My Thoughts on Ross University

[Skip Intro]

Originally posted by Dr. Cuts
Out of curiosity though, what are your feelings about Ross?

Well, Cuts, that's a very difficult question to answer objectively. I have very complex feelings about Ross, some of which (I'm certain) are born out of what I'm sure a lot of medical students feel when they hit the doldrums of not being able to always see the light at the end of the tunnel. Nonetheless, I can only try to answer the question as best I can without interjecting too much unsupportable opinion, recognizing however that a lot of my statements will have evolved from my personal experiences and observations and will naturally reflect that bias on some level.

In general, the "pros" about Ross are as follows:

(1) You will get your chance. By this, I mean that many students who could not, for whatever reason, get an acceptance into a U.S. school - or, who chose not to play the AMCAS game (which is rare, granted - but I've met a few, myself included) - will get a quality, Western-medicine based medical education that will provide a good foundation for when you get back to the U.S.

(2) Accelerated nature of the program. The pre-clinical phase is 16 months divided into four semesters. In that time, students cover the core curriculum which consists of the following: Biochemistry (1 semester), Histology (1 semester), Doctor, Patient, and Society (1 semester ethics course P/F), Anatomy (1 semester), Neurobehavioral 1 & 2 (2 semesters), Medical Physiology (1 semester), Pathology 1 & 2 (2 semesters), Medical Microbiology/Immunology (1 semester), Pharmacology (1 semester), and Intro to Clinical Medicine (1 semester). These courses (or equivalents) form the core of all medical education programs and prepares one well for Step I.

(3) Administering of the NBME Shelf Exams. Ross gives the "shelf" exams that many U.S. medical schools take at the end of each course. This represents a large part of our grade as well. Doing well on such an exam - and, more importantly, feeling like you have been taught the subject matter covered on the exam - is a good indicator of what you've learned and what the U.S. system expects that you SHOULD be learning.

(4) Extensive connection to U.S. programs I believe that Ross currently has the largest selection of U.S. affiliate hospitals of all Caribbean schools, even SGU. This does not necessarily mean that they are better (or worse) than SGU's hospitals, per se, but assures that a student will have a fairly large selection when it comes time for clerkships.

(5) The warm weather. This is a superficial and personal reason, but I hate cold weather. So, that's a small bonus in my book.

"Cons":

Although I could probably spend several pages with picky little personal pet peeves that don't matter in the grand scheme of things, I'll limit it to the few that are most relevant:

(1) The "stigma" associate with ALL Carib schools. Yes, discussed ad nauseum, existent, and hopefully something that will ultimately fade away someday. Perhaps wishful thinking on my part.

(2) The high attrition rate. I find that, clearly, there are a lot of people who get acceptances and attend this school who, quite simply, don't want it bad enough. The school says that "officially" there's only about 10% of the class that doesn't make it. In my "unofficial" estimation, I think it's closer to about 40% of any starting class won't make it to graduation. The school IS trying to do something about this, but I think a better start would be a more selective admissions policy. (Yes, I said that.)

(3) The potential "for profit" conflict of interest. This is a bigger area of concern for me, and I don't have a lot of room to go into this in detail (PM with your e-mail if you want more in depth response). But, suffice it to say, that the administration has you by the "short hairs" once you've invested a significant portion of money and time into this program. In essence, they are trying to tighten-up the program a bit and have created a bit of a "hit the moving target" phenomenon... sorry for being so cagey. Let's just say that a LOT of students are transferring to other schools after this semester...

(4) Dominica. This can be a pro or a con, depending on how one looks at it. Personally, I've just about reached my tolerance limit with this island. It is almost certainly the poorest island in the Caribbean. If there actually exists a poorer country down in these parts, I'd love for someone to point it out to me. Likewise, students are seen as a "cottage industry" and as a result get overcharged for everything. For example, my little piece of crap efficiency apartment is $600 U.S. a month. But, it's either live close to campus or live far away (which is cheaper) but both less safe and convenient. The food is horrible, too. And, there's absolutely nothing to do but study... and scuba dive if you have the inclination and the time. (It does give you a MUCH deeper appreciation of what we have in the U.S.)

Well, that's a good start. I could go on and on, I'm sure, but a lot of it would be nit-picky stuff that some would find not as annoying as I do. Likewise, others may find things about the school and the island more frustrating than I do.

Suffice it to say that Ross, as I've consistently stated, is a means to an end. It is one of the more recognized Carib schools in the U.S. Is there room for improvement? Clearly. But, I think the University is attempting to address a lot of long-standing issues and continuously make this place better and better. We'll see...

-Skip

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[Pursuing MD]

Skip, you said about the attrition rate: "I think it is closer to about 40% of any starting class won't make it to graduation."

Why do you think this is the case? Do a lot of the students just fail out b/c they cannot handle the workload or do they just hate the living conditions? Do they transfer into another med school?

Thanks!

 

[Skip Intro]

Originally posted by Pursuing MD
Skip, you said about the attrition rate: "I think it is closer to about 40% of any starting class won't make it to graduation."

Why do you think this is the case? Do a lot of the students just fail out b/c they cannot handle the workload or do they just hate the living conditions? Do they transfer into another med school?

Thanks!

If you look at the number of students that start a class, anywhere from 200-270, multiply that by the number of classes that start per year (3), and then look at the number of graduating students per year, the numbers just don't add up. There should be close to 700 or so students in any given
"graduating class". On Ross' website, there are only abou 350 or so that graduate and have their residencies listed. Accounting for "slower track" students, transfers in and out, and overall program attrition, that puts the number of students actually entering the school and eventually graduating at about 60%.

I think that the reasons for this are multi-factorial. My class (starting last fall and currently winding-up the third semester), started with about 265. We are currently hovering around 200. Last semester, we had about 35 "repeats" (those who didn't pass at least one course in second) who got held back. There were also several students who just left during 1st and 2nd semesters. We had a few that didn't last longer than the first week. Many get acceptances and aren't prepared to do the work. Some transfer to other Carib schools. Some never pass Step I. Some never get the chance to even sit for Step I, though. I think a very few (maybe 10-12 per year) will actually do well enough to transfer into U.S. schools. But, no one should come here thinking that they are going to be that lucky person. I have a feeling, but no real way of knowing, that many who do are heavily connected.

Originally posted by Molybdenum
Hey Skip,
Can you be a little more specific about the food at Ross? exactly how bad is it??? I heard their water causes diarrhea or something...is that true or is it just a rumor?

I got sick at least once a week during my first semester. I lost about 16 pounds by the end of it. It was terrible. One of the many tribulations you must endure on the island. The problem is that there isn't a great selection of food. There are about 10 or so vendors at "the Shacks" that offer basically the same thing everyday. Any one of these places would get shut down by any local health authority in the U.S. in about 30 seconds. I'm not joking.

Then, there is the on-campus cafeteria, called the Seaside Cafe (which the students have affectionately dubbed the "Seasick" Cafe) that offers about 3 or 4 regular items. Those are: chicken, chicken, chicken, and - oh yeah! - chicken. If you are a steak lover, you will definitely suffer while down here.

Of course, you can always buy food at the James Store or Tina's. Everyone loves paying the equivalent of $5 U.S. for a box of stale Pop-Tarts. Or, how about $18 E.C. (about $6.75 U.S.) for a six- pack of Lipton "Brisk" ice tea?

The water? I've NEVER - let me repeat that NEVER - had one drink out of the tap. When it rains, the water gets cloudy. Most students buy bottled water and refill them on campus at the heavily filtered and conditioned water fountains. This seems to do the trick. If you have to drink the tap water, boil it first then filter it through a Brita or the like.

Whomever believes that they are coming to Dominica to "buy" their medical degree or have a 16-month Caribbean vacation will be sorely disappointed shortly after arrival. If you survive this program, I believe you will get a good medical education. There are two schools of thought: what doesn't kill you makes you stronger -OR- what doesn't kill you only prolongs the inevitable. Still, there are some moments when this place isn't so bad. But, the phrase caveat emptor has taken on new meaning for me. If I could me Robert Ross just once I'd ask him why in HELL he chose to put the school on this island!

 

[Skip Intro]

Hard to believe that I posted this over SIX YEARS AGO! My, how the times have changed. But, it really feels like I've been caught sort of in a time warp. Seems like only yesterday...

Now, I'm getting ready to finish my anesthesiology residency in June '09. I'll be moving on to private practice. It's amazing how fast it's gone, yet at the same time it seems just like yesterday that I was sweating it out down in Dominica.

It's also amazing how much I've learned about medicine, and myself, in that timeframe. I have to say honestly looking back through the years, I might not have chosen to go this route and put myself through all of this. But, in many ways, I'm glad I did.

-Skip

 

[Decicco]

Nice post! I think the Ross and SGU are very underrated opportunities.

EDIT: By "underrated," I'm not suggesting that they compete on the same level as US-MD schools.

 

[Law2Doc]

Nice post! I think the Ross and SGU are very underrated opportunities.

No, they are rated pretty appropriately. For every extremely successful graduate like the OP, there are several dozen who don't make it nearly as far as the high attrition and the less impressive residency options. Think of it as a hail mary pass. If it's successful you get your touchdown. But most of the time it's just a lousy throw.

 

[chessknt]

Yea, the failed individuals wont come back to tell us their failure stories.

 

[phospho]

I feel that the very small amount of students who are successful utilizing the carib option are students who would have been successful doing the U.S. route, but had irrepairable ugrad grades, bad luck with the MCAT, bad luck in general, or a combination of these 3.

The hoops they seem they need to jump through are numerous (and as a personal opinion, not worth it).

congrats to the OP!!!

 

[Decicco]

No, they are rated pretty appropriately. For every extremely successful graduate like the OP, there are several dozen who don't make it nearly as far as the high attrition and the less impressive residency options. Think of it as a hail mary pass. If it's successful you get your touchdown. But most of the time it's just a lousy throw.

Its not like the school has an attrition quota and must fail that many students each year. These are students that likely shouldn't have went to medical school in the first place. Stastics say nothing about what an individual will do, and if they apply themselves in the same was as they would at a US school, they will not have a problem graduating in the Caribbean. My point is, when comparing attrition rates at US MD and C-MD schools, don't forget that these are different students--some of those in the Caribbean don't belong in medical school, but this should have a neglidgable effect on your own performance.

I agree that as far as residency goes, a US MD is best. For those without that option, I think a C-MD could be considered.

 

[HeatherMD]

my friend is at SGU and she LOVES it!

Caribbean is my last last resort though.. I know there's lots of ties to US residencies, but I'm unsure how well they hook up with Canada.

Ross does have posters all over my school however! Maybe maybe..

 

[JaggerPlate]

No, they are rated pretty appropriately. For every extremely successful graduate like the OP, there are several dozen who don't make it nearly as far as the high attrition and the less impressive residency options. Think of it as a hail mary pass. If it's successful you get your touchdown. But most of the time it's just a lousy throw.

Well said.

 

[Excelsius]

Hard to believe that I posted this over SIX YEARS AGO! My, how the times have changed. But, it really feels like I've been caught sort of in a time warp. Seems like only yesterday...

Now, I'm getting ready to finish my anesthesiology residency in June '09. I'll be moving on to private practice. It's amazing how fast it's gone, yet at the same time it seems just like yesterday that I was sweating it out down in Dominica.

It's also amazing how much I've learned about medicine, and myself, in that timeframe. I have to say honestly looking back through the years, I might not have chosen to go this route and put myself through all of this. But, in many ways, I'm glad I did.

-Skip

You are saying that you might not have done it again. You mean that you would have chosen another route or not have become a doctor at all? If another route, what would you have done differently? Do you regret getting a degree from a Carib med school? What do you think is the most negative aspect of the path you took and current your degree? Since it is so rare for someone to come back after more than six years, it would be very helpful if you could detail the important things you have learned and perhaps give some recommendations.


To me it seems that anyone really wanting to go to a US medschool can do so because there are multiple paths. First, there are those students who get in with GPAs below 3.0. While rare, it does happen even on SDN. That shows that you can spend a lot of time on ECs to make up even for the worst grades. The other option is to double major in something or just take extra units to bring the GPA above 3.0. If that's still not enough, you can do a post bacc. If that's not enough, you can do an SMP. At this point if you still don't make it, there is always the DO route. If that fails as well, you still can choose to pursue another professional degree, and apply to med school after that, by which time you'll have a lot of ECs and maybe even research, depending on the field. Med schools seems to accept more and more non-trads with a lot of experience.

The only limitation I see where you might not be able to make it to med school is if you just cannot do well on the MCAT, such as a 23 or below combined with a low GPA. The Caribbean will be your chance here, but the question is if you can't get an average score on the MCAT, can you really make it through Caribbean med schools? Probably not. Therefore, it seems to me that it is always possible to get into a US med school if you exhaust all the routes.


Some quick numbers: let's assume that you have pretty bad grades - low GPA and mediocre MCAT. Let's assume that your acceptance probability to any one school is about 2% (the national average is 42.7%). That's a very conservative number assuming that some schools have 10th percentile matriculant GPAs below 3.2 and the majority have it lower than 3.4. So if you apply to 15 schools within your echelon, your probability of getting at least a single acceptance will be 1-(98/100)^15=0.2614. Maybe that's not that great, but you didn't apply to many schools. Let's increase that to the higher number of 40: 1-(98/100)^40=.5543. A 55% acceptance probability is better than a flip of a coin and is 13% better than the national average, and all this simply by applying to many school. Yes, maybe 40 schools will be expensive and a lot of work in terms of essays, but that's nothing compared to the costs you would incur attending the Caribbean. If you had really low numbers and were overzealous, you could bump that number to 50 or 60 schools (some people on SDN apply to more than 40 schools with almost average scores!) and increase your acceptance probability to a whopping 70.24%. SDN gives you the tools to start working on the essays a year or more in advance of applying. So you can use math to get yourself into med school, if nothing else.

 

[p30doc]

The other option is to double major in something or just take extra units to bring the GPA above 3.0. If that's still not enough, you can do a post bacc. If that's not enough, you can do an SMP. At this point if you still don't make it, there is always the DO route.

Some quick numbers: let's assume that you have pretty bad grades - low GPA and mediocre MCAT. Let's assume that your acceptance probability to any one school is about 2% (the national average is 42.7%).

Most DO schools want a minimum 3.0 gpa as well, so it is not the last ditch option that you suggest it is.

Your numbers are way off, acceptance rate for any one school is about 5-6% on average, no school has a 42.7% average acceptance rate. This is the final applicant success rate, i think the average applicant applies to ~13 schools. So your 2% acceptance chance at any one school is wayy to generous for someone with low GPA and mediocre MCAT.

 

[Decicco]

Most DO schools want a minimum 3.0 gpa as well, so it is not the last ditch option that you suggest it is.

True, other options are an SMP, the Caribbean, or just strengthening your application and trying again. Along with DO school, each of these are options that need to be thought long and hard about. These four routes are competiting for much the same type of student, and which you choose can have significant repercussions. Not a decision to take lightly or rush into. I'm happy to hear that things worked out well for the OP.

 

[chessodoc]

True, other options are an SMP, the Caribbean, or just strengthening your application and trying again. Along with DO school, each of these are options that need to be thought long and hard about. These four routes are competiting for much the same type of student, and which you choose can have significant repercussions. Not a decision to take lightly or rush into. I'm happy to hear that things worked out well for the OP.

What are the thoughts on Antigua?

 

[pianola]

REALLY interesting read. Super-congrats to the OP!

 

[Demas567]

(1) The "stigma" associate with ALL Carib schools. Yes, discussed ad nauseum, existent, and hopefully something that will ultimately fade away someday. Perhaps wishful thinking on my part.

You think that this is something that will go away someday?



Definitely wishful thinking there.

 

[Law2Doc]

You think that this is something that will go away someday?



Definitely wishful thinking there.

Well, it will go away but not in the manner the prior poster thinks. Currently US allo schools are increasing enrollment, but the number of residencies are not increasing. In a couple of years, the number of US students will equal the number of US residency slots (one of the long stated goals of the AAMC). After that point there will be no stigma for caribbean schools because all those schools will rapidly disappear.

 

[Excelsius]

Most DO schools want a minimum 3.0 gpa as well, so it is not the last ditch option that you suggest it is.

Your numbers are way off, acceptance rate for any one school is about 5-6% on average, no school has a 42.7% average acceptance rate. This is the final applicant success rate, i think the average applicant applies to ~13 schools. So your 2% acceptance chance at any one school is wayy to generous for someone with low GPA and mediocre MCAT.

I don't know whether you misunderstood what I said or your data is different. All my statistics come from AAMC. Here is a general link. If really necessary, I may show exactly what table to use to come up with the numbers. Anyone can do it - just cross reference several of the tables. Here are some numbers:

I.n State Matriculation for CA: 17.21%.
.In State Matriculation for West: 17.1%.
.In State Matriculation for Northeast: 23.8% (Central and South are about 31%).
.Out of State Matriculation for CA: 23.8%.
.Total Rate of CA Resident Matriculation: 40.2%.
.National Average of Matriculation: 42%.

. National average of 42% means that the average applicant has 42 out of a hundred chance to get into a single medical school within USA. It does not mean you have a 42% chance of getting into any one medical school. Even CA residents have a 40% chance of getting in somewhere (17% within the state). These numbers are correct. I think that you make an error when you look at the individual school statistics because you don't count the fact that many students apply to several schools. By default, only one school is going to allow them to matriculate, ..even if they have the best scores. If you do look at matriculant data, then you'll see something like 1.79% matriculation for Georgetown or 8.84% for Alabama. The range is from 1.22% to 20.49% (or 40-100% at the higher end if you include the special programs). A conservative average for all schools is 4.48% (5.64% if you want to be all inclusive). But again, these numbers are for matriculants only and they don't say much. The acceptances could be a one or several percentages over that. My 2% is only an estimation of the average. If the average applicant has about 5% chance of getting into any one school (average being around 3.65 GPA and 30.8P MCAT), 2% is reasonable because it has 60% less probability of getting in than the average student.

Obviously, my calculation is rough. If you have a 2.0 GPA and 25MCAT, 2% is too high. If you have 3.5 GPA, 33 MCAT, but no research, 2% is again somewhat high for a research oriented and high ranking school like Stanford. I can't go through every single permutation because it's just an average calculation. I will work on a more precise Excel tool and post it when I am done.

Also note this: the GPA and MCAT averages in MSAR are inflated because students with high numbers get several acceptances and inflate the numbers. In conrast, students with low numbers may get only a single acceptance (MilkmanAl) and not affect the averages as much. What we really need is the average GPA of matriculated students. That would be much more accurate. So perhaps the average is skewed by 0.1, 0.2, or more in GPA alone, especially at the mid to low tier schools. This brings down their 10th percentile acceptances as well.
Another note: med school admissions is random at times. If you have a 4.0 and 35 and but are empty as a person in terms of growth and experiences, you may not even get an interview whereas the guy with 3.2 GPA and 31 MCAT will get an acceptance just because of his essays and maturity. There is also the interview filter, so you can't just fake your essay (which isn't a rare occurrence it seems). Because of all these unknowns, I think my 2% is justified as an average estimate.
.

 

[pianola]

...all those schools will rapidly disappear.

How disappear? People will tear down the buildings? What do you mean?


Right now Caribbean-ers don't have a good shot at a US Allo residency...are you saying they'll have no shot in the future? Is that what you mean?

 

[gogoplata]

To the OP, if you don't mind answering, what is or will be your salary as an anesthesiologist?

 

[Heathrow6]

Currently US allo schools are increasing enrollment, but the number of residencies are not increasing. In a couple of years, the number of US students will equal the number of US residency slots (one of the long stated goals of the AAMC).

I spoke with a physician in Orlando yesterday who said that several of the hospitals in the area are expanding the number of residency slots for existing Internal Medicine programs. Maybe this is only happening in certain areas of the country?

 

[Decicco]

Well, it will go away but not in the manner the prior poster thinks. Currently US allo schools are increasing enrollment, but the number of residencies are not increasing. In a couple of years, the number of US students will equal the number of US residency slots (one of the long stated goals of the AAMC). After that point there will be no stigma for caribbean schools because all those schools will rapidly disappear.

Something doesn't sound right about this.. If this were true, where would FMGs and DOs go? If nothing else, these schools will still be able to fill residencies like family practice, rural medicine, etc.

 

[Law2Doc]

I spoke with a physician in Orlando yesterday who said that several of the hospitals in the area are expanding the number of residency slots for existing Internal Medicine programs. Maybe this is only happening in certain areas of the country?

It is. Florida is getting a few new slots. But they dwarfed that with a couple new schools. Other places aren't getting an increase. The total number of funded residency slots nationally is fairly stagnant (by design).

 

[Law2Doc]

Something doesn't sound right about this.. If this were true, where would FMGs and DOs go? If nothing else, these schools will still be able to fill residencies like family practice, rural medicine, etc.

DO's have their own residencies to a degree. FMGs will be SOL. No, if you don't get a residency, you will not be able to do family or rural medicine. No residency slots, no FMGs. The AAMC has long has the goal (as seen in speeches of the president dating back to 2005) that US medical education should meet US healthcare needs. They also have expressed concern at the LCME not having oversight over the education of all physicians who end up in US residencies.
They have begun increasing med school seats significantly, beginning last year, but no increases in US residency slots in sight. You do the math.

 

[Law2Doc]

How disappear? People will tear down the buildings? What do you mean?


Right now Caribbean-ers don't have a good shot at a US Allo residency...are you saying they'll have no shot in the future? Is that what you mean?

yes, that's exactly what I mean. No available residency slots, no reason for these schools to exist.

 

[GoSpursGo]

DO's have their own residencies to a degree. FMGs will be SOL. No, if you don't get a residency, you will not be able to do family or rural medicine. No residency slots, no FMGs. The AAMC has long has the goal (as seen in speeches of the president dating back to 2005) that US medical education should meet US healthcare needs. They also have expressed concern at the LCME not having oversight over the education of all physicians who end up in US residencies.
They have begun increasing med school seats significantly, beginning last year, but no increases in US residency slots in sight. You do the math.

Veeeeery interesting, L2D... but it makes sense. I think America would certainly benefit from a few more people with 27/3.4's who never even considered the Carrib getting into a US Allo school, and thus eventually those residency spots rather than the 20/2.8 who just jumped to the Carrib getting a residency spot.

 

[Heathrow6]

It is. Florida is getting a few new slots. But they dwarfed that with a couple new schools. Other places aren't getting an increase. The total number of funded residency slots nationally is fairly stagnant (by design).

Keep in mind that there are another four years until UCF and FIU are placing grads anywhere. So these slots that are opening now are obviously not going to be filled by these additional students. Also, I asked, and these slots will be federally funded. So unless some residencies are eliminating positions in other parts of the country (which they might be, I have no idea) the number is not as stagnant as it may seem. And finally, I understand that there are a fair number of slots that are not filled each year (in neurology, etc). So, I don't think that those schools are going to be shutting down tomorrow.

 

[HeatherMD]

I think that so long as there's a shortage of healthcare professionals, especially doctors, the Caribbean school graduates will not lose their places in north american medicine.

We need them, and it's good that they are.

I wish US & Canada would just erect 100 more medical schools so they'd stop rejecting such fantastic people!

 

[GoSpursGo]

I think that so long as there's a shortage of healthcare professionals, especially doctors, the Caribbean school graduates will not lose their places in north american medicine.

We need them, and it's good that they are.

I wish US & Canada would just erect 100 more medical schools so they'd stop rejecting such fantastic people!

But I think that's the point. There's a shortage of healthcare professionals in the US, and accordingly, the US allo schools are going to increase their class sizes. If the schools keep expanding like they expect to, then I think the eventual expectation is that this shortage will be completely met by these new US allo students.

It's good that we have the Carrib schools for now to help meet the needs of the medical field... but eventually, I think there may no longer be such a need.

 

[HeatherMD]

eventually when?

the physician shortage is not going to be solved in 5 years.
Or 10.
Or even 20.

 

[GoSpursGo]

eventually when?

the physician shortage is not going to be solved in 5 years.
Or 10.
Or even 20.

True. However, while these schools aren't going to vanish overnight, I do think that, slowly but surely, fewer and fewer of their students will wind up with acceptances to residencies. If a school like SGU gets 100 students into a US residency this year (totally made-up number), then maybe in 5 years it gets in 90, and then in 10 maybe it gets 70... maybe by 20 years from now it will only get in 20 people. So while they will still serve a function, going Carrib will become even riskier than it already is, to the point that I would think it would become overwhelmingly untenable for someone to go there when there will be so few residency slots obtained from such a large class size.

 

[USArmyDoc]

The residency positions will go to US MD/DO grads. I have spoken to many residency programs and I was inquiring about scores, etc. It was wierd....many of them told me that they rate the US MD/DO grads differently than the FMG's. The FMG's need better scores to compete with US grads.....totally not fair but what can you do

I mean a doctor is a doctor...let them prove to you their knowledge....who cares where they go.

 

[Excelsius]

Some observations: med school matriculation more than doubled within the 20 years from 1961 to 1981 - from 8,483 to 17,268. Now from 1981 to today, which is 27 years (approaching 30), you would expect more than doubling, given the advances in medicine and given that the baby boomers are getting older. Well, that is not the case. Last year, only 17,376 enrolled. This year it was 17,826. Not only that, there are less students graduating now than in 1980s because more and more people seem to drop out. So there were more doctors being produced in the years like 1983, 84, 85, ... than any other time in history. While the doctor growth has been stagnant since 1980, the baby boomers have made the population grow older at an increasing rate. Between 1981 and 2002 there have been an additional 9.4 million people aged over 65. Their total growth is 36%. Population growth? Only 26%. The elderly population is growing faster than the overall population.

There is a problem with this picture. When the demand is so much higher than the supply, there is going to be a huge crush in the healthcare system if something is not done quickly. We already see four hour waits in emergency rooms - some of the patients dying before a doctor is able to see them - and it takes months before you can schedule an appointment with your doctor. The situation is such that even if you were to double the current med school enrollment, it might still not be enough to meet the demend (and it would take seven on more years for these extra doctors to be able to work). Somehow I think that all the Caribbean schools are here to stay for a long while. I don't know what are the requirements for opening a residency in any given hospital, but desperation might mandate many hospital to open such programs. I also don't know what one bases the assumption that the residency spots have not been growing. When you see that there were almost 1000 more graduates in 1984 than in 2002, it makes you think that any lack of resident programs is caused by the shortage of students filling those programs.

 

[Law2Doc]

eventually when?

the physician shortage is not going to be solved in 5 years.
Or 10.
Or even 20.

Actually the shortage will be solved in 20 years out without doing anything. The generation behind the baby boomers is substantially smaller. As the baby boomer generation dies off, suddenly the elderly will make up a smaller percentage of our population. Since the elderly have the highest demand for physicians, when this group disappears, our needs will go down. If we actually expanded to meet the current demand, we might end up with a glut of physicians, which would be bad for the profession. Which is probably part of the thinking behind not rapidly expanding to meet need, just reallocating a residency slot or two's funding to Florida or places with a disproportionate number of elderly retirees.

 

[Law2Doc]

The residency positions will go to US MD/DO grads. I have spoken to many residency programs and I was inquiring about scores, etc. It was wierd....many of them told me that they rate the US MD/DO grads differently than the FMG's. The FMG's need better scores to compete with US grads.....totally not fair but what can you do

I mean a doctor is a doctor...let them prove to you their knowledge....who cares where they go.

The problem is the proving of knowledge. US schools are accredited by LCME, which carefully supervises, inspects and maintains specific requirements for US schools and residencies. The boards are a flawed test designed to demonstrate mimimum proficiency, not quality, and really tells you nothing about how this person will be with patients or working in a team, the keys to any service organization. So there is really no way an FMG can prove equality with the US. In general, all you know about them is the board score. That's often not enough to override the substantial quality control you have gotten. So to even look at someone coming from a system not endorsed by the LCME, you set your threshold higher. Because you don't have a good ability to gauge what these folks are bringing to the table. It's not about fairness, it's about a closed system where you know what you are getting in and out, and what is happening in between. It's actually the most fair system on the planet -- you try getting licensed to practice in another country, and you will see that the US gives far more opportunities at present. Because we currently have the demand -- our residency slots outnumber our educational supply. Once this changes, we will join the ranks of all the other nations with their closed medical education system.

 

[Law2Doc]

Some observations: med school matriculation more than doubled within the 20 years from 1961 to 1981 - from 8,483 to 17,268. Now from 1981 to today, which is 27 years (approaching 30), you would expect more than doubling, given the advances in medicine and given that the baby boomers are getting older. Well, that is not the case. Last year, only 17,376 enrolled. This year it was 17,826. Not only that, there are less students graduating now than in 1980s because more and more people seem to drop out. So there were more doctors being produced in the years like 1983, 84, 85, ... than any other time in history. While the doctor growth has been stagnant since 1980, the baby boomers have made the population grow older at an increasing rate. Between 1981 and 2002 there have been an additional 9.4 million people aged over 65. Their total growth is 36%. Population growth? Only 26%. The elderly population is growing faster than the overall population.

There is a problem with this picture. When the demand is so much higher than the supply, there is going to be a huge crush in the healthcare system if something is not done quickly. We already see four hour waits in emergency rooms - some of the patients dying before a doctor is able to see them - and it takes months before you can schedule an appointment with your doctor. The situation is such that even if you were to double the current med school enrollment, it might still not be enough to meet the demend (and it would take seven on more years for these extra doctors to be able to work). Somehow I think that all the Caribbean schools are here to stay for a long while. I don't know what are the requirements for opening a residency in any given hospital, but desperation might mandate many hospital to open such programs. I also don't know what one bases the assumption that the residency spots have not been growing. When you see that there were almost 1000 more graduates in 1984 than in 2002, it makes you think that any lack of resident programs is caused by the shortage of students filling those programs.

The number of people in med school has had ebbs and flows. In 2000, there were 16,303 matriculants. This year there will be closer to 18,000 (more if you count DO). That's a decent jump. And schools are slated to increase size another 10-15% in the next couple of years, and a few new schools are slated to open over the next couple of years. That's huge. If you think more people are dropping out today than the 80s, you need to do some fact checking. A whopping 5% leave US allo med school at most these days; I doubt it was significantly different back then.

At present, about 40% of offshore folks manage to land US residencies. If the number of US students increases without residencies increasing, this 40% will decline. Currently there is no plan to expand US residency slots substantially, if at all, but it is a known fact that the number of graduating seniors the next 4 years will be greater in each of those 4 years (assuming no major attrition beyond the norm); meaning there are more people who are in their fourth year, and more than that currently in their third year, and so on. So expect that 40% to go down a few percentage points in the next couple of years. Whether offshore schools are able to stay in business is going to depend both on how comfortable folks are with those declining odds, and whether those schools are able to get folks competitive enough to not destroy those odds further (which is a real problem for offshore schools, because as US med school seats increase, they lose some of the better students who had previously had to go offshore -- so it's a vicious cycle).

The number of resident slots is governed by funding, not bodies. If they have funding, they fill the slot. Meaning if there isn't a US student to fill the slot, they import someone. So available residency slots remain full regardless of how many folks are in US med school -- this isn't the limiting factor, money is. So your last statement is dead wrong, there are no "lack of residency programs... caused by a shortage of students filling those programs". The programs are full.

The number of residencies is fairly flat. The number of med students since 2000 has not been, nor will it be in the next couple of years. The AAMC has stated (in the current decade, so looking back to the 80s for this is fruitless) that one of their current goals is to have US education fill US need. The thought is that if more US seats exist, that will mean the better offshore applicants will have a better chance to get in in the US, and if those folks are going to become US residents anyhow, it would be preferable for us to have LCME oversight over their education, rather than trust some offshore place whose motivation isn't quality as much as placement.

 

[Excelsius]

The number of people in med school has had ebbs and flows. In 2000, there were 16,303 matriculants. This year there will be closer to 18,000 (more if you count DO). That's a decent jump. And schools are slated to increase size another 10-15% in the next couple of years, and a few new schools are slated to open over the next couple of years. That's huge. If you think more people are dropping out today than the 80s, you need to do some fact checking. A whopping 5% leave US allo med school at most these days; I doubt it was significantly different back then.

At present, about 40% of offshore folks manage to land US residencies. If the number of US students increases without residencies increasing, this 40% will decline. Currently there is no plan to expand US residency slots substantially, if at all, but it is a known fact that the number of graduating seniors the next 4 years will be greater in each of those 4 years (assuming no major attrition beyond the norm); meaning there are more people who are in their fourth year, and more than that currently in their third year, and so on. So expect that 40% to go down a few percentage points in the next couple of years. Whether offshore schools are able to stay in business is going to depend both on how comfortable folks are with those declining odds, and whether those schools are able to get folks competitive enough to not destroy those odds further (which is a real problem for offshore schools, because as US med school seats increase, they lose some of the better students who had previously had to go offshore -- so it's a vicious cycle).

The number of resident slots is governed by funding, not bodies. If they have funding, they fill the slot. Meaning if there isn't a US student to fill the slot, they import someone. So available residency slots remain full regardless of how many folks are in US med school -- this isn't the limiting factor, money is. So your last statement is dead wrong, there are no "lack of residency programs... caused by a shortage of students filling those programs". The programs are full.

The number of residencies is fairly flat. The number of med students since 2000 has not been, nor will it be in the next couple of years. The AAMC has stated (in the current decade, so looking back to the 80s for this is fruitless) that one of their current goals is to have US education fill US need. The thought is that if more US seats exist, that will mean the better offshore applicants will have a better chance to get in in the US, and if those folks are going to become US residents anyhow, it would be preferable for us to have LCME oversight over their education, rather than trust some offshore place whose motivation isn't quality as much as placement.

In 2000-01, there were 16,699 matriculants; however, only 15,796 graduates, i.e., still lower than those years in the 80s. And the latest statistic of 2005, 8.4% didn't graduate. The numbers are the same throughout 2000s. In 1983 it was only 4.7%, in 1984 only 4%. So the 5% average or less was in the 80s, not now. Currently that rate has almost doubled. My statistics are from AAMC. If you are looking at different numbers, let me know.

Looking at the numbers over the years, I don't see any trends of significant matriculant increases. For decades the number has been around 17,000 +- 500. That's a sine wave rather than even a simple logarithmic increase. 2006 had the largest number of matriculants at 17,826, but thatn't not a significant increase. And how many US schools are coming online? It's about 12 of them by 2015. That's another 1800 or so spot increase. Significant compared to the last 20 years, but not much historically or based on the demand.

If you assume that the decrease of about 1000 graduates between 80s and early 2000 was completely filled with foreign labor, then you may be right. I don't know much about residencies. It just makes sense that if there is a decrease of 1000 spots within the US, there isn't going to be any drive to increase those spots.

Maybe AAMC is trying to meet its goal of US graduates filling US residencies, but currently it seems that endeavor is going to be a very long term process since there is no significant spike in matriculants. Maybe the competition for foreign graduates will increase, but only if AAMC wants it that way unnaturally. Naturally, the demand is high enough to import any additional doctors. If you close the residency door to them, they will come through immigration after they become doctors elsewhere. There are lawyers who solely specialize in professional immigration and there are books dedicate to medical professional immigration specifically. The demand will have to be met even if AAMC tries to artificially limit residencies to foreigners (i.e., not based on supply and demand).

 

[Law2Doc]

Looking at the numbers over the years, I don't see any trends of significant matriculant increases. For decades the number has been around 17,000 +- 500. That's a sine wave rather than even a simple logarithmic increase. 2006 had the largest number of matriculants at 17,826, but thatn't not a significant increase. And how many US schools are coming online? It's about 12 of them by 2015. That's another 1800 or so spot increase. Significant compared to the last 20 years, but not much historically or based on the demand.

You are underestimating the number of students already in the pipeline. The current graduating class is the last one which is of similar size to the one preceding it. There are more third years than fourth years at most schools, and more second years than third years, and more first years than second years. Presumably, there will be more matriculants brought in again this year. Most med schools increased 5-10% over the last couple of years and hope to add another 5-10% over the next couple of years. And when you combine that with the other dozen med schools being added (which will ultimately be closer to 2000 more seats because as schools increase in size, 150 won't be the average any more), and you very quickly will close the gap between med students and residencies. As I mentioned, this past year, only about 40% of non-US allo folks landed US residencies. If a couple hundred more folks are coming out of US schools in the next few years, that will bring the percentage down to an ugly percentage. And as more folks get into US schools instead of having to go offshore, it pushes the quality of offshore school matriculants down proportionately, probably making the odds of landing a decent residency worse.

Again, since the current plan to make US medical schools meet US healthcare needs began being expressed by the AAMC in this past decade, it is silly to keep talking about what happened in the 1980s. The current plan is to close the gap. And schools have taken affirmative steps to do this starting two to three years ago. Expect it to happen.

 

[Law2Doc]

In 2000-01, there were 16,699 matriculants; however, only 15,796 graduates, i.e., still lower than those years in the 80s. And the latest statistic of 2005, 8.4% didn't graduate. The numbers are the same throughout 2000s. In 1983 it was only 4.7%, in 1984 only 4%. So the 5% average or less was in the 80s, not now. Currently that rate has almost doubled. My statistics are from AAMC. If you are looking at different numbers, let me know.

The AMSA magazine last year published a statistic that there was approximately currently a 5% attrition rate, with about a 1.5% leaving for academic reasons, and the remainder leaving for other reasons. So there's just no way the attrition is anything close to 8.4%, unless AAMC and you are including folks going into PhD or joint degree programs who simply don't graduate in 4 years with their class, and folks who otherwise don't complete in 4 years (but will graduate) due to illness or academic reasons or taking research years. In the 80s the number of folks who took research years or did joint degrees was lower, so that may explain the difference in AAMC's numbers -- the attrition rate is probably historically about 5% (both then and now), but the number of people taking longer to graduate may be increasing due to various joint offerings and research options.

 

[HeatherMD]

True. However, while these schools aren't going to vanish overnight, I do think that, slowly but surely, fewer and fewer of their students will wind up with acceptances to residencies. If a school like SGU gets 100 students into a US residency this year (totally made-up number), then maybe in 5 years it gets in 90, and then in 10 maybe it gets 70... maybe by 20 years from now it will only get in 20 people. So while they will still serve a function, going Carrib will become even riskier than it already is, to the point that I would think it would become overwhelmingly untenable for someone to go there when there will be so few residency slots obtained from such a large class size.

I see what you mean.

But on the upside, the day North American med schools can fill all the North American residency spots will be a bright one indeed, and we won't need to consider the Caribbean schools, and their stats will fall, and less applicants will go there, etc.

OR the Caribbean schools will become more competitive, with more and more North American applicants fighting for a spot each year, and as the graduates get better and better, we may come to rely on them more and more because they make good doctors. It's possible the Caribbean schools will only gain credibility, not lose it.

 

[Decicco]

OR the Caribbean schools will become more competitive, with more and more North American applicants fighting for a spot each year, and as the graduates get better and better, we may come to rely on them more and more because they make good doctors. It's possible the Caribbean schools will only gain credibility, not lose it.

I don't think so. It seems like the less competitive medical schools tend to expand class sizes rather than raising their admissions bar.

 

[HeatherMD]

I don't think so. It seems like the less competitive medical schools tend to expand class sizes rather than raising their admissions bar.

oh. Well.. damn.

 

[ButImLETired]

I see what you mean.

But on the upside, the day North American med schools can fill all the North American residency spots will be a bright one indeed, and we won't need to consider the Caribbean schools, and their stats will fall, and less applicants will go there, etc.

OR the Caribbean schools will become more competitive, with more and more North American applicants fighting for a spot each year, and as the graduates get better and better, we may come to rely on them more and more because they make good doctors. It's possible the Caribbean schools will only gain credibility, not lose it.

Mostly, as Law2Doc said, they still won't be under the watchful eye of the LCME so regardless of how competitive they become, their training still won't be on par with and privy to the same regulations as the US med schools. Having students with good numbers is one thing- having the LCME dictate how to train their students is quite another. Residency directors will still prefer the devil they know to the devil they don't.

 

[student1799]

You are underestimating the number of students already in the pipeline. The current graduating class is the last one which is of similar size to the one preceding it. There are more third years than fourth years at most schools, and more second years than third years, and more first years than second years. Presumably, there will be more matriculants brought in again this year. Most med schools increased 5-10% over the last couple of years and hope to add another 5-10% over the next couple of years. And when you combine that with the other dozen med schools being added (which will ultimately be closer to 2000 more seats because as schools increase in size, 150 won't be the average any more), and you very quickly will close the gap between med students and residencies. As I mentioned, this past year, only about 40% of non-US allo folks landed US residencies. If a couple hundred more folks are coming out of US schools in the next few years, that will bring the percentage down to an ugly percentage. And as more folks get into US schools instead of having to go offshore, it pushes the quality of offshore school matriculants down proportionately, probably making the odds of landing a decent residency worse.

Again, since the current plan to make US medical schools meet US healthcare needs began being expressed by the AAMC in this past decade, it is silly to keep talking about what happened in the 1980s. The current plan is to close the gap. And schools have taken affirmative steps to do this starting two to three years ago. Expect it to happen.

I'm not an advocate of Caribbean med schools as "plan B" for students who can't get into US allo schools. However, I think there's a big hole in the above argument: there is currently, right now, a very serious shortage of doctors in rural areas of this country, and the doctors who DO work in these areas are disproportionately FMGs. So if the AMA tries to make it even harder for FMGs to get US residencies than it already is, this shortage--which is already at crisis level--is likely to get even worse.

Here is an article from Medical News Today on the subject:

Physician Shortage Disproportionately Affects Rural, Urban Areas; Restrictions On Foreign Doctors Could Add To Problem

25 Jul 2007

A nationwide physician shortage is affecting rural and inner-city residents the most and is being exacerbated by restrictions put in place on foreign doctors who want to practice in the U.S. after the Sept. 11, 2001, terrorist attacks, the AP/Philadelphia Inquirer reports. According to the American Medical Association, more than 35 million people live in underserved areas, and it would require 16,000 physicians to immediately alleviate the shortage of doctors in those areas. One government estimate indicates the U.S. could require as many as 24,000 physicians in 2020 to fill the shortage, the AP/Inquirer reports.

To help relieve the shortage in some areas of the U.S., including the Mississippi Delta region and Appalachia, the federal government through a number of state and federal work programs began issuing J-1 visa waivers, which allow foreign physicians to work in rural areas for three to five years and could allow them to seek permanent residency. The majority of J-1 waivers come from a 13-year-old program sponsored by Sen. Kent Conrad (D-N.D.) that issues 30 waivers per state per year. That program is set to expire in 2008, according to the AP/Inquirer.

Since 2001, the government has implemented higher fees, harder tests and stricter rules on determining "underserved" areas, making it more difficult for foreign physicians to attain the visas and obtain permanent residency, the AP/Inquirer reports. According to the Government Accountability Office, the number of physicians in training with J-1 visa waivers declined by nearly half over the last 10 years, from 11,600 in the 1996-1997 academic year to fewer than 6,200 in the 2004-2005 academic year. In addition, HHS in 2003 took control of a Department of Agriculture foreign doctor program and has approved 61 J-1 waivers since that time, according to the AP/Inquirer.

Stephen Smith, senior adviser to the Health Resources and Services Administration administrator, said, "We just aren't getting that many applications because the pool is smaller, and the tendency is to go to the states because the rules about what they can do are much broader."

However, Conrad said the doctor shortage "will mostly be felt in rural America," adding, "We're facing a real crisis" (Talbott [1], AP/Philadelphia Inquirer, 7/22).

Other Countries
Developing nations in recent years have begun calling on physicians to practice in their home countries rather than in places such as the U.S., the AP/Inquirer reports. Some health policy experts say that although foreign doctors in the U.S. might be treating underserved, low-income populations, the physicians are needed more in their home countries.

According to Fitzhugh Mullan of George Washington University, more than 10% of at least 20 countries' physician work forces leave to practice in wealthier nations. The AP/Inquirer reports that the U.S. exports less than one-tenth of 1% of its physicians to other nations. Mullan said the holes created when physicians leave their countries usually remain unfilled.

Meanwhile, South African Medical Association President Kgosi Letlape said that the migration of doctors creates a trickle-up effect, adding, "We are in a continuum. What South Africa loses to the developed world, to the United States, say, we gain from Uganda" (Talbott [2], AP/Philadelphia Inquirer, 7/22).

My conclusion is that it would be VERY politically unpopular in rural states (aka "the pro-America parts of America") to tighten the screws any further on FMGs. Ergo, the Caribbean schools look unlikely to disappear any time soon.

 

[Decicco]

My conclusion is that it would be VERY politically unpopular in rural states (aka "the pro-America parts of America") to tighten the screws any further on FMGs. Ergo, the Caribbean schools look unlikely to disappear any time soon.

Maybe Law2Doc would argue that DOs will begin to fill this necessity more as there will be more US-MDs to take competitive MD residencies.

 

[JaggerPlate]

Maybe Law2Doc would argue that DOs will begin to feel this necessity more as there will be more MDs to take competitive MD residencies.

DO schools are built on 'primary care' mission statements, and generally place an emphasis on primary care. However, as compensation and benefits of PC fields decline, so do the number of DO students entering these fields. It's important to note that DO students have their own AOA approved residencies in all ACGME residency fields (that only DO students can apply for), but the sad truth is that there are not enough residencies for DO students. However, even though there aren't enough residencies for all DO students, there are still a TON of PC AOA residencies that do not fill ... meaning that these fields just aren't popular.

I feel your argument doesn't work though because ACGME residencies aren't targeted at FMG MD students. They are created to train US MD students. However, as we all know, they are open to all DO and FMG students as well. Data also shows that DO students are generally given preference above FMG students in the ACGME match, meaning that it is very unlikely that DO students are going to fill primary care fields and allow less competitive FMG students to soak up the other residencies. I understand that certain MD students would rather see MDs in these residencies, but it's really clear that DO students land more competitive ACGME residencies that FMG MDs.

What I'm trying to say is that asking DO students to fill a gap that no one wants anymore to allow less competitve FMG MD students to take residencies simply because they have an 'MD,' doesn't make any sense and won't happen anytime soon. The best thing that could happen is for the AOA to beef up their residencies in desired fields (ie gas, derm, ENT, etc) to take pressure off the ACGME spots. You aren't going to see this anytime soon, nor are you going to see DO students flocking to primary care (a side note here - many DO schools are still very well known for placing students into primary care and reach levels up to 80% PCP fields, but most range around 30-45% into FP, IM etc, with large portions specializing, which isn't unlike US MD schools).

Both DO and FMG paths have their ups and downs ... and I don't think it's any secret that I support the DO path and you may be more supportive of the FMG (specifically SGU and Ross) path. I personally think FMGs would feel the tightening far more tha DOs, and I think DOs will continue matching successfully.

 

[Decicco]

I should have clarified in my above post that I was talking about US-MDs, not foreign ones. Law2Doc's argument is that the number US-MD students will soon match the number of MD residency spots. He previously said that this would leave DOs with DO residencies while FMGs would be out of luck. There are not enough DO residency spots for all DO students, so maybe they would fill less competitive MD residencies instead (family practice, rural medicine, etc).

 

[JaggerPlate]

I should have clarified in my above post that I was talking about US-MDs, not foreign ones. Law2Doc's argument is that the number US-MD students will soon match the number of MD residency spots. He previously said that this would leave DOs with DO residencies while FMGs would be out of luck. There are not enough DO residency spots for all DO students, so maybe they would fill less competitive MD residencies instead (family practice, rural medicine, etc).

Oh gotcha. Yeah, this will probably be the trend because in most cases there is still some bias for US MD students in ACGME residencies (which makes sense). Something else that would be interesting which people discuss from time to time would be opening up AOA residences to MD students. This would potentially help with funding issues and opening new residencies, but it could just result in more flooding of AOA derm and gas and still leave PCP residencies open. Who knows ...

 

[Excelsius]

You are underestimating the number of students already in the pipeline. The current graduating class is the last one which is of similar size to the one preceding it. There are more third years than fourth years at most schools, and more second years than third years, and more first years than second years. Presumably, there will be more matriculants brought in again this year. Most med schools increased 5-10% over the last couple of years and hope to add another 5-10% over the next couple of years. And when you combine that with the other dozen med schools being added (which will ultimately be closer to 2000 more seats because as schools increase in size, 150 won't be the average any more), and you very quickly will close the gap between med students and residencies. As I mentioned, this past year, only about 40% of non-US allo folks landed US residencies. If a couple hundred more folks are coming out of US schools in the next few years, that will bring the percentage down to an ugly percentage. And as more folks get into US schools instead of having to go offshore, it pushes the quality of offshore school matriculants down proportionately, probably making the odds of landing a decent residency worse.

Again, since the current plan to make US medical schools meet US healthcare needs began being expressed by the AAMC in this past decade, it is silly to keep talking about what happened in the 1980s. The current plan is to close the gap. And schools have taken affirmative steps to do this starting two to three years ago. Expect it to happen.

There may be more MS2s than MS3s, etc, but all we need to look at is the number of students who actually graduate. It doesn't matter what happens somewhere in the middle of the road. Again, there is no evidence of the sort of increases that you are mentioning. A 10% increase would equal to over 1700 more matriculants. In fact, the increase between 2006 and 2007 is just about 2.5% and it is the largest increase in the recent history. It has been much lower (even negative %) in the previous years. So there is no exploding pipeline that was mentioned in the Allo forum. Think about it - the 12 or so medschool that are supposed to be in operation by 2015 will barely add the 10% increase that you are talking about, yet you are claiming that the 10% or so increase has already happened within the last two years and will happen again within the next two years. That's 20% increase between 2007 and 2011 = about 3470 extra seats without any new med schools coming on board (or maybe one or two). That's just not the case.

As I said, if AAMC has determined that it wants to limit foreign residents, then it may do so artificially, but not because we will have enough doctors. What will then happen is that we will start seeing a large increase in immigration of foreign trained doctors and the question may arise as to why are these people not allowed to finish their residency right here in the USA, which seems to be better for everyone (after all, residents are a very cheap labor force). I wonder what the Obama administration will have to say about AAMC trying to impose these limits if it does not have a very good reason for doing so. You said that residencies are federally funded, right? Well then, if the government increases funding for more residencies, there isn't much AAMC will be able to do about it. I still think that the reason residencies have not expanded over the years, is because the resident population itself has been stagnant. You just don't know what will happen to residencies once the resident numbers increase for the first time in over 20 years.