Public opinion on number of residency slots

[dnnash]

Has anyone read this article? Specifically the last part about increasing residency slots only being a problem of congress not funding it?

http://www.slate.com/articles/healt..._scramble_foreign_doctors_and_a_shortage.html

I know there's a few thread similar to this, but what I'm wondering is if you guys think this accurately represents public opinion on the topic.

I get the impression that most people here think increasing residency spots would only serve to increase FMG and IMG matches and saturate the market. But according to this article we're already going to face a shortage of physicians and have to start importing them anyway in coming years. Any thoughts on that?


What's the downside of increasing residency spots in primary care or under served regions when there are plenty of qualified FMGs willing to take them? It seems it would certainly give mid levels less ammunition in their fight for autonomy.

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[Awesome Sauceome]

My understanding of it is that we wont be importing docs, we will simply lower our standards and have mid-levels do physician's jobs for less money.

Also as I understand it, the physician shortage is geographically dependent. Some areas are overflowing with docs while others dont have anything for miles and miles.

The downside to increasing residency spots (with federal money) with the specific goal of training FMGs is the fact that we are using american money to train foreign physicians which may or may not just leave when they are done, seems like a poor investment on paper.

 

[deleted547631]

My understanding of it is that we wont be importing docs, we will simply lower our standards and have mid-levels do physician's jobs for less money.

Also as I understand it, the physician shortage is geographically dependent. Some areas are overflowing with docs while others dont have anything for miles and miles.

The downside to increasing residency spots (with federal money) with the specific goal of training FMGs is the fact that we are using american money to train foreign physicians which may or may not just leave when they are done, seems like a poor investment on paper.

Real talk: they don't leave if they don't have to.

 

[tiedyeddog]

FMG's who do residency here do not leave. They are cashing it in here, not so much where they came from.

 

[notbobtrustme]

FMG's who do residency here do not leave. They are cashing it in here, not so much where they came from.

cash rules everything around me

 

[BrooklynBulls]

The solution is already taking place. The MD/DO merger will add residency spots to the allopathic match that should alleviate SOME of the pressure for less competitive applicants, and the rapidly increasing class sizes of allopathic (and the now really booming) osteopathic schools will very quickly make IMGs/FMGs less competitive than they've ever been. There will probably always be room for outstanding candidates regardless of school of graduation, but I think in 20 years there will probably only be a few Caribbean schools left standing, with likely smaller class sizes than ever, and FMGs will be realizing that their only way to an attending position in the US would be to go through medical school again, here.

 

[PathoTurnUp1865]

cash rules everything around me

CREAM

 

[jdh71]

Don't expect an increase in residency spots until amgs actually fill all of the available residency spots.

 

[PL198]

what I don't understand about the whole "expand expand expand" movement is that you're going to lose quality for sure. They act like letting in the kids with a 22 MCAT is going to be good for medicine. I really doubt it.

 

[the argus]

what I don't understand about the whole "expand expand expand" movement is that you're going to lose quality for sure. They act like letting in the kids with a 22 MCAT is going to be good for medicine. I really doubt it.

I think you're being a little dramatic.

How about this person: nontraditional student, 31 MCAT, 2.6 GPA from bachelors degree, 3.8 sGPA from postbac, 3.0 cGPA

That was me when I was applying to US allopathic. I was put on a few waitlists, but was never accepted because of my cGPA. Do you think I'm incapable of being a competent physician because I was 17 and immature/lazy went I went to (a highly ranked) college?

The people the expansion will benefit are those like me and those with competitive stats except for low MCAT scores (27-29). Do you really think quality will be affected because these docs scored 3 points lower on a standardized test that has nothing to do with medicine?

 

[JP2740]

I think you're being a little dramatic.

How about this person: nontraditional student, 31 MCAT, 2.6 GPA from bachelors degree, 3.8 sGPA from postbac, 3.0 cGPA

That was me when I was applying to US allopathic. I was put on a few waitlists, but was never accepted because of my cGPA. Do you think I'm incapable of being a competent physician because I was 17 and immature/lazy went I went to (a highly ranked) college?

The people the expansion will benefit are those like me and those with competitive stats except for low MCAT scores (27-29). Do you really think quality will be affected because these docs scored 3 points lower on a standardized test that has nothing to do with medicine?

2.6?

 

[cbrons]

using american money to train foreign physicians which may or may not just leave when they are done, seems like a poor investment on paper.

Why would they jump through hoops to do a US residency just to leave? If they want to practice elsewhere, they don't need a US residency, they come do the residency rigamarole in order to practice here.

 

[PL198]

I think you're being a little dramatic.

How about this person: nontraditional student, 31 MCAT, 2.6 GPA from bachelors degree, 3.8 sGPA from postbac, 3.0 cGPA

That was me when I was applying to US allopathic. I was put on a few waitlists, but was never accepted because of my cGPA. Do you think I'm incapable of being a competent physician because I was 17 and immature/lazy went I went to (a highly ranked) college?

The people the expansion will benefit are those like me and those with competitive stats except for low MCAT scores (27-29). Do you really think quality will be affected because these docs scored 3 points lower on a standardized test that has nothing to do with medicine?

No, but the significance of how lazy you were when you were 17 certainly affects your stats, which schools value.

My point is, when you open up the slots, you get less qualified candidates, no questions asked.

 

[the argus]

No, but the significance of how lazy you were when you were 17 certainly affects your stats, which schools value.

My point is, when you open up the slots, you get less qualified candidates, no questions asked.

Maybe it made me less "qualified," but the point of medical school is not to just gather the most "qualified" people. The point is to train competent physicians.

I wasn't saying that it was wrong I didn't get accepted over someone else. Why would a school have chosen me over someone who had a good GPA. The issue is that there is a physician/resident shortage, willing candidates in the country, but no positions for them because of the LCME's self-imposed and completely arbitrary limit on the number of medical students.

The question is whether the number of medical school positions accurately reflects the number of willing people who can become competent physicians, and I think the answer is obviously no.

 

[Wordead]

Maybe it made me less "qualified," but the point of medical school is not to just gather the most "qualified" people. The point is to train competent physicians.

I wasn't saying that it was wrong I didn't get accepted over someone else. Why would a school have chosen me over someone who had a good GPA. The issue is that there is a physician/resident shortage, willing candidates in the country, but no positions for them because of the LCME's self-imposed and completely arbitrary limit on the number of medical students.

The question is whether the number of medical school positions accurately reflects the number of willing people who can become competent physicians, and I think the answer is obviously no.

There is no shortage of medical students.

And you're just arguing semantics when you say competent physician vs qualified. Theres no appreciable difference. Nor do we need anymore borderline physicians per your lowering the bar theory.

 

[PatsyStone]

what I don't understand about the whole "expand expand expand" movement is that you're going to lose quality for sure. They act like letting in the kids with a 22 MCAT is going to be good for medicine. I really doubt it.

I almost wonder if in the future instead of having unqualified students fail out of Carib schools, we'll see a steady increase in the attrition rates at all of the new DO schools that are being rubberstamped

 

[the argus]

There is no shortage of medical students.

And you're just arguing semantics when you say competent physician vs qualified. Theres no appreciable difference. Nor do we need anymore borderline physicians per your lowering the bar theory.

What?

1. 6000+ foreign trained doctors match into residency every year, so yes, there is a shortage of US medical students. Everyone agrees with this, which is why they are increasing enrollment at pre-existing schools and opening new ones.

2. It's not semantics. Are you saying that the current number of medical student positions accurately reflects the number of people that have the capacity to become competent physicians? Like this has somehow been studied and the LCME came up with the number based on some kind of data?

This is like claiming there are only 407 US allopathic seniors that are competent enough to be dermatologists because that is how many derm positions there are in the match. That is obviously ridiculous. The more "qualified" people get those positions (i.e. higher test scores, etc), but that doesn't mean the people that don't match wouldn't be competent dermatologists.

 

[Stagg737]

I almost wonder if in the future instead of having unqualified students fail out of Carib schools, we'll see a steady increase in the attrition rates at all of the new DO schools that are being rubberstamped

Doubtful, but as a DO student I wouldn't mind seeing this happen. There are a few DO schools out there that need some serious overhuals given the stats they churn out, and I hope that the merger will force them to raise their standards. I think it would be more likely that we would just see students from those schools graduating but not being able to match, but only time will tell that story.

Surprisingly though, I don't think these are necessarily the 'new' schools. I can name one or 2 less than 10 years old that I'd already consider to be pretty strong just by looking at their match lists. I can also name 1 that's almost 20 years old that makes me wonder how they are still around given the stats of their incoming students as well as their average board scores/pass rates.

 

[cbrons]

What?

1. 6000+ foreign trained doctors match into residency every year, so yes, there is a shortage of US medical students. Everyone agrees with this, which is why they are increasing enrollment at pre-existing schools and opening new ones.

2. It's not semantics. Are you saying that the current number of medical student positions accurately reflects the number of people that have the capacity to become competent physicians? Like this has somehow been studied and the LCME came up with the number based on some kind of data?

This is like claiming there are only 407 US allopathic seniors that are competent enough to be dermatologists because that is how many derm positions there are in the match. That is obviously ridiculous. The more "qualified" people get those positions (i.e. higher test scores, etc), but that doesn't mean the people that don't match wouldn't be competent dermatologists.

We dont need more med students, just more residencies

 

[Wordead]

What?

1. 6000+ foreign trained doctors match into residency every year, so yes, there is a shortage of US medical students. Everyone agrees with this, which is why they are increasing enrollment at pre-existing schools and opening new ones.

2. It's not semantics. Are you saying that the current number of medical student positions accurately reflects the number of people that have the capacity to become competent physicians? Like this has somehow been studied and the LCME came up with the number based on some kind of data?

This is like claiming there are only 407 US allopathic seniors that are competent enough to be dermatologists because that is how many derm positions there are in the match. That is obviously ridiculous. The more "qualified" people get those positions (i.e. higher test scores, etc), but that doesn't mean the people that don't match wouldn't be competent dermatologists.

And how many unmatched US grads are there? Obviously there are plenty of medical students that are deemed to be of too poor quality to take over the foreign grads, so increasing the number of these people does nobody any good except the people pocketing tuition. Which leads into the motivation behind increasing enrollment and opening new schools - the schools make a ****ton of money from guaranteed loans, which is the same scam the carib schools have been running for years.

 

[hallowmann]

I almost wonder if in the future instead of having unqualified students fail out of Carib schools, we'll see a steady increase in the attrition rates at all of the new DO schools that are being rubberstamped

COCA, the accrediting body of DO schools, supposedly limits the attrition rate to not be "excessive". Right now, it's around 7-8% on average. I doubt it'll increase steadily. There are plenty of qualified people that will do just fine filling those spots.

We've seen a steady increase in competition in MD schools over the last 2 decades. That has caused a trickling increase in the stats of DO and even Carib MD students. DO matriculant stats have steadily increased alongside MD stats. The new DO (and MD for that matter) schools aren't accepting less qualified people, they're just accepting the people that would have attended more established DO and low-mid tier MD schools 10, 15, or 20 years ago. The low-mid tier MDs from 10-20 years ago are the upper 50% of DOs students now.

My guess is that unless there is a major drop in the interest to attend med school, we won't see huge attrition before the growth of med schools slow and come to a stop (i.e. when US graduates are at parity with residency positions). COCA already requires that DO schools place >98% of their graduates in GME to maintain accreditation, so that will inherently prevent expansion beyond that point.

And how many unmatched US grads are there? Obviously there are plenty of medical students that are deemed to be of too poor quality to take over the foreign grads, so increasing the number of these people does nobody any good except the people pocketing tuition. Which leads into the motivation behind increasing enrollment and opening new schools - the schools make a ****ton of money from guaranteed loans, which is the same scam the carib schools have been running for years.

In addition to tuition money, I think the scam of new MD & DO schools is to edge out foreign grads (specifically the Carib grads) and to have more money for GME, which lines the same pockets of those individuals running the schools/hospitals.

Honestly though, I don't have a problem with expanding PC residencies, especially in underserved areas. It won't saturate the PC market anytime soon, and it may actually solve a lot of problems with the disparity of care that we as a nation have.

 

[mimelim]

What?

1. 6000+ foreign trained doctors match into residency every year, so yes, there is a shortage of US medical students. Everyone agrees with this, which is why they are increasing enrollment at pre-existing schools and opening new ones.

2. It's not semantics. Are you saying that the current number of medical student positions accurately reflects the number of people that have the capacity to become competent physicians? Like this has somehow been studied and the LCME came up with the number based on some kind of data?

This is like claiming there are only 407 US allopathic seniors that are competent enough to be dermatologists because that is how many derm positions there are in the match. That is obviously ridiculous. The more "qualified" people get those positions (i.e. higher test scores, etc), but that doesn't mean the people that don't match wouldn't be competent dermatologists.

What exactly does the LCME owe you to entitle you to access to more training spots? Just because you could potentially be a competent Dermatologist, doesn't mean that you have a right to it. As someone on the other side of the residency admissions process, there is a reason there are 6000+ FMGs that match every year. They are better than the US MD/DO students that applied to those programs. Opening more US MD/DO spots does not automatically increase the pool of good US MD/DO residency candidates.

 

[the argus]

What exactly does the LCME owe you to entitle you to access to more training spots? Just because you could potentially be a competent Dermatologist, doesn't mean that you have a right to it. As someone on the other side of the residency admissions process, there is a reason there are 6000+ FMGs that match every year. They are better than the US MD/DO students that applied to those programs. Opening more US MD/DO spots does not automatically increase the pool of good US MD/DO residency candidates.

As someone on the other side of the residency admission process, you don't seem to actually know the statistics of the match. Last year, there were 1093 unmatched US MD and 610 unmatched DO. I wasn't a math major in college, but I'm pretty sure 1703 is less than 6301 (number of IMG matches).

The majority of IMGs match because there are not enough US graduates, plain and simple. Your post shows that you have no idea what you're talking about.

Wordead was arguing that the number of available US medical student positions reflects the number of potential competent physicians, which is ridiculous. This is exemplified by the >2600 US-IMGs that matched into residency positions this year. These people would have been fine in US medical schools and passed the USMLE just the same. There were just not enough spots for them in the US medical education system. But there is absolutely need for them in the US residency system, so them having to go abroad for medical school is pretty stupid.

Smart people who study these things also came to this conclusion, which is why they are increasing the number of medical school positions. You seem to be under the impression that the LCME had chosen the number of first year US medical school positions based on some data about the number of qualified applicants. They didn't, it was a self-imposed and arbitrary number.

 

[deleted390966]

Opening more US MD/DO spots does not automatically increase the pool of good US MD/DO residency candidates.

That is because the admission process is extremely stringent that keeps out people who would actually make very good doctors, while med schools try very hard to keep students who fail classes multiple times.

For many, the only difference is the CHANCE - except if your academic record is dismal then I do think you shouldn't be in med school; otherwise, there is very little difference between those who got interviewed and accepted and those who are rejected post-interview.

 

[notbobtrustme]

there is a reason there are 6000+ FMGs that match every year. They are better than the US MD/DO students that applied to those programs. Opening more US MD/DO spots does not automatically increase the pool of good US MD/DO residency candidates.

Maybe for a small minority, but most FMGs go to programs, for example in IL, like Jackson Park Hospital, Cook County and UI-Arbana, in which the teaching is poor, the volume is high or the location is undesirable (or all 3). After having been through the County System, I can see why few AMGs want to be there. The scutwork is high and the teaching is basically non-existent. These programs are designed for former attendings in order to move the meat through the system.

 

[the argus]

That is because the admission process is extremely stringent that keeps out people who would actually make very good doctors, while med schools try very hard to keep students who fail classes multiple times.

For many, the only difference is the CHANCE - except if your academic record is dismal then I do think you shouldn't be in med school; otherwise, there is very little difference between those who got interviewed and accepted and those who are rejected post-interview.

Exactly, thats the point. The pool already exists.

By increasing medical students spots you are not increasing the pool, you are just increasing access.

 

[John4321]

I think you're being a little dramatic.

How about this person: nontraditional student, 31 MCAT, 2.6 GPA from bachelors degree, 3.8 sGPA from postbac, 3.0 cGPA

That was me when I was applying to US allopathic. I was put on a few waitlists, but was never accepted because of my cGPA. Do you think I'm incapable of being a competent physician because I was 17 and immature/lazy went I went to (a highly ranked) college?

The people the expansion will benefit are those like me and those with competitive stats except for low MCAT scores (27-29). Do you really think quality will be affected because these docs scored 3 points lower on a standardized test that has nothing to do with medicine?

That was basically me too when applying this cycle. Non-trad, 32 MCAT, 2.62 GPA Bachelors, 3.59 sGPA from postbac, 2.92 cGPA. Accepted at a couple though.

 

[IlDestriero]

There are ample spots for American medical applicants now. There is no obligation to provide training spots for foreign trained graduates.
The physician "shortage" will not change with more spots, even if they are all primary care, most people don't want to live in undesirable and/or rural areas and will continue to flood the more desirable areas and cities. And many who are forced into primary care will try to get specialty training through fellowships.
If some AMGs lose a spot to some superior FMG candidates who has jumped through all the hoops to practice here, they probably deserve it and the AMG can match somewhere else or apply again next year.