Senator Casey introduces bill to remove cap on residency slots

[DermViser]

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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.

Do you know what you're talking about? The DO merger also brings their AOA residencies under the ACGME.

 

[jakeislove]

Do you know what you're talking about? The DO merger also brings their AOA residencies under the ACGME.

What are the requirements that would allow you to apply to a DO program? September 15th is just around the corner.

 

[Polonium-210]

Not going to pass in an election year, that's for sure. Probably won't see the light of day until possibly January 20, 2019, when a new president is sworn in. Our current political environment is not unlike 1915 on the Western Front. If Democrats lose the Senate, Obama will certainly dig in his heels and use his veto power to knock down the vast majority of proposed bills as Republicans cannot possibly hope to capture 15 of the 21 vulnerable Democratic seats in the Senate to obtain super majority. Democrats have an equally slim chance of retaking the House. If after this November nothing changes in the Senate majority wise, then you can expect another two more years of what we have seen for the last four: political maneuvering without any productivity.

 

[MS114]

For those of you saying that it will flood the market…you are not looking at the big picture here. Revised projections that just came out this year put the physician shortage at a little under 100,000 by 2020. Even this huge number of residency increase is a drop in the pond, there will STILL be a huge shortage. You also need to realize that nearly 20-30 million more people will be added to rolls over the next 5 years, along with a large majority of baby boomer docs retiring. This, combined with immigration and population growth, will strain resources immensely. So if you don't feel like competing with IMGs and others……seriously get over yourselves. We need more doctors, and if quality residency spots can be opened up…then i say let them do it. I would rather have more qualified doctors out there then a flood of more PAs and FNPs who will no longer be monitored (or at least not as much).

Your salaries are going to be fine….people will still get sick, and you will still be paid….the sky won't fall if this passes.

Plus some people said it best up top….no way that expanded GME gets passed when hard core fiscal conservatives hold the purse strings….lol you have a better chance of winning the lottery

 

[username456789]

For those of you saying that it will flood the market…you are not looking at the big picture here. Revised projections that just came out this year put the physician shortage at a little under 100,000 by 2020. Even this huge number of residency increase is a drop in the pond, there will STILL be a huge shortage. You also need to realize that nearly 20-30 million more people will be added to rolls over the next 5 years, along with a large majority of baby boomer docs retiring. This, combined with immigration and population growth, will strain resources immensely. So if you don't feel like competing with IMGs and others……seriously get over yourselves. We need more doctors, and if quality residency spots can be opened up…then i say let them do it. I would rather have more qualified doctors out there then a flood of more PAs and FNPs who will no longer be monitored (or at least not as much).

Your salaries are going to be fine….people will still get sick, and you will still be paid….the sky won't fall if this passes.

Plus some people said it best up top….no way that expanded GME gets passed when hard core fiscal conservatives hold the purse strings….lol you have a better chance of winning the lottery

...except there really isn't much of a physician shortage at all. There's a physician distribution problem.

 

[AsclepiusMD]

I really hope this doesn't go through. Inflation in residency positions will create far too much competition for attending positions. The last thing we need for $200K+ debt-holders is a situation like the PhD-milling that occurs in the scientific community.

 

[jakeislove]

I really hope this doesn't go through. Inflation in residency positions will create far too much competition for attending positions. The last thing we need for $200K+ debt-holders is a situation like the PhD-milling that occurs in the scientific community.

What's wrong with competition?

 

[DermViser]

I really hope this doesn't go through. Inflation in residency positions will create far too much competition for attending positions. The last thing we need for $200K+ debt-holders is a situation like the PhD-milling that occurs in the scientific community.

You'll change your tune, when you're an MS-4.

 

[Mad Jack]

I really hope this doesn't go through. Inflation in residency positions will create far too much competition for attending positions. The last thing we need for $200K+ debt-holders is a situation like the PhD-milling that occurs in the scientific community.

I'm assuming you mean academic attending positions? You realize all of these new residencies would require new attendings to oversee them right? The current attendings can only look after a gaggle of interns and residents of a certain size, after all. And that, should you fail to find an academic position (no idea why anyone in their right mind would want one anyway), there are plenty of employed and private practice positions out there? This isn't nearly enough slots to completely flood the market with physicians.

 

[jakeislove]

You'll change your tune, when you're an MS-4.

Do you believe people think they're so awesome that they'll get a residency no matter how man slots are available? Not being antagonistic. I'm sincerely curious if US pre-med students really think a projected excess of US MD/DO graduates for available residency positions can not possibly affect them.

 

[DermViser]

Do you believe people think they're so awesome that they'll get a residency no matter how man slots are available? Not being antagonistic. I'm sincerely curious if US pre-med students really think a projected excess of US MD/DO graduates for available residency positions can not possibly affect them.

Pretty much. Medical students these days, are considered to be a highly entitled lot.

 

[el_duderino]

Pretty much. Medical students these days, are considered to be a highly entitled lot.

http://en.wikipedia.org/wiki/Weasel_word

 

[DermViser]

http://en.wikipedia.org/wiki/Weasel_word

I'm trying to be nice, by not outright accusing, but the term "millenial medical student" can be found in the literature.

 

[jakeislove]

Pretty much. Medical students these days, are considered to be a highly entitled lot.

I didn't know the fantasy extended to pre-med and only ask out of morbid curiosity. It's difficult to believe people still feel things are guaranteed in life.

I wouldn't advise someone to begin offshore especially considering the advice we're being given in the hospitals.

Though not necessarily an optimist, I believe they'll have to increase slots next year. US school enrollment would suffer if too many graduates didn't get residencies. There's probably a magic number students can tolerate or dismiss as being exceptions to the rule, stupid, inferior, or whatever makes them feel better.

 

[DermViser]

I didn't know the fantasy extended to pre-med and only ask out of morbid curiosity. It's difficult to believe people still feel things are guaranteed in life.

I wouldn't advise someone to begin offshore especially considering the advice we're being given in the hospitals.

Though not necessarily an optimist, I believe they'll have to increase slots next year. US school enrollment would suffer if too many graduates didn't get residencies. There's probably a magic number students can tolerate or dismiss as being exceptions to the rule, stupid, inferior, or whatever makes them feel better.

That's the main reason the AAMC is clamoring for more residency spots. The AAMC told med schools to increase enrollment -- so they did. Now residency spots need to open up on the other end. Now, whether they will be in specialties that US med students want, is a whole another story.

 

[jakeislove]

That's the main reason the AAMC is clamoring for more residency spots. The AAMC told med schools to increase enrollment -- so they did. Now residency spots need to open up on the other end. Now, whether they will be in specialties that US med students want, is a whole another story.

Nothing changes in American politics until stay at home Moms get pissed, LOL! Only half-joking but when middle class families basically say "We did everything to put little Johnny through medical school and now you're telling us there aren't enough residencies? Are we going to lose our house when he can't pay back those loans?!" someone who truly cares about getting re-elected (to advance their own agenda) will do something.

 

[DermViser]

Nothing changes in American politics until stay at home Moms get pissed, LOL! Only half-joking but when middle class families basically say "We did everything to put little Johnny through medical school and now you're telling us there aren't enough residencies? Are we going to lose our house when he can't pay back those loans?!" someone who truly cares about getting re-elected (to advance their own agenda) will do something.

For all intents and purposes, a physician education cost is out of reach for a middle class family. They've moved on to NP and PA school, esp. if they desire to go for something like FM, Gen Peds, Gen IM.

 

[jakeislove]

For all intents and purposes, a physician education cost is out of reach for a middle class family. They've moved on to NP and PA school, esp. if they desire to go for something like FM, Gen Peds, Gen IM.

Only time will tell.

I don't believe someone who truly wants to be a doctor will be satisfied in another medical context. Besides, "Hope springs eternal... " People get married on a daily basis despite the divorce rate being around 50%. Perhaps medical school is like marriage, LOL! 🙂

 

[DermViser]

Only time will tell.

I don't believe someone who truly wants to be a doctor will be satisfied in another medical context. Besides, "Hope springs eternal... " People get married on a daily basis despite the divorce rate being around 50%. Perhaps medical school is like marriage, LOL! 🙂

With increasing scope of practice of other professions, NP or PA, there are very much viable, and more affordable alternatives.

 

[el_duderino]

Only time will tell.

I don't believe someone who truly wants to be a doctor will be satisfied in another medical context. Besides, "Hope springs eternal... " People get married on a daily basis despite the divorce rate being around 50%. Perhaps medical school is like marriage, LOL! 🙂

With a few exceptions, I agree. I was asked in an interview why I wanted to go to medical school instead of becoming a nurse or PA, since those are cheaper, quicker, and still allow you to provide care to people.

 

[jakeislove]

With increasing scope of practice of other professions, NP or PA, there are very much viable, and more affordable alternatives.

I don't know if viability, scope of practice, affordable, etc.... are even considerations for medical students. Especially when it's taken into account that many don't look at being a doctor as a job.

The people I know becoming NPs were RNs first and wanted to do more.

The PAs I've met wanted to become PAs first because the pay is good, allows starting a family sooner, and the availability of positions. The students didn't need to know the same volume of information as us but seemed pretty happy.

 

[DermViser]

I don't know if viability, scope of practice, affordable, etc.... are even considerations for medical students. Especially when it's taken into account that many don't look at being a doctor as a job.

The people I know becoming NPs were RNs first and wanted to do more.

The PAs I've met wanted to become PAs first because the pay is good, allows starting a family sooner, and the availability of positions. The students didn't need to know the same volume of information as us but seemed pretty happy.

Yes, bc we all know that your typical millenial medical student taking in 6 figure debt sees medicine as a "calling". You've got to be kidding me.

 

[DermViser]

With a few exceptions, I agree. I was asked in an interview why I wanted to go to medical school instead of becoming a nurse or PA, since those are cheaper, quicker, and still allow you to provide care to people.

And as usual everyone lies with this question.

 

[el_duderino]

And as usual everyone lies with this question.

I dunno how true that is. In my case, I absolutely didn't lie. Maybe you did. Only you know for sure.

 

[jakeislove]

Yes, bc we all know that your typical millenial medical student taking in 6 figure debt sees medicine as a "calling". You've got to be kidding me.

Maybe you've hit on the goal! When all the money, lifestyle, and prestige are taken out of medicine only those people who feel it's a calling will be caring for patients.

 

[DermViser]

I dunno how true that is. In my case, I absolutely didn't lie. Maybe you did. Only you know for sure.

Was never asked that question on my med school interviews. That being said, most traditional med students haven't explored those options.

 

[DermViser]

Maybe you've hit on the goal! When all the money, lifestyle, and prestige are taken out of medicine only those people who feel it's a calling will be caring for patients.

Take all those things away, then the best and the brightest won't do medicine. Even the biggest dolt knows that Obamacare is not good for doctors.

 

[Mad Jack]

Take all those things away, then the best and the brightest won't do medicine. Even the biggest dolt knows that Obamacare is not good for doctors.

There's a *chance* it'll be good for some physicians, such as those in primary care. It is still too early to tell if PCPs will benefit though. But specialists are definitely getting boned.

 

[Mad Jack]

And as usual everyone lies with this question.

It's any easy question to not lie to though. "I want more autonomy than the PA or NP path would provide. I want to be a leader in health care..." etc etc etc. Why would anyone have to lie?

 

[DermViser]

There's a *chance* it'll be good for some physicians, such as those in primary care. It is still too early to tell if PCPs will benefit though. But specialists are definitely getting boned.

Actually, no it won't. Perfect example: Obamacare was supposed to bring Medicaid reimbursement rates up on par with Medicare so that primary care physicians see more of the those patients. Simple enough, right? Guess what? It's been delayed.

Also, if your idea of being good to primary care physicians is by advocating PAs and NPs (which is what Obamacare does), then I would hate to see what hurting is. Obamacare aims for primary care physicians to be more managers of a PCMH (Primary Care Medical Home).

 

[DermViser]

It's any easy question to not lie to though. "I want more autonomy than the PA or NP path would provide. I want to be a leader in health care..." etc etc etc. Why would anyone have to lie?

Except physicians don't have and are continuing to lose autonomy. Also, NPs in many states have complete autonomy as well. With PAs, it's not as if the physician is peering over their shoulder when they do PEs. They sign charts.

 

[el_duderino]

Except physicians don't have and are continuing to lose autonomy. Also, NPs in many states have complete autonomy as well. With PAs, it's not as if the physician is peering over their shoulder when they do PEs. They sign charts.

As much as they're "losing autonomy" they're still the leaders of the health care team, and PAs and NPs don't have the ability to practice truly independently. PAs and NPs are called midlevels for a reason. You can't pretend their authority or responsibility is as great as a physician's.

 

[DermViser]

As much as they're "losing autonomy" they're still the leaders of the health care team, and PAs and NPs don't have the ability to practice truly independently. PAs and NPs are called midlevels for a reason. You can't pretend their authority or responsibility is as great as a physician's.

Again, in many states NPs can practice COMPLETELY independently and autonomously and do not work under a physician. New York is the latest example. Physicians being "leaders" of the health care team is only allowed as much as scope of practice laws allow. It has nothing to do with the education of a physician.

 

[jakeislove]

Take all those things away, then the best and the brightest won't do medicine. Even the biggest dolt knows that Obamacare is not good for doctors.

The best and brightest might better be determined by intent than standardized test scores.

I think a part of the problem is people thinking the world owes them something for becoming a doctor.

Obamacare isn't intended to help doctors. Generally, I feel it's going to create more class warfare between doctors and laypeople. The average person doesn't need to know or care what it costs to provide medical care. I'm also of a mind that mid-levels are insurance against doctors being able to say no to the ACA.

 

[Mad Jack]

Actually, no it won't. Perfect example: Obamacare was supposed to bring Medicaid reimbursement rates up on par with Medicare so that primary care physicians see more of the those patients. Simple enough, right? Guess what? It's been delayed.

Also, if your idea of being good to primary care physicians is by advocating PAs and NPs (which is what Obamacare does), then I would hate to see what hurting is. Obamacare aims for primary care physicians to be more managers of a PCMH (Primary Care Medical Home).

The PCMH is a dream that has fallen through again and again. I honestly don't think it is going to ever come to fruition, but if it did, it would likely lead to an increase in PCP pay as they'd collect the revenues produced by a group of providers. The job would suck, but I can't see PCP pay decreasing after PCMH implementation. What level of a role NPs and PAs versus physicians have in the future is still up for debate- yes, more of them are being advocated for, but much like physicians, PAs and NPs don't much care for PCP work when they can do any number of other things instead. My bet is, they won't start to supplant PCPs until every other market (hospitalists, surgical units, specialist offices, MICUs, etc) is saturated.

Reimbursements have already been increased substantially in the medicaid population- yeah, future talks on rates have stalled, but things are happening at the state level in my state after the number of providers accepting medicaid doubled in a year. So even if things don't pan out at the federal level, it is possible that the states will step up to the plate.

 

[DermViser]

The best and brightest might better be determined by intent than standardized test scores.

I think a part of the problem is people thinking the world owes them something for becoming a doctor.

Obamacare isn't intended to help doctors. Generally, I feel it's going to create more class warfare between doctors and laypeople. The average person doesn't need to know or care what it costs to provide medical care. I'm also of a mind that mid-levels are insurance against doctors being able to say no to the ACA.

Not when patients start dying left and right. You can bet the public will get pissed when congressmen and bigwigs get MDs for their care and the public gets NPs/PAs. The only reason physicians are as protected as they are is bc the general public wants their doctor. Look at the big ruckus about "If you want to keep your doctor".

 

[DermViser]

The PCMH is a dream that has fallen through again and again. I honestly don't think it is going to ever come to fruition, but if it did, it would likely lead to an increase in PCP pay as they'd collect the revenues produced by a group of providers. The job would suck, but I can't see PCP pay decreasing after PCMH implementation. What level of a role NPs and PAs versus physicians have in the future is still up for debate- yes, more of them are being advocated for, but much like physicians, PAs and NPs don't much care for PCP work when they can do any number of other things instead. My bet is, they won't start to supplant PCPs until every other market (hospitalists, surgical units, specialist offices, MICUs, etc) is saturated.

Reimbursements have already been increased substantially in the medicaid population- yeah, future talks on rates have stalled, but things are happening at the state level in my state after the number of providers accepting medicaid doubled in a year. So even if things don't pan out at the federal level, it is possible that the states will step up to the plate.

A dream? It's already being implemented with ACOs, bundled payments, etc. Also, how long do you think states can handle the increased strain on their budget? Spoiler alert: They can't.

 

[Mad Jack]

Except physicians don't have and are continuing to lose autonomy. Also, NPs in many states have complete autonomy as well. With PAs, it's not as if the physician is peering over their shoulder when they do PEs. They sign charts.

The PAs I worked with were certainly not fully autonomous. Any major change to the patient's treatment plan required a call to the attending. They handled scut work- entering orders, sitting in the unit while the physicians were in surgery to make sure things were going smoothly, putting in A-lines and central lines when there were no residents were available, etc. All real decisions fell on the attendings, and any reasonably complex procedure was theirs to perform.

The PAs basically had the life of an intern or resident. Forever. Management positions are basically unavailable to them, they have minimal opportunities for research, they can never craft institutional policies, and so on and so forth. They can't teach, and they don't get full partnership in the medical group, which precludes them from helping direct medical group policy. How is that in any way comparable or equal to a physician in autonomy?

And as to nurses, that's simple. I wanted to learn medicine, not nursing. A nurse can be as autonomous as they like, but at the end of the day, they're still a nurse practicing nursing.

 

[DermViser]

The PAs I worked with were certainly not fully autonomous. Any major change to the patient's treatment plan required a call to the attending. They handled scut work- entering orders, sitting in the unit while the physicians were in surgery to make sure things were going smoothly, putting in A-lines and central lines when there were no residents were available, etc. All real decisions fell on the attendings, and any reasonably complex procedure was theirs to perform.

The PAs basically had the life of an intern or resident. Forever. Management positions are basically unavailable to them, they have minimal opportunities for research, they can never craft institutional policies, and so on and so forth. They can't teach, and they don't get full partnership in the medical group, which precludes them from helping direct medical group policy. How is that in any way comparable or equal to a physician in autonomy?

And as to nurses, that's simple. I wanted to learn medicine, not nursing. A nurse can be as autonomous as they like, but at the end of the day, they're still a nurse practicing nursing.

Funny how you go to the PA argument. Stay on point. Nurse Practioners doing H&Ps and writing prescriptions aren't practice nursing. They're practicing medicine, and they're able to do so autonomously. You know that PAs can work in an outpatient setting and can work in a variety of specialties, not just surgery or primary care, and not just at academic medical centers, right?

 

[Mad Jack]

A dream? It's already being implemented with ACOs, bundled payments, etc. Also, how long do you think states can handle the increased strain on their budget? Spoiler alert: They can't.

Every attempt at it in my state has failed thusfar. Perhaps the model has proven successful elsewhere, but no practices in my area are adopting it, and the only ones I know of that were a part of the pilot dropped the model after the project was over.

 

[DermViser]

Every attempt at it in my state has failed thusfar. Perhaps the model has proven successful elsewhere, but no practices in my area are adopting it, and the only ones I know of that were a part of the pilot dropped the model after the project was over.

Considering the Obamacare is based off of the PCMH, it will start being adopted once it's critical for getting reimbursement.

 

[el_duderino]

Funny how you go to the PA argument. Stay on point. Nurse Practioners doing H&Ps and writing prescriptions aren't practice nursing. They're practicing medicine, and they're able to do so autonomously. You know that PAs can work in an outpatient setting and can work in a variety of specialties, not just surgery or primary care, and not just at academic medical centers, right?

Do you wish you had become an NP instead of MD?

 

[Mad Jack]

Funny how you go to the PA argument. Stay on point. Nurse Practioners doing H&Ps and writing prescriptions aren't practice nursing. They're practicing medicine, and they're able to do so autonomously. You know that PAs can work in an outpatient setting and can work in a variety of specialties, not just surgery or primary care, and not just at academic medical centers, right?

But only a physician has maximum autonomy in any given setting. A nurse may be autonomous in a few states and particular practice settings, but they're practicing nursing (in a legal sense), with an inferior nursing education. I don't want to be autonomously practicing nursing with an inferior education at a primary care clinic in Nodak. I want to have the option to be autonomous in the field of my choice, in the state of my choice, with the best medical education available.

Also NPs act identically to PAs at my former employer, they're all lumped together as MLPs and employed by the medical group, so the same arguments apply in that regard.

 

[DermViser]

Do you wish you had become an NP instead of MD?

With my specific specialty, no. If I was an FM doc, then yes, as the ROI would not be worth it.

 

[DermViser]

But only a physician has maximum autonomy in any given setting. A nurse may be autonomous in a few states and particular practice settings, but they're practicing nursing (in a legal sense), with an inferior nursing education. I don't want to be autonomously practicing nursing with an inferior education at a primary care clinic in Nodak. I want to have the option to be autonomous in the field of my choice, in the state of my choice, with the best medical education available.

Also NPs act identically to PAs at my former employer, they're all lumped together as MLPs and employed by the medical group, so the same arguments apply in that regard.

It's "nursing" in name only.

 

[jakeislove]

Not when patients start dying left and right. You can bet the public will get pissed when congressmen and bigwigs get MDs for their care and the public gets NPs/PAs. The only reason physicians are as protected as they are is bc the general public wants their doctor. Look at the big ruckus about "If you want to keep your doctor".

"People are dying because doctors are greedy and want too much money" is all they have to say. 🙂 People will believe it and no amount math or logic will help people understand that someone with $400K+ in debt can afford to participate.

^ That's another reason why I feel they'll be obligated to increase residency slots. It'll make residents available to patients, indenture more doctors to public service, and put pressure on people in private practice to bend over.

 

[maxxor]

It's "nursing" in name only.

It's practicing medicine without a medical license.

 

[DermViser]

"People are dying because doctors are greedy and want too much money" is all they have to say. 🙂 People will believe it and no amount math or logic will help people understand that someone with $400K+ in debt can afford to participate.

^ That's another reason why I feel they'll be obligated to increase residency slots. It'll make residents available to patients, indenture more doctors to public service, and put pressure on people in private practice to bend over.

Why would doctors be blamed for NPs f'ing up? They're already pissed they can't keep their old doctor, if they like their doctor.

 

[DermViser]

It's practicing medicine without a medical license.

Which is why they want no oversight from medicine. Their license falls under the nursing board and thus medicine has no right to mandate them completing residencies, taking a licensure exam, etc. bc they are practicing "nursing".

 

[Mad Jack]

It's "nursing" in name only.

You and I know that it's just semantics, but drawing lines like that works for the "why medicine" question. I could argue that, by virtue of their significantly inferior education, they are not practicing medicine in any real sense of the word. Any more than an automotive technician is practicing the same craft as an automotive engineer when both are building engines. They're no more practicing medicine than a child with a paint-by-numbers watercolor of Starry Night is an artist.

I really should have had a cup of coffee before I started debating and crafting analogies lol.