# of total residency spots, FMGs

[chef]

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i read that this yr 23,965 applicants applied, of which 14,332 were american grads, and match rate was 79%. this means that total # of spots were 18,932.

if there are so many more spots open vs # of us grads, then why arent there more med schools and more US grads to fill those open spots? is there a reason why US "reserves" 4600 spots for FMGs every year? I don't have anything against FMGs or this is not US vs FMGs but I'm just curious why # of US grad<# of spots by >4500. Are there spots/fields/locations US grads just avoid to fill?

 

[MacGyver]

the reason is that the number of residency slots has increased greatly the last 20 years. At one point in time it used to be just slightly above the number of US medical graduates.

However, once hospitals caught on that you could make a profit by having more residency slots (Medicare pays $100k per resident, per year, hospital only pays residents $40k per year; you do the math) the number of slots started increasing sharply.

As a result, you know have a substantial number of residency slots going to FMGs.

Factoid: this year, there was an increase of over 300 new residency slots!

 

[Brewster]

Those spots that go to FMGs go to them for several reasons:
1) The programs preferred the FMG to the US medical grad and thus ranked the FMG higher.
2) The program preferred the US grad, but the US grad did not rank the program. Thus the US grad goes unmatched and the FMG gets the spot.
3) The US grad did not apply to/interview at that program.

Remember, that in order for an applicant (US grad or FMG) to match at a program, two things must happen:
- The applicant must rank the program.
- The program must rank the applicant.
This does not alway work out, thus you end up with unmatched applicants and unfilled programs.

As for the increase in residency spots, I suppose it might have to do with money, but I doubt that is the driving factor. I think a big part of it is the upcoming 80-hour work week restriction, so hospitals need more residents to fill the same number of working hours. Also, there is a growing shortage in some fields, so it is not unreasonable that the system would want to train more people. The number of residency spots a program is allowed is ultimately decided by the Residency Review Committee (which is part of the ACGME) for that specialty, so programs cannot just decide on a whim that they want more residents so they can make more money. They have to demonstrate that they have the resources (faculty, patient base, etc) to support and adequately train all the residents.

 

[Celiac Plexus]

Originally posted by MacGyver

However, once hospitals caught on that you could make a profit by having more residency slots (Medicare pays $100k per resident, per year, hospital only pays residents $40k per year; you do the math) the number of slots started increasing sharply.

The number of residency slots changes for a variety of reasons. For example rads increased the number of slots to meet increased demand for their services. Anesthesiology will probably do the same (it already increased the number of slots by a few this year). EM will probably increase the number as well based on supply and demand.

As for hospitals using residents as a money-making device. Yes, this is partially true in the sense that the government does pay programs a little over 100K for resident training per annum. However there are pretty significant costs to train residents that are in addition to a salary. Insurance, materials, extra personnel hired to manage the residency program. Furthermore, the hospital loses money on residents in the sense that residents are not nearly as efficient as attendings, and slow attendings down. A surgeon, for example, could handle a higher volume of patients if he/she did not have to spend time training residents. Or at the very least, would take up less OR time. THose extra expenses add up quickly.

So, no, the number of resident increases are not dependent on the US government's compensation system. More than likely the population has grown faster than the number of training slots has grown. Therefore over time, the demand for doctors has outstripped our nation's capacity to train them. Voila, more residency slots.

 

[BellKicker]

Those numbers don't even include pre-matches, which go, almost exclusively, to IMGs. We'll see the real numbers next year when pre-matches are out-lawed.

To Chef: I've said this many times before and I'll say it again. This is a win-win situation for everyone who's in med school or beyond. There are European countries that have more grads than spots every year. People are on wait-lists just to start residency. Just imagine that scenario for a minute and breathe a sigh of relief.

Then you have the other extreme, such as in my country. Here, there are always open residency slots because the gap is so big it can't even be filled by IMGs (tougher immigration laws and language tests might also explain this). And you know what, as selfish as it makes me sound, again it's a win-win situation for anyone in or past med school.

I have a question for y'all, btw. The number of spots this year increased by 450 out of which a little more than 300 were PGY-1 spots. What happens to the remaining PGY-2 or 3 spots? I realize one could change residencies after one year but that would just leave another spot open. Could someone explain this?

 

[Brewster]

Originally posted by BellKicker
I have a question for y'all, btw. The number of spots this year increased by 450 out of which a little more than 300 were PGY-1 spots. What happens to the remaining PGY-2 or 3 spots? I realize one could change residencies after one year but that would just leave another spot open. Could someone explain this?

They could be filled by people who matched for a transitional/prelim year but not for a PGY-2 position.

 

[BellKicker]

Ahhhh, okay. Thanks, Brewster.

 

[MacGyver]

We could argue all day as to the specific amount that hospitals profit off of each resident, but its absolutely clear that, given the choice, its better financially for them to have MORE residents rather than fewer.

I cant believe some of you are denying that simple truth.

also, if you look at population statistics, you will find that the number of doctors per capita in the US has INCREASED SLIGHTLY over the past 30 years, not decreased.

So thats BS about how the population has outstripped doctor supply. Thats not true at all. There is a geographical disparity, but residency slots dont solve that problem in spite of strong efforts and wishful thinking to make it so.

I do agree that hospitals cant just establish residency programs on a whim. However, that hasnt stopped a trend in increasing numbers of residency slots that have outpaced population growth.

Residents are cheap labor whose salary and other fees are paid totally by the federal government. Given the choice between PAs, NPs, and residents, the hospital will choose the resident due to the financial incentives.

Residents are the cheapest form of medical labor in existence. Hell, even CNAs and nursing assistants cost more to the hospital than resident labor.