More American medical students then residency spots?

[Dr Gerrard]

So you guys know how there are way more law school graduates than positions, right? I don't know the details but I have heard this over and over.

You think there will be a time where there are more medical school graduates (from US schools) than there are residency spots?

I am starting in July, so 4 years down the road is a long time. Many use job security as a huge factor for choosing medicine. If this is gone, I don't even know what I would do.

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[Sloo0]

^ Population, ^ in crappy food products, ^ violence, etc = ^ need for Dr's.


Take a deep breath.

 

[WDeagle]

Probably sometime soon there will be more USMD/DO grads than residency spots. At least now there are FM programs in undesirable locations to scramble into. Someday those programs are going to be ranked by 4th years.

 

[Guillemot]

The world is going to **** I tell you.

 

[DoctwoB]

Probably sometime soon there will be more USMD/DO grads than residency spots. At least now there are FM programs in undesirable locations to scramble into. Someday those programs are going to be ranked by 4th years.

As they should be. The fact that we have to import so many physicians when many qualified pre-meds don't get into a med school is messed up. I would oppose having med school spots pass (or get get very close to) residency spots, but closing that gap is a good thing.

 

[Dr Gerrard]

oh so right now there is a pretty big gap?

 

[45408]

Probably sometime soon there will be more USMD/DO grads than residency spots.

And hell will have just frozen over.

At least now there are FM programs in undesirable locations to scramble into. Someday those programs are going to be ranked by 4th years.

That may be, but we won't have more US grads than residency positions, I promise you that.

 

[patel2]

And hell will have just frozen over.


That may be, but we won't have more US grads than residency positions, I promise you that.

I'm sure that the AAMC won't ever expand to the point where there are more MD grads than residency spots. But with DO schools rapidly expanding, do you think it could ever reach the point where DO residencies become filled each year, and the remaining pool of MD and DO graduates exceeds ACGME residency spots? I haven't crunched numbers or anything, but the rate of expansion seems to make this scenario plausible at some point.

If so, I'd imagine FMGs would be left in the worst position in that scenario, while DOs would also have more trouble matching into ACGME

 

[GoodmanBrown]

I'm sure that the AAMC won't ever expand to the point where there are more MD grads than residency spots. But with DO schools rapidly expanding, do you think it could ever reach the point where DO residencies become filled each year, and the remaining pool of MD and DO graduates exceeds ACGME residency spots? I haven't crunched numbers or anything, but the rate of expansion seems to make this scenario plausible at some point.

If so, I'd imagine FMGs would be left in the worst position in that scenario, while DOs would also have more trouble matching into ACGME

Follow this link. Go to page v. Rest easy.

Total match applicants: 23,000
PGY-1 spots: 37,500
Unfilled: >= 38.6%

Those numbers include US-MD, DO, and IMG applicants. The number of applicants has certainly risen over the last 50 years, but the number of residencies has risen equally fast.

 

[Dr Gerrard]

Follow this link. Go to page v. Rest easy.

Total match applicants: 23,000
PGY-1 spots: 37,500
Unfilled: >= 38.6%

Those numbers include US-MD, DO, and IMG applicants. The number of applicants has certainly risen over the last 50 years, but the number of residencies has risen equally fast.

great link.. but i seem to see it being backwards

total match applicants: 30,543
total positions offered: 25,520 (2,711 of these were second year positions)

total US MD applicants: 16,070

 

[87DO15]

When the medical school expansion started in 2002, the aim was for a 30% increase in medical school spots (LCME). At that time, there were roughly 16000 positions, so the increase would lead to ~21000 positions in LCME schools. This was supposed to happen for the graduating class of 2015 (entering this year), but apparently they are only going to have accomplished a 21% increase by then (~19500), according to an article I read (don't ask where, I do remember that number though).

I'm not sure if you meant just LCME grads, but I'll add DO grads as well, who will number ~5000 in 2015. Together, thats ~24500 US graduates. If you count ACGME prelim (surgery + internal medicine) and ACGME transitional/prelim years, there are ~26000 positions in the match each year. Considering about 22,100 are categorical or advanced PGY2, that means ~4000 are transitional years. However, most who match into a PGY2 also need a PGY1 period, unless they are a previous graduate and are already in a PGY1 position. I don't know where to find that data...suppose all the people matching PGY2 also matched into PGY1, that's ~2700 spots less. So totally, there are ~23500 positions (categorical + preliminary).

So, you have 24500 US MD+DO for 23500 positions in ACGME match, but of course there are ~2500 AOA spots as well. So, you have 24500 US MD+DO students with ~26000 spots. (Again, because of the issue with the preliminary, categorical, PGY2 advanced, etc. these aren't exact numbers). However, this is assuming every US student will match and IMG/FMG don't match until after all of this, which we know isn't true. But unless DO schools stop expanding, there may very well be a time when US students outnumber the US residency positions. For now, though, there are "technically" enough spots for US students. We know no group matches at 100% though, so it will still get much tougher for all groups to match positions, with DO/FMG/IMG feeling more of a strain than US LCME students.

If I somehow completely messed these numbers up, let me know. They are not absolute numbers, and I honestly somewhat confused myself typing this up...so yeah.......

 

[TheMan21]

I'm not saying that I advocate this, but what are the odds of excluding DOs, IMGs, and FMGs from the match? Is it legal (I could see where it could be seen as discrimination)?

 

[Sloo0]

I'm not saying that I advocate this, but what are the odds of excluding DOs, IMGs, and FMGs from the match? Is it legal (I could see where it could be seen as discrimination)?

That wouldnt make sense. Residencies want the best candidate possible, what are they supposed to do, ignore a DO student who got a 230 in favor of an MD who got a 207 on Step I?

 

[87DO15]

I'm not saying that I advocate this, but what are the odds of excluding DOs, IMGs, and FMGs from the match? Is it legal (I could see where it could be seen as discrimination)?

I think the UK has limited the number of FMGs training there, and I imagine other countries have done something similar. It's possible...not very likely, but possible. I think the more likely option would be for residency directors to simply interview more US MDs than anybody else. Until the number of US LCME student surpasses the number of residency positions, though, that wouldn't make much sense. There'll still be a couple thousand spots for DO/FMG/IMG...for now, at least.

Edit: Yeah, I second what the guy above me said.

 

[ACSurgeon]

That wouldnt make sense. Residencies want the best candidate possible, what are they supposed to do, ignore a DO student who got a 230 in favor of an MD who got a 207 on Step I?

That is exactly what happens. There is tremendous pressure on ACGME programs to take MD students before IMG's and DO's. I'm not sure how this is enforced, or how much better (on paper/in person) a DO student has to be compared to an MD student for a program to rank that person higher. Keep in mind, most applicants can see the MD/DO mix of a program, but not the average step 1. Many 4th year MD students see a large number of DO's and IMG's as a red flag.

I'm not saying that I advocate this, but what are the odds of excluding DOs, IMGs, and FMGs from the match? Is it legal (I could see where it could be seen as discrimination)?

This is not discrimination, but common sense. How is it that DO residencies can "discriminate" against MD students and not allow them to apply? Same principle. Each governing body needs to prioritize its own first.

I think if we ever get to a point where the # of US seniors equaled the # of PGY1 spots, that there the rules might change where DO's/IMG's are not qualified to apply (or MD students will be allowed to apply to DO residencies). Theoretically, the ONLY reason non-US MD's are allowed to to apply now is to fill a void.

 

[Brigade4Radiant]

That is exactly what happens. There is tremendous pressure on ACGME programs to take MD students before IMG's and DO's. I'm not sure how this is enforced, or how much better (on paper/in person) a DO student has to be compared to an MD student for a program to rank that person higher. Keep in mind, most applicants can see the MD/DO mix of a program, but not the average step 1. Many 4th year MD students see a large number of DO's and IMG's as a red flag.



This is not discrimination, but common sense. How is it that DO residencies can "discriminate" against MD students and not allow them to apply? Same principle. Each governing body needs to prioritize its own first.

I think if we ever get to a point where the # of US seniors equaled the # of PGY1 spots, that there the rules might change where DO's/IMG's are not qualified to apply (or MD students will be allowed to apply to DO residencies). Theoretically, the ONLY reason non-US MD's are allowed to to apply now is to fill a void.

That medical student may have had better clinical grades. Also in a lot of D.O schools you are not doing clerkship under the residency system it is just you and the attending. So they may be biased when it comes to D.O's 3rd and 4th year.

Also I doubt a 207 MD passes over a 230 D.O often, when the avg MD step score is 222. And I can't find the avg D.O step score because schools don't want to publish them.

 

[gravitywave]

That medical student may have had better clinical grades. Also in a lot of D.O schools you are not doing clerkship under the residency system it is just you and the attending. So they may be biased when it comes to D.O's 3rd and 4th year.

Also I doubt a 207 MD passes over a 230 D.O often, when the avg MD step score is 222. And I can't find the avg D.O step score because schools don't want to publish them.

DO USMLE pass rate is lower than that of US MD, so it stands to reason that the average scores for DO are lower as well. agree that it's tough to find these numbers.

 

[ACSurgeon]

That medical student may have had better clinical grades. Also in a lot of D.O schools you are not doing clerkship under the residency system it is just you and the attending. So they may be biased when it comes to D.O's 3rd and 4th year.

Also I doubt a 207 MD passes over a 230 D.O often, when the avg MD step score is 222. And I can't find the avg D.O step score because schools don't want to publish them.

I can't tell what the difference has to be in the step score for a DO to be ranked higher than an MD student, but I do know that their is pressure on ACGME programs to take MD seniors over DO's and IMG's. Also, keep in mind that the step score is just part of the application. Being from an MD school will have significant weight, also, the connections/research/LOR's, etc play a role. Granted, a DO student can rotate at allopathic programs and get LOR's from faculty that would be known to residency programs.

As an example, an MD student with a 230 score has a shot at most residencies. A DO with the same score doesn't. For more average residencies, the same will still be true, and the DO student will need a much better score than their MD counterpart to be ranked higher. Again, I couldn't tell you what the difference has to be.

 

[Law2Doc]

...

Total match applicants: 23,000
PGY-1 spots: 37,500
...

As mentioned above, you got this backward. There were 30k total applicants (US, DO, IMG) seeking about 23k spots in the match in 2010. Total US allo grads from this group were about 16k.

 

[thechad]

what are the odds of excluding DOs, IMGs, and FMGs from the match?

About the same as the odds of excluding Lepurchauns from the Unicorn match.

 

[naus]

As they should be. The fact that we have to import so many physicians when many qualified pre-meds don't get into a med school is messed up. I would oppose having med school spots pass (or get get very close to) residency spots, but closing that gap is a good thing.

Especially since most foreign medical degrees are bachelor degrees and not particularly competitive in the first place (outside of UK, Canada, Australia, Netherlands). In China and India for instance, mid tier high schoolers opt for medicine.

Having fluent English skills as a physician is more important than 10 more points on Step 1.

 

[MedStudentWanna]

I'm not saying that I advocate this, but what are the odds of excluding DOs, IMGs, and FMGs from the match? Is it legal (I could see where it could be seen as discrimination)?

I don't know about IMGs and FMGs, but as far as DOs, it'll never happen. They're opening VSACS to DOs next year who want to do electives at LCME hospitals.

 

[MedStudentWanna]

That is exactly what happens. There is tremendous pressure on ACGME programs to take MD students before IMG's and DO's.

Well, many PDs are stronger than the pressure put on them then. Just look at the DO match lists. Derm at Mayo last year, allo plastics this year. You know many qualified MDs were turned down in favor of those DOs for those positions, and many more.

 

[MedStudentWanna]

That medical student may have had better clinical grades. Also in a lot of D.O schools you are not doing clerkship under the residency system it is just you and the attending. So they may be biased when it comes to D.O's 3rd and 4th year.

Also I doubt a 207 MD passes over a 230 D.O often, when the avg MD step score is 222. And I can't find the avg D.O step score because schools don't want to publish them.

DO schools don't publish average step scores because it's only a subset of students who take them. DO students aren't encouraged to take the steps. They take COMLEX and you can average COMLEX scores on school websites.

 

[FutureDoc734]

We just had our first residency application workshop at my med school. Our Dean was very, VERY adamant about making sure that we understand what's happening.

To summarize it, yes, the number of residency spots is almost unchanged, yet the number of US applicants, FMGs, and DO applicants continues to increase. And, add also the huge # of FMGs that are trying to match here while paying the hospital to do their residency here (in other words, free money for the hospital). On top of that, we are getting "smarter" (better step scores, better grades, etc), and a residency program is not going to prefer an American MD with a 195 Step 1 from a FMG with a step 1 of 230; it's just not gonna happen.

Last year, only about 100 family medicine residency spots (not a competitive specialty) were unfilled; that's down from the usual 400+ of years past. Just that should tell you what we are facing. In years past, you could apply to about 10-15 residency programs and be fine; now, they're advising us to apply to at least 25-30 for a noncompetitive specialty, and upwards of 50 for something competitive. That is the nature of the beast right now.

I think the bottom line is, work hard at getting good grades throughout med school and kill the board exams. Then, you'll feel confident in matching, especially if you don't choose something super competitive.

 

[Socrates25]

The problem here is that the AMA/LCME/ACGME/AAMC dont know what the "other hand" is doing.

The "other hand" = DO programs which are spreading like wildfire.

All the publications that the AAMC puts out about a so-called "doctor shortage" absolutely ignore that DOs exist, they also ignore the impact of NPs and PAs. Their bull**** studies simply pretend that MDs provide 100% of all medical care in the United States. Of course we all know thats totally bogus, and workforce projections based on BS assumptions like that are garbage.

Another problem is that the AAMC workforce studies and expansion studies IGNORE the fact that not only are new MD/DO campuses being built, there has been a HUGE increase in the number of seats at already existing med schools. 15 years ago 99% of med schools had 100-150 seats. Now its routine to see existing med schools expand their entry class to 175, 200, even 250 seats. A school going from 150 to 250 seats is a 166% increase, yet the workforce studies ignore that.

United States has too many doctors, not too few. Consider the fact that the average patient now has 3-4 doctors taking care of them, whereas in years past that would have been 1-2 at most.

The death of primary care and the influx of PAs/NPs means that the number of doctors per patient is going to skyrocket as PCPs give up trying to manage patients with multiple comorbidities in a 15 minute office visit and instead simply refer them off to various specialists.

Notice how the total reimbursements to health care "providers" keeps skyrocketing every year yet individual doctors salaries are either flat or declining. Thats because we have too many cooks in the kitchen, and the only way Medicare knows how to handle that is to pay each cook less.

 

[Pansit]

I can't tell what the difference has to be in the step score for a DO to be ranked higher than an MD student, but I do know that their is pressure on ACGME programs to take MD seniors over DO's and IMG's. Also, keep in mind that the step score is just part of the application. Being from an MD school will have significant weight, also, the connections/research/LOR's, etc play a role. Granted, a DO student can rotate at allopathic programs and get LOR's from faculty that would be known to residency programs.

As an example, an MD student with a 230 score has a shot at most residencies. A DO with the same score doesn't. For more average residencies, the same will still be true, and the DO student will need a much better score than their MD counterpart to be ranked higher. Again, I couldn't tell you what the difference has to be.

Your putting way too much value on a board score. All have to meet some minimum value to be considered at a particular program. But if an MD and DO both meet that value, the rest of it depends on the program director. If the DO rotated at their site and really like him than they will choose him. If the MD was a total douche, then they wont. If the PD doesnt want DO's...then he wont choose them. But judging from the match lists every year, DO's do just fine in acgme competitive programs. The trick...as with all medical students, is to rotate at a site, do well, make connections, and you will have a good shot. Especially at programs that have had DO's in the past, and have shown that they are just as capable if not better.

 

[ACSurgeon]

Your putting way too much value on a board score. All have to meet some minimum value to be considered at a particular program. But if an MD and DO both meet that value, the rest of it depends on the program director. If the DO rotated at their site and really like him than they will choose him. If the MD was a total douche, then they wont. If the PD doesnt want DO's...then he wont choose them. But judging from the match lists every year, DO's do just fine in acgme competitive programs. The trick...as with all medical students, is to rotate at a site, do well, make connections, and you will have a good shot. Especially at programs that have had DO's in the past, and have shown that they are just as capable if not better.

Unfortunately, it's not ONLY about how capable you are. I have no doubt that every year programs take MD students who are LESS capable than their DO counterparts. As MD schools graduate more students, the difficulty for DO's to match will only increase.

 

[Brigade4Radiant]

Unfortunately, it's not ONLY about how capable you are. I have no doubt that every year programs take MD students who are LESS capable than their DO counterparts. As MD schools graduate more students, the difficulty for DO's to match will only increase.

No not really MDs while graduating more students all take the USMLE while only like 40% of D.Os take it. MD does have more students but even going by matriculating stats MDs outpace DOs. Also LCME schools need to have a close partnership with a hospital and have their rotations under the residency system. Some DO schools have to do their clerckships at many different areas that don't have residents and some of these rotations may be good and some of them may not be so good.

 

[Law2Doc]

... and a residency program is not going to prefer an American MD with a 195 Step 1 from a FMG with a step 1 of 230; it's just not gonna happen. ...

Actually the American MD still usually gets the nod at most places, and here's why. The step numbers are nice indicators as to how that person may perform on inservice exams, Step 3, board certification exams. So sure, it's important for one component of residency, one of several things the PD cares about. But it's not really what gives the PD headaches during residency. The PD most importantly cares about folks who can do their job in an American system without ever having any issues the PD has to deal with. Which means that if that person doesn't do well with the typical US patient, that's a problem. Or if that person has language issues, that's a problem. Or if that person has difficulty with attendings, that's a problem. There is a skillset that US students pick up in US med school rotations (real ones, not the paid shadowing experiences that some offshore schools pay community hospitals to provide and call rotations), that is very hard to capture elsewhere. You learn how to deal with US patients, US attendings, know the expectations, learn to work as a team player, know when you are allowed to say "I don't know", etc. So there are huge advantages to PDs of folks who have done rotations in the US system and gotten rave reviews by attendings, folks who have done sub-internships, have done away rotations. Folks who know the expectations and have at the med school level actually met them. That is something IMGs rarely bring to the table, and for most PDs it outweighs a board score because the board score issue only gives him a headache once a year when the inservice exam results come out, while the dealing with US patients and attendings issues come up over and over again. Lots of IMGs make the jump into the US system with no issues. But as a percentage, the folks who got good evals in US med schools have fewer issues than any other group.

At any rate, in residency you will get to know your PD who often and repeatedly will share with the residents that he just interviewed X or Y applicant who had some sort of crazy high score but unfortunately simply would never work out.

 

[Lokhtar]

On top of that, we are getting "smarter" (better step scores, better grades, etc), and a residency program is not going to prefer an American MD with a 195 Step 1 from a FMG with a step 1 of 230; it's just not gonna happen.

Well, I won't so so sure. Many American students judge a residency by how many US MDs there are vs. FMGs/DOs, so there is pressure there to pick US MD grads as much as possible.

 

[Law2Doc]

Well, I won't so so sure. Many American students judge a residency by how many US MDs there are vs. FMGs/DOs, so there is pressure there to pick US MD grads as much as possible.

Also true. It's dangerous for a program to get labeled as an "IMG heavy" residency, because in subsequent years their IMG applications with lower stats shoot up and US applications with higher stats go down.

As much as folks like to point to Step 1 as the "single factor" that drives this train, it is just one, albeit an important, factor. There is a lot of US residency preparation folks get in the latter two years of US med school that isn't ever adequately replicated elsewhere. PDs would be unhappy to lose that. They can get away with a number of US med school grads who set the tone for the other residents. But when trying to instill a certain approach, more people educated under the desired system is better. The PD simply doesn't want to deal with a lot of issues that come up due to learning under a different system. This is infinitely more work for a PD than someone who flubs an inservice exam, and as a result is also a high priority for PDs. Often a higher concern than the pure Step 1 number.

To get a residency, I think it's safe to say you are better off with a 195 being a US allo grad than being an IMG with a 230 but limited US clinical experience, or a difficult accent.