No more IMGs in 2019?

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residency-500.png


source: NRMP

http://capsules.kaiserhealthnews.org/index.php/2013/02/the-yawning-chart-med-school-students-fear/

Things aren't looking good for IMGs.
 
#1: Projections range, but general ballpark for when there will be more graduates of U.S. MD/DO programs than there are ACGME accredited residency spots for them is 2015-2017 (http://www.nejm.org/doi/full/10.1056/NEJMhpr1107519 among others)

#2: Taking this into account, the ACGME has stated repeatedly that their goal is to transition to the point that every residency spot is filled by a US graduate

#3: There is almost no movement on Medicare funding more residency spots (capped by the balanced budget act of 1997 and not raised since) and efforts by the ACGME, AMA, etc to switch to other systems (google all-payer residency funding if you want to get deeper) have very little traction right now because everyone in organized medicine is focusing on Medicare funding in general and repealing the SGR (which has a better, but still not great, chance of occurring this year because the CBO lowered the projected cost by more than $100 billion)

In sum: I'd think twice about going anywhere other than the US if you want a US spot :nono:
 
mulberry said:
Why the hell is medicare doing nothing to expand the residency slots? it makes NO sense (other than funding, but we can make the money for that)

Dr shortage? No problem! open new schools, screw over everyone else (IMGs, FMGs, etc)
Click to expand...

Then we'll have a supply problem.

The system was never made to take in IMGs. No where else in the world was this possible and soon Carrib schools are screwed.
 
It must have been wonderful to apply to med school and residency in 1971.
 
mulberry said:
Why the hell is medicare doing nothing to expand the residency slots? it makes NO sense (other than funding, but we can make the money for that)

Dr shortage? No problem! open new schools, screw over everyone else (IMGs, FMGs, etc)
Click to expand...

I don't understand why residency training costs money. It's free labor for the hospital. Obviously there's a learning curve where residents are absolutely useless for the first couple months, but after a while they are undoubtedly generating revenue.
 
circulus vitios said:
I don't understand why residency training costs money. It's free labor for the hospital. Obviously there's a learning curve where residents are absolutely useless for the first couple months, but after a while they are undoubtedly generating revenue.
Click to expand...

I've been thinking/reading about this a lot recently. I still don't understand it.
 
mulberry said:
Why the hell is medicare doing nothing to expand the residency slots? it makes NO sense (other than funding, but we can make the money for that)

Dr shortage? No problem! open new schools, screw over everyone else (IMGs, FMGs, etc)
Click to expand...

Undecided on my stance on the IMGs/FMGs, but I know that the "bottleneck" problem makes it so that some US M.D. school graduates do not get residencies. Apparently there's a "scramble day" for people that don't match. Not sure why Medicare is paying for residency training anyways.

darklabel said:
Then we'll have a supply problem.

The system was never made to take in IMGs. No where else in the world was this possible and soon Carrib schools are screwed.
Click to expand...

:eyebrow:
 
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Have medical school classes increased enough to fill all IMG slots (~6,000) by 2019?
 
circulus vitios said:
I don't understand why residency training costs money. It's free labor for the hospital. Obviously there's a learning curve where residents are absolutely useless for the first couple months, but after a while they are undoubtedly generating revenue.
Click to expand...

From Wikipedia:

On the other hand, some argue that Medicare subsidies for training residents simply provide surplus revenue for hospitals which recoup their training costs by paying residents salaries (roughly $45,000 per year) that are far below the residents' market value.
Click to expand...

It gives these two sources:

Reinhardt (2002). Health Affairs 21 (5): 28–32.

Nicholson and Song; Song, D (2001). "The incentive effects of the Medicare indirect medical education policy". Journal of Health Economics 20 (6): 909–933. doi:10.1016/S0167-6296(01)00099-6. PMID 11758052.

The second one doesn't seem especially relevant at first glance, and I can't open the first one on my work computer for some reason. If someone can find a PDF of the paper, or post the abstract, that would be awesome.
 
WompyWomperton said:
Undecided on my stance on the IMGs/FMGs, but I know that the "bottleneck" problem makes it so that some US M.D. school graduates do not get residencies. Apparently there's a "scramble day" for people that don't match. Not sure why Medicare is paying for residency training anyways.



:eyebrow:
Click to expand...

Guess should've been a little more specific. Too much supply = decrease in pay across the board and leads to unemployed doctors
 
sinombre said:
I've been thinking/reading about this a lot recently. I still don't understand it.
Click to expand...

The attending that takes time to teach you or do a case with your help typically could do it faster and run through more without you. More true of interns than seniors. Shouldn't cost as much as it does though.
 
Curious to see what will happen this year since programs cant make pre-match offers anymore if they take any residents through the match.

That was bread and butter for IMGs lol
 
darklabel said:
Guess should've been a little more specific. Too much supply = decrease in pay across the board and leads to unemployed doctors
Click to expand...

"As Americans, we demand top quality comprehensive healthcare, but we have to be willing to pay for it. If you want a ride somewhere but you only want to pay $5, you are going to end up riding in a cab, not a Ferrari."

Somehow, someone needs to start forking out some money if we want to take care of everyone. That could mean increasing spending in both residency training and primary care compensation (since we need primary care docs). If only it were that easy...
 
do you think the government might increase the total number of residency sports for residency applicants? hope they do that soon....or else even american graduates will find themselves not securing a residency spot because soon the number of AMGs will be more than the number of residency spots avaliable....
 
As physicians you should hope that the ACGME decreases the residency spots and the AAMC decreases the numbers in each medical school. You would want to increase the demand for you as a physician. By having too many residency spots you are creating a lot of competition for yourself in the future.

I know that residents are actively trying to decrease the number of positions so that there wouldn't be an oversupply in the future.

Also we should expand the number of nurse practitioner and physician assistant positions so that they can cover the simple things that don't need the physician to do. Most of family practice can be done by a NP or PA. Also a lot of the things I do in my sub-specialty clinic (ie dictating histories, calling in prescriptions) can be done by an NP or PA and don't need a physician's time.
 
stems said:
As physicians you should hope that the ACGME decreases the residency spots and the AAMC decreases the numbers in each medical school. You would want to increase the demand for you as a physician. By having too many residency spots you are creating a lot of competition for yourself in the future.

I know that residents are actively trying to decrease the number of positions so that there wouldn't be an oversupply in the future.

Also we should expand the number of nurse practitioner and physician assistant positions so that they can cover the simple things that don't need the physician to do. Most of family practice can be done by a NP or PA. Also a lot of the things I do in my sub-specialty clinic (ie dictating histories, calling in prescriptions) can be done by an NP or PA and don't need a physicians time.
Click to expand...

Yeah, I was just about to post about increasing residency spots, but you pretty much summed it up. Don't want to flood the market like law schools.
 
I agree. If you get into a US MD or DO school and perform marginally well you will have no problem finding a residency spot. It may not be a competitive residency and it may not be in your preferred location, but you will find one. If you don't get a spot then you just didn't work hard enough IMHO and you don't deserve it. We shouldn't dilute the market by adding more residency positions. Rather, mid level providers should fill in the gaps.

Yes, IMGs are in a tough spot and it's only getting worse, but that isn't America's fault. Go
Practice in the country you trained in. After all, the Global physician shortage is much worse than US physician shortage. If you wanted to work here you should have gotten into med school here.
 
mulberry said:
Why the hell is medicare doing nothing to expand the residency slots? it makes NO sense (other than funding, but we can make the money for that)

Dr shortage? No problem! open new schools, screw over everyone else (IMGs, FMGs, etc)
Click to expand...
Why would medicare really want to open its doors to doctors trained in schools that don't have the known regulations and rigor of American universities? Thank god they are not increasing residency slots. Otherwise the profession would go straight to the toilet like with law school.
 
TriagePreMed said:
Why would medicare really want to open its doors to doctors trained in schools that don't have the known regulations and rigor of American universities? Thank god they are not increasing residency slots. Otherwise the profession would go straight to the toilet like with law school.
Click to expand...

Good point. 👍
 
TriagePreMed said:
Why would medicare really want to open its doors to doctors trained in schools that don't have the known regulations and rigor of American universities? Thank god they are not increasing residency slots. Otherwise the profession would go straight to the toilet like with law school.
Click to expand...

Right, because for the last 30-40 yrs its been going down the toilet because of physicians with poor foreign training practicing in the US. I mean its not like to practice in the US you need to have graduated from an accredited medical school or pass the same licensing and board exams that US MGs have to. Right? right?

Something like 20% of practicing physicians in this country are FMGs.

Personally I think we badly need to increase residency spots to fill in the gaps in primary care in a lot of underserved areas (unless you want those to be taken over by PAs and NPs that have half as much training as even foreign doctors). If medicare had the money or Congress was willing to fund it, it probably would have already happened. All that would mean is that the same couple thousand or so FMGs/US IMGs would be matching as they've been doing for decades.
 
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hallowmann said:
. I mean its not like to practice in the US you need to have graduated from an accredited merdical school or pass the same licensing and board exams that US MGs have to. Right? right?
.
Click to expand...

It's trending this way. Facts are facts. I think it's for the best. These are good jobs we should be giving to US grads.
 
OrthoPod57 said:
It's trending this way. Facts are facts. I think it's for the best. These are good jobs we should be giving to US grads.
Click to expand...

How exactly is it trending that way? If anything its harder for foreign grads to match and become licensed in this country than it was earlier, and accreditation restrictions are even tighter than they were decades ago.

Also, US medical grads aren't exactly standing in the unemployment lines, they are always given priority in residency spots. They already get the good jobs. We still need people to go and work in primary care in underserved areas like inner cities and rural areas. Those have been traditionally taken by low tier US MGs and US IMGs and FMGs.

EDIT: In case I read your post wrong, basic restrictions have been there for a while, its just that as time progresses, more states are using the restrictions set forth by the CA medical board, which are some of the most stringent regulations in the US.
 
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hallowmann said:
How exactly is it trending that way? If anything its harder for foreign grads to match and become licensed in this country than it was earlier, and accreditation restrictions are even tighter than they were decades ago.

Also, US medical grads aren't exactly standing in the unemployment lines, they are always given priority in residency spots. They already get the good jobs. We still need people to go and work in primary care in underserved areas like inner cities and rural areas. Those have been traditionally taken by low tier US MGs and US IMGs and FMGs.

EDIT: In case I read your post wrong, basic restrictions have been there for a while, its just that as time progresses, more states are using the restrictions set forth by the CA medical board, which are some of the most stringent regulations in the US.
Click to expand...

Thats a very positive thing. There are lots of strong foreign schools in other countries(UK, Australia, China etc.) and then there are shady school in the caribbean(see: any school not in the big 4..or better yet search for the St. James Med school thread!). Having strict standards is a step in the right direction. I think that smart, capable, intelligent foreign-born doctors shouldn't be discouraged to come to the US and be a helpful part of the community if they want to make that decision. They might have a much harder path, but if they are able to communicate well, know their stuff and show that they can function in an American hospital, all the better!
 
circulus vitios said:
I don't understand why residency training costs money. It's free labor for the hospital. Obviously there's a learning curve where residents are absolutely useless for the first couple months, but after a while they are undoubtedly generating revenue.
Click to expand...

Simple - residents dont generate much money. The first few months you are worse then useless -- you don't know what you are doing, incur medmal insurance costs, and most importantly slow down the attendings and fellows who otherwise could be generating more revenue. Additionally you require training in the form of didactic lectures, and require lots of GME staff hours and ACGME compliance, so your existence necessitates hiring one or more full time administrators. You probably aren't actually generating money until your third year or later, and since a lot if residencies are only three years, obviously it's not a money making structure. But it works out because you are government subsidized.
 
mulberry said:
Why the hell is medicare doing nothing to expand the residency slots? it makes NO sense (other than funding, but we can make the money for that)
Click to expand...

The number of spots was capped back in 1997 as part of the Balanced Budget Act. Changing that will take an act of Congress. Literally.
 
I'm curious as to how residents were paid and handled before GME and Medicare. We've had this system for 100+ years now and Medicare is only 50 years old and I'd imagine the original act didn't intend to fund resident education anyways.
 
ajeersiae said:
do you think the government might increase the total number of residency sports for residency applicants? hope they do that soon....or else even american graduates will find themselves not securing a residency spot because soon the number of AMGs will be more than the number of residency spots avaliable....
Click to expand...

The only american grads who will find themselves not securing residency spots are the ones that are not being realistic about their residency options.
 
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WompyWomperton said:
Honestly, I'm still learning and keeping an open mind with this debate. I happened upon this article today, it's worth a quick read:

http://www.slate.com/blogs/moneybox/2013/02/26/american_doctors_are_overpaid.html
Click to expand...

Basically this article, and the column that it refers to, can be summarized as follows: I think physicians are paid too much. Sure, they take on an extraordinary amount of debt (and spend a good chunk of their life training, which I'll ignore), but I still think they're overpaid.

He doesn't even make an argument, he just states an opinion.
 
sinombre said:
Basically this article, and the column that it refers to, can be summarized as follows: I think physicians are paid too much. Sure, they take on an extraordinary amount of debt (and spend a good chunk of their life training, which I'll ignore), but I still think they're overpaid.

He doesn't even make an argument, he just states an opinion.
Click to expand...

I don't like how he blames the physicians themselves and ignores overhead cost. I don't think that paying physicians less would solve the real problem.

I do like the idea of financial assistance being based on the specialty you go into (based on needs of the country).
 
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WompyWomperton said:
I don't like how he blames the physicians themselves and ignores overhead cost. I don't think that paying physicians less would solve the real problem.
Click to expand...

I don't think he really does that... in the article he refers to, he says:

"This doctor compensation gap is hardly the only issue in overpriced American health care—overpriced medical equipment, pharmaceuticals, prescription drugs, and administrative overhead are all problems—but it’s a huge deal."

But still, he basically gives no support for his conclusion. And nowhere does he mention how much time it takes to become a physician. 10 years of training? 80 hour work weeks? No big deal.
 
sinombre said:
I don't think he really does that... in the article he refers to, he says:

"This doctor compensation gap is hardly the only issue in overpriced American health care—overpriced medical equipment, pharmaceuticals, prescription drugs, and administrative overhead are all problems—but it’s a huge deal."

But still, he basically gives no support for his conclusion. And nowhere does he mention how much time it takes to become a physician. 10 years of training? 80 hour work weeks? No big deal.
Click to expand...

Yeah I kind of jumped the gun when I read "by international standards, America has the highest-paid doctors in the world."
 
I think the idea of using midlevels is a really poor idea. Statistically they are not as effective as physicians, far less trained, and who is to say that in 10 years they won't demand more specialties?

The idea of creating competition is so stupid. There is a shortage of physicians, specifically primary care. Even specialties are projected to be short, so where is the competition then?

Sent from my SAMSUNG-SGH-I747 using Tapatalk 2
 
stems said:
As physicians you should hope that the ACGME decreases the residency spots and the AAMC decreases the numbers in each medical school. You would want to increase the demand for you as a physician. By having too many residency spots you are creating a lot of competition for yourself in the future.

I know that residents are actively trying to decrease the number of positions so that there wouldn't be an oversupply in the future.

Also we should expand the number of nurse practitioner and physician assistant positions so that they can cover the simple things that don't need the physician to do. Most of family practice can be done by a NP or PA. Also a lot of the things I do in my sub-specialty clinic (ie dictating histories, calling in prescriptions) can be done by an NP or PA and don't need a physician's time.
Click to expand...

Poor radiologists. It's hard right now for the residents.
 
You're reading too much into what I said and making your own conclusions. I didn't say foreign trained physicians must be poor in training or don't do a good job or don't pass the USMLE. What I said was that given the option, it is better to have uniformity based on what you know and can influence rather than subject yourself to the variability because you don't have enough physicians at home. Right? right?

People may go into primary care, but that doesn't automatically mean they will serve and treat in underserved areas just because they are IMG/FMG. Many will do their residency and jump ship. Part of the problem is not a real physician shortage but rather a concentration of physicians in certain areas. If the government gave real incentives to work in underserved regions, then people would choose it.

hallowmann said:
Right, because for the last 30-40 yrs its been going down the toilet because of physicians with poor foreign training practicing in the US. I mean its not like to practice in the US you need to have graduated from an accredited medical school or pass the same licensing and board exams that US MGs have to. Right? right?

Something like 20% of practicing physicians in this country are FMGs.

Personally I think we badly need to increase residency spots to fill in the gaps in primary care in a lot of underserved areas (unless you want those to be taken over by PAs and NPs that have half as much training as even foreign doctors). If medicare had the money or Congress was willing to fund it, it probably would have already happened. All that would mean is that the same couple thousand or so FMGs/US IMGs would be matching as they've been doing for decades.
Click to expand...
 
i dont agree with you. actually, there are lots of people who have to move the the US for many reasons, and most of them are personal. of course we could practice in the countries we trained in, but what if we already trained there, and are in a situation of having to move to another country like the united states?
 
OrthoPod57 said:
I agree. If you get into a US MD or DO school and perform marginally well you will have no problem finding a residency spot. It may not be a competitive residency and it may not be in your preferred location, but you will find one. If you don't get a spot then you just didn't work hard enough IMHO and you don't deserve it. We shouldn't dilute the market by adding more residency positions. Rather, mid level providers should fill in the gaps.

Yes, IMGs are in a tough spot and it's only getting worse, but that isn't America's fault. Go
Practice in the country you trained in. After all, the Global physician shortage is much worse than US physician shortage. If you wanted to work here you should have gotten into med school here.
Click to expand...
i dont agree with you. actually, there are lots of people who have to move the the US for many reasons, and most of them are personal. of course we could practice in the countries we trained in, but what if we already trained there, and are in a situation of having to move to another country like the united states?
 
TriagePreMed said:
You're reading too much into what I said and making your own conclusions. I didn't say foreign trained physicians must be poor in training or don't do a good job or don't pass the USMLE. What I said was that given the option, it is better to have uniformity based on what you know and can influence rather than subject yourself to the variability because you don't have enough physicians at home. Right? right?

People may go into primary care, but that doesn't automatically mean they will serve and treat in underserved areas just because they are IMG/FMG. Many will do their residency and jump ship. Part of the problem is not a real physician shortage but rather a concentration of physicians in certain areas. If the government gave real incentives to work in underserved regions, then people would choose it.
Click to expand...

NJ---> major physician shortage
NJ---> over 40% FMGs (in the top 4 in the country)
 
I dont see how this country owes you just because you live in it. In my opinion, we want the best doctors to be treating our citizens. So if there is an IMG that is really talented, I dont mind making a little room for them.
 
Law2Doc said:
Simple - residents dont generate much money. The first few months you are worse then useless -- you don't know what you are doing, incur medmal insurance costs, and most importantly slow down the attendings and fellows who otherwise could be generating more revenue. Additionally you require training in the form of didactic lectures, and require lots of GME staff hours and ACGME compliance, so your existence necessitates hiring one or more full time administrators. You probably aren't actually generating money until your third year or later, and since a lot if residencies are only three years, obviously it's not a money making structure. But it works out because you are government subsidized.
Click to expand...

Excellent point considering that all residencies are at least three years or more.
 
notbobtrustme said:
I'm curious as to how residents were paid and handled before GME and Medicare. We've had this system for 100+ years now and Medicare is only 50 years old and I'd imagine the original act didn't intend to fund resident education anyways.
Click to expand...

Before the mid 20th century, residency was still optional for physicians. In the years prior to public GME financing the demand for residency training was increasing without a centralized organizational structure. During this period the need was filled by hospitals, who provided trainees with room, board, and clothing/laundry, but essentially nothing else (hence the term "resident").
 
Gut Shot said:
Before the mid 20th century, residency was still optional for physicians. In the years prior to public GME financing the demand for residency training was increasing without a centralized organizational structure. During this period the need was filled by hospitals, who provided trainees with room, board, and clothing/laundry, but essentially nothing else (hence the term "resident").
Click to expand...

ah thanks, that clears up a lot actually.
 
MelonMan said:
I dont see how this country owes you just because you live in it. In my opinion, we want the best doctors to be treating our citizens. So if there is an IMG that is really talented, I dont mind making a little room for them.
Click to expand...

Couple of reasons: (1) taxpayers are footing the bill for resident education and prefer to be subsidizing locals. (2) there is less chance of a US citizen taking his skills elsewhere so less risk of brain drain, (3) we know what kind of medical training and education people get when doing it under LCME oversight. We can never be sure about training we don't oversee and mandate. The USMLE is not a good proxy for this. (4) when US citizens rack up debt and don't find jobs, it's this country that bears the brunt of the loss if tax revenues, unemployment, welfare. We need our highly trained people to find gainful employment or as a Country we are F'ed.

"Best doctor" and "really talented" are vague and subjective terms, certainly not defined based on USMLE score, and in this country the best way to gauge this objectively is for someone to complete their studies at a med school that is LCME regulated, and do well in US rotations.
 
Law2Doc said:
Simple - residents dont generate much money. The first few months you are worse then useless -- you don't know what you are doing, incur medmal insurance costs, and most importantly slow down the attendings and fellows who otherwise could be generating more revenue. Additionally you require training in the form of didactic lectures, and require lots of GME staff hours and ACGME compliance, so your existence necessitates hiring one or more full time administrators. You probably aren't actually generating money until your third year or later, and since a lot if residencies are only three years, obviously it's not a money making structure. But it works out because you are government subsidized.
Click to expand...

Are there any states or private organizations (Kaiser, large hospital chains, etc) that subsidize their own residency programs in exchange for service requirements? (i.e. Commonwealth of Virginia pays for 30 new FM residency positions out of their own pocket in exchange for an obligation to work as an FM physician in rural Virginia for X years?) Obviously takes away your bargaining power when looking for a job, but if they offered a fair wage at the onset, this arrangement might work for some people who like the end prospect or who might not otherwise have a shot at residency (weak applicants, IMGs in a few years, etc.).
 
TriagePreMed said:
You're reading too much into what I said and making your own conclusions. I didn't say foreign trained physicians must be poor in training or don't do a good job or don't pass the USMLE. What I said was that given the option, it is better to have uniformity based on what you know and can influence rather than subject yourself to the variability because you don't have enough physicians at home. Right? right?

People may go into primary care, but that doesn't automatically mean they will serve and treat in underserved areas just because they are IMG/FMG. Many will do their residency and jump ship. Part of the problem is not a real physician shortage but rather a concentration of physicians in certain areas. If the government gave real incentives to work in underserved regions, then people would choose it.
Click to expand...

I guess I still don't get your point. Accreditation means that those schools have the "known regulations and rigor" to practice medicine in the US. Thats why accreditation is required. So again, I don't see how your point makes sense. Why shouldn't Medicare open spots, even if they'd be taken by FMGs, given that primary care is/will by 2014 be a problem?

I agree with your second point generally, but I also know a ton of FMGs in underserved areas (anecdotal of course). That being said we definitely need more underserved insentives, and while right now distribution is an issue, I believe after the PPACA fully kicks in primary care physician numbers will also be an issue. Also, increasing residencies in underserved areas would, while not guaranteeing that those physicians stay in those areas, guarantee a few years of service. It would also probably increase the total number (not percentage) of underserved docs, since for a lot of people its easier to stay in a place that you've lived for 3-5 yrs than it is to jump ship, especially if you have a family. The percent who stay in those areas would be unchanged, but having more residencies there means more people will stay there.
 
hallowmann said:
I guess I still don't get your point. Accreditation means that those schools have the "known regulations and rigor" to practice medicine in the US. Thats why accreditation is required. So again, I don't see how your point makes sense. Why shouldn't Medicare open spots, even if they'd be taken by FMGs, given that primary care is/will by 2014 be a problem?

I agree with your second point generally, but I also know a ton of FMGs in underserved areas (anecdotal of course). That being said we definitely need more underserved insentives, and while right now distribution is an issue, I believe after the PPACA fully kicks in primary care physician numbers will also be an issue. Also, increasing residencies in underserved areas would, while not guaranteeing that those physicians stay in those areas, guarantee a few years of service. It would also probably increase the total number (not percentage) of underserved docs, since for a lot of people its easier to stay in a place that you've lived for 3-5 yrs than it is to jump ship, especially if you have a family. The percent who stay in those areas would be unchanged, but having more residencies there means more people will stay there.
Click to expand...

Offshores schools do NOT have LCME accreditation. All US schools have the same accreditation, so they know what they are getting. Offshore schools are very variable, so it's questionable. Strong schools in other nations with good reputations produce great foreign doctors in Asia, Europe, etc. For-profit schools are another story.
 
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