Number of Medical Schools Increasing?

[Masseter Spasm]

From yesterday's New York Times cover:

http://www.nytimes.com/2010/02/15/education/15medschools.html

How will this affect our profession (physician) and specialty (anesthesia)?

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[Coastie]

From yesterday's New York Times cover:

http://www.nytimes.com/2010/02/15/education/15medschools.html

How will this affect our profession (physician) and specialty (anesthesia)?

Awesome. 30 new 4th rate medical schools with one in the shadow of steve carrell's "The Office". We are quickly becoming law school, part deux.

 

[Jeff05]

it won't make any difference. simply, FMGs will just be replaced with AMGs. The number of medical school spots will still be limited, however, by the necessity to provide adequate years of mentoring/clinical experience

 

[SleepIsGood]

they could have just helped fund the CURRENT med schools in the US. That way infrastructure is already there. All that would have been done is INCREASE class size....

No need to have re invented the wheel.

 

[karizma098]

well, finally a thread that i can offer insight /experience into.

the question of all the growing med schools is a pretty hot topic in current medical school classrooms as well.

the majority of new schools that have opened up in the last 3 years or are planning on opening up are osteopathic schools - as an osteopathic medical student, i can definitely say most in the community are very concerned about this. the trend started back in 06' and has gotten stronger since then. the median MCAT of upper level DO schools has consistently been in the 27+ arena, but some of these newer schools have accepted students with median mcats of 24 -25. this doesn't bode well for our profession , but then again, the vast majority of osteopathic students go into family practice, very few are interested or able to match into uber competitive specialties.

however, MD schools have been popping up as well. unfortunately, the number of residency spots is staying put - and i don't think there are any plans to increase the number of spots in anesthesia, radiology, ER, surg, any competitive fields. ( as there shouldn't be..)

we've had numerous speakers from the AOA, AMA, nbme etc etc come in and talk about what the outcome is going to be.

this is going to have a big impact on the AOA residencies for Do's - there are already not nearly enough spots to match DO's into DO residencies, so it's going to push more of us into the MD match - ( very likely into the unfilled FP and IM spots )

basically - if you're a resident now, or are going to be a resident by 2012/2013 - this won't impact you very much. the class sizes haven't grown out of tune with the residency spots too much at that point . if you're going to be applying to residency any time after 2012 - you're in some pretty deep water.

most speakers agree on one thing - there is going to be a huge 'bottleneck' in the next 4 years for the competitive residency spots - what this is going to do is force the american grads from all these schools into less desirable specialties like FP/IM/Peds/prelim surg, etc so on and so on. these spots go unfilled every year and there is a growing shortage ( especially of FP's).

if anything, i think this bodes better for specialists because the students applying to anesthesia, radiology, and other comp. specialties are going to be higher and higher quality, which in turn will lead to better leaders in our field. at the same time, there will also be more qualified candidates in family practice and like fields, which will shunt off some of the competition these fields are facing from Nurse practitioner, PA, or other midlevels that are impinging on the market. ( ie, walgreens take care clinic ).

in the long run, previous poster is right - it's just going to screw over the IMG/FMG crowd more as less, and less of them will be able to compete against american grads for desirable spots. you will see a lot more kids with 220's and higher not matching gas or rads and having to go into less competitive fields.

overall it will help with the physician shortage, and probably saturate the metro market more than it already is...so if you're ahead of the bottleneck, great, if you're not, better rock that step 1.

 

[MossPoh]

they could have just helped fund the CURRENT med schools in the US. That way infrastructure is already there. All that would have been done is INCREASE class size....

No need to have re invented the wheel.

For many schools, increasing class size might as well be building a new school. Many schools may also view that as hurting their educational quality. I don't think it is a bad thing that more schools are coming out, as long as they give a solid education. Population is growing everywhere. Even a thousand doctors more a year will only chip at that. That flood will still have some spillover into the rural areas that need it.

 

[bigdan]

they could have just helped fund the CURRENT med schools in the US. That way infrastructure is already there. All that would have been done is INCREASE class size....

No need to have re invented the wheel.

Fear not...they're increasing class sizes as well (at least in NY). My medical school had been 100 students/class for years and years. I entered with 100, and by my 4th year, they were admitting an MS1 class of ~130.

 

[karizma098]

Fear not...they're increasing class sizes as well (at least in NY). My medical school had been 100 students/class for years and years. I entered with 100, and by my 4th year, they were admitting an MS1 class of ~130.

i entered with 160 as an Ms-1, am going into my 3rd year and by then the ms1 class will have 200....

 

[bigdan]

Exactly. If memory serves, I think the year I entered medical school (2005) there were just over 16,000 seats for incoming MS1 in this country, and I think that went up to over 18,000 last year.

dc

 

[avatarftw]

a

 

[LawNonTrad]

I wonder why people in this subforum keep saying that it is getting tougher to match anesthesiology and that it will be tougher to match it in the future. My dad is board-certified in anesthesiology and he's heard people say for years that anesthesiology is going to get uber competitive sometime soon. You can even go back to the archives on studentdoctor and saying the same thing in 2001, then in 2004, then in 2006, and now this year people are saying it again.

From my research, the average (mean) step 1 score is around 221. The average (mean) step 1 score for US seniors who matched in anesthesiology last year was 224. The average (mean) step 1 score for independent applicants who matched in anesthesiology last year was 226.

The following are US senior applicant stats from last year's anesthesiology match:

Of those with step scores between 201 and 210, 90% matched.
Of those with step scores between 211 and 220, 93% matched.
Of those with step scores between 221 and 230, 96% matched.
Of those with step scores between 231 and 240, 99% matched.
Of those with step scores between 241 and 250, 99% matched.

If my composite math is correct, 95% of those with 221 or above matched anesthesiology last year, and the national mean score for step 1 is 221.

Furthermore, the match rate for US seniors ranking at least 9 programs on ERAS was almost 99%.

This data is all from NRMP's charting outcomes in the match, 2009:

http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

Now let's take a brief look at the step 1 score breakdown from last year's anesthesiology match:

1103 US seniors matched, 91 didnt

1 with score 180 or below
21 with score between 181 and 190
53 with score between 191 and 200
152 with score between 201 and 210
223 with score between 211 and 220
256 with score between 221 and 230
198 with score between 231 and 240
126 with score between 241 and 250
63 with score between 251 and 260
9 with score above 260
1 score unknown-exclude

Let's ignore two scores: 1 below 180 and the person whose score is unknown. Look at the rest:

1.9% of those who matched had step 1 between 181 and 190.
4.8% of those who matched had step 1 between 191 and 200.
13.8% of those who matched had step 1 between 201 and 210.
20.2% of those who matched had step 1 between 211 and 220.
23.2% of those who matched had step 1 between 221 and 230.
17.95% of those who matched had step 1 between 231 and 240.
11.42% of those who matched had step 1 between 241 and 250.
5.7% of those who matched had step 1 between 251 and 260.
0.8% of those who matched had step 1 above 260.

More than 4 in 10 of those who matched last year had step 1s below the national average.

The interesting thing about this data is that there are a bunch of people with low step 1s matching anesthesiology and a bunch of people with high step 1s matching anesthesiology. What this tells me is that anesthesiology, perhaps more than any other specialty, really has a divide between some programs and others. My guess is that the people with 260s are applying to super-well-known and recognized programs in the field, perhaps Mass General and Stanford? But most programs in the field aren't super well known, so any US senior with at least an average step 1 score won't have problems matching anesthesiology.

I'm not going to go into as much detail on the other specialties in this thread listed as comparable to anesthesiology, like radiology, but suffice it to say that radiology is getting more competitive every year and will only get more so. I agree with people who say that anesthesiology is about the same level of competitiveness as emergency medicine right now.

I agree with those who said that the biggest impact of the increasing number of schools will be to push the FMG/IMGs out of the competition for most residencies.

 

[karizma098]

Why do people in this thread keep saying that it is harder this year to match anesthesiology? My dad is board-certified in anesthesiology and he's heard people say for years that anesthesiology is going to get uber competitive sometime soon. You can even go back to the archives on studentdoctor and saying the same thing in 2001, then in 2004, then in 2006, and now this year people are saying it again.

From my research, the average (mean) step 1 score is around 221. The average (mean) step 1 score for US seniors who matched in anesthesiology last year was 224. The average (mean) step 1 score for independent applicants who matched in anesthesiology last year was 226.

The following are US senior applicant stats from last year's anesthesiology match:

Of those with step scores between 201 and 210, 90% matched.
Of those with step scores between 211 and 220, 93% matched.
Of those with step scores between 221 and 230, 96% matched.
Of those with step scores between 231 and 240, 99% matched.
Of those with step scores between 241 and 250, 99% matched.

If my composite math is correct, 95% of those with 221 or above matched anesthesiology last year, and the national mean score for step 1 is 221.

Furthermore, the match rate for US seniors ranking at least 9 programs on ERAS was almost 99%.

This data is all from NRMP's charting outcomes in the match, 2009:

http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

Now let's take a brief look at the step 1 score breakdown from last year's anesthesiology match:

1103 US seniors matched, 91 didnt

1 with score 180 or below
21 with score between 181 and 190
53 with score between 191 and 200
152 with score between 201 and 210
223 with score between 211 and 220
256 with score between 221 and 230
198 with score between 231 and 240
126 with score between 241 and 250
63 with score between 251 and 260
9 with score above 260
1 score unknown-exclude

Let's ignore two scores: 1 below 180 and the person whose score is unknown. Look at the rest:

1.9% of those who matched had step 1 between 181 and 190.
4.8% of those who matched had step 1 between 191 and 200.
13.8% of those who matched had step 1 between 201 and 210.
20.2% of those who matched had step 1 between 211 and 220.
23.2% of those who matched had step 1 between 221 and 230.
17.95% of those who matched had step 1 between 231 and 240.
11.42% of those who matched had step 1 between 241 and 250.
5.7% of those who matched had step 1 between 251 and 260.
0.8% of those who matched had step 1 above 260.

More than 4 in 10 of those who matched last year had step 1s below the national average.

The interesting thing about this data is that there are a bunch of people with low step 1s matching anesthesiology and a bunch of people with high step 1s matching anesthesiology. What this tells me is that anesthesiology, perhaps more than any other specialty, really has a divide between some programs and others. My guess is that the people with 260s are applying to super-well-known and recognized programs in the field, perhaps Mass General and Stanford? But most programs in the field aren't super well known, so any US senior with at least an average step 1 score won't have problems matching anesthesiology.

I'm not going to go into as much detail on the other specialties in this thread listed as comparable to anesthesiology, like radiology, but suffice it to say that radiology is getting more competitive every year and will only get more so. I agree with people who say that anesthesiology is about the same level of competitiveness as emergency medicine right now.

BTW, don't take any of this as a bash on anesthesiology. Anesthesiology is a great area of medicine. I'm just a lowly premed who loves statistics who wanted to try to set the record straight on some things.

i don't think anyone is saying that matching anesthesiology is incredibly difficult - it's not as hard as matching other competitive fields, but it's still more competitive than internal med, peds, ob, fp, and usually ER, depending on the program. there's more than statistics to this formula -

from what i've seen. the average score for matching was reported as 225 last year? but maybe i'm wrong. also i think matching into ANY anesthesia program ANYWHERE is not incredibly hard - but matching a mid level or upper level academic or otherwise program is harder - u need closer to a 230 to do that, as u stated, there is disparity between the more prestigous programs and the easier community programs.

Also, D.O's , FMG's, and IMG's have to score higher to match into these spots.

 

[karizma098]

good call-

40% is still a pretty large chunk, i guess i was lumping OB, peds, general IM, OMT medicine into the "FP" category. some even argue that er is an FP specialty. my point is that 60% or higher of graduating D.O classes are matching into specialties like FP and IM, not rads, anesthesia, etc, etc. i'd say only 20-30% of classes at schools i've seen match into competitive residencies.

nothing wrong with that, as most DO schools push their students towards a primary care career anyways.

Just a slight correction to your statement about specialty choice.

"the vast majority of osteopathic students go into family practice, very few are interested or able to match into uber competitive specialties."

On page 16 of the 2009 AOA OMP Report, the percent of DO's that are currently practicing family and general practice has dropped from 56.4% in 1984 to 40.9% in 2009. Those figures do not support your statement of "vast majority" going into family practice. In fact, the opposite could be argued based on the trend/actual figures.


http://www.osteopathic.org/pdf/2009_AOA_OMP_Report.pdf

 

[LawNonTrad]

i don't think anyone is saying that matching anesthesiology is incredibly difficult - it's not as hard as matching other competitive fields, but it's still more competitive than internal med, peds, ob, fp, and usually ER, depending on the program. there's more than statistics to this formula -

I agree. I think what you have to take into account however for fields like IM is that probably >=50% of those people are going to go on to do fellowships (gastro, cards, heme/onc, etc.) and not stay in primary care. IM's average step 1 score for matching last year was 225. Anesthesiology's average was 224. The average for ALL US seniors who matched last year was 225.

from what i've seen. the average score for matching was reported as 225 last year?

See above. You're correct that the average for US seniors over ALL programs was 225.

also i think matching into ANY anesthesia program ANYWHERE is not incredibly hard - but matching a mid level or upper level academic or otherwise program is harder - u need closer to a 230 to do that, as u stated, there is disparity between the more prestigous programs and the easier community programs.

Right. From what many people in the field have told me however, anesthesiology is one of the fields that cares least about where you do your residency, as long as you can pass the very difficult boards. The boards are the dealbreaker. As long as the residency is ACGME accredited, and you pass the boards, you'll still be able to get a phenomenal job. Especially if you don't mind living an hour or so outside of a major metro area- mass shortages of both anesthesiologists and CRNAs across the country. The shortage is more pronounced in more rural areas obviously, but there are still shortages in some metro areas even. Bad for patients and hospitals perhaps, but it's great market for anesthesiology from what I see. If you can get into an ACGME residency and pass the difficult boards, then you're set. Not a bad place to be.

Also, D.O's , FMG's, and IMG's have to score higher to match into these spots.

Yep, as I said above, the average step 1 score for independent applicants (DOs, FMGs and IMGs) who matched anesthesiology last year was 226. So the average independent applicant probably has to score about 2 points higher on the step 1 exam in order to match anesthesiology. What this tells me is that there is not much of a bias against DOs at all in anesthesiology, which is a good thing for graduating DOs. I already know that there's not much of a bias against FMGs in the process, because it seems like 1 in 4 anesthesiology residents is an FMG these days. Don't know a lot about IMGs but I know of at least 4 or 5 at the local programs.

Anesthesiologists also seem to be some of the nicer people in medicine, which is interesting, considering that they have to put up with surgeons all day.

 

[LawNonTrad]

good call-

40% is still a pretty large chunk, i guess i was lumping OB, peds, general IM, OMT medicine into the "FP" category. some even argue that er is an FP specialty. my point is that 60% or higher of graduating D.O classes are matching into specialties like FP and IM, not rads, anesthesia, etc, etc. i'd say only 20-30% of classes at schools i've seen match into competitive residencies.

nothing wrong with that, as most DO schools push their students towards a primary care career anyways.

I guess I must disagree with this also, sorry. ER is on par with anesthesiology as you've already conceded. I don't know anyone who considers ER to be a primary care field. The loan payback programs certainly don't- a lot consider ob/gyn to be, but NOT ER. ER is a specialty program. DOs with decent step 1 scores can match anesthesiology if they want to. Dozens upon dozens of them match EM every year I believe-more than a few post on the boards here. They could have gas if they could have ER-they simply chose not to. Perhaps they wanted the shorter residency and they like shift work. Or perhaps they just love the field. Reasons nonwithstanding, I still don't see why you're putting rads and anesthesia in the same sentence. The average step 1 for US seniors matching rads last year was 238. Only 13.1% of US seniors matching rads last year had a step 1 220 or below. This is compared to over 40% of us seniors who matched anesthesiology.

Yes, anesthesiology is part of the ROAD, as they call it, but it is the least competitive residency of the four by far. Does this surprise the heck out of me? Yes. It should be more competitive given all the benefits and cool stuff that you get to do in anesthesiology. Maybe people are worried that the CRNAs will take the field over, a topic oft-discussed in this boards so I won't get into it again. Who knows the real reason. But the fact remains that anesthesiology is not in the same category of competitiveness as optho or derm or rads. Yet. Things could change. Believe me, though, I don't want them to. I want anesthesiology to stay just as it is, so even if I'm not top of my class with AOA and a 250 board score five years from now, I can still get a spot.

 

[avatarftw]

a

 

[cfdavid]

it won't make any difference. simply, FMGs will just be replaced with AMGs. The number of medical school spots will still be limited, however, by the necessity to provide adequate years of mentoring/clinical experience

This is what I think too. This is the short and sweet solution to our primary care shortage. Pretty soon, you'll need to be AOA to do anesthesiology.

Future grads will have no choice but to apply to IM/FM residencies simply due to lack of other options.

cf

 

[LawNonTrad]

This is what I think too. This is the short and sweet solution to our primary care shortage. Pretty soon, you'll need to be AOA to do anesthesiology.

Future grads will have no choice but to apply to IM/FM residencies simply due to lack of other options.

cf

Do you think that this would apply to someone hypothetically graduating from medical school in 2016 as well? Can fields like this really become that competitive in such a short span? Even most of the new schools aren't scheduled to open until at least 2013 or 2014, so they wouldn't be graduating students until at least 2017 or 2018. 2016 grads wouldn't be competing with those people, right? Just my hunch. The 30% enrollment increase can't be in full effect for at least 10 years.

 

[karizma098]

many new schools have opened up in the last 5 years - especially in the last 2-3 years. you've got 4 or 5 new DO schools pumping out ~ 900 kids every year, other DO schools have pumped up class averages 20-50 students per class, with MD schools following suit.

there are limited seats in anesthesia, it's simply a fact that it will get more competitive, supply will have to meet the demand sooner or later. most stats point this at 2012-2013.

LawnonTrad, nobody says anesthesia is as competitive as rads, optho, derm - that's not the case. it is however still considered a more competitive field than most others though. there are more factors to an applicant than just a step 1 score - but as i said earlier, i only see the step 1 scores increasing for all these fields, not just Gas.

as you said yourself, the average anesthesia score sits around 225 - radiology has always been about 10 points upwards of this, and will probably continue to be. i'm just a firm believer that this will shift up to anesthesia being closer to 230 or 235 and rads being even higher.

anesthesia residency programs will not increase their seats to meet the demand, more students are going to be forced into FP and IM - this is just a fact of life, it's pure math.

my dad is a cardiac/pain anesthesiologist. he got an out of match contract in the mid 90's with a board score that was barely passing - he was an FMG and studied for his steps for 2 or 3 months max after moving here. his program doesn't even interview people with less than 210's anymore. competition will continue to rise.

 

[periopdoc]

Adding new CRNA's is as easy as recruiting and hiring. Adding new residents entails getting approval from the RRC including proving that you will not be diluting the overall residency experience. This can be tricky in places where numbers like cardiac and vascular are dwindling and residents are already struggling to get their numbers(most places). It is much easier to add CRNA's than to increase resident slots.

- pod

 

[karizma098]

anesthesia residencies don't need to - and don't want to- increase their spots. this dilutes the markets and you have a lot more competition. competing with CRNA's is one thing - u can command a higher salary for your training and medical degree - but increasing anesthesiologists just creates competition for everyone else and will hurt salary outlook . think back to the mid 90's and the anesthesia crunch - the going salaries were in the 100-140k arena and jobs were impossible to find. most PD's and anesthesiologists remember this and won't let the market get that diluted again.

specialties need to keep their spots low - so they stay just that, specialties. we don't need more anesthesiologists and rads docs.

 

[LawNonTrad]

anesthesia residencies don't need to - and don't want to- increase their spots. this dilutes the markets and you have a lot more competition. competing with CRNA's is one thing - u can command a higher salary for your training and medical degree - but increasing anesthesiologists just creates competition for everyone else and will hurt salary outlook . think back to the mid 90's and the anesthesia crunch - the going salaries were in the 100-140k arena and jobs were impossible to find. most PD's and anesthesiologists remember this and won't let the market get that diluted again.

specialties need to keep their spots low - so they stay just that, specialties. we don't need more anesthesiologists and rads docs.

This is scary stuff. I did not know about the 1990s shortage. My dad never mentioned it. Are any specialties or primary care fields safe? There are posts in a few different forums on here of people having trouble finding jobs. How is this possible? Very concerning.

The last thing I'd want is to complete something like an EM or Anes residency and not be able to find a job after.

 

[periopdoc]

Agree with the point about needing the RRC to increase slots. Not sure about how much of a hurdle that this is or what the priorities of the RRC are.

It is a big hurdle. We have been trying to increase the UW residency size and it is not easy. Their priority is to ensure adequate, quality training for residents. This means that you have to prove that the expansion will not dilute the experience for the existing residency slots. This may entail overworking residents for a few years to prove to them that you have the necessary caseload. We have the potential to increase our caseload by partnering with a private institution who would host at least two full-time senior residents. To prove to the RRC that the caseload is there, we may have to initiate the partnership and cover it with existing residents before we recruit additional residents.

-pod

 

[LawNonTrad]

many new schools have opened up in the last 5 years - especially in the last 2-3 years. you've got 4 or 5 new DO schools pumping out ~ 900 kids every year, other DO schools have pumped up class averages 20-50 students per class

Believe me, I know about the DO schools. It seems like there's a new one opening up every few months. That does not concern me as much as a bunch of new MD ones opening up, because a DO applicant with equal stats to an MD applicant will almost never beat the MD applicant out for an ACGME spot. The DO has to be at least slightly better or in some cases significantly better, depending on the amount of DO prejudice at the program.

 

[karizma098]

Believe me, I know about the DO schools. It seems like there's a new one opening up every few months. That does not concern me as much as a bunch of new MD ones opening up, because a DO applicant with equal stats to an MD applicant will almost never beat the MD applicant out for an ACGME spot. The DO has to be at least slightly better or in some cases significantly better, depending on the amount of DO prejudice at the program.

agree absolutely.

i'm at a pretty respectable DO school here in chicago - many of my dad's friends are PD's and straight up told him that i'll need to be closer to the 230 range to compete with the MD 220 crowd. it sucks, but thats just how it is sometimes. i can handle the 10 point spread, i think.

i wish the AOA would do something about all these new DO schools, makes us look silly with them opening up these schools left and right.

 

[karizma098]

Disagree. Academic department chairmen would love nothing more than to fill and expand their slots, (assuming that they can fill them with good quality folks). Chairmen have to balance their budgets and allocate funds for research, etc. Having to pay less in salaries to get the clinical work done totally dovetails with this. Less CRNAs, less non-academic MDs, less AAs doing cases and more residents serves this agenda because residents cost a lot less.

Agree with the point about needing the RRC to increase slots. Not sure about how much of a hurdle that this is or what the priorities of the RRC are.

i was aware of wanting to fill slots -nobody wants unfilled slots...but it seems like it would be counterproductive to the field, diluting anesthesia spots like that - in that case, why wouldnt we increase ortho, derms, rads spots as well? those would easily fill with decent applicants.

i always thought that the specialists wanted to keep their field competitive to keep salaries and demand high.

but then again, doctors aren't the best economists.

 

[Jeff05]

many new schools have opened up in the last 5 years - especially in the last 2-3 years. you've got 4 or 5 new DO schools pumping out ~ 900 kids every year, other DO schools have pumped up class averages 20-50 students per class, with MD schools following suit.

there are limited seats in anesthesia, it's simply a fact that it will get more competitive, supply will have to meet the demand sooner or later. most stats point this at 2012-2013.

LawnonTrad, nobody says anesthesia is as competitive as rads, optho, derm - that's not the case. it is however still considered a more competitive field than most others though. there are more factors to an applicant than just a step 1 score - but as i said earlier, i only see the step 1 scores increasing for all these fields, not just Gas.

as you said yourself, the average anesthesia score sits around 225 - radiology has always been about 10 points upwards of this, and will probably continue to be. i'm just a firm believer that this will shift up to anesthesia being closer to 230 or 235 and rads being even higher.

anesthesia residency programs will not increase their seats to meet the demand, more students are going to be forced into FP and IM - this is just a fact of life, it's pure math.

my dad is a cardiac/pain anesthesiologist. he got an out of match contract in the mid 90's with a board score that was barely passing - he was an FMG and studied for his steps for 2 or 3 months max after moving here. his program doesn't even interview people with less than 210's anymore. competition will continue to rise.

your dad does cardiac and pain? what?

 

[cfdavid]

This is scary stuff. I did not know about the 1990s shortage. My dad never mentioned it. Are any specialties or primary care fields safe? There are posts in a few different forums on here of people having trouble finding jobs. How is this possible? Very concerning.

The last thing I'd want is to complete something like an EM or Anes residency and not be able to find a job after.

I seriously think general, office-based IM will be very safe in the future. Even FM, with some entrepreneurial skills, you could clean house. This is my opinion, and certainly the average renumeration of said specialties is way lower, for the time being. But, the point is, they have many ways to augment their income if they get a bit creative which most are not.

cf

 

[Camel]

I seriously think general, office-based IM will be very safe in the future. Even FM, with some entrepreneurial skills, you could clean house. This is my opinion, and certainly the average renumeration of said specialties is way lower, for the time being. But, the point is, they have many ways to augment their income if they get a bit creative which most are not.

cf

I agree. The FP I worked with on that rotation owned his own office - a solo practice - in a small town. He dispensed his own meds (no need for a pharmacy), had his own laboratory (CBC, thyroid fxn, etc right there), his own x-ray, dexa scanner, stress test equipment, and an ambulatory surgery "OR suite" where he did colonoscopies and minor skin lesion removal. It was incredible, and he had plenty of variety and lived quite comfortably.

A neurologist I worked with does pain procedures (just things like steroid injections for occipital nerve pain etc.) and brings in over $400k in his solo practice. And this is in a fairly impoverished area, but he limits his Medicare/aid pts to 3 per referring physician.

The problem is that after all of our medical education, most people don't feel like learning all of the intricacies of billing (which also tend to change from year to year).

 

[karizma098]

your dad does cardiac and pain? what?

he has a fellowship in pain, but is trained in cardiac from his residency days as well. there's also another guy that is trained in hearts , not pain, but does a little bit of pain on the side as well.

isn't that kinda common in smaller towns?

 

[karizma098]

It is about the local economy. i.e. my department. my budget.
not the "global" economy.

disagreement of opinion.. i still don't think anesthesia seats will boost up anytime soon. it may be your department and budget, but its not your call to increase seats as you wish - or once again, every program wouuld be doing that to get more cheap labor - and theyre not.

 

[karizma098]

I agree. The FP I worked with on that rotation owned his own office - a solo practice - in a small town. He dispensed his own meds (no need for a pharmacy), had his own laboratory (CBC, thyroid fxn, etc right there), his own x-ray, dexa scanner, stress test equipment, and an ambulatory surgery "OR suite" where he did colonoscopies and minor skin lesion removal. It was incredible, and he had plenty of variety and lived quite comfortably.

A neurologist I worked with does pain procedures (just things like steroid injections for occipital nerve pain etc.) and brings in over $400k in his solo practice. And this is in a fairly impoverished area, but he limits his Medicare/aid pts to 3 per referring physician.

The problem is that after all of our medical education, most people don't feel like learning all of the intricacies of billing (which also tend to change from year to year).

i agree 100%. i know family practice docs making 400k+ with their own labs in small towns, and i know family practice docs making 110k in chicago working for loyola/uic/cdh etc.

 

[GoodmanBrown]

I'm going to play devil's advocate here and propose that competition won't really increase. Here's my thinking and feel free to disagree.

With the current 18,000 odd spots, you have to be of a certain academic caliber to get into medical school. You need a certain MCAT score and certain GPA. These change person-to-person because of ECs, story, etc. But even if you change water into wine and heal the sick, you won't get into med school with a 20 on the MCAT and a 2.0 GPA. It just ain't gonna happen. Medical school spots generally go to people with high MCATs and GPAs.

These additional spots aren't letting in better qualified students, or even candidates with equal MCAT scores and GPAs. They're letting in candidates that would otherwise have never gotten into medical school. So, people with MCATs in the low 20s and GPAs of ~2.5 will increasingly get into medical school.

And while it's an imperfect predictor for sure, previous academic success certainly correlates to future academic success. Likewise, MCAT score is correlated with Step 1 score. So, this "flood" of new med school students will perform adequately in medical school, but are very, very unlikely to enter medical school and become rock stars at the top of the class.

I predict we'll see an overall drop in the average AMG Step 1 score (as less competitive candidates get into US medical schools), while more competitive specialties see no significant change in average Step 1 scores. Competitive specialties won't get more competitive because the vast majority of the additional students won't be able to compete.

 

[Jeff05]

he has a fellowship in pain, but is trained in cardiac from his residency days as well. there's also another guy that is trained in hearts , not pain, but does a little bit of pain on the side as well.

isn't that kinda common in smaller towns?

we're all trained in cardiac during residency. it is rare, however, for someone to really do both.

 

[LawNonTrad]

agree absolutely.

i'm at a pretty respectable DO school here in chicago - many of my dad's friends are PD's and straight up told him that i'll need to be closer to the 230 range to compete with the MD 220 crowd. it sucks, but thats just how it is sometimes. i can handle the 10 point spread, i think.

i wish the AOA would do something about all these new DO schools, makes us look silly with them opening up these schools left and right.

It has gotten to the point where I've rethought my entire consideration of DO as a medical school avenue for myself. Nothing against DO personally, you understand. If you can pass the MD boards for your specialty then you're every bit as much a physician as the MD guy in my book-same residency, same test, you get the point. But this is why I will probably do a reputable special master's program if I don't get into an MD school for the 2012 cycle. It would suck to delay medical school by a year (best-case scenario), but DO for people who'd be matriculating in 2013 or later seems like much more of a gamble than it did in the future. As I mentioned above, right now DOs with decent stats who want ACGME gas and EM can have it. That may very well change in the next 5-10 years. I suspect that almost 100% of those spots will be filled by US MD graduates.

It really seems like future years, even as early as the 2016 graduating class, will be tougher for DOs. With all the new additional DO schools, and MD program directors who don't know the difference in quality produced by the older and more reputable DO schools (compared to the newer and in some cases for profit ones), it seems like competition for ACGME spots in fields like EM and Anesthesia could certainly get more competitive in the next 10 years. As I said, I don't think this will affect the graduating MD students anywhere near as much as it will affect the DO students. DO class sizes are already huge and getting bigger as you said.

Logic suggests that there will be a simple downward shift in the residency match. MDs might have a slight shift downward into less competitive specialties overall (neurology, for instance, or pm&r), but the real "pain", for lack of a better word, will be felt by the DO students graduating in the second half of this decade and beyond, as the massive increase in DO students (as well as increases in IMGs) forces almost all DO students that want an MD residency into FM/IM/peds, etc.

Just my thoughts on the matter.

 

[karizma098]

It has gotten to the point where I've rethought my entire consideration of DO as a medical school avenue for myself. Nothing against DO personally, you understand. If you can pass the MD boards for your specialty then you're every bit as much a physician as the MD guy in my book-same residency, same test, you get the point. But this is why I will probably do a reputable special master's program if I don't get into an MD school for the 2012 cycle. It would suck to delay medical school by a year (best-case scenario), but DO for people who'd be matriculating in 2013 or later seems like much more of a gamble than it did in the future. As I mentioned above, right now DOs with decent stats who want ACGME gas and EM can have it. That may very well change in the next 5-10 years. I suspect that almost 100% of those spots will be filled by US MD graduates.

It really seems like future years, even as early as the 2016 graduating class, will be tougher for DOs. With all the new additional DO schools, and MD program directors who don't know the difference in quality produced by the older and more reputable DO schools (compared to the newer and in some cases for profit ones), it seems like competition for ACGME spots in fields like EM and Anesthesia could certainly get more competitive in the next 10 years. As I said, I don't think this will affect the graduating MD students anywhere near as much as it will affect the DO students. DO class sizes are already huge and getting bigger as you said.

Logic suggests that there will be a simple downward shift in the residency match. MDs might have a slight shift downward into less competitive specialties overall (neurology, for instance, or pm&r), but the real "pain", for lack of a better word, will be felt by the DO students graduating in the second half of this decade and beyond, as the massive increase in DO students (as well as increases in IMGs) forces almost all DO students that want an MD residency into FM/IM/peds, etc.

Just my thoughts on the matter.

i don't think you're off base here.

i had a few MD school interviews and a good MCAT score, but my undergrad gpa was weak. i did a masters and re-applied and was waitlisted till the last day at most MD schools. the carrib didnt appeal so i went for a decent DO school. i think this is the case for most DO students - they aren't super weak, just a grade or two shy of the allo schools.

DO students have to work harder to get the same ACGME residency spots. this is fact of life. as more of them enter the market place, alongside with more MD's, there will be more competition. but this will affect the whole market - not Just DO's...discrimination has gone down towards DO's since the 80's and 90's. some PD's dont like them, some don't care. ( i don't think there are any that prefer them, haha ).

however, i don't necessarily think it will get that much harder. yeah, if MD students start consistently getting 240's for getting into anesthesia, then DO's with 220's will not match. however, by your own logic - if u dont expect the field to get more competitive with usmle step 1 scores, DO's will continue to match - as long as they are a hair or two above their MD counterparts with their step 1 scores.

i absolutely urge you to do a masters if youre not interested in attending an osteopathic school - but if that doesnt work out, i'd say DO is an option to consider - as most of the upper level DO schools match students in to radiology, anesthesiology , ER, etc, every year. again, u may prefer to wait or go to the carrib, and thats personal preference.

at the end of the day we all have to take our steps and get boarded, most DO's do fine on their usmle's and do acgme residencies to become competent physicians - it's just a means to an end for us.

if it gets harder in the future, i'm not sure...all i know is i'll be applying to residency in a year and a half so it's not my problem right now.

 

[LawNonTrad]

but this will affect the whole market - not Just DO's...discrimination has gone down towards DO's since the 80's and 90's. some PD's dont like them, some don't care. ( i don't think there are any that prefer them, haha ).

In my opinion, it will affect the DOs/IMGs more than it will affect the MD students because most of the new physicians are going to be DOs. If you're a PD and you are looking at twice as many DO apps, that will lessen the chance of matching for the DOs.

however, i don't necessarily think it will get that much harder. yeah, if MD students start consistently getting 240's for getting into anesthesia, then DO's with 220's will not match. however, by your own logic - if u dont expect the field to get more competitive with usmle step 1 scores, DO's will continue to match - as long as they are a hair or two above their MD counterparts with their step 1 scores.

My comments earlier were based on the assumption that the average stats say the same. Also, I was not fully aware at that point of how much DO schools were going to be pumping out DOs. With that new information in hand, it seems logical to me that the more DO spots you have applying for ACGME spots, fewer DOs will end up matching in competitive specialties. At almost every program there will continue to be at least a slight MD preference for the foreseeable future. Do you disagree? I don't think it will affect your class yet or maybe not even mine, because the real impact of these new DO schools and massively increased DO class sizes will come in 2020 or later. My hunch is that a lot of the current lower and mid-tier allo EM and gas programs that willingly take DOs will CONTINUE to.

The gist of what I'm saying, however, isn't that this will STOP. What I think will happen is that the massive influx of new DOs into the match will simply result in MORE unmatched DOs. The DOs in the top 20% or so of their class will continue to be able to get these residencies. It's simply that with much larger class sizes and more DOs graduating every year, that you'll have more unmatched DOs in these programs. Again, the general pushdown effect. You'll have to be a slightly better DO applicant to get the residencies in the future because you'll be competing with so many other DOs.

Do you agree? I apologize if the above reasoning was convoluted, haha. I tried to make it as uncomplicated as possible.

Another minor point about this is that the prejudice some programs hold toward DOs might not be based entirely on perceived DO inferiority. One MD student complained to me that they view it as unfair that DO students can compete in the allo match yet MD students cannot compete in the osteo match. And their gripe is completely justified in my opinion. Perhaps some PDs feel the same way? Maybe I'm off-base, however. And I read somewhere that the AOA is thinking about opening up the osteo match to MDs.

Keep in mind that there aren't many MD schools out there with huge class sizes. It seems to me like almost every DO school has 250 or 300 kids graduating a year, and this will only increase. Many MD schools have less than 150- even if MD schools increase their output, the change will still pale in comparison to the DO increase.

i absolutely urge you to do a masters if youre not interested in attending an osteopathic school - but if that doesnt work out, i'd say DO is an option to consider - as most of the upper level DO schools match students in to radiology, anesthesiology , ER, etc, every year. again, u may prefer to wait or go to the carrib, and thats personal preference.

What master's program did you do out of curiosity? Was it a special master's? If you were borderline before completing it and did well in a special master's then it's surprising that you did not get an allo acceptance-from what I've read on here, at least. If it was just a regular master's program then it's not surprising, because according to all the pre-meds and current allo students on here, SMP performance is the only type of graduate performance that can at least somewhat make up for a poor undergraduate performance. A non-special master's degree, on the other hand, is almost irrelevant. It's just another EC. What was your GPA out of curiosity?

at the end of the day we all have to take our steps and get boarded, most DO's do fine on their usmle's and do acgme residencies to become competent physicians - it's just a means to an end for us.

I agree that this is the case presently. Any DO who does well on USMLE step 1 and wants allo EM or gas can get it. I am just rethinking my earlier thoughts that this might always be the case.

 

[karizma098]

In my opinion, it will affect the DOs/IMGs more than it will affect the MD students because most of the new physicians are going to be DOs. If you're a PD and you are looking at twice as many DO apps, that will lessen the chance of matching for the DOs.

i understand where youre coming from - but there likely wont be twice as many DO's, closer to a 25% increase i'd say. i think what youre saying here makes sense - the more DOs that graduate the more they will compete against each other for those competitive spots and the lower percentage that will be able to match.

My comments earlier were based on the assumption that the average stats say the same. Also, I was not fully aware at that point of how much DO schools were going to be pumping out DOs. With that new information in hand, it seems logical to me that the more DO spots you have applying for ACGME spots, fewer DOs will end up matching in competitive specialties. At almost every program there will continue to be at least a slight MD preference for the foreseeable future. Do you disagree? I don't think it will affect your class yet or maybe not even mine, because the real impact of these new DO schools and massively increased DO class sizes will come in 2020 or later. My hunch is that a lot of the current lower and mid-tier allo EM and gas programs that willingly take DOs will CONTINUE to.

i agree - there will always be a slight hair of preference - this is why DO's have to perform on a standard deviation higher to get those same residency spots, usually. Many Do's match into upper tier EM and gas programs as well, but they are usually superstars in their class.

The gist of what I'm saying, however, isn't that this will STOP. What I think will happen is that the massive influx of new DOs into the match will simply result in MORE unmatched DOs. The DOs in the top 20% or so of their class will continue to be able to get these residencies. It's simply that with much larger class sizes and more DOs graduating every year, that you'll have more unmatched DOs in these programs. Again, the general pushdown effect. You'll have to be a slightly better DO applicant to get the residencies in the future because you'll be competing with so many other DOs.

i wouldn't say more unmatched DO's, but definitely more Do's in family and IM that don't want to be there. once again, a lot of the kids scoring 220's will start self selecting themselves out of the running for anesthesia or EM if they are unable to match and will head into other fields. the superstars will stay where they're at.

Do you agree? I apologize if the above reasoning was convoluted, haha. I tried to make it as uncomplicated as possible.

Another minor point about this is that the prejudice some programs hold toward DOs might not be based entirely on perceived DO inferiority. One MD student complained to me that they view it as unfair that DO students can compete in the allo match yet MD students cannot compete in the osteo match. And their gripe is completely justified in my opinion. Perhaps some PDs feel the same way? Maybe I'm off-base, however. And I read somewhere that the AOA is thinking about opening up the osteo match to MDs.

i don't think very many MD students WANT to do AOA residencies. they are usually community programs in less desirable areas with less academic exposure ant training. however, i think most DO's are open to allowing MD's into the AOA match.

Keep in mind that there aren't many MD schools out there with huge class sizes. It seems to me like almost every DO school has 250 or 300 kids graduating a year, and this will only increase. Many MD schools have less than 150- even if MD schools increase their output, the change will still pale in comparison to the DO increase.

disagree- i think the average class size is always less than 200. it will be tough to break this 200 barrier and maintain education quality...( or so they say )

What master's program did you do out of curiosity? Was it a special master's? If you were borderline before completing it and did well in a special master's then it's surprising that you did not get an allo acceptance-from what I've read on here, at least. If it was just a regular master's program then it's not surprising, because according to all the pre-meds and current allo students on here, SMP performance is the only type of graduate performance that can at least somewhat make up for a poor undergraduate performance. A non-special master's degree, on the other hand, is almost irrelevant. It's just another EC. What was your GPA out of curiosity?

I did an M.S in biotechnology at Rush U in chicago. at the time i was between that and taking a year off or doing a SMP. i was completely oblivious about SMP's at the time and had only been accepted to the rosalind franklin program and rush ( out of 3 i applied to...) the rush prog was close to home and interesting so i did it - my gpa in the program was ~ 3.8. my undergrad MD gpa was a 3.25 sci, 3.5 overall ( low end, i know. i had some horrendous freshman year grades that haunted me for the rest of my career. ) my Mcat was 12V 8Bio 10PS T. i had interviews at 4 md schools, was rejected at 2, waitlisted at 2 and accepted at none. after the masters i just didnt feel like waiting any longer, i was 23 and wanted to get started with med school. plus my school ( ccom ) had a pretty impressive match list that year so i went for it.


I agree that this is the case presently. Any DO who does well on USMLE step 1 and wants allo EM or gas can get it. I am just rethinking my earlier thoughts that this might always be the case.[/QUOTE]

I think this will always be the case - but the definition of "well" on the usmle might change. either way, working hard is the major component of this equation...Do's have to put in a little extra work and deal with a bit more bs.

 

[karizma098]

we're all trained in cardiac during residency. it is rare, however, for someone to really do both.

yeah, there's only 1 cardiac guy around so he picks up the slack as much as he can. i've scrubbed in with him a few times on hearts, not as interesting as i thought, i like the Pain lifestyle more myself.

 

[doctor712]

To add to the conversation, UMiami's regional campus, FAU/UM is breaking off to its own medical school, unaffiliated with UM any longer. The new affiliation will be FAU/SCRIPPS. So, technically, one new med school into the AMCAS database. Though it's only on paper really. It'll be 10K per year LESS than UMMSM, which is a good thing, they used to have the exact same tuition of course.

As someone who is taking MCAT soon and applying June 1, I've been checking out of state places to apply, and statistics therein. Not that I think I have a chance in hell outside of my own backyard. It's amazing how some coastal schools get 10-12K apps for their 150 spots (places like Georgetown or Drexel), while other schools, still opened to out of state apps, get 3K for their 150 (KU as I recall). Odds in midwest beat any school down here in FL. 1-10 students were accepted to UArizona. ACCEPTED. 1000 apply for their 100 or so spots. Unreal. 1 of 10 don't even get interviews at large schools on coast. Anyway, I don't think these 10 or so new schools will change things much. And it won't become like law school, some of which are simply "night" schools.

42000 of us apply every year, 18000 or so get in and, believe it or not, 1000 or so that get in, DO NOT matriculate into med school that year. I looked twice, but it's there in black and white. So, maybe they are deferring, I have NO idea, after all that work, 1000 apps go the whole way then don't attend. That's about 7-10 students per MD school. (they don't attend anywhere is what I'm saying).

I still think that the above poster Goodman is on to something here. But my feeling is the extra 1000-2000 seats coming in the future will not go to those with 20MCATS and 2.4 GPAs. There are TONS of folks with 27MCATS and 3.6 GPAs that just do not get into medical school. For whatever reason. The demand will always outweigh seats. Maybe no research. No volunteering. No personal skills in interview. I mean, 24000 don't get in, I have to believe many of those folks would be fine through med school. I'd guess the top 1000-2000 of those have very competitive stats, at least. Are they those people that can blow through a Orgo reaction but cannot carry a conversation? No idea. But I think those are the folks who will be admitted to these new schools. I don't think the field will be hurt, but what the heck do I know. Each new medical school wants to be the next AMAZING REPUTATION school. UCF is said to be as selective as these top tier schools, its a school thats one year old. If they wanted to fill their rooms with nothing but 3.8GPA and 39MCAT students, leaving the rest to go to Harvard and beyond, they would have NO problem doing so, from day one.
But they won't, nor should they I don't think.

D712

 

[karizma098]

I still think that the above poster Goodman is on to something here. But my feeling is the extra 1000-2000 seats coming in the future will not go to those with 20MCATS and 2.4 GPAs. There are TONS of folks with 27MCATS and 3.6 GPAs that just do not get into medical school. For whatever reason. The demand will always outweigh seats. Maybe no research. No volunteering. No personal skills in interview. I mean, 24000 don't get in, I have to believe many of those folks would be fine through med school. I'd guess the top 1000-2000 of those have very competitive stats, at least. Are they those people that can blow through a Orgo reaction but cannot carry a conversation? No idea. But I think those are the folks who will be admitted to these new schools. I don't think the field will be hurt, but what the heck do I know. Each new medical school wants to be the next AMAZING REPUTATION school. UCF is said to be as selective as these top tier schools, its a school thats one year old. If they wanted to fill their rooms with nothing but 3.8GPA and 39MCAT students, leaving the rest to go to Harvard and beyond, they would have NO problem doing so, from day one.
But they won't, nor should they I don't think.

D712

totally correct...there are way too many kids with B+/A- Gpa's and 27+ Mcats that don't get in every year. they are still qualified and would still make good docs, competition is just fierce. extra seats will probably go to these types of candidates that fall between the cracks.