Petition to Address Residency Shortages

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No. The issue is that PDs need to be cognizant of the American public interest when making their decisions since their programs are being funded by federal money. These measures are here to protect the public tax payer interest. It's very similar to the instate vs outstage status when it comes to med school admission. Nobody is whining about it. I don't understand why we can't outline measures that prioritize competitively US med grads. Continuing with the status quo by doing nothing is straight up ignorant.
Your ignorance of the way in which both economics and educational policy function and why they do so is both painful and amusing all at once. Painful because your entitlement is inherently un-American, amusing because you're so misguided.

The American public interest is having skilled doctors that work in America.

State schools have such policies because there's statistical evidence showing that if you go to school in your home state, you'll stay, and keep your degree there, boosting economic activity. People from out of state tend to get a degree then leave the state, resulting in your state losing that invested cash. It isn't about educating citizens of your state because they are citizens of your state, it is about educating citizens of your state so that they stay in your state, allowing you to keep the educational gains that you paid for.

Doctors educated in the United States almost universally stay, regardless of their country of origin. It doesn't matter if they're foreign or domestic. That talented Pakistani doctor we invested in isn't running back to his home with all that training- he's staying here, saving the lives of our elderly, better than the near-washout that barely scraped by in a US MD school could. So who's the better deal: the talented guy who's helping your citizens, or the buffoon that happens to be a citizen whom you gave a position not out of merit, but out of entitlement?

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It's because they are statically superior to their US counterparts. I'm all for providing the best patient care for our people. However, I'm not in favor of opening a blind door to everyone especially when there are equally competitive US grads.

The issue is not as black and white as you are making it out to be.
You're telling a resident in a highly competitive field and a medical student that spent many years working at a top teaching hospital with some of the best PDs in the world what is black and white and how things work? Talk to any of the PDs around here, they'll vehemently disagree with you- you have no idea what you're talking about. It's not like FMGs with equal stats to US MDs are stealing those 'murrican's residencies. You have to be a stellar candidate to beat out a US MD if you're an overseas grad, or apply to the sorts of places that US grads refuse to work (IMG sweatshops, uncompetitive residencies in BFE). Most of those FMG applications go right in the trash. Only the best of the best ever see the light of day. If you want to send those people packing, you're a shame to your forefathers, who established a nation where men and women could make a way for themselves, rather than be beat out by the entitled children of those that came before them.
 
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You're telling a resident in a highly competitive field and a medical student that spent many years working at a top teaching hospital with some of the best PDs in the world what is black and white and how things work? Talk to any of the PDs around here, they'll vehemently disagree with you- you have no idea what you're talking about. It's not like FMGs with equal stats to US MDs are stealing those 'murrican's residencies. You have to be a stellar candidate to beat out a US MD if you're an overseas grad, or apply to the sorts of places that US grads refuse to work (IMG sweatshops, uncompetitive residencies in BFE). Most of those FMG applications go right in the trash. Only the best of the best ever see the light of day. If you want to send those people packing, you're a shame to your forefathers, who established a nation where men and women could make a way for themselves, rather than be beat out by the entitled children of those that came before them.

You are exaggerating the differences in your examples to make a point especially when they are no brainer decisions. From your data, it seems that the current system is appropriating the proper resources to areas of need.

This brought us back to the original discussion at hand. Do you feel that we need to increase residency slots then?
 
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You are exaggerating the differences in your examples to make a point especially when they are no brainer decisions. From your data, it seems that the current system is appropriating the proper resources to areas of need.

This brought us back to the original discussion at hand. Do you feel that we need to increase residency slots then?
That was my point. These decisions are no-brainers for a PD. They aren't picking random 230 with no research Indian FMG over random 230 US MD with no research. They're picking obviously better FMGs over US MDs and DOs, because that's the smart thing to do.

As to more residencies- I think they should just ease the cap up a bit, so that quality institutions can train more residents. The issue right now is that we can train more residents, but only at place that don't have existing residencies. We should be expanding at the hospitals that have the resources (many of which have grown substantially in size since the 90s) not in random ass community hospitals that send all the good pathology to regional referral centers.
 
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We should be expanding at the hospitals that have the resources (many of which have grown substantially in size since the 90s) not in random ass community hospitals that send all the good pathology to regional referral centers.

This is the main problem especially with med schools being open left and right. I feel strongly against increasing residency slots for the sake of accommodating a huge supply of med grad students from these schools. At some point, the quality of patient care will suffer as the results. In your opinion, what qualifies as an adequate hospital in order to have more residency slots?
 
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This is the main problem especially with med schools being open left and right. I feel strongly against increasing residency slots for the sake of accommodating a huge supply of med grad students from these schools. At some point, the quality of patient care will suffer as the results. In your opinion, what qualifies as an adequate hospital in order to have more residency slots?
That's highly dependent upon the specialty and I'm really not experienced enough nor qualified to answer for that reason. FM might be able to train at a 100 bed hospital no problem, but general surgery would need a good variety of cases that a smaller hospital might not get, for instance.
 
That's highly dependent upon the specialty and I'm really not experienced enough nor qualified to answer for that reason. FM might be able to train at a 100 bed hospital no problem, but general surgery would need a good variety of cases that a smaller hospital might not get, for instance.
Cool. Thank you for taking the time out of your busy schedule to inform me of the misconceptions about our health care system. I learn a lot from this discussion.
 
Why are we opening our door to everyone to pursue these liberties in this country when they and their ancestors have done nothing to this country? Why are we using federal money to promote such practice in the first place?
if ancestry is the only thing that matters, then are you saying that ONLY Native Americans (aka, "Indians") have the "rights" to liberty in the USA? :laugh:
 
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Cool. Thank you for taking the time out of your busy schedule to inform me of the misconceptions about our health care system. I learn a lot from this discussion.
The system is very, very complicated. I've held ideas similar to yours in the past, but the farther along you go, the more you realize there's a method to the madness. I'm a big systems and policy guy, and I've thought about this stuff backwards and forwards because I want to change it someday. The US grads first proposition seems good if you're new to things, but worse the more you know about GME financing and the mission statement of CMS in regard to GME and the match. A better idea would be limiting class sizes based on match rates, as the COCA has done. Anyone matches less than 98% of their grads, they suffer a class size cut. You want a bigger class? Make better students that can compete with the rest of them, US grad and otherwise. This saves the taxpayers (can't pay loans for students without seats) and patients (they get the best doctors possible, not whomever happened to get pumped out at the bottom of a domestic physician class).
 
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Doesn't matter. Priority should be given to US grads on all levels especially when US federal money is used to fund these programs.

The federal money isn't intended to benefit the student. It is intended to increase/maintain the supply of competent physicians serving the population of the country. Assuming that foreign grads continue clinical practice in the US after residency at the same rates as US grads (which I would assume is the goal for most), the money is equally well spent either way according to the actual goals of the funding.
 
What would be the issue with training more MDs/DOs and reducing the number of NPs/PAs. I realize this may reduce physician pay individually but wouldn't it be better for patients/healthcare? Again I realize this might be my naivete as I am only a premed.
 
What would be the issue with training more MDs/DOs and reducing the number of NPs/PAs. I realize this may reduce physician pay individually but wouldn't it be better for patients/healthcare? Again I realize this might be my naivete as I am only a premed.
The lead time and training costs for physicians are much higher. It costs about a million dollars to train a doctor (much of which is paid for by the government), along with a bare minimum of 11 total years of training (excluding the rare exceptions). You could train five PAs in that amount of time for far less money, very little of which is provided by the government. Ideally, yeah, everyone would get to see a physician, but that would be a massive misappropriation of resources. Then there's the whole issue of training sites- there simply aren't enough sites that would be able to train enough doctors to see everyone, even with unlimited funds. There's only so many patients to go around, and you need a certain number of those, coupled with competent faculty, to make GME possible.
 
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Any recommendation for books on healthcare economics?
 
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I am not in favor of opening all of our training slots to fmgs especially when we have equally competitive applicants at home.
I'm sure it's probably already been said but you understand, 68PGunner that giving someone an upper hand while not meriting the upper hand (like for example, FMGs that are as competitive or not more so being unmatched) sounds pretty sketch right?
 
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I'm sure it's probably already been said but you understand, 68PGunner that giving someone an upper hand while not meriting the upper hand (like for example, FMGs that are as competitive or not more so being unmatched) sounds pretty sketch right?

I'm not going to rehash my thoughts. Obviously my stand on this matter is very clear either ways. It seems that the PDs are doing the right things in my opinion as doorkeepers. If you feel discriminated about the current process, you need to stop whining and overcome your challenge.

The PDs are doing a great job. It seems that the only issue left is to tweak our current system a little bit in order to direct our resources to the right places.
 
I'm sure it's probably already been said but you understand, 68PGunner that giving someone an upper hand while not meriting the upper hand (like for example, FMGs that are as competitive or not more so being unmatched) sounds pretty sketch right?

If you study forever for a test, you're doing to do better than if you didn't study for months. Doesn't make you more competitive. Why should us mds choose foreign grads over us mds? You are owed nothing
 
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Psai, so, a couple things. First, I really have no idea where you're getting this notion that people who graduated outside of the states get a whole year to study for the USMLEs. Maybe that is a Caribbean thing but I go to an Irish school and we have two months off to study same as everyone else. Second of all, lets say all of these foreign grads did in fact study for a year, and got a really high mark I don't really see what sympathy the person who didn't study as long should get. Is the test not a valid marker for an applicant's competence? If it isn't then what the hell are you guys doing using it as such? Of course, it would be silly to say that the only way to assess someone's suitability for a residency is only dependent on the boards, there are LORs, performance on electives, research etc. The problem that I am frustrated with is when a foreign grad is as good as a US grad over all of these factors and still doesn't get chosen because "you know they didn't graduate here so...gross". Obviously I am not suggesting that a foreign grad who didn't do as well as his US grad competition should get the job anyways, however, 68PGunner is saying that a US grad shouldn't have to perform as well as a foreigner to get the same job.
 
When did I say that people study for a whole year? The test is designed to measure minimum competency. It is not designed to stratify students. It is used that way because it is the only thing that is universal among students from across the country. Clinical grades have some subjectiveness built in as do letters of recommendation. If you wanted to be an american doctor, why didn't you go to school in america? Maybe it's because you weren't competitive enough to get in. Residencies want people with a good track record who will continue to have a good record. Also, american students are familiar and known. You know which schools send good people. Why take a random person from abroad when you have your pick of strong applicants?
 
If you wanted to be an american doctor, why didn't you go to school in america? Maybe it's because you weren't competitive enough to get in. Residencies want people with a good track record who will continue to have a good record. Also, american students are familiar and known. You know which schools send good people. Why take a random person from abroad when you have your pick of strong applicants?
The notion that "American schools are better" is fallacious. Some are obviously better, but not all; for example, a new osteopathic school has MCAT cut-off at 17, which is a joke. Some others have GPA cut-off at 2.7; some accept applicants with <25 MCAT. Some lower-tier MD schools accept applicants with ~3.0 and sub-30 MCAT... On the other hand, European schools are pretty homogeneous in requirements. Some people with 30 MCAT and 3.6 GPA don't get into Irish schools. UK schools require candidates to have nearly perfect A's, and some that are receptive to Americans require minimum 29 MCAT. If someone chose a reputed European school over a lower-tier D.O. school, I'd totally understand.

So the only thing I can conclude about why US graduates are given huge priority over foreign ones is that PDs are familiar with US training and Medicine has become a patriotic game, which is sad. And this is not the case for only the US: all first-world countries are like that, too: it is almost impossible for American doctors to come practice in those countries.
 
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I also didn't say american schools are better. I said they are familiar and known. Why do you guys keep setting up strawmen? But we train american doctors for american people. We have no responsibility to train foreign doctors. When great foreign doctors come here to train, they do get picked up and trained. But if you want to practice here, why did you study elsewhere? I don't care about your requirements. Why didn't you attend an american school?
 
If you study forever for a test, you're doing to do better than if you didn't study for months. Doesn't make you more competitive. Why should us mds choose foreign grads over us mds? You are owed nothing
It's not all about just your scores, hence why Carib graduates not only need better scores, but better letters, more research, etc to compete with a US graduate at the same residency. They have to distinguish themselves to compete with an average applicant, basically. I think that's plenty fair.
 
I also didn't say american schools are better. I said they are familiar and known. Why do you guys keep setting up strawmen? But we train american doctors for american people. We have no responsibility to train foreign doctors. When great foreign doctors come here to train, they do get picked up and trained.
Because you said: "If you wanted to be an american doctor, why didn't you go to school in america? Maybe it's because you weren't competitive enough to get in".

But if you want to practice here, why did you study elsewhere? I don't care about your requirements. Why didn't you attend an american school?
Because this US school hasn't had its curriculum proven, is in the middle of nowhere, and scatters their students in the wind to train at sub-par rotation sites (or doesn't even have stable rotation sites), while the other (foreign) school is solid in every way?
 
The notion that "American schools are better" is fallacious. Some are obviously better, but not all; for example, a new osteopathic school has MCAT cut-off at 17, which is a joke. Some others have GPA cut-off at 2.7; some accept applicants with <25 MCAT. Some lower-tier MD schools accept applicants with ~3.0 and sub-30 MCAT... On the other hand, European schools are pretty homogeneous in requirements. Some people with 30 MCAT and 3.6 GPA don't get into Irish schools. UK schools require candidates to have nearly perfect A's, and some that are receptive to Americans require minimum 29 MCAT. If someone chose a reputed European school over a lower-tier D.O. school, I'd totally understand.

So the only thing I can conclude about why US graduates are given huge priority over foreign ones is that PDs are familiar with US training and Medicine has become a patriotic game, which is sad. And this is not the case for only the US: all first-world countries are like that, too: it is almost impossible for American doctors to come practice in those countries.
American schools train American citizens to function in the American health care system better than any schools in the world. It isn't about them being the best overall, it's that they are the schools that best train someone to operate within our system. That's why US rotations are so critical for foreign graduates- we need evals saying that they can function well in our system, which is very different than the NHS or whatever system their home nation has.

As to perfect As- grading standards are very different in Europe. I'm living with a person who graduated near the top of her class in the Netherlands, and she's shocked by how hard her graduate coursework is here in the US, and how easy it is for one to fail. The educational goals over there are to measure minimum competency, while here they are to distinguish students with differing levels of competency, and she's having a tough time grappling with that. I've heard similar of Canadian schools- you need practically straight As to get into a Canadian medical school, but the As are easier to come by, so you can't really directly compare a Canadian GPA with a US GPA.
 
Psai, I didn't make any strawmen, people have mentioned (not you, however, that's my bad) that foreign grads get up to a year to study for the USMLEs. Anyways, no one is saying America has a responsibility to train foreign doctors, however, the Match is very much trying to make the application system at the very least seem meritocratic from the way things used to work. When perfectly qualified applicants that studied overseas don't get matched, or even as many interviews, the appearance of a merit based process takes a hit and instead just looks like protectionism. You're points seem to stress that the only way to judge the quality of medical school graduate is by the fact that they studied in the states; then why bother with any of these requirements at all? Obviously no one is saying that we should get rid of the USMLEs, class grades, etc and just distribute residency positions at random among the US grads. They must account for something, but, it seems they account for less depending on who acquired them. That is profoundly sketch no matter how you look at it.

Also,
but the As are easier to come by
I'm Canadian, and that's definitely not true.
 
Psai, I didn't make any strawmen, people have mentioned (not you, however, that's my bad) that foreign grads get up to a year to study for the USMLEs. Anyways, no one is saying America has a responsibility to train foreign doctors, however, the Match is very much trying to make the application system at the very least seem meritocratic from the way things used to work. When perfectly qualified applicants that studied overseas don't get matched, or even as many interviews, the appearance of a merit based process takes a hit and instead just looks like protectionism. You're points seem to stress that the only way to judge the quality of medical school graduate is by the fact that they studied in the states; then why bother with any of these requirements at all? Obviously no one is saying that we should get rid of the USMLEs, class grades, etc and just distribute residency positions at random among the US grads. They must account for something, but, it seems they account for less depending on who acquired them. That is profoundly sketch no matter how you look at it.

Also,

I'm Canadian, and that's definitely not true.
Have you taken American and Canadian coursework? I mean, I've only got the few anecdotes I've seen on here, so feel free to correct me if I'm wrong.
 
As to perfect As- grading standards are very different in Europe. I'm living with a person who graduated near the top of her class in the Netherlands, and she's shocked by how hard her graduate coursework is here in the US, and how easy it is for one to fail. The educational goals over there are to measure minimum competency, while here they are to distinguish students with differing levels of competency, and she's having a tough time grappling with that. I've heard similar of Canadian schools- you need practically straight As to get into a Canadian medical school, but the As are easier to come by, so you can't really directly compare a Canadian GPA with a US GPA.
I agree that grading in Europe is easier than in the US.
On the other hand: Organic Chem, Calculus and Physics are required classes in European high school.
 
No, that's a good point I have not taken American and Canadian Coursework but even if I did my N=1 wouldn't really account for much anyway ha. For what it's worth I did my undergrad and master's degree in Canada. Also, comparing med school in Ireland with my friends doing med school in Canada it appears that I have a lot more tests, exams etc not to mention the Canadian med students aren't ranked. but again, pretty anectdotal.
 
No, that's a good point I have not taken American and Canadian Coursework but even if I did my N=1 wouldn't really account for much anyway ha. For what it's worth I did my undergrad and master's degree in Canada. Also, comparing med school in Ireland with my friends doing med school in Canada it appears that I have a lot more tests, exams etc not to mention the Canadian med students aren't ranked. but again, pretty anectdotal.
I believe the medical schools to be roughly equivalent amongst first world, Western nations, with the exception of a few of the Mediterranean countries. But each school trains students for their particular system, and selects and rewards students that will operate well within that system. So a US graduate, while likely just as competent as their UK counterpart, would have a difficult adjustment period in the NHS, and an NHS physician might find themselves quite frustrated with the nature and pace of care in the US.
 
Because you said: "If you wanted to be an american doctor, why didn't you go to school in america? Maybe it's because you weren't competitive enough to get in".


Because this US school hasn't had its curriculum proven, is in the middle of nowhere, and scatters their students in the wind to train at sub-par rotation sites (or doesn't even have stable rotation sites), while the other (foreign) school is solid in every way?

My statement was about the quality of the applicant. He's talking about the quality of the school. These are two different things. Not sure where the confusion lies
 
If it's the school I'm thinking of, my learned colleague's words are 100%sports on.

They've already gone through an abnormally high attrition for their first class.

And anyone with a brain can tell that this new osteopathic school is going to face significant stigma too when their grads actually reach the match...
 
If it's the school I'm thinking of, my learned colleague's words are 100%sports on.

They've already gone through an abnormally high attrition for their first class.
The school I was referring to hasn't enrolled any class yet. Reading through its school-specific thread, a bunch of students were accepted with 20-22 MCAT.
 
I don't know, but 15+ years ago, a lot of DO school had their MCAT in that range... One of my mentors got into DMU in the early 90s with 18 MCAT.

Man i got that on one section
 
I personally think that unmatched US grads who didn't initially match because of outlandish expectations deserve a second chance to compete among their US respective peers for a residency spot.

I realize we've moved on from this topic, but I just watched Point Break, and felt like quoting Patrick Swayze:

"If you want the ultimate, you gotta to be willing to pay the ultimate price."
 
I don't know, but 15+ years ago, a lot of DO school had their MCAT in that range... One of my mentors got into DMU in the early 90s with 18 MCAT.

This is exactly why I am so amused with posters on here who seem to dislike schools for accepting low MCAT scores, while making assumptions that the applicant has nothing else going for them. Unless you have their entire application with you, it seems rather foolish to comment on it. A lot of the physicians I have spoken with received MCAT scores that today would be considered low. Are they not competent? Are their schools silly for accepting them? How do we interpret this?

Personally, and I'm still thinking this through, but it seems like rising MCAT scores only speaks about the number and ridiculousness of hoops that medical students have to jump through today versus in the past.
 
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Medical schools will just open up in order to fill those spots.. This is a vicious cycle that ultimately decreases the value of our education and decreases our opportunity later on. I'm sure other people have said this already and others have argued, but I just wanted to add my two cents. While we probably do need some more spots, I think medicine needs to be very careful about how they approach this... Unless you want what happened to attorneys happening to doctors.

I'd also add that the physician shortages are not in the cities, but rather in the middle of nowhere and creating more residencies will do nothing to change that fact. Most people simply don't want to live in these communities.
 
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