Senator Casey introduces bill to remove cap on residency slots

Started by el_duderino
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

Browse articles Compare schools My application plan Read Interview Feedback
Practice for interviews Ask an Advisor
el_duderino

el_duderino

Some men play tennis, I erode the human soul
Verified Member
10+ Year Member
Physician
Advertisement - Members don't see this ad
http://www.pamedsoc.org/MainMenuCat...al&utm_source=twitter.com&utm_campaign=buffer

"U.S. Sen. Robert Casey, from Pennsylvania, has introduced legislation that would increase the number of residency slots by 15,000 nationwide by 2019 — a 58 percent increase over the 26,000 slots currently funded through Medicare.

"The Residency Physician Shortage Reduction Act would remove the cap on the number of federally-funded residency slots available at teaching hospitals across the county."
 
el_duderino said:
http://www.pamedsoc.org/MainMenuCat...al&utm_source=twitter.com&utm_campaign=buffer

"U.S. Sen. Robert Casey, from Pennsylvania, has introduced legislation that would increase the number of residency slots by 15,000 nationwide by 2019 — a 58 percent increase over the 26,000 slots currently funded through Medicare.

"The Residency Physician Shortage Reduction Act would remove the cap on the number of federally-funded residency slots available at teaching hospitals across the county."
Click to expand...

Would be nice, but all of those extra spots cost money, something like $95,000 per resident per year. Good luck getting that through the current Congress.
 
Advertisement - Members don't see this ad
A little competition is always good IMO... You guys/gals should check the pathology and radiology forums for a little perspective... I am pretty sure they are not competing with NP/PA for jobs.
 
PhillyMed777 said:
I'd agree with you. Huge increase in slots, many of which will initially be given to non-US graduates. I don't want this increase to happen.
Anyone have any ideas on the likelihood of this passing.
Click to expand...

Slim to none, pretty sure this was attempted last year. Yup: https://www.govtrack.us/congress/bills/113/hr1180

Never made it past committee. Even Obama's 2014 and 2015 budgets called for a reduction in Medicare GME support. Expanding residency spots would cost an enormous amount of money: $95,000 per resident per year * 15,000 new residency spots = ~$1.5 billion. Try selling that to your Congressional tea baggers.
 
PhillyMed777 said:
And I wonder what will happen if even more slots for path/rads are added...can't be good (this is of course assuming that these slots include ones in path/rads, which could be untrue)
Click to expand...
It will be even worst for paths and rads... I really don't think it's a good thing to follow Pharmacy and law schools foot step...Residency is what has kept physicians supply in-check; if we open a LOT MORE residency slots, I think what will follow will no be so pleasant. Besides, these slot will be taken by many FMG (non US citizens) . Do you really want to compete with physicians who have ZERO student debt?
 
BestDoctorEver said:
It will be even worst for paths and rads... I really don't think it's a good thing to follow Pharmacy and law schools foot step...Residency is what has kept physicians supply in-check; if we open a LOT MORE residency slots, I think what will follow will no be so pleasant. Besides, these slot will be taken by many FMG (non US citizens) . Do you really want to compete with physicians who have ZERO student debt?
Click to expand...
If you are asking me specifically , obviously no. Did you read my posts above lol? I'd hate to see this increase.
 
My guess is that something will be done if a projected lack of residency slots affects US medical school enrollment.
 
Advertisement - Members don't see this ad
IMO, what would happen is this:

Medical schools will love it. Classes will swell. Revenue will swell. Profit will swell.

Hospitals will love it -- more cheap laborers....except at Beth Israel. Because their residents are incompetant and need their hands held according to administration (http://www.dnainfo.com/new-york/201...l-residents-are-not-competent-enough-unionize).

There would come to be a surplus of physicians and there will STILL be midlevels encroaching with increased SOP.

Who thinks the nursing bodies are going to say "Well, looks like we don't need to push our scope of practice anymore. With all those new residency spots, looks like the docs have it from here in out." ?

As an aside: Midlevels achieve these gains via lobbying and petitioning for them to occur. Politicians don't lay in their bed and have AH-HA moment and decide to give nurse practitioners equal scope as FM docs. The nursing lobbies push it -- and often they gain ground...because their lobbies are great at what they do.

Physician lobbies appear to be mediocre at best and pathetic/nonexistent at worst.

It isn't the case where "Oh now the small town in rural Kentucky will finally have it's own set of specialists -- if only we open the bottleneck of residency spots."

No, instead the places where no one wants to practice will still have no one wanting to practice there and everywhere else will just get that much more competitive.

There is no easy solution to the maldistribution of accessible healthcare providers across the US.

Also, this just in: Of those 15,000 new residency spots, only 17 are going to be dermatology. Sorry derm-hopefuls. 😉
 
Last edited:
I'm not sure if it was exactly the same, but I think a bill along the same lines has been proposed a couple times in the last few years. Normally it causes a good stir, people talk about how great it would be, then after a month or two you never hear about it again. Would love to see this one pass though... even though it's pretty idealistic to think that suddenly they're going to agree to increase the spots that drastically in a short amount of time.
 
Frazier said:
IMO, what would happen is this:

Medical schools will love it. Classes will swell. Revenue will swell. Profit will swell.

Hospitals will love it -- more cheap laborers....except at Beth Israel. Because their residents are incompetant and need their hands held according to administration (http://www.dnainfo.com/new-york/201...l-residents-are-not-competent-enough-unionize).

There would come to be a surplus of physicians and there will STILL be midlevels encroaching with increased SOP.

Who thinks the nursing bodies are going to say "Well, looks like we don't need to push our scope of practice anymore. With all those new residency spots, looks like the docs have it from here in out." ?

As an aside: Midlevels achieve these gains via lobbying and petitioning for them to occur. Politicians don't lay in their bed and have AH-HA moment and decide to give nurse practitioners equal scope as FM docs. The nursing lobbies push it -- and often they gain ground...because their lobbies are great at what they do.

Physician lobbies appear to be mediocre at best and pathetic/nonexistent at worst.

It isn't the case where "Oh now the small town in rural Kentucky will finally have it's own set of specialists -- if only we open the bottleneck of residency spots."

No, instead the places where no one wants to practice will still have no one wanting to practice there and everywhere else will just get that much more competitive.

There is no easy solution to the maldistribution of accessible healthcare providers across the US.

Also, this just in: Of those 15,000 new residency spots, only 17 are going to be dermatology. Sorry derm-hopefuls. 😉
Click to expand...
You can bet most of those positions will be primary care spots. Esp. since the govt. believes we have more than enough specialists.
 
Frazier said:
IMO, what would happen is this:

Medical schools will love it. Classes will swell. Revenue will swell. Profit will swell.

Hospitals will love it -- more cheap laborers....except at Beth Israel. Because their residents are incompetant and need their hands held according to administration (http://www.dnainfo.com/new-york/201...l-residents-are-not-competent-enough-unionize).

There would come to be a surplus of physicians and there will STILL be midlevels encroaching with increased SOP.

Who thinks the nursing bodies are going to say "Well, looks like we don't need to push our scope of practice anymore. With all those new residency spots, looks like the docs have it from here in out." ?

As an aside: Midlevels achieve these gains via lobbying and petitioning for them to occur. Politicians don't lay in their bed and have AH-HA moment and decide to give nurse practitioners equal scope as FM docs. The nursing lobbies push it -- and often they gain ground...because their lobbies are great at what they do.

Physician lobbies appear to be mediocre at best and pathetic/nonexistent at worst.

It isn't the case where "Oh now the small town in rural Kentucky will finally have it's own set of specialists -- if only we open the bottleneck of residency spots."

No, instead the places where no one wants to practice will still have no one wanting to practice there and everywhere else will just get that much more competitive.

There is no easy solution to the maldistribution of accessible healthcare providers across the US.

Also, this just in: Of those 15,000 new residency spots, only 17 are going to be dermatology. Sorry derm-hopefuls. 😉
Click to expand...
Where did you find that only 17 are going to be derm?...I'd like to see the breakdown myself which is why I ask
 
DermViser said:
Maybe not Path or Rads -- much more primary care. Someone has to be the head administrator of the Primary Care Medical Home (PCMH).
Click to expand...

You're forgetting that there's a "projected shortage" in pathology. Might as well deliver the killing blow like the CAP wants. Radiology isn't much different from the looks of it.
 
circulus vitios said:
You're forgetting that there's a "projected shortage" in pathology. Might as well deliver the killing blow like the CAP wants. Radiology isn't much different from the looks of it.
Click to expand...
You can bet the "shortage" report will be gamed. That being said. We do NOT have a shortage of physicians in this country. We have a maldistribution. Even the Obamacare architect(s) themselves have said this directly.
 
I don't understand why the gov't has to pay for residency slots. Don't they generate much more than enough revenue to be paid for by hospitals? This is something I've never understood.
 
Advertisement - Members don't see this ad
Bancrofti said:
I'm not sure if it was exactly the same, but I think a bill along the same lines has been proposed a couple times in the last few years. Normally it causes a good stir, people talk about how great it would be, then after a month or two you never hear about it again. Would love to see this one pass though... even though it's pretty idealistic to think that suddenly they're going to agree to increase the spots that drastically in a short amount of time.
Click to expand...

Yeah, bills like this get introduced all the time. Hardly newsworthy. As mentioned it always sounds good to say there should be more residency slots but when it comes time to pay for it nobody wants to try to sell to voters that they want to throw more money to train those who will become the richer segments of our population. So it's a nonstarter.
 
PL198 said:
I don't understand why the gov't has to pay for residency slots. Don't they generate much more than enough revenue to be paid for by hospitals? This is something I've never understood.
Click to expand...

Nope it's expensive to train residents. It only becomes lucrative in later years . Interns slow down attendings to a noncompetitive rate. You are really worse than useless when you first start -- we all were. So the fed really has to incentivize hospitals to offer training because they could be much more streamlined and cost effective without us. This has been addressed ad nauseum in other threads though.
 
Law2Doc said:
Nope it's expensive to train residents. It only becomes lucrative in later years . Interns slow down attendings to a noncompetitive rate. You are really worse than useless when you first start -- we all were. So the fed really has to incentivize hospitals to offer training because they could be much more streamlined and cost effective without us. This has been addressed ad nauseum in other threads though.
Click to expand...
And this is where I think NPs and PAs are at an advantage here. They can advertise that they don't "need" residency training, unlike those slow doctors. Their schooling is so good they are ready on Day 1.
 
PL198 said:
I don't understand why the gov't has to pay for residency slots. Don't they generate much more than enough revenue to be paid for by hospitals? This is something I've never understood.
Click to expand...
What I don't understand is why hospitals have to take a loss for delinquent patients. Is there some agreement with the government?

Furthermore, is this increase actually in legislation or not?

jakeislove said:
How many residency slots could have been funded with what we've spent on Tomahawk missiles to blow up in Iraq and Libya?
Click to expand...
But uh...how does that profit the arms industry manufacturers, whose powerful lobby decides what's what?
 
Anastomoses said:
What I don't understand is why hospitals have to take a loss for delinquent patients. Is there some agreement with the government? Furthermore, is this increase actually in legislation or not?
Click to expand...
Even if all the delinquent patients paid, that is irrelevant to residents. Residents are not able to pump out RVUs as fast as attendings. Education by-in large is an unfunded mandate. Hospitals know teaching faculty at an academic medical center will have LOWER RVUs bc one of their responsibilities is to teach (i.e. teaching rounds, going to the med school and doing a lecture, etc.) Hospitals know this and draw up contracts accordingly.

My guess is that the Bill has been written and turned in and dropped in the Hopper, it just has to come up for a vote, or it might get forever stuck in committee and never make it out for a vote.
 
Donald Kimball said:
Slim to none, pretty sure this was attempted last year. Yup: https://www.govtrack.us/congress/bills/113/hr1180

Never made it past committee. Even Obama's 2014 and 2015 budgets called for a reduction in Medicare GME support. Expanding residency spots would cost an enormous amount of money: $95,000 per resident per year * 15,000 new residency spots = ~$1.5 billion. Try selling that to your Congressional tea baggers.
Click to expand...

Think hard as to the reason bo is decreasing residency spots..
 
PikminOC said:
Think hard as to the reason bo is decreasing residency spots..
Click to expand...
Exactly. There is a reason to not increase the number of residency spots. Ezekiel Emanuel (physician) and Jonathan Gruber (MIT economist) have said this with respect to 1) decreasing the number of years in residency training in IM and Surgery, for example 2) who patients will be seeing for their medical care needs.
 
Advertisement - Members don't see this ad
DermViser said:
They also say OB-Gyn, of all things, is primary care. The NHSC also gives scholarships bc they need all the help they can get.
Click to expand...

OB/Gyn is often counted as primary care by both health insurance companies and medical schools, primarily because general OB/Gyns act as PCPs for quite a few patients. Ask how many females in your med school class have seen another physician regularly besides their OB/Gyn. So no, it's not as ridiculous as you make it sound to count as a primary care field.
 
DermViser said:
No, it's not that.
Click to expand...

Why not?!

We read here on a daily basis how superior AMGs are compared to IMG/FMGs..... perhaps senators drank the Koolaid, too. A lot of the areas IMG/FMG residencies are in places where people from 'good' schools have zero interest in going. What better way to force the bestest and brightest minds to underserved areas than fear?
 
jakeislove said:
Why not?!

We read here on a daily basis how superior AMGs are compared to IMG/FMGs..... perhaps senators drank the Koolaid, too. A lot of the areas IMG/FMG residencies are in places where people from 'good' schools have zero interest in going. What better way to force the bestest and brightest minds to underserved areas than fear?
Click to expand...
Bc that's not the actual objective. The actual objective is to have a lot of care done by NPs and PAs and not to see a physician for that care, bc physician care is expensive. Ezekiel Emmanuel has said this, by saying, you don't need a doctor for all of your care. Jonathan Gruber has said this by saying that PC doctors will be more administrative in nature and spend only 1/3 of their time actually seeing patients.
 
DermViser said:
Bc that's not the actual objective. The actual objective is to have a lot of care done by NPs and PAs and not to see a physician for that care, bc physician care is expensive. Ezekiel Emmanuel has said this, by saying, you don't need a doctor for all of your care. Jonathan Gruber has said this by saying that PC doctors will be more administrative in nature and spend only 1/3 of their time actually seeing patients.
Click to expand...

Divide and conquer. Basically using fear on all sides so a population of people who feel entitled to a certain lifestyle are forced to accept whatever deal is put on the table. Does anyone think DOs entering the match is to help MD students have more job security?

IMG/FMG basically have a nuclear option. I wouldn't leave the US but it's common knowledge that we have the option of practicing in our degree's country of origin after residency. The loans are private... no one wants to try getting re-elected if a national medical emergency were declared (under the ACA) and doctors could say no.

Like most people, all they care about is money and power.
 
You must log in or register to reply here.

Similar threads

R
Submitted my residency application today after 6 years on this website.
Replies
2
Views
362
nobadwaves
N
P
Impact of UK graduate school grades on American residency applications?
Replies
3
Views
760
premed_1234
P
D
Residency Consultation Services
Replies
1
Views
360
NotAProgDirector
NotAProgDirector
M
MD Peds residency signal help
Replies
1
Views
464
GoSpursGo
GoSpursGo
V
  • Locked
House bill 238 to give AI prescribing authority
2 3
Replies
103
Views
10K
chilly_md
chilly_md