New Residencies Bill In Congress

[saphire2000]

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Members don't see this ad.

Apparently there is a bill introduced now in congress to increase the number of residencies by 15,000 in the next 5 years. Is there any medical organization opposing this? Or maybe this have absolutely no chance of happening. It sounds scary to me.

 

[sylvanthus]

There also talking about cutting funding to residency programs. No freakin clue what is going to happen.

 

[Powdermonkey]

Apparently there is a bill introduced now in congress to increase the number of residencies by 15,000 in the next 5 years. Is there any medical organization opposing this? Or maybe this have absolutely no chance of happening. It sounds scary to me.

How would it be a bad thing? We are increasing medical school enrollment yet we aren't increasing post graduate training. I've read reports that by 2015 we will have just the right amount of residency spots available for graduating seniors. But new schools are going up as is class size. We absolutely have to increase residencies or we won't have enough training programs.

 

[123165]

How would it be a bad thing? We are increasing medical school enrollment yet we aren't increasing post graduate training. I've read reports that by 2015 we will have just the right amount of residency spots available for graduating seniors. But new schools are going up as is class size. We absolutely have to increase residencies or we won't have enough training programs.

We need the AOA to allow physicians who did not do an AOA residency to direct residency programs. A lot of DO's did ACGME residencies because of a lack of AOA spots, and now cannot start AOA residencies because of it.

 

[costales]

It's S.1627 - Resident Physician Shortage Reduction Act of 2011. A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes.
http://thomas.loc.gov/cgi-bin/query/z?c112:S.1627:#
Sponsor: Sen Nelson, Bill [FL] (introduced 9/23/2011)
Cosponsors: Sen Reid, Harry [NV] - 9/23/2011; Sen Schumer, Charles E. [NY] - 9/23/2011
Status: Read twice and referred to the Committee on Finance.

A similar bill (S.973/H.R.2251) was introduced in 2009. It was supported by the AAMC, but never got out of committee.

A big part of this is to help mitigate the recent state budget cuts. For instance, Texas is eliminating the state's primary care residency program (on top of 10% funding cuts for medical schools and Medicaid rate cuts for teaching hospitals).

 

[TallScrubs]

Someone remind me to write these senators and thank them for their efforts

 

[WestcoastMedicine]

So large academic hospital clearly have residencies, maybe expand fellowships and more obscure residencies at the well established places (aerospace medicine, occupational medicine etc). So where are they going to have these residencies?

My only concern would be at smaller places where you are more likely to be doing an apprenticeship and not having wards, clinics that are dependent on residents to function. I always felt I didn't learn as much on electives where they only have a residents there once in a blue moon because they are not designed to have the resident manage issues first prior to the attending. Seems that they still depend on the attendings and let the residents tag along. You want to have programs where the residents are the front lines and the main people responsible with attending/fellow oversight(atleast for medicine/surgery/pediatrics/rads). I would think this would not be an issue for family and emergency. That would be my only concern about making sure they are quality places.

 

[tehdude]

This isn't going to help anything.

 

[Wolverines83]

This isn't going to help anything.

Why do you say that? Like an earlier poster said, increasing enrollment without increasing residency slots sounds like the ultimate nightmare scenario. This proposed residency increase basically creates more jobs for us. Am I missing something?

 

[123165]

Why do you say that? Like an earlier poster said, increasing enrollment without increasing residency slots sounds like the ultimate nightmare scenario. This proposed residency increase basically creates more jobs for us. Am I missing something?

God help us if we end up like the lawyers

 

[Aislinn]

Why do you say that?

Because he's argumentative and oppositional.

 

[tehdude]

Why do you say that? Like an earlier poster said, increasing enrollment without increasing residency slots sounds like the ultimate nightmare scenario. This proposed residency increase basically creates more jobs for us. Am I missing something?

The shortage of primary care physicians is not due to a lack of residency spots. There are more residency slots each year available than there are new graduates to fill them. They can't even interest graduates in the primary care spots they have now. What's adding more spots going to do? If you want to build up the number of primary care docs, you have to significantly increase primary care reimbursements from Medicare and other insurers.

 

[Longshanks]

The shortage of primary care physicians is not due to a lack of residency spots. There are more residency slots each year available than there are new graduates to fill them. They can't even interest graduates in the primary care spots they have now. What's adding more spots going to do? If you want to build up the number of primary care docs, you have to significantly increase primary care reimbursements from Medicare and other insurers.

Maybe you missed the article from the NEJM this week, but in 2015 there will no longer be "extra spots". The graduates from MD and DO programs combined will exceed the amount of ACGME residency positions available. So, while addressing the primary care shortage is part of it (but that is an entirely different debate and won't get solved until there are better reimbursements or incentives), this is more about making sure graduates can get into training programs. No training = no license = no job. We don't want to follow the same fate as our law school counterparts, do we?

 

[Morsetlis]

http://www.nejm.org/doi/full/10.1056/NEJMhpr1107519

Highlights:

Given the current concern over the federal deficit, the likelihood that Congress will remove the cap on Medicare's GME support is nil. In an interview, Dr. Thomas Nasca, CEO of the ACGME, expressed concern over the narrowing gap between the number of entry-level GME posts and the growing number of medical school graduates. Nasca said, "We estimate that we will see domestic production of medical school graduates functionally surpass our current total number of GME postgraduate year-one pipeline positions [posts that lead to initial specialty certification] by 2015 or sooner, and this does not include some 10,000 non–U.S.-citizen international medical graduates and about 3700 U.S.-citizen international medical graduates who seek GME posts in U.S. teaching hospitals.

Comes with a pretty graph.

I'd like to think that people recognize that there's a healthcare shortage as opposed to a lawyers shortage.

 

[tehdude]

Maybe you missed the article from the NEJM this week, but in 2015 there will no longer be "extra spots". The graduates from MD and DO programs combined will exceed the amount of ACGME residency positions available. So, while addressing the primary care shortage is part of it (but that is an entirely different debate and won't get solved until there are better reimbursements or incentives), this is more about making sure graduates can get into training programs. No training = no license = no job. We don't want to follow the same fate as our law school counterparts, do we?

If they keep expanding the number of medical school graduates exponentially, sure, eventually there might not be many unfilled slots. Is this a good thing?

And I don't think the author included match slots for the military, DOs, urology, ophthalmology, San Fran, plastics, etc in his projections.

 

[Morsetlis]

Doesn't the SFmatch include plastics? At least, that's what it says on their website.

Man I got a lot to learn...

 

[Valadi]

Doesn't the SFmatch include plastics? At least, that's what it says on their website.

Man I got a lot to learn...

Independent plastics applicants go through SF match I think. Integrated goes through nrmp.

 

[Wolverines83]

Summary for those who don't want to read my whole post.

1) 3000 extra slots/yr from 2013 to 2017 of which at least 1500/yr will be in shortage specialties designated by a study by US Department of Health and Human Services.
2) Just looking at the graphs provided in the study we get this:
a) All medicine subspecialties are included
b) Gen surg, optho, ortho, ENT, urology, anesthesiology (technically even though the difference is only 500), path, psych, rads, family practice,
c) peds and non-specialty im are actually going to be over supplied by 2020 according to the study.

So there's obviously a plan to create many non primary care residencies. Sounds like good news to me.


Copy and paste from the Senate Bill:

‘(i) IN GENERAL- For each of fiscal years 2013 through 2017 (and succeeding fiscal years if the Secretary determines that there are additional residency positions available to distribute under clause (iii)(II)), the Secretary shall increase the otherwise applicable resident limit for each qualifying hospital that submits a timely application under this subparagraph by such number as the Secretary may approve for portions of cost reporting periods occurring on or after July 1 of the fiscal year of the increase. Except as provided in clause (iii), the aggregate number of increases in the otherwise applicable resident limit under this subparagraph shall be equal to 3,000 in each of fiscal years 2013 through 2017, of which at least 1,500 in each such fiscal year shall be used for full-time equivalent residents training in a shortage specialty residency program (as defined in subparagraph (F)(iii)).

This defines what a "shortage specialty" is.

(I) PRIOR TO REPORT ON SHORTAGE SPECIALTIES- Prior to the date on which the report of the National Health Care Workforce Commission is submitted under section 3 of the Resident Physician Shortage Reduction Act of 2011, any approved residency training program in a specialty identified in the report entitled ‘The Physician Workforce: Projections and Research into Current Issues Affecting Supply and Demand’, issued in December 2008 by the Health Resources and Services Administration, as a specialty whose baseline physician requirements projections exceed the projected supply of total active physicians for the period of 2005 through 2020.
‘(II) AFTER REPORT ON SHORTAGE SPECIALITIES- On or after the date on which the report of the National Health Care Workforce Commission is submitted under such section, any approved residency training program in a physician specialty identified in such report as a specialty for which there is a shortage.’.

Now we can debate the validity of this study but the fact is, that's what the law is going off and regardless of accuracy it's the best predictor of how these residencies will be distributed. There's also a bunch of other crap in there but I only looked at the specialty surplus/shortage part.

 

[tehdude]

peds and non-specialty im are actually going to be over supplied by 2020 according to the study.

😱😱😱

 

[Daedra22]

The shortage of primary care physicians is not due to a lack of residency spots. There are more residency slots each year available than there are new graduates to fill them. They can't even interest graduates in the primary care spots they have now. What's adding more spots going to do? If you want to build up the number of primary care docs, you have to significantly increase primary care reimbursements from Medicare and other insurers.

I think more than that, you would have to contractually require a certain number of med students to go into primary care when they get into med school. That would weed out the many people who will talk primary care in an interview when they secretly want to do [insert specialty here]. I think you'd see a very different applicant pool overall. Personally, I wouldn't go into FP even if they made the money of a dermatologist. That's not because I think less of FP docs, but because I really, really don't want that job (also don't want to be a dermatologist, for that matter). Kudos to those who become primary care docs and do it well.

 

[tehdude]

Another thing, you often hear statistics about how there's a critical shortage of primary care physicians, especially in rural areas. Even if you add the 40,000 family doctors they say they need, it's not going to solve the problem, because most graduates rather practice medicine in a city rather than say in the Appalachian Mountains.

 

[123165]

.

 

[saphire2000]

God help us if we end up like the lawyers

Exactly! Or pharmacists, or . . .

 

[DwightSchruteDO]

How many of these new spots will be osteopathic? creating more allopathic spots in the competitive fields mentioned above doesn't really help us (DO students) much.

 

[DocEspana]

If they keep expanding the number of medical school graduates exponentially, sure, eventually there might not be many unfilled slots. Is this a good thing?

And I don't think the author included match slots for the military, DOs, urology, ophthalmology, San Fran, plastics, etc in his projections.

Article includes: ACGME match, AOA match, SF match (which, with ACGME, covers all plastics), AUA match. All added together. Number of USMD + DO graduates will outnumber the number of spots between 2015 and 2020. The 2015 number is, honestly, from a quote *tangentally* related to the data. The actual data suggests closer to 2020. Just saying.

Article does NOT include: Military match.