them, whenever a new dental or chiropractic school comes on-line or expands the student body?

What is your expected conversion for osteopathic programs? 50%? 75%? 100%?

What do we do when a graduate from a foreign medical school matches into a US-based residency? Is some other program under obligation to accept another trainee, because Prem Reddy vaguely hinted at the promise that everybody who gets a participation MD ribbon in 2021 is somehow guaranteed a residency spot?

Listen, I'm no fan of the GME. I think that every time the government steps in to try to do by administration what the free market will do with cold efficiency, the government screws it up. With the backing of the AMA, government has throttled the supply of physicians. It'd be disingenuous of me, a member of the guild whose paycheck reflects the inefficiencies of governmental overreach, to complain too loudly about it. But it is clear that into the the void created by a scarcity of MDs has marched a steady stream of DOs, NPs, PAs, CRNAs, and others.

CRNAs can be churned out in 18 months. And they are doing their best to erode the trust surgeons and patients have in the generic "anesthesia provider." Anytime things start looking up for our field, the CRNA schools open the taps. But now you want the government to be under obligation to offer residency training to as many poorly-educated physicians as crooks like Prem Reddy can pin a diploma on? I hope you are just teasing me.

If you are serious--if you think that society at large or government in particular has an obligation to make sure that every student who (for whatever reason) was passed over for admission into a legitimate medical school has a soft place to land--are you going to similarly make sure that jobs exist for every ITT graduate, every cosmetic school graduate, every clown college graduate, every law school graduate, every Masters of Fine Arts?

If not, why not?

Medical school used to be a pretty safe bet to get reliably into the top 10%. And, if you stick to the main routes (University-associated allopathic programs), it still is. But just like there are cheap imitations of every other sought-after good on the planet (timepieces, iPhones, jewelry...) we now live in a world where there are cheap (in quality, though obviously not cheap in cost) imitations to medical education. I know, I know, we've all worked with colleagues who came from the Caribbean who were "just as good as any doc," but more and more, those are the exceptions, and the rule is that they paid close to half a million dollars for a worthless degree. I feel sorry for them. I really do. But making it easier for Prem Reddy and St. George's to fleece students (by being able to promise that the US taxpayer is under obligation to pay to train them upon graduation) is only going to make things worse.

I'm happy to have you change my mind.

Not sure why you think I’m a Prem Reddy apologist. I’m not. My point is that we shouldn’t be opening any new medical schools if their graduates have no place to complete their training. Otherwise it is we taxpayers who will be saddled with their bad debt. We shouldn’t be making the GME bottleneck worse by opening more medical schools.

 

[nimbus]

Tell that to the other advanced fields where grads have no guarantee of a job/training and often don't end up working in their field but yea, in a civilized world, all educational programs would be linked to available training opportunities/jobs and schools would not be allowed to expand/open when too many grads are being produced relative to opportunities.

Completely agree. Just because other fields have expensive predatory schools doesn’t mean medicine should join the fray. I also think we should means test student loans just like we rate risk when applying for a home mortgage.

‘Financially Hobbled for Life’: The Elite Master’s Degrees That Don’t Pay Off

Lured by the aura of degrees from top-flight institutions, many master’s students at universities across the U.S. took on debt beyond what their pay would support, an analysis of federal data on borrowers found.

www.wsj.com

 

[Big Swinging Doc]

I agree that we shouldn't be opening new medical schools, cashing tuition checks, and leaving newly minted doctors without any place to train. That's bad. And it doesn't take a Masters of Health Administration to understand that.

But it's also not my role, nor the role of government, to tell Prem Reddy or Western College of the Pacific or the University of Phoenix that they CAN'T masquerade as a medical school.

Again, buyer beware.

I don't like it any more than you do, but just because they are doing wrong by the students doesn't obligate the US taxpayer to pick up the tab for their training.

If there's a real market for second-tier trainees, HCA will upramp their numbers even in excess of what GME will reimburse them to do. They'll create some sort of shady grey market residency with guaranteed position inside of HCA after graduation. They will print up even shinier badges for those sneetches without stars and start a marketing campaign something like, "brain of a doctor, mind of a corporate automaton," and then put imitation PhD candidates on the case of proving how "cost effective" and "not significantly more unsafe than the control" their graduates are, and in time nobody will know the difference. And, those of us who will still recognize the difference will be kept by the dictates of decorum from pointing it out. We'll call it the Corporate Emperor's New Residency.

 

[nimbus]

Bottleneck may occur even before residency during the clerkship years. Looks like some medical schools will be no better than NP programs that make their students to arrange their own clerkships a la carte.



“The University of Washington is an allopathic medical school, whose graduates are doctors of medicine, while the proposed Montana schools would train doctors of osteopathic medicine. Both kinds of doctors are fully licensed physicians. The students study the same curriculum and participate in the same clinical training, but they take different licensing exams, and the schools are accredited by different panels: The Liaison Committee on Medical Education for allopathic schools, and the Commission on Osteopathic College Accreditation for osteopathic schools.

Dr. Jay Erickson, assistant dean for regional affairs and rural health and assistant clinical dean for Montana WWAMI, criticized lax osteopathic school accreditation standards for creating a potential Montana medical student logjam that could affect his program.

“The LCME which accredits allopathic medical schools would never approve two new medical schools in a state of 1 million people with limited clinical teaching opportunities that are largely utilized by Montana WWAMI and the existing residencies,” Erickson said in an email.”

Influx of Medical School Students Could Overwhelm Montana Resources, Program Leaders Warn - KFF Health News

Leaders of a regional medical school program in Montana say two proposed medical schools could create a flood of students they worry will strain the clinical faculty and resources in the state they use for training.

khn.org