More Residency Slots

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AbRKnight

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Looks like good news for some med students as I can't see this not passing eventually...

http://www.ama-assn.org/amednews/2009/05/25/prse0528.htm

Bill would raise cap on Medicare-funded residency slots
Legislation would give preference to positions in primary care, general surgery and other physician shortage specialties.

By Susan J. Landers, AMNews staff. Posted May 28.

Washington Bills have been introduced in the Senate and House of Representatives to reduce current and projected physician shortages by increasing the number of Medicare-supported residency positions.

The measures, both called the Resident Physician Shortage Reduction Act of 2009, would expand the number of positions by 15%. The increase would amount to about 15,000 additional residency slots, bringing the total to approximately 115,000, the bills' sponsors said.

Preference for the positions would be given to primary care, general surgery, nonhospital community-based settings and other areas of need, according to the legislation.

The measures also would change regulations to let residents train in nonhospital settings. And they would allow residency slots from closed hospitals to be used by nearby teaching hospitals so the slots are not lost, as is currently the case.

The bills lift a cap placed by the Balanced Budget Act of 1997 on the number of resident physicians each teaching hospital can claim for reimbursement under Medicare. Medicare does not generally reimburse such hospitals for training residents beyond the capped number of slots.

The AMA supports the bills. "Although medical schools are increasing their class sizes and several new allopathic medical schools and colleges of osteopathic medicine are scheduled to open within the next few years, Medicare-funded GME residency positions have not increased," AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, wrote in a letter to Senate and House bill sponsors.

The Senate measure was introduced by Sens. Bill Nelson (D, Fla.) and Charles Schumer (D, N.Y.) and Majority Leader Harry Reid (D, Nev.). The companion House bill was filed by Reps. Joseph Crowley (D, N.Y.), Kendrick Meek (D, Fla.) and Kathy Castor (D, Fla.).

"No health care reform effort will be complete or even adequate unless we address the shortage of doctors in this country," Schumer said in a statement.

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Preference for the positions would be given to primary care, general surgery, nonhospital community-based settings and other areas of need, according to the legislation.

I wonder how the more xenophobic members of our Congress will react when all of these spots are filled by FMGs since we can't fill the current number of primary care spots with US grads...
 
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Preference for the positions would be given to primary care, general surgery, nonhospital community-based settings and other areas of need, according to the legislation.

The measures also would change regulations to let residents train in nonhospital settings. And they would allow residency slots from closed hospitals to be used by nearby teaching hospitals so the slots are not lost, as is currently the case.

WTF? How the hell do you train residents in a non-hospital setting. That automatically rules out any new IM, surgery, gas, peds residencies. The only primary care residency that you could have with no hospital training would be family practice. If this goes thru, the ACGME family practice committees would have to eliminate all their hospital training requirements. Are FPs really going to allow their specialty to transition 100% into an outpatient setting with absolutely zero inpatient training? I doubt it.

Dermatology residency could be done 100% outpatient, but something tells me the derm powers that be arent going to be applying to open up any new residency slots.
 
Looks like good news for some med students as I can't see this not passing eventually...

Sure, if by "some med students" you mean DOs and IMGs. The emphasis seems to be on residencies that already are going unfilled or will be shortly (e.g., general surgery).

It's kinda like saying that they're going to increase seating on the Titanic. Let me know when they offer a few more lifeboats, thanks.
 
I wonder how the more xenophobic members of our Congress will react when all of these spots are filled by FMGs since we can't fill the current number of primary care spots with US grads...

Agreed. The AAMC has been talking about how US med school grads need to fill US needs since at least 2005, and part of the reason for the increase in US med school seats has been for this end. I don't see them conceding this point now that they have made such huge strides toward this end the past few years.

This smacks of something that will be horse-traded away for something congress really cares about or wants to pay the big money for. It's much easier to talk about increasing doctors than selling to the public that we are going to address rising healthcare costs by throwing in another 500 mill in residency training expenses. Expect that 15,000 slots to end up more like 150 before the bill gets passed. Just my opinion.
 
WTF? How the hell do you train residents in a non-hospital setting. That automatically rules out any new IM, surgery, gas, peds residencies. The only primary care residency that you could have with no hospital training would be family practice. If this goes thru, the ACGME family practice committees would have to eliminate all their hospital training requirements. Are FPs really going to allow their specialty to transition 100% into an outpatient setting with absolutely zero inpatient training? I doubt it.

Dermatology residency could be done 100% outpatient, but something tells me the derm powers that be arent going to be applying to open up any new residency slots.

100% not true--I'm not going into derm fwiw--there's absolutely no way you could train a dermatologist solely by outpt. Although we think derms only have great board scores because everybody wants a great lifestyle and the amount of spots is limited, you still have to be pretty damn smart to do the field.
 
The only primary care residency that you could have with no hospital training would be family practice. If this goes thru, the ACGME family practice committees would have to eliminate all their hospital training requirements. Are FPs really going to allow their specialty to transition 100% into an outpatient setting with absolutely zero inpatient training? I doubt it.

I don't even see FP being around much longer. Most of the family practice, imo, is going to transition into the hands of DNPs and PAs.
 
I thought medicare was going to be bankrupt by 2014? Aren't these positions paid out of medicare?

Anyhow if this does pass that would actually go towards their goal of having more primary care docs around. As med schools increase enrollment, more will be forced towards primary care. Originally they would have squeezed out FMG's and DO's but now there's room for everyone in primary care.
 
100% not true--I'm not going into derm fwiw--there's absolutely no way you could train a dermatologist solely by outpt. Although we think derms only have great board scores because everybody wants a great lifestyle and the amount of spots is limited, you still have to be pretty damn smart to do the field.

i don't see what it is about derm that requires intelligence. AK, SK, wart, hemangioma. shave it off or freeze it off. if you don't know what it is do a punch biopsy. if it's a skin cancer cut it off. if it's too late refer to onco. remove some unwanted hair, remove a tattoo. you could do this job with a 6-month community college course.
 
i don't see what it is about derm that requires intelligence. AK, SK, wart, hemangioma. shave it off or freeze it off. if you don't know what it is do a punch biopsy. if it's a skin cancer cut it off. if it's too late refer to onco. remove some unwanted hair, remove a tattoo. you could do this job with a 6-month community college course.

Try spending like 2 seconds in a dermatology office, and you'll see how wrong your comments are. Good luck dealing with psoriasis that doesn't respond to most medical treatment with the community college ocurse. Love the bashing of other fields that always seems to stem from 100% jealousy.
 
If its wet, dry it, if its dry, wet it. Boom im derm certified
 
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Looks like good news for some med students as I can't see this not passing eventually...

Actually, I think it's going to be tough to get this bill through. It's in the finance sub-committee at the moment, and I'm guessing it'll carry a pricetag somewhere in the billions (for direct and indirect costs). At a time when part of the administration's plan is to cut medicare costs, this would be a sharp swing in the opposite direction.
 
The measures, both called the Resident Physician Shortage Reduction Act of 2009, would expand the number of positions by 15%. The increase would amount to about 15,000 additional residency slots, bringing the total to approximately 115,000, the bills' sponsors said.
115,000 residency slots? There are only ~16,000 US allo grads per year. How do they figure 115,000 slots? Or are they multiplying the number of slots by the duration of the residency?
 
115,000 residency slots? There are only ~16,000 US allo grads per year. How do they figure 115,000 slots? Or are they multiplying the number of slots by the duration of the residency?



I'd assume it's basically "number of residents in the US at any given moment" (or at least number of available positions for residents).
 
If this passes, it's most likely to be included in the health reform bill, not standalone.
 
If this passes, it's most likely to be included in the health reform bill, not standalone.

It'll be the thing proponents agree to leave on the cutting room floor in order to get a health reform bill passed, more likely. I sure wouldn't bet on it happening. It goes against what the AAMC has been asserting for the last 4 years (about US schools filling all US needs), AND it is wicked expensive. So it's good lip service for some congressmen who want to say they tried to do something, but it will not likely happen.
 
It'll be the thing proponents agree to leave on the cutting room floor in order to get a health reform bill passed, more likely. I sure wouldn't bet on it happening. It goes against what the AAMC has been asserting for the last 4 years (about US schools filling all US needs), AND it is wicked expensive. So it's good lip service for some congressmen who want to say they tried to do something, but it will not likely happen.

Yeah, I sure wouldn't be holding my breath for it. However, I wouldn't be surprised if some congressperson slips it in at the last minute. That's how we got the "buy American" provision in the stimulus bill and salary caps on top executives in the bailout bill.
 
Yeah, I sure wouldn't be holding my breath for it. However, I wouldn't be surprised if some congressperson slips it in at the last minute. That's how we got the "buy American" provision in the stimulus bill and salary caps on top executives in the bailout bill.

No -- it's already in, so it can't be "slipped in". This is fodder to be traded away in order to be allowed to slip something else in. (And FWIW, nothing ever actually gets "slipped in" -- there are hundreds of lawyers working on these bills from every angle. If something gets in, it is something that makes the bill palatable to the majority. In most cases, it's give and take -- I'll give you this if you take this out. And the above is sure to be a victim of this.
 
I don't even see FP being around much longer. Most of the family practice, imo, is going to transition into the hands of DNPs and PAs.

Most medical students spend their time in urban locations and somehow come to the conclusion that FP is on its way out and fast.

This just isn't true in most rural locations, especially in the west and midwest, where small communities rely heavily on docs that can do small procedures, manage acute issues, and be a primary provider for folks longitudinally.

Not to hijack the thread, I'm tired of folks who perpetuate the idea that FP will be gone in our lifetime.
 
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Most medical students spend their time in urban locations and somehow come to the conclusion that FP is on its way out and fast.

This just isn't true in most rural locations, especially in the west and midwest, where small communities rely heavily on docs that can do small procedures, manage acute issues, and be a primary provider for folks longitudinally.

Not to hijack the thread, I'm tired of folks who perpetuate the idea that FP will be gone in our lifetime.

Agreed. Although I have been an urbanite all my life, I understand this role for FP is very important... and ultimately cost effective.
 
Looks like good news for some med students as I can't see this not passing eventually...

http://www.ama-assn.org/amednews/2009/05/25/prse0528.htm

Bill would raise cap on Medicare-funded residency slots
Legislation would give preference to positions in primary care, general surgery and other physician shortage specialties.

By Susan J. Landers, AMNews staff. Posted May 28.

Washington Bills have been introduced in the Senate and House of Representatives to reduce current and projected physician shortages by increasing the number of Medicare-supported residency positions.

The measures, both called the Resident Physician Shortage Reduction Act of 2009, would expand the number of positions by 15%. The increase would amount to about 15,000 additional residency slots, bringing the total to approximately 115,000, the bills' sponsors said.

Preference for the positions would be given to primary care, general surgery, nonhospital community-based settings and other areas of need, according to the legislation.

The measures also would change regulations to let residents train in nonhospital settings. And they would allow residency slots from closed hospitals to be used by nearby teaching hospitals so the slots are not lost, as is currently the case.

The bills lift a cap placed by the Balanced Budget Act of 1997 on the number of resident physicians each teaching hospital can claim for reimbursement under Medicare. Medicare does not generally reimburse such hospitals for training residents beyond the capped number of slots.

The AMA supports the bills. "Although medical schools are increasing their class sizes and several new allopathic medical schools and colleges of osteopathic medicine are scheduled to open within the next few years, Medicare-funded GME residency positions have not increased," AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, wrote in a letter to Senate and House bill sponsors.

The Senate measure was introduced by Sens. Bill Nelson (D, Fla.) and Charles Schumer (D, N.Y.) and Majority Leader Harry Reid (D, Nev.). The companion House bill was filed by Reps. Joseph Crowley (D, N.Y.), Kendrick Meek (D, Fla.) and Kathy Castor (D, Fla.).

"No health care reform effort will be complete or even adequate unless we address the shortage of doctors in this country," Schumer said in a statement.

Well it's about time.

I'm just a premed, but I'm confused. Why the heck is everyone happy about this? That's how lawyers became unemployed. This is why some pharmacists can't find good jobs. That's why in certain locations, some dentists are struggling to find work. Adding more doctors to the profession will make all our lives harder. There has to be something I'm missing.
 
Most medical students spend their time in urban locations and somehow come to the conclusion that FP is on its way out and fast.

This just isn't true in most rural locations, especially in the west and midwest, where small communities rely heavily on docs that can do small procedures, manage acute issues, and be a primary provider for folks longitudinally.
Not to hijack the thread, I'm tired of folks who perpetuate the idea that FP will be gone in our lifetime.

What is going to keep the rural communities from acquiring their medical care from a DNP or PA who will charge much less than an MD or DO? And PAs can do everything bolded above. If they are capable of placing a ventric, then they can easily do any small procedure that would be done in a rural FP's office.
 
I'm just a premed, but I'm confused. Why the heck is everyone happy about this? That's how lawyers became unemployed. This is why some pharmacists can't find good jobs. That's why in certain locations, some dentists are struggling to find work. Adding more doctors to the profession will make all our lives harder. There has to be something I'm missing.

Agreed. Shortages are more beneficial than gluts to the folks already en route to their profession. So the average US allo med student shouldn't be excited for this. But for the crowd worried about landing a residency at all (IMGs/FMGs), this probably sounds wonderful.
 
I'm just a premed, but I'm confused. Why the heck is everyone happy about this? That's how lawyers became unemployed. This is why some pharmacists can't find good jobs. That's why in certain locations, some dentists are struggling to find work. Adding more doctors to the profession will make all our lives harder. There has to be something I'm missing.

Well I am no expert on the subject but I know the number of residency slots has remained unchanged since 1996. That being said, the population in the United States is always inreasing. Many sources agree that we are headed for a physician shortage in the coming years. I won't quote a number but most say in the tens of thousands.(google it and see what you find

So I wouldn't worry about being unemployed due to too many docs, I personally think reimbursment reduction is a far greater threat to the profession.
 
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So I wouldn't worry about being unemployed due to too many docs, I personally think reimbursment reduction is a far greater threat to the profession.

It's not an issue of being unemployed, it's an issue of salaries decreasing due to oversupply. The current shortage is caused by the baby boomer generation, who is getting old right about now, living longer and their healthcare needs are skyrocketing. But the generations after this one aren't as large. So you don't want to ramp up the number of doctors only to have the number of patients fall away. Then you would get to a comparable situation as law, where the real problem isn't so much the number of unemployed lawyers as the fact that some percentage do well while others don't.Additionally, the AAMC, since 2005, has been expressing that US med schools should fill US needs. Med schools have been increasing their ranks faster than residency slots the last few years, and making a huge dent in the number of offshore imports needed. Part of the reason for this is that the LCME has no quality control oversight over the training folks get elsewhere, which is a bad thing if you want to ensure a certain standard of care and common knowledge base amongst physicians. Not to mention that the people requiring primary care physicians in the least desirable locations were finally going to get US educated doctors as the number of US med students approximated residency slots. All this will be undone if you increase residency slots.

But all this is moot, because everyone is going to balk at the cost involved, at a time when the consensus is that healthcare costs need to be slashed not increased.
 
It's not an issue of being unemployed, it's an issue of salaries decreasing due to oversupply. The current shortage is caused by the baby boomer generation, who is getting old right about now, living longer and their healthcare needs are skyrocketing. But the generations after this one aren't as large. So you don't want to ramp up the number of doctors only to have the number of patients fall away. Then you would get to a comparable situation as law, where the real problem isn't so much the number of unemployed lawyers as the fact that some percentage do well while others don't.Additionally, the AAMC, since 2005, has been expressing that US med schools should fill US needs. Med schools have been increasing their ranks faster than residency slots the last few years, and making a huge dent in the number of offshore imports needed. Part of the reason for this is that the LCME has no quality control oversight over the training folks get elsewhere, which is a bad thing if you want to ensure a certain standard of care and common knowledge base amongst physicians. Not to mention that the people requiring primary care physicians in the least desirable locations were finally going to get US educated doctors as the number of US med students approximated residency slots. All this will be undone if you increase residency slots.

But all this is moot, because everyone is going to balk at the cost involved, at a time when the consensus is that healthcare costs need to be slashed not increased.

I am not saying you are wrong but you would think that the AMA would have considered that when formulating their projections.
 
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