Medical School Enrollment has grown 25% since 2002-2003.

[Astra]

Combined first-year enrollment at existing MD-granting and DO-granting medical schools is projected to reach 30,186 by 2020–2021, an increase of 55 percent compared with 2002–2003.

source: https://members.aamc.org/eweb/upload/2015_Enrollment_Report.pdf

Lots of interesting stuff in there.

Will residency slots grow to meet the increased enrollment?

If not, with the increased competition for residency slots, perhaps school prestige will play an even greater role in securing a residency spot.

Also, curious as to how the DO/MD merger will play a role in this.

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[libertyyne]

The DO schools have been opening at an incredible rate.

 

[efle]

Some more insane facts that stood out:

• First-year enrollment at DO-granting schools in 2020–2021 is expected to reach 8,468, a 185 percent increase from 2,968 students in 2002–2003.

• Half of medical schools reported concerns about their own incoming students’ ability to find residency positions of their choice after medical school

• 85 percent of respondents expressed concern about the number of clinical training sites and the supply of qualified primary care preceptors. Seventy-two percent expressed concern about the supply of qualified specialty preceptors

• Forty-four percent of respondents reported feeling pressure to pay for clinical training slots, though the majority of schools currently do not pay for clinical training.

 

[libertyyne]

Some more insane facts that stood out:

First-year enrollment at DO-granting schools in 2020–2021 is expected to reach 8,468, a 185 percent increase from 2,968 students in 2002–2003.

Half of medical schools reported concerns about their own incoming students’ ability to find residency positions of their choice after medical school

85 percent of respondents expressed concern about the number of clinical training sites and the supply of qualified primary care preceptors. Seventy-two percent expressed concern about the supply of qualified specialty preceptors

Forty-four percent of respondents reported feeling pressure to pay for clinical training slots, though the majority of schools currently do not pay for clinical training.

This can potentially become a revenue source for struggling hospitals. The NY hospitals taking Caribbean grads have probably thought of it as such.

 

[efle]

Where does the money come from to pay for clinical slots? How much does a clinical slot cost? This is all interesting stuff

 

[Astra]

Some more insane facts that stood out:

• First-year enrollment at DO-granting schools in 2020–2021 is expected to reach 8,468, a 185 percent increase from 2,968 students in 2002–2003.

• Half of medical schools reported concerns about their own incoming students’ ability to find residency positions of their choice after medical school

• 85 percent of respondents expressed concern about the number of clinical training sites and the supply of qualified primary care preceptors. Seventy-two percent expressed concern about the supply of qualified specialty preceptors

• Forty-four percent of respondents reported feeling pressure to pay for clinical training slots, though the majority of schools currently do not pay for clinical training.

Oh boy, I can see it now.


WAMC:

260 Step 1 , 260 Step 2, AOA, 5 pubs, Honors in all Clinical rotations


I'm trying to match into Family Medicine. Should I take 2 or 3 gap research years?

 

[libertyyne]

Where does the money come from to pay for clinical slots? How much does a clinical slot cost? This is all interesting stuff

IIRC IMGs and have to pay the school for rotations and it is something like 17K per quarter or something else ridic, I imagine that goes towards that. To be fair we have to continue to pay tuition in clinical years as well.
Medical School Tuition – Leading Education. Competitive Costs. | St. George’s University
Tuition and Financial Aid - American University of Antigua (AUA)

 

[Astra]

@efle @gonnif

This isn't actually correct. Despite the prevailing narrative on SDN and some media articles, the number of residency positions has increased substantially over the past decade. They are being funded through a number of different sources.

You can look at the data from the ACGME here,
ACGME Data Resource Book

On page 79 you will see that the number of AMGs (USMD + DO) starting residency each year has increased quite a bit over the past decade, but the number of IMGs has stayed mostly stable. That's because the increase in residency positions on a yearly basis has basically equaled the increase in AMGs. The increase in yearly AMGs is forecasted to begin to outpace the yearly increase in residency positions over the coming 10 years, but this hasn't happened yet.

 

[efle]

I couldn't find any numbers in the document about GME slots over this same time period. Has it been expanding, just not fast enough? Are match rates at DO programs getting worrisome? Or is the brunt of the competition spike going to hit internationals?

Edit: Thanks for link above, it looks like there has been about a 20% increase in accredited programs during the last ten years? So growing but perhaps not fast enough?

 

[cactusman]

Could med school go the way of law school in terms of financial prospects and prestige? Or at least a little closer to that?

 

[libertyyne]

I couldn't find any numbers in the document about GME slots over this same time period. Has it been expanding, just not fast enough? Are match rates at DO programs getting worrisome? Or is the brunt of the competition spike going to hit internationals?

Edit: Thanks for link above, it looks like there has been about a 20% increase in accredited programs during the last ten years? So growing but perhaps not fast enough?

I thought the GME slots were fixed because the funding hasnt been updated.

 

[Astra]

Could med school go the way of law school in terms of financial prospects?

If residency slots explode, yes. Until then, there will be a controlled supply of licensed doctors so the market doesn't oversaturate

 

[libertyyne]

Could med school go the way of law school in terms of financial prospects and prestige? Or at least a little closer to that?

Yes, but the payor system would have to be changed. Currently as it stands there is still pent up demand for services. Plus if you really want to get cynical read up on supply induced demand, or provider induced demand for clinical services.

 

[darkjedi]

There were 28,849 total PGY-1 slots in the NRMP match this year, with 18,539 US MD applicants. There's really no residency crunch any time soon. With the ACGME/AOA merger, there will be more applicants, but also more DO slots converting to ACGME/LCME.

The only people who will feel the pressure are IMGs/FMGs

 

[efle]

There were 28,849 total PGY-1 slots in the NRMP match this year, with 18,539 US MD applicants. There's really no residency crunch any time soon. With the ACGME/AOA merger, there will be more applicants, but also more DO slots converting to ACGME/LCME.

The only people who will feel the pressure are IMGs/FMGs

This seems pretty straightforward and reassuring.

So what's the deal with 50% of med schools saying they worry about their students GME prospects?

 

[libertyyne]

This seems pretty straightforward and reassuring.

So what's the deal with 50% of med schools saying they worry about their students GME prospects?

by worry they mean being able to go into something other then Primary care(IM,Peds,FP,OBGYN,Pysch) in a location of their choice.

 

[cactusman]

This seems pretty straightforward and reassuring.

So what's the deal with 50% of med schools saying they worry about their students GME prospects?

Maybe in the "residency positions of their choice," the important part is "of their choice."

Edit: @libertyyne beat me to it.

 

[efle]

Ah gotcha so the schools are scared expansion means a lot more competition for specialties

 

[libertyyne]

I am curious if the merger in residencies will make it more difficult for DO to match into something other then primary care.

Ah gotcha so the schools are scared expansion means a lot more competition for specialties

That and they are posturing like this crisis looms to get congress to pay them more money to expand ACGME.

 

[Astra]

Prestige plays a part in terms of the wider network of academic physicians who come tend to come from the "top" medical schools. Will it make much more of a difference in future than it does now? probably not. Residency acceptance has always had a much larger competent of small group dynamics as in personal recommendation as well as "social" and "personality" skills. You will be working in a team in stressful condition and residencies want someone who knows their stuff and will fit with the team

Hypothetically, if twice as many qualified ( stats, EC's wise) applicants apply to the same specialty residencies, wouldn't there be more emphasis on which med school they are coming from? PD's would be more likely to choose someone who is coming from an established med school or a school where the person got someone famous to vouch for them. This doesn't mean a top med school per say but an established school in that region compared to a graduate of a newer school.

So in the future, it may be even more worth it attending an established school vs a cheap newer school.

 

[Goro]

Since ~2000, the number of MD and DO schools opened has been identical. Yes, it's a bigger proportion of DO schools, but that's because there were fewer DO schools to start with. Hence, their number has roughly doubled, while MD schools have increased by a ballpark of 10%. I don't have the exact % number handy, but I'm sure one of the numbers obsessed among will correct me.

As of right now, there are still more residency slots than there are bodies to fill them.

The DO schools have been opening at an incredible rate.

 

[Goro]

Keep in mind that huge numbers of Baby Boom doctors will be retiring or dying soon. That means a massive physician shortage is coming. Old people vote and Congress listens to them, so my take is that one can expect more funding for GME. After all, we won't be paying for the NIH, PBS or the NEftA.

I thought the GME slots were fixed because the funding hasnt been updated.

If residency slots explode, yes. Until then, there will be a controlled supply of licensed doctors so the market doesn't oversaturate

 

[Goro]

Whether seats or schools, the number is the same!

Should really look at this by seats and not schools.

https://members.aamc.org/eweb/upload/2014medicalschoolenrollmentreport.pdf
GME continues to be a concern for medical schools at the state and especially at the national level. While entry-level residency positions are continuing to grow at a rate of about 1 percent a year, enrollment in undergraduate medical education is growing much faster. (cited as Jolly P, Erikson C, Garrison G. U.S. graduate medical education and physician specialty choice. Academic Medicine. 2012; 88:468-474.)


View attachment 216457

View attachment 216458

 

[AnatomyGrey12]

Are match rates at DO programs getting worrisome?

I'm sure the newer schools will have more people SOAP then they would like, but the DO match rate is around 81.7% in the NRMP match. This number has gone up consistently every year for the last few years, and the overall DO match rate lies around 87% with a placement rate of around 99%. Numbers courtesy of @hallowmann

I am curious if the merger in residencies will make it more difficult for DO to match into something other then primary care

I doubt it honestly. The reason I do is becaise people always seem to separate specialties into primary care and competitive fields. There are specialties outside of PC that aren't competitive. Yes it will probably become more difficult for a DO to match surgical subs, derm, optho, etc. (How difficult will just have to be seen because everyone seems to have an opinion and the truth is that no one knows), but there are a lot of specialties outside of PC that DOs already match to well and there is no reason for that to change. Fields like Gas, Rads, PMR, and EM will likely remain fields matched consistently by DOs and be reasonable goals for DO students. I would even go on a limb and add gen surg to that list except on the end of more competitive.

 

[efle]

My understanding is that DO was originally established due to some ideological differences from allopathic, but now that's pretty much all evaporated outside an OMM class that DO students don't even view as that legitimate themselves.

So, what is the impetus for groups looking to open a new medical school to go DO half the time, MD the other half? Is it easier/faster/cheaper to set up DO?

 

[darkjedi]

Keep in mind that huge numbers of Baby Boom doctors will be retiring or dying soon. That means a massive physician shortage is coming. Old people vote and Congress listens to them, so my take is that one can expect more funding for GME. After all, we won't be paying for the NIH, PBS or the NEftA.

Considering the lead time in training a physician from opening up new med school slots to being fully trained n is 7-12 years, it's rapidly approaching the point where it's too late to make a difference. Not to mention that the shortage is predominately in primary care specialties, which opening up new med school or residency slots won't necessarily address. This crunch is also coming at a time when it appears that insurance rates will skyrocket for this exact population. All-in-all it doesn't look like to be a great time to be a baby boomer in need of medical care.

 

[AnatomyGrey12]

So, what is the impetus for groups looking to open a new medical school to go DO half the time, MD the other half? Is it easier/faster/cheaper to set up DO?

Yes it is easier. I actually interviewed at one of the newer DO schools and they said they originally were going to set up an MD school but that some of the LCME research requirements would have given them trouble, and they ultimately decided to do DO because it would be completed sooner. They were started by the rather large major healthcare center in the town, for the purpose of creating more doctors for the state and ultimately want to draw most of their class from the state.

 

[libertyyne]

Considering the lead time in training a physician from opening up new med school slots to being fully trained n is 7-12 years, it's rapidly approaching the point where it's too late to make a difference. Not to mention that the shortage is predominately in primary care specialties, which opening up new med school or residency slots won't necessarily address. This crunch is also coming at a time when it appears that insurance rates will skyrocket for this exact population. All-in-all it doesn't look like to be a great time to be a baby boomer in need of medical care.

Hey, they wanted this.

But more to the topic at hand, do you think keeping ACGME funding at current levels would force larger class sizes to go into PC going forward?

 

[darkjedi]

So, what is the impetus for groups looking to open a new medical school to go DO half the time, MD the other half? Is it easier/faster/cheaper to set up DO?

The COCA is generally more lax with accreditation than the LCME is. The LCME has an incredibly tight leash on the standards of MD training, and schools are routinely put on probation for seemingly small things. Generally speaking it requires a lot more resources to establish an MD school

 

[libertyyne]

The COCA is generally more lax with accreditation than the LCME is. The LCME has an incredibly tight leash on the standards of MD training, and schools are routinely put on probation for seemingly small things. Generally speaking it requires a lot more resources to establish an MD school

Do you see this contributing to continued preference given to MD graduates or will PDs take the time to sift through higher quality DO and MD schools in the applicant pool?

 

[darkjedi]

Hey, they wanted this.

But more to the topic at hand, do you think keeping ACGME funding at current levels would force larger class sizes to go into PC going forward?

I don't think the primary care shortage is something that can be fixed with the residency system alone. It's a much more complicated issue than merely expanding the total number of slots. Probably the biggest reason for the primary care shortage is the reimbursement scheme, it simply just doesn't pay to be a primary care doc. The AMA and other medical groups are pushing back against mid-level creep, but until something is done about the primary care shortage, insurance/government/patients are going to be forced to fill that gap with other providers.

Do you see this contributing to continued preference given to MD graduates or will PDs take the time to sift through higher quality DO and MD schools in the applicant pool?

I'm not sure theres much evidence that the more stringent LCME accreditation standards make a big difference in education standards between MD and DO. The key is still getting good quality clinical rotations for your students.

 

[libertyyne]

I don't think the primary care shortage is something that can be fixed with the residency system alone. It's a much more complicated issue than merely expanding the total number of slots. Probably the biggest reason for the primary care shortage is the reimbursement scheme, it simply just doesn't pay to be a primary care doc. The AMA and other medical groups are pushing back against mid-level creep, but until something is done about the primary care shortage, insurance/government/patients are going to be forced to fill that gap with other providers.


I'm not sure theres much evidence that the more stringent LCME accreditation standards make a big difference in education standards between MD and DO. The key is still getting good quality clinical rotations for your students.

Thank you for your responses. I should have stated my question better.

Simplified model:
Current state:
100 Residencies available
65 Primary Care
35 Specialized

Current Students
50 total graduates
15 Primary Care filled
35 Specialized filled
50 Unfilled or filled with IMG


If the residency slots arent expanded wouldnt the following occur?

Future state without ACGME expansion
100 Residencies
65 Primary Care
35 Specialized

70 total Graduates
35 Primary Care filled
35 Specialized filled
30 unfilled or filled with IMG


So by not expanding the PC numbers will increase and more total primary care graduates.


I might be completely off base here as I dont know if programs have the ability to flex from specialized to primary care or vice versa.

 

[NotYou20]

Wish tuition only rose 25%...

 

[darkjedi]

I might be completely off base here as I dont know if programs have the ability to flex from specialized to primary care or vice versa.

Its up to the hospital systems to decide how many slots to devote to each specialty, which is dependent upon how many slots each of their residency programs is accredited for. A hospital can't just double the number of family medicine or internal medicine slots even if it wanted to because it needs to meet ACGME standards for their program. Medicare does play slightly higher for primary care specialties, but not enough that it makes a big difference.

 

[libertyyne]

Its up to the hospital systems to decide how many slots to devote to each specialty, which is dependent upon how many slots each residency program is accredited for. A hospital can't just double the number of family medicine or internal medicine slots even if it wanted to because it needs to meet ACGME standards for their program. Medicare does play slightly higher for primary care specialties, but not enough that it makes a big difference.

So the logic would stand that if the residency slots stay stagnant, increasing graduates would mean more primary care residencies filled.

 

[efle]

So the logic would stand that if the residency slots stay stagnant, increasing graduates would mean more primary care residencies filled.

Don't they tend to get pretty filled as it is, just with non US-MD peeps? So really its like the specialties stay jam-packed and the primary care residencies become a higher percentage US grads?

 

[darkjedi]

So the logic would stand that if the residency slots stay stagnant, increasing graduates would mean more primary care residencies filled.

I'm not sure I understand.

The primary care residencies are getting filled. If not by US MDs, then currently by IMGs and FMGs.

 

[libertyyne]

I'm not sure I understand.

The primary care residencies are getting filled. If not by US MDs, then currently by IMGs and FMGs.

Since the number of specialty residency slots will stay the same, More US medical school graduates means more people will have to take the primary care spots. A higher percentage of the class will end up in primary care.

 

[Goro]

Sadly, a lot faster and cheaper. No real requirement for scholarly activity. For MD schools, you have to have those pesky expensive research labs.

So, what is the impetus for groups looking to open a new medical school to go DO half the time, MD the other half? Is it easier/faster/cheaper to set up DO?

 

[Goro]

This is the mission of the AOA. No surprise.

Since the number of specialty residency slots will stay the same, More US medical school graduates means more people will have to take the primary care spots. A higher percentage of the class will end up in primary care.

 

[darkjedi]

Since the number of specialty residency slots will stay the same, More US medical school graduates means more people will have to take the primary care spots. A higher percentage of the class will end up in primary care.

The primary slots are already getting filled, whether its a US students or IMG doesn't really matter since they still result in a primary care trained physician. Even if US MD/DO slots open up, the number of of people who are primary care trained are going to be relatively similar, doesn't really matter if a higher percentage of them are US graduates.

 

[efle]

Sadly, a lot faster and cheaper. No real requirement for scholarly activity. For MD schools, you have to have those pesky expensive research labs.

They got that at CNU ?? I thought it was previously just a pharmacy school sort of in the middle of nowhere

 

[efle]

The primary slots are already getting filled, whether its a US students or IMG doesn't really matter since they still result in a primary care trained physician. Even if US MD/DO slots open up, the number of of people who are primary care trained are going to be relatively similar, doesn't really matter if a higher percentage of them are US graduates.

So what's up with this primary care shortage I'm always hearing about, if there are plenty of internationals filling up the available primary care spots?

Do they leave after getting their residency training or something ?

 

[Goro]

CN"u" pulled a number of fast ones on LCME.

They got that at CNU ?? I thought it was previously just a pharmacy school sort of in the middle of nowhere

 

[darkjedi]

So what's up with this primary care shortage I'm always hearing about, if there are plenty of internationals filling up the available primary care spots?

Do they leave after getting their residency training or something ?

The proportions of residency slots are rather skewed. People also wind up sub-specializing and doing fellowships rather than staying in primary care because it pays so much more.

 

[libertyyne]

Just wanted to leave this for your viewing pleasure.

 

[darkjedi]

Just wanted to leave this for your viewing pleasure.
View attachment 216467

lol where did that come from, that's such a terrible graph

 

[libertyyne]

I

lol where did that come from, that's such a terrible graph

I made it .

 

[cactusman]

I made it .

You should send it to some DO schools, I'm sure a few would use it as promotional material.

 

[efle]

lol where did that come from, that's such a terrible graph

I made it .

lmao