Senate proposal to add 1000 new pain residency positions

[Cold-Eeze]

Opioid Workforce Act of 2021 Introduced in Senate

Sens. Maggie Hassan (D-N.H.) and Susan Collins (R-Maine) introduced the Opioid Workforce Act of 2021 in the Senate on April 27.

www.aamc.org

This bill was recently introduced in the senate aiming to add 1,000 new Medicare-supported positions in the areas of pain and addiction medicine. Given that there are currently less than 350 pain fellowship spots, is there any concern that this will significantly reduce training exposure during fellowship and heavily oversaturate the pain job market? Current pain fellows were already struggling to find jobs during the COVID pandemic.

There is definitely a need to address the opioid epidemic, but I don't think that adding 1000 pain fellows a year is the solution. Does anyone have any thoughts on this?

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[narcotics999]

Forced detoxification, drug dealers in jails or in electric chairs, no drug-dealer fellowship. This is the solution.

 

[Lecithin5]

Lol how about supporting a thousand new residency spots for a *variety* of different specialties? We all know that the number of med school spots have been increasing without a commensurate increase in residency positions.

 

[GassYous]

Lol how about supporting a thousand new residency spots for a *variety* of different specialties? We all know that the number of med school spots have been increasing without a commensurate increase in residency positions.

Medical school spots increasing doesn't mean that residency spots should increase.

 

[vm26]

Lol how about supporting a thousand new residency spots for a *variety* of different specialties? We all know that the number of med school spots have been increasing without a commensurate increase in residency positions.

A bill has already been introduced that would increase residency spots by 14K over the next 7 years. Given mid-level encroachment, this will be a death blow for several specialties, and great news for private equity and large HC systems that will welcome cheap labor.

https://www.asam.org/docs/default-source/advocacy/letters-and-comments/aamc-section-x-section-house-resident-physician-shortage-reduction-act_final-3-17-(002).pdf?sfvrsn=42285bc2_2

 

[coffeebythelake]

Medical school spots increasing doesn't mean that residency spots should increase.

No need to create a bottleneck at residency admissions. For American trained grads it is hard enough to matriculation into med school. Not saying everyone gets whatever residency spot they want. But from from practical perspective thry should focus on opening residency spots in fields that are in demand such as family medicine, pediatrics, and internal medicine.

 

[anbuitachi]

No need to create a bottleneck at residency admissions. For American trained grads it is hard enough to matriculation into med school. Not saying everyone gets whatever residency spot they want. But from from practical perspective thry should focus on opening residency spots in fields that are in demand such as family medicine, pediatrics, and internal medicine.

hasnt there been a huge increase in residency spots recently?

 

[Hoya11]

Forced detoxification, drug dealers in jails or in electric chairs, no drug-dealer fellowship. This is the solution.

agree, it does sound like the motivation may be to correct the opiate epidemic mess ..

addiction medicine and addiction psychiatry may occupy many of these 1000 spots

what would be really exciting is if this initiative also came with some new tougher opiate prescribing laws and regulations of big pharma making opioids.. i doubt that will happen though. keep the pumps, fentanyl patches and exalgo like products out of here. the industry is the problem

 

[pgg]

Forced detoxification, drug dealers in jails or in electric chairs, no drug-dealer fellowship. This is the solution.

Yeah the War On Drugs has been working so, soooo well. All we have to do is put the dealers in jail.

 

[GassYous]

No need to create a bottleneck at residency admissions. For American trained grads it is hard enough to matriculation into med school. Not saying everyone gets whatever residency spot they want. But from from practical perspective thry should focus on opening residency spots in fields that are in demand such as family medicine, pediatrics, and internal medicine.

Why? Look at em, unfettered increases in residency spots and all that happened was their job market collapsed and people went through med school and residency to end up with nothing.

 

[Lecithin5]

Medical school spots increasing doesn't mean that residency spots should increase.

Huh? I would agree if medical school spots increased by like a million, but that’s not happening.

I don’t think that increasing residency spots by 1000, divided across multiple specialties that are in need, will collapse the job market (it’s already collapsed!)

 

[Beeftenderloin]

Yeah the War On Drugs has been working so, soooo well. All we have to do is put the dealers in jail.

I had the same immediate reaction to this comment that you did, and was about to type a similar response, but I think they’re talking about pill mills, not actual drug dealers.

 

[deleted126335]

Why? Look at em, unfettered increases in residency spots and all that happened was their job market collapsed and people went through med school and residency to end up with nothing.

That is a feature. Not a bug.

 

[coffeebythelake]

Why? Look at em, unfettered increases in residency spots and all that happened was their job market collapsed and people went through med school and residency to end up with nothing.

Open up residency spots isn't going to cause the job market to collapse. It might counter the mid-level provider arguments about how they are serving communities because of physician shortage.

 

[Beeftenderloin]

Open up residency spots isn't going to cause the job market to collapse. It might counter the mid-level provider arguments about how they are serving communities because of physician shortage.

Lol. Take a stroll over to the emergency medicine forum. This is EXACTLY what’s happening to that specialty right now. A ton of new residency programs have opened up in recent years, flooding the market with new grads. That, in addition to mid-level encroachment has made job prospects for new ER docs a disaster right now.

 

[coffeebythelake]

Lol. Take a stroll over to the emergency medicine forum. This is EXACTLY what’s happening to that specialty right now. A ton of new residency programs have opened up in recent years, flooding the market with new grads. That, in addition to mid-level encroachment has made job prospects for new ER docs a disaster right now.

I would think the proliferation of lesser paid and lesser trained mid-levels is a much greater threat

 

[CCM-MD]

I would think the proliferation of lesser paid and lesser trained mid-levels is a much greater threat

Proliferation of midlevels is a greater threat so you would rather have unemployed physicians?

 

[deleted126335]

Proliferation of midlevels is a greater threat so you would rather have unemployed physicians?

Oversupply of trainees. Midlevel encroachment. Private equity. AMGs. Hostile payors. Hospitals shaving wherever they can. Ever increasing supervisory ratios. Exploitive senior docs with no vision beyond their own careers. An impotent ASA. Burdensome ABA.

“The enemy is in front of us, the enemy is behind us, the enemy is to the right and to the left of us. They can't get away this time!”​

― Douglas MacArthur

 

[TeslaCoil]

This is a PROPOSED bill. It would cost a lot in tax dollars. Most residency spots are government subsidized. All things considered I will be very surprised of this thing passes a vote.

 

[maxxor]

This is a PROPOSED bill. It would cost a lot in tax dollars. Most residency spots are government subsidized. All things considered I will be very surprised of this thing passes a vote.

Residency spots are profitable. The Hahnemann drama has removed any doubt from my mind that hospitals make money from residencies. Years of baby boomers telling me that residents make the hospital lose money was all proven a lie when we saw hospital systems were willing to spend millions of dollars to get Hahnemann’s training spots.

Across the country HCA is opening and self funding residencies to create a steady oversupply to drive physician costs down. They would absolutely lobby for this bill to reduce their costs even further.

 

[Twiggidy]

They should use the money that would fund these 1000 new residency positions and focus the money on treatment facilities. It's a complete was of money to create positions that will likely go unfilled or filled with people who will do something else afterwards.

 

[maxxor]

They should use the money that would fund these 1000 new residency positions and focus the money on treatment facilities. It's a complete was of money to create positions that will likely go unfilled or filled with people who will do something else afterwards.

They won’t be unfilled. If US grads don’t take them, the FMG/IMGs will.

That’s precisely the point. The powers that be have decided they want to crush the cost of medical labor, much like they did to PhDs in the 1980s and 1990s. It’s almost the same playbook. Expand PhD programs and tie immigration status to their educational programs, placing the trainees in a bad situation where they cannot advocate for themselves or leave if the environment is abusive lest they get deported.

 

[TheLoneWolf]

They won’t be unfilled. If US grads don’t take them, the FMG/IMGs will.

That’s precisely the point. The powers that be have decided they want to crush the cost of medical labor, much like they did to PhDs in the 1980s and 1990s. It’s almost the same playbook. Expand PhD programs and tie immigration status to their educational programs, placing the trainees in a bad situation where they cannot advocate for themselves or leave if the environment is abusive lest they get deported.

This

 

[Twiggidy]

They won’t be unfilled. If US grads don’t take them, the FMG/IMGs will.

That’s precisely the point. The powers that be have decided they want to crush the cost of medical labor, much like they did to PhDs in the 1980s and 1990s. It’s almost the same playbook. Expand PhD programs and tie immigration status to their educational programs, placing the trainees in a bad situation where they cannot advocate for themselves or leave if the environment is abusive lest they get deported.

But that's just the thing. The IMG will do the fellowship, get that US license, and then, if anesthesia trained, just go join an anesthesia practice. The suffer for that 1 year to reap the benefit of being able to practice in the United States afterward. Meanwhile, nothing is done about about the "opioid crisis"

 

[TheLoneWolf]

Anesthesia and pain management fellowship trained. Practice both.

I think a big mistake here is for the public and politicians to equate pain management with addictions management or to believe that pain management as is currently practiced can effectively reign in the opioid epidemic.

PP pain is, in large part, but not wholly, a trade of pills for shots. Has been for years. If anything, bad actors have thrived on the false notion that they can reign in high opioid users with procedures, effectively manage those who divert and patients who use street drugs when for the most part they are wholly uninformed and uninterested in the biopsychosocial model and much more invested in biomedical management.

We have the best technology, best research, best drugs compared to any time previously. We still have the so called "epidemic of pain" which has in large part lead to the opioid epidemic.

The cure for the opioid epidemic is NOT in interventional procedures. The answer is in addictions management, something the fellowship trained guys got a month of training in. Many fellows just pop their head in, say hi then leave to the fluoro suite.

A far more reasonable answer is place all that money and training spots in addictions management and psychiatry. That will make real changes. Open up prescribing of Suboxone, that will make a difference.

The pain market is already saturated and too many of the new grads just wanna be needle jockeys.

The promise that interventional pain management will cut down on opioid use in patients is marketing. There is poor quality data that our interventions decrease daily morphine equivalent dose. Industry funded and low n values. It's so far a false bill of goods.

I would argue that if they actually do use this money to fund non multidisciplinary "Spine fellowships" and more grads as they currently practice, it will exacerbate the problem not improve it.

 

[TeslaCoil]

Residency spots are profitable. The Hahnemann drama has removed any doubt from my mind that hospitals make money from residencies. Years of baby boomers telling me that residents make the hospital lose money was all proven a lie when we saw hospital systems were willing to spend millions of dollars to get Hahnemann’s training spots.

Across the country HCA is opening and self funding residencies to create a steady oversupply to drive physician costs down. They would absolutely lobby for this bill to reduce their costs even further.

Yes I realize that thank you. My point is that many if not most spots are government subsidized. Meaning tax dollars help to pay residents. Hence why this is being introduced as a bill. They’re asking for money from the budget. Therefore, while they are profitable to the hospital, they still cost money in the form of tax dollars.

 

[Gern Blansten]

Anesthesia and pain management fellowship trained. Practice both.

I think a big mistake here is for the public and politicians to equate pain management with addictions management or to believe that pain management as is currently practiced can effectively reign in the opioid epidemic.

PP pain in large part, but not wholly, a trade of pills for shots. Has been for years. If anything bad actors have thrived on the false notion that they can reign in high opioid users, those who divert, those who use street drugs when for the most part they are wholly uninformed and uninterested in the biopsychosocial model and much more invested in the biomedical of management.

We have the best technology, best research, best drugs compared to any time previously. We still have the so called "epidemic of pain" which has in large part lead to the opioid epidemic.

The cure for the opioid epidemic is NOT in interventional procedures. The answer is in addictions management, something the fellowship trained guys got a month of training in. Many fellows just pop their head in, say hi then leave to the fluoro suite.

A far more reasonable answer is place all that money and training spots in addictions management and psychiatry. That will make real changes. Open up prescribing of Suboxone, that will make a difference.

The pain market is already saturated and too many of the new grads just wanna be needle jockeys.

The promise that interventional pain management will cut down on opioid use in patients is marketing. There is poor quality data that our interventions decrease daily morphine equivalent dose. Industry funded and low n values. It's so far a false bill of goods.

I would argue that if they actually do use this money to fund non multidisciplinary "Spine fellowships" and more grades as they currently practice, it will exacerbate the problem not improve it.

Yep. This pretty much nails it.

 

[maxxor]

Yes I realize that thank you. My point is that many if not most spots are government subsidized. Meaning tax dollars help to pay residents. Hence why this is being introduced as a bill. They’re asking for money from the budget. Therefore, while they are profitable to the hospital, they still cost money in the form of tax dollars.

I tend to think about who benefits when I weight whether or not legislation will pass.

In this case, big business does.

 

[TeslaCoil]

Yes I realize that thank you. My point is they are government subsidized. Meaning tax dollars help to pay residents. Therefore, while they are profitable to the hospital, they still cost money in the form of tax dollars.

I tend to think about who benefits when I weight whether or not legislation will pass.

In this case, big business does.

Okay. I doubt it though. With the economy currently in the ****ter (GDP in the ****ter, unemployment at a record high), I hiiighly doubt this will pass anytime soon if at all. Doesn't seem like a very high priority compared to border control, covid, the military, hacker threats etc. just sayin.

 

[hebel]

If I wanted to curb the opioid epidemic as a politician, I'd start with giving Americans livable wages.

 

[TheLoneWolf]

If I wanted to curb the opioid epidemic as a politician, I'd start with giving Americans livable wages.

Ok. How are those two involved? Also, who pays for it?

 

[GassYous]

If I wanted to curb the opioid epidemic as a politician, I'd start with giving Americans livable wages.

So that they can pay for more opioids?

 

[Student189045]

Huh? I would agree if medical school spots increased by like a million, but that’s not happening.

I don’t think that increasing residency spots by 1000, divided across multiple specialties that are in need, will collapse the job market (it’s already collapsed!)

it's already increasing by like 1.5-2k a year since 2010 when it used to increase by 200 a year from 1970-2010. We are seeing the effects now, obviously. Anyone in medical school should be planning for alternative sources of income, I know I am.

 

[nimbus]

Okay. I doubt it though. With the economy currently in the ****ter (GDP in the ****ter, unemployment at a record high), I hiiighly doubt this will pass anytime soon if at all. Doesn't seem like a very high priority compared to border control, covid, the military, hacker threats etc. just sayin.

Gross Domestic Product, 1st Quarter 2021 (Second Estimate); Corporate Profits, 1st Quarter 2021 (Preliminary Estimate) | U.S. Bureau of Economic Analysis (BEA)

Real gross domestic product (GDP) increased at an annual rate of 6.4 percent in the first quarter of 2021 (table 1), according to the "second" estimate released by the Bureau of Economic Analysis. In the fourth quarter of 2020, real GDP increased 4.3 percent.

www.bea.gov

 

[epidural man]

Opioid Workforce Act of 2021 Introduced in Senate

Sens. Maggie Hassan (D-N.H.) and Susan Collins (R-Maine) introduced the Opioid Workforce Act of 2021 in the Senate on April 27.

www.aamc.org

This bill was recently introduced in the senate aiming to add 1,000 new Medicare-supported positions in the areas of pain and addiction medicine. Given that there are currently less than 350 pain fellowship spots, is there any concern that this will significantly reduce training exposure during fellowship and heavily oversaturate the pain job market? Current pain fellows were already struggling to find jobs during the COVID pandemic.

There is definitely a need to address the opioid epidemic, but I don't think that adding 1000 pain fellows a year is the solution. Does anyone have any thoughts on this?

Oh great -

Even more pain physicians who get trained into thinking the answer to chronic pain is by somehow blocking a nociceptive input peripherally (which has and will continue to completely fail miserably).

I wonder if in my lifetime, we will ever listen to the data and change our ways.

www.tamethebeast.org