'Shortage of residency slots may have chilling effect on next generation of physicians'

[W19]

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It ain't getting any better... They should add 2 more years residency to every specialty and demand all physicians to be board re-certified every 5 years... [sarcasm]

http://thehill.com/blogs/congress-blog/healthcare/266610-shortage-of-residency-slots-may-have-chilling-effect-on-next?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+TheHillCongressBlog+(The+Hill:+Congress+Blog)

 

[SouthernSurgeon]

http://www.nejm.org/doi/full/10.1056/NEJMp1511707

 

[chipwhitley]

Honestly there's only a shortage if you happen to be an IMG. We really should do something to stop people from being conned by many of these newly opened shady offshore schools that prey on young people's dreams.

 

[CherryRedDracul]

"If this imbalance is not addressed, the number of American MD and DO graduates will exceed the number of first-year residency positions, which by some estimates could occur as soon as 2017."

A citation for this would be very nice because based on the current data, this scenario is outlandish.

 

[Goro]

Indeed. we could open at least ten new medical schools with a 100 students a pop and it wouldn't make a dent in the shortfall of candidates.

With the Baby Boom generation of doctors retiring over the next decade, there will be an even great need of doctors in the US.

And unlike the Millennials, us old folks vote. Congress knows this.

"If this imbalance is not addressed, the number of American MD and DO graduates will exceed the number of first-year residency positions, which by some estimates could occur as soon as 2017."

A citation for this would be very nice because based on the current data, this scenario is outlandish.[/QUOTE]

 

[ski89]

Every community needs an Eeore.. SDNs is @W19

 

[psychMDhopefully]

Isn't something like 6000 spots still taken my IMGs and Caribs? Honestly though, somebody does need to stop the DO schools from proliferating like rabbit. How may LECOMS and Touros are there now? 12?

 

[Anicetus]

Isn't something like 6000 spots still taken my IMGs and Caribs? Honestly though, somebody does need to stop the DO schools from proliferating like rabbit. How may LECOMS and Touros are there now? 12?

I am not a fan of this outlook. Most of those spots are in crappy undesirable locations. Shipping me out to South Dakota where I have no desire to live because I'm subpar as a med student sounds like slavery.

 

[Reckoner]

Shipping me out to South Dakota where I have no desire to live because I'm subpar as a med student sounds like slavery.

No it doesn't

 

[ski89]

I am not a fan of this outlook. Most of those spots are in crappy undesirable locations. Shipping me out to South Dakota where I have no desire to live because I'm subpar as a med student sounds like slavery.

Lol yeah sacrificing a few years in an undesirable location in order to gain a skill set that commands a 6 figure salary sounds just like slavery.. You poor thing.

 

[libraryismyhome]

So if one goes to an undesirable location, one would not settle in an undesirable location after residency. Then whats the point of sending subpar students to undesirable places?

 

[the argus]

I'm not naive enough to be surprised by this, but I still find it incredibly disheartening that the dean of a US medical school will be so blatantly dishonest.

"If this imbalance is not addressed, the number of American MD and DO graduates will exceed the number of first-year residency positions, which by some estimates could occur as soon as 2017"

We don't need estimates for this! The number of USMD and DO graduates in 2017 is already known, as they are currently in school as MS3. And the number is nowhere near equalling the number of first year residency positions. What a dickhead. Students of Quinnipiac should let him know what a dickhead he is and demand a higher standard from their school leadership.

 

[Brorthopedic]

So if one goes to an undesirable location, one would not settle in an undesirable location after residency. Then whats the point of sending subpar students to undesirable places?

Call me crazy but I guess some people want to be physicians just for the sake of helping others

 

[Mad Jack]

So if one goes to an undesirable location, one would not settle in an undesirable location after residency. Then whats the point of sending subpar students to undesirable places?

Statistically, residents are far more likely to end up staying where they train than to relocate to some middle of nowhere location they've never been post-residency. As much as people may hate these places initially, some of them- not all, but some- will start to set down roots, meeting people they care about, becoming integrated in the community, etc. And, for many, it is the first time they have ever experienced small town living, which some people surprisingly find they enjoy.

 

[Mad Jack]

I am not a fan of this outlook. Most of those spots are in crappy undesirable locations. Shipping me out to South Dakota where I have no desire to live because I'm subpar as a med student sounds like slavery.

 

[libraryismyhome]

Statistically, residents are far more likely to end up staying where they train than to relocate to some middle of nowhere location they've never been post-residency. As much as people may hate these places initially, some of them- not all, but some- will start to set down roots, meeting people they care about, becoming integrated in the community, etc. And, for many, it is the first time they have ever experienced small town living, which some people surprisingly find they enjoy.

But seriously south dakota? That's like being rich in developing countries. Would their spouses want to live there? Would they be willing to send their kids to schools in dakota and end up in community colleges or second tier state schools? Most medical professionals care a lot about their kids education and environment since that's what they learn all the time during doctoring, humanity, and health disparity courses..

 

[Mad Jack]

But seriously south dakota? That's like being rich in developing countries. Would their spouses want to live there? Would they be willing to send their kids to schools in dakota and end up in community colleges or second tier state schools? Most medical professionals care a lot about their kids education and environment since that's what they learn all the time during doctoring, humanity, and health disparity courses..

Your high school doesn't doom you to some second tier state school, so long as you do well on the SAT and ACT. It's always been amusing to me, the assumptions made on SDN about how private high school is basically a must for future success- my no-name public high school in a rural county in Washington state has turned out many physicians, engineers, and lawyers. As to their spouse wanting to live there, what if they were single when they started and meet their spouse there? What if they don't want children, a decision well-off millennials are making more and more?

I mean, I'm not saying it is ideal, I'm just saying that the data points to people doing rural residencies staying to practice an absurdly high percentage of the time. And it's not like you'll be in some tiny town with one stop light- Sioux Falls and Rapid City are the only two places with residencies in SD, both of which have metro populations of over 100k, as well as private schools and the like if that's your thing.

 

[libraryismyhome]

Your high school doesn't doom you to some second tier state school, so long as you do well on the SAT and ACT. It's always been amusing to me, the assumptions made on SDN about how private high school is basically a must for future success- my no-name public high school in a rural county in Washington state has turned out many physicians, engineers, and lawyers. As to their spouse wanting to live there, what if they were single when they started and meet their spouse there? What if they don't want children, a decision well-off millennials are making more and more?

I mean, I'm not saying it is ideal, I'm just saying that the data points to people doing rural residencies staying to practice an absurdly high percentage of the time. And it's not like you'll be in some tiny town with one stop light- Sioux Falls and Rapid City are the only two places with residencies in SD, both of which have metro populations of over 100k, as well as private schools and the like if that's your thing.

I see your points. When i was a teenager, My parents brought me to usa for the pursuit of educational opportunities. Therefore, to me, i would feel guilty for making my future spouse and children to live in areas that offer worse amenities than my current area.

There could be plenty of middle class or uppermiddle class jobs such as engineers and doctors after living in areas like south dakota.
However, they wont be mit, caltech grads and doctors wouldnt be ivy grads. There would be very few lawyers working in major city law firms or professionals working in wall street.

And the scary thing is that since no one is as successful as these people with middle class jobs, they will be complacent.

Since my parents successfully settled as middle class in usa, and i will be upper middle, my future children must have the opportunities to climb higher than upper middle class jobs.

But again, these are my family values. I don't think there are right or wrong answers.

 

[Med Ed]

I'm not naive enough to be surprised by this, but I still find it incredibly disheartening that the dean of a US medical school will be so blatantly dishonest.

"If this imbalance is not addressed, the number of American MD and DO graduates will exceed the number of first-year residency positions, which by some estimates could occur as soon as 2017"

We don't need estimates for this! The number of USMD and DO graduates in 2017 is already known, as they are currently in school as MS3. And the number is nowhere near equalling the number of first year residency positions. What a dickhead. Students of Quinnipiac should let him know what a dickhead he is and demand a higher standard from their school leadership.

The 2017 apocalypse was a scenario previously put forth by the NRMP itself and disseminated at national meetings up until around 2013. With the all-in policy and some middle growth of residency positions this projection changed.

 

[Mad Jack]

I see your points. When i was a teenager, My parents brought me to usa for the pursuit of educational opportunities. Therefore, to me, i would feel guilty for making my future spouse and children to live in areas that offer worse amenities than my current area.

There could be plenty of middle class or uppermiddle class jobs such as engineers and doctors after living in areas like south dakota.
However, they wont be mit, caltech grads and doctors wouldnt be ivy grads. There would be very few lawyers working in major city law firms or professionals working in wall street.

And the scary thing is that since no one is as successful as these people with middle class jobs, they will be complacent.

Since my parents successfully settled as middle class in usa, and i will be upper middle, my future children must have the opportunities to climb higher than upper middle class jobs.

But again, these are my family values. I don't think there are right or wrong answers.

Hey, everybody's got different values.

Personally, I'm all about happiness. Money can't buy it, nor can a fancy position, parental approval, or a name on your diploma. Those things may be what you derive satisfaction from, but happiness is another thing entirely. Happiness is sort of this elusive thing that you find in the strangest places- your kids' smiles, a shift ending early, a dog being sososososo happy to see you when you get home, the season premier of your favorite show, whatever. It's different for everybody.

Those big goals can land you with a big name position you hate, parents that are thrilled with you for doing a job you loathe, and a bunch of money you never get the time to enjoy because you're so busy chasing the next big thing. They can also lead you into great and satisfying opportunities, and a life you truly enjoy and find fulfillment from. Ultimately success, prestige, money, and pleasing your family may or may not bring you happiness. And a lot of people that go to these rural residencies, well, they probably realize that they don't need all that other stuff (aside from the money, which they'll make more than their big city counterparts while also having a substantially lower cost of living). So I guess that's my take on it.

 

[Slack3r]

I am not a fan of this outlook. Most of those spots are in crappy undesirable locations. Shipping me out to South Dakota where I have no desire to live because I'm subpar as a med student sounds like slavery.

Easy solution: do better.

 

[DOFOSHO]

So if one goes to an undesirable location, one would not settle in an undesirable location after residency. Then whats the point of sending subpar students to undesirable places?

 

[Stagg737]

But seriously south dakota? That's like being rich in developing countries. Would their spouses want to live there? Would they be willing to send their kids to schools in dakota and end up in community colleges or second tier state schools? Most medical professionals care a lot about their kids education and environment since that's what they learn all the time during doctoring, humanity, and health disparity courses..

Keep in mind the Dakotas are actually two of the more financially profitable states to practice in. COL is low, income is high (due to the need to attracts docs), and from the data I've seen malpractice and other costs are low. It's one of the few places that you could start paying off decent amounts of student debt and still have a pretty reasonable lifestyle. Not saying I want to end up there, but there's definitely positives to almost any location if you look for them.

 

[WingedOx]

But seriously south dakota? That's like being rich in developing countries. Would their spouses want to live there? Would they be willing to send their kids to schools in dakota and end up in community colleges or second tier state schools? Most medical professionals care a lot about their kids education and environment since that's what they learn all the time during doctoring, humanity, and health disparity courses..

Dude, have you ever actually been to the Dakotas?

 

[KnuxNole]

I see your points. When i was a teenager, My parents brought me to usa for the pursuit of educational opportunities. Therefore, to me, i would feel guilty for making my future spouse and children to live in areas that offer worse amenities than my current area.

There could be plenty of middle class or uppermiddle class jobs such as engineers and doctors after living in areas like south dakota.
However, they wont be mit, caltech grads and doctors wouldnt be ivy grads. There would be very few lawyers working in major city law firms or professionals working in wall street.

And the scary thing is that since no one is as successful as these people with middle class jobs, they will be complacent.

Since my parents successfully settled as middle class in usa, and i will be upper middle, my future children must have the opportunities to climb higher than upper middle class jobs.

But again, these are my family values. I don't think there are right or wrong answers.

Less than 1% of people would me MIT/Cal tech engineers so that point is moot, same for docs from ivy league schools or Wall Street(especially Wall street, a crappy place!). Even if you lived in a huge city, there is an extremely high chance that would never happen anyway.

 

[FindMeOnTheLinks]

Small-town Midwest is probably one of the most gratifying places to live. It makes you realize that money, cars, clothes etc is not what really matters. It's really hard to understand unless you've lived it. I've lived in all kinds of places from a big city on the east coast and southeast, to medium Midwest cities, down to 5000-person rural communities. My favorite place easily was the small town. I guess it's personality dependent, but don't knock it till you try it. I for one plan to move to a rural-ish location once I am an attending.

 

[CherryRedDracul]

Lol yeah sacrificing a few years in an undesirable location in order to gain a skill set that commands a 6 figure salary sounds just like slavery.. You poor thing.

#firstworldproblems

 

[Anicetus]

Lol yeah sacrificing a few years in an undesirable location in order to gain a skill set that commands a 6 figure salary sounds just like slavery.. You poor thing.

Who said its only for a few years? Sometimes people get stuck there because they get offered a deal they can't really turn down. Then they are stuck in a small town that lacks diversity, lacks good food (no the barfood, burger joint, and subpar sushi place that gets their frozen fish shipped in from hundreds of miles away don't count as good food), and surrounded by fields and farmland. Coming from major cities on the coast my whole life, that does sound like slavery to me. I could otherwise try to brainwash myself into thinking its a content life being in a small town that's mostly white and black people, and keep thinking that good bbq joints make up for lack of food diversity. I could also keep making myself feel better by finding my small city or town on buzzfeed "top 21 places to eat or live", which seem like a scam to get people out of the much better, saturated cities on the coasts.

 

[jeffk805dent]

Small-town Midwest is probably one of the most gratifying places to live. It makes you realize that money, cars, clothes etc is not what really matters. It's really hard to understand unless you've lived it. I've lived in all kinds of places from a big city on the east coast and southeast, to medium Midwest cities, down to 5000-person rural communities. My favorite place easily was the small town. I guess it's personality dependent, but don't knock it till you try it. I for one plan to move to a rural-ish location once I am an attending.

I feel small town places anywhere in the US are one of the most gratifying places to live. The atmosphere in Kingman, AZ is a lot more relaxed than Los Angeles, CA. Kind of wish food and culture was a little more diverse though.

 

[Mad Jack]

Who said its only for a few years? Sometimes people get stuck there because they get offered a deal they can't really turn down. Then they are stuck in a small town that lacks diversity, lacks good food (no the barfood, burger joint, and subpar sushi place that gets their frozen fish shipped in from hundreds of miles away don't count as good food), and surrounded by fields and farmland. Coming from major cities on the coast my whole life, that does sound like slavery to me. I could otherwise try to brainwash myself into thinking its a content life being in a small town that's mostly white and black people, and keep thinking that good bbq joints make up for lack of food diversity. I could also keep making myself feel better by finding my small city or town on buzzfeed "top 21 places to eat or live", which seem like a scam to get people out of the much better, saturated cities on the coasts.

The towns these places are in aren't microscopic- Sioux falls has a metro population of 228,000, and actually has some great places to eat. Your idea of what the Midwest is and what it actually is are very different things, basically. It does have less diversity than a big city, so it'd be a hard place to live if you're not white and crave your native culture, that I get. But I'm in Maine, and I'll tell you- a lot of the people in my class came from big cities and they were shocked at how awesome Portland and the surrounding area is. There's a ton of great bars, some of the best places to eat I've ever been to in my life (and I've been all over, in this country and others, big cities and small), and low cost of living. Plus the people are all crazy nice, something you don't get a lot of in the city, the outdoors are way more fun than most people realized (we've got a bunch of classmates that regularly surf well into the winter, wearing wetsuits and the like), etc etc.

I was actually quite skeptical about whether I would enjoy Maine, as I picked it over Touro-Harlem, which would have put me in the city, but it was the best decision I ever made. There's a lot of people that feel the same way after being up here for a couple years, it kind of snaps you out of the Northeast mentality and makes you realize there's more to life and that all the things you thought really mattered are either available elsewhere or weren't that big of a deal to begin with. As to living in smaller cities being a "scam," trust me, I know a lot of people that have had kids and relocated to places like Colorado and North Carolina, and not a single one has come back. Not one. And that's after leaving behind everything, friends, extended family, job- the lifestyle is that much better.

 

[22031 Alum]

Who said its only for a few years? Sometimes people get stuck there because they get offered a deal they can't really turn down. Then they are stuck in a small town that lacks diversity, lacks good food (no the barfood, burger joint, and subpar sushi place that gets their frozen fish shipped in from hundreds of miles away don't count as good food), and surrounded by fields and farmland. Coming from major cities on the coast my whole life, that does sound like slavery to me. I could otherwise try to brainwash myself into thinking its a content life being in a small town that's mostly white and black people, and keep thinking that good bbq joints make up for lack of food diversity. I could also keep making myself feel better by finding my small city or town on buzzfeed "top 21 places to eat or live", which seem like a scam to get people out of the much better, saturated cities on the coasts.

The ironic thing is, this makes you sound just as provincial and ignorant as I'm sure you believe the "small town" folks are.

 

[ThoracicGuy]

Who said its only for a few years? Sometimes people get stuck there because they get offered a deal they can't really turn down. Then they are stuck in a small town that lacks diversity, lacks good food (no the barfood, burger joint, and subpar sushi place that gets their frozen fish shipped in from hundreds of miles away don't count as good food), and surrounded by fields and farmland. Coming from major cities on the coast my whole life, that does sound like slavery to me. I could otherwise try to brainwash myself into thinking its a content life being in a small town that's mostly white and black people, and keep thinking that good bbq joints make up for lack of food diversity. I could also keep making myself feel better by finding my small city or town on buzzfeed "top 21 places to eat or live", which seem like a scam to get people out of the much better, saturated cities on the coasts.

So you're saying that someone is stuck there because they accepted a job there? No one forced them to accept the job. Maybe they weighed the risks and benefits of taking that job, including the location, versus other jobs and picked the undesirable location. That doesn't make it slavery and that doesn't make them stuck. If they ended up not liking the place they can always move.

 

[PL198]

I see your points. When i was a teenager, My parents brought me to usa for the pursuit of educational opportunities. Therefore, to me, i would feel guilty for making my future spouse and children to live in areas that offer worse amenities than my current area.

There could be plenty of middle class or uppermiddle class jobs such as engineers and doctors after living in areas like south dakota.
However, they wont be mit, caltech grads and doctors wouldnt be ivy grads. There would be very few lawyers working in major city law firms or professionals working in wall street.

And the scary thing is that since no one is as successful as these people with middle class jobs, they will be complacent.

Since my parents successfully settled as middle class in usa, and i will be upper middle, my future children must have the opportunities to climb higher than upper middle class jobs.

But again, these are my family values. I don't think there are right or wrong answers.

Meet your clone W19

I pray you both are trolls.

 

[Mad Jack]

Meet your clone W19

I pray you both are trolls.

He's most likely legit, and has a worldview that is fairly common amongst the children of immigrants that have lived in a big city their entire lives. Nothing wrong with it- they just have different priorities in regard to their lives, and no idea what they're talking about in regard to everything that sits in between the costs care of not having lived there, leaving them with nothing but a handful of preconceived notions to operate off of.

 

[FindMeOnTheLinks]

I feel small town places anywhere in the US are one of the most gratifying places to live. The atmosphere in Kingman, AZ is a lot more relaxed than Los Angeles, CA. Kind of wish food and culture was a little more diverse though.

Agree. Small town anywhere is awesome. I don't know why I had to throw Midwest in there, probably because the topic at hand was the Dakotas specifically.

I would gladly do my residency in a rural location if it were an academic program but sadly academic centers just aren't located where there aren't many people!!!

 

[libraryismyhome]

Less than 1% of people would me MIT/Cal tech engineers so that point is moot, same for docs from ivy league schools or Wall Street(especially Wall street, a crappy place!). Even if you lived in a huge city, there is an extremely high chance that would never happen anyway.

Yes. You and i are gonna be docs so we are 5% at least so i would like to give my future kids the opportunities to be top 1%

 

[libraryismyhome]

He's most likely legit, and has a worldview that is fairly common amongst the children of immigrants that have lived in a big city their entire lives. Nothing wrong with it- they just have different priorities in regard to their lives, and no idea what they're talking about in regard to everything that sits in between the costs care of not having lived there, leaving them with nothing but a handful of preconceived notions to operate off of.

At least you have a broad sense of pov while these rural country lovers diss me for thinking differently. Sounds very much like trump supporters.

 

[jeffk805dent]

So you're saying that someone is stuck there because they accepted a job there? No one forced them to accept the job. Maybe they weighed the risks and benefits of taking that job, including the location, versus other jobs and picked the undesirable location. That doesn't make it slavery and that doesn't make them stuck. If they ended up not liking the place they can always move.

This is true. While I maybe ****ed (as a general dentist) my wife (oral surgeon) can easily find a job in saturated metro city with near ease. That to me sounds like the opposite of slavery.

 

[jeffk805dent]

Sounds very much like trump supporters.

obviously an n=1 case but most trump supporters I've met tend to be conservatives from suburban/metro areas. Scott Walker/Ted Cruz would have been a lot of small town conservatives dream

 

[PL198]

At least you have a broad sense of pov while these rural country lovers diss me for thinking differently. Sounds very much like trump supporters.

yes if you don't accept the fact that not living in a city of 1 million+ is slavery, you are clearly automatically a trump supporter.

I can't take you seriously

 

[CherryRedDracul]

yes if you don't accept the fact that not living in a city of 1 million+ is slavery, you are clearly automatically a trump supporter.

I can't take you seriously

😆😆😆

 

[Mad Jack]

I feel like there is a real disconnect between the sides here.

yes if you don't accept the fact that not living in a city of 1 million+ is slavery, you are clearly automatically a trump supporter.

I can't take you seriously

That's not what he was saying, he was saying your attack on his personal views simply because you disagree with and do not believe them to be legitimate makes you seem, to him, ignorant like a Trump supporter. People like him are very real, it's a common value that is imparted on the children of immigrant parents. "We sacrificed everything for you, we worked hard so that you can do well, so you owe us a professional career and a degree from the most prestigious school you can manage to get into." They're basically living vicariously through their kids, since they had to spend their lives building up the resources for their offspring to do the things that they wish they could have done, but were unable to do care of being born in another country.

 

[FiveOClock]

I don't see what is so difficult about this problem. The answer is to create a bill that creates more primary care spots and REMOVES spots for oversaturated specialities. The concentration of specialists in urban areas can easily be fixed by offering higher compensation to rural care. And of course, remove all bonuses given to procedures being performed in hospitals. The key to fixing healthcare in the future is to squeeze hospitals hard and make them cut ADMINISTRATION. Rather than consolidate (Obamacare-style) we need to be encouraging more private, solo practice that is cost effective rather than lining the American Hospital Associations pockets. Of course, Senate Democrats would never support such a proposal that gutted their buddies so hard. And the Republicans have Donald Trump, who supports a single-payer system.

 

[Mad Jack]

I don't see what is so difficult about this problem. The answer is to create a bill that creates more primary care spots and REMOVES spots for oversaturated specialities. The concentration of specialists in urban areas can easily be fixed by offering higher compensation to rural care. And of course, remove all bonuses given to procedures being performed in hospitals. The key to fixing healthcare in the future is to squeeze hospitals hard and make them cut ADMINISTRATION. Rather than consolidate (Obamacare-style) we need to be encouraging more private, solo practice that is cost effective rather than lining the American Hospital Associations pockets. Of course, Senate Democrats would never support such a proposal that gutted their buddies so hard. And the Republicans have Donald Trump, who supports a single-payer system.

For the record, Trump actually isn't for single payer. Here's a quote from him on the issue:

http://www.breitbart.com/big-govern...gle-payer-healthcare-tax-increase-on-wealthy/

Scott Pelley: The uninsured person is going to be taken care of. How? How?

Donald Trump: They’re going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably–

Scott Pelley: Make a deal? Who pays for it?

Donald Trump: —the government’s gonna pay for it. But we’re going to save so much money on the other side. But for the most it’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.

So basically, the government is going to pay for the uninsured, but private plans will cover everyone else. Basically he's saying he's going to rebrand Obamacare as Trumpcare with an added bonus of paying hospitals to care for the uninsured.

 

[ThoracicGuy]

I don't see what is so difficult about this problem. The answer is to create a bill that creates more primary care spots and REMOVES spots for oversaturated specialities. The concentration of specialists in urban areas can easily be fixed by offering higher compensation to rural care. And of course, remove all bonuses given to procedures being performed in hospitals. The key to fixing healthcare in the future is to squeeze hospitals hard and make them cut ADMINISTRATION. Rather than consolidate (Obamacare-style) we need to be encouraging more private, solo practice that is cost effective rather than lining the American Hospital Associations pockets. Of course, Senate Democrats would never support such a proposal that gutted their buddies so hard. And the Republicans have Donald Trump, who supports a single-payer system.

Congress doesn't set the number of residency positions per field. Some fields do well in limiting their numbers, such as pediatric surgery. Some fields don't and you get a glut of people and a hard time finding jobs sometimes. Where will you create these primary care spots and how will you get medical students to choose primary care instead of a specialty?

Rural positions already generally pay more to attract people. Urban positions are often lower paying as they already have a bunch of people competing for the same job offer they just don't have to offer as much.

 

[DokterMom]

I see your points. When i was a teenager, My parents brought me to usa for the pursuit of educational opportunities. Therefore, to me, i would feel guilty for making my future spouse and children to live in areas that offer worse amenities than my current area.

There could be plenty of middle class or uppermiddle class jobs such as engineers and doctors after living in areas like south dakota.
However, they wont be mit, caltech grads and doctors wouldnt be ivy grads. There would be very few lawyers working in major city law firms or professionals working in wall street.

And the scary thing is that since no one is as successful as these people with middle class jobs, they will be complacent.

Since my parents successfully settled as middle class in usa, and i will be upper middle, my future children must have the opportunities to climb higher than upper middle class jobs.

But again, these are my family values. I don't think there are right or wrong answers.

Less than 1% of people would me MIT/Cal tech engineers so that point is moot, same for docs from ivy league schools or Wall Street(especially Wall street, a crappy place!). Even if you lived in a huge city, there is an extremely high chance that would never happen anyway.

You're mistaken if you assume that living in a place like South Dakota will necessarily deny your future children opportunities. Do you know how many South Dakotans get into Harvard? OK, so maybe it's only 2 or 3. (Out of the 5 or 6 who apply -- so probably better odds than New Yorkers.)

You're defining success by someone's academic credentials and paycheck. I'm not suggesting those values are without merit, but they're so limited! Rural U.S. is not like rural India or rural China or rural Mexico where opportunities are scare -- particularly for young people with educated parents, the Internet, and a genuine curiosity to learn.

OK - So prosperity is new to you. For your children, it won't be. They will grow up rich with successful parents. But with what kind of value system? There are countless examples of 2nd-3rd generation immigrants becoming the spoiled rich kids everybody despises and accomplishing nothing. They're rich. Maybe they got into good schools -- they're done. The pressures to 'make good' on your parent's sacrifices don't apply to them (and won't fly coming from you), and if you've given them nothing more meaningful to hold onto -- well...

I'm just suggesting that becoming a 1%'er isn't really a goal worth striving for. Strive instead to make a difference.

 

[Mansamusa]

I don't see what is so difficult about this problem. The answer is to create a bill that creates more primary care spots and REMOVES spots for oversaturated specialities. The concentration of specialists in urban areas can easily be fixed by offering higher compensation to rural care. And of course, remove all bonuses given to procedures being performed in hospitals. The key to fixing healthcare in the future is to squeeze hospitals hard and make them cut ADMINISTRATION. Rather than consolidate (Obamacare-style) we need to be encouraging more private, solo practice that is cost effective rather than lining the American Hospital Associations pockets. Of course, Senate Democrats would never support such a proposal that gutted their buddies so hard. And the Republicans have Donald Trump, who supports a single-payer system.

Offering higher salary for rural jobs won't do much. Like I would never in a million years work in a rural place (unless it was just for residency and I could leave afterwards).

What should be done is recruit more rural students to med school and encourage city schools to create rural tracks to train these rural students- likes Tufts and Tulane and other schools have now. And then things could be done to expose students to rural health while in school- like Tulane requiring all students to do their family med rotation in rural Louisiana, Mississippi, and Alabama

 

[FiveOClock]

Congress doesn't set the number of residency positions per field. Some fields do well in limiting their numbers, such as pediatric surgery. Some fields don't and you get a glut of people and a hard time finding jobs sometimes. Where will you create these primary care spots and how will you get medical students to choose primary care instead of a specialty?

Rural positions already generally pay more to attract people. Urban positions are often lower paying as they already have a bunch of people competing for the same job offer they just don't have to offer as much.

Congress could easily adjust Medicare to fund new residency positions and defund others. Medical students will accept primary care spots or be unemployed, thats the whole point. If you cut the number of specialists positions, you make them more competitive. If the match rate for orthopedic surgery dropped to 20%, there would be a hell of lot less people applying. It will take a couple of cycles of students going unmatched and feeling that pain for people to get the message.

New primary care residency positions should be placed at rural hospitals. This will help solve the rural healthcare shortage.

For the record, Trump actually isn't for single payer. Here's a quote from him on the issue:

http://www.breitbart.com/big-govern...gle-payer-healthcare-tax-increase-on-wealthy/

So basically, the government is going to pay for the uninsured, but private plans will cover everyone else. Basically he's saying he's going to rebrand Obamacare as Trumpcare with an added bonus of paying hospitals to care for the uninsured.

Right of course. He'll just make it work. Since everyone will be so interested in getting private health insurance once you start handing it out to everyone for free if they don't have it. There is a reason why the ACA required a radical and constitutionally questionable individual mandate to buy a private product or be punished.

Offering higher salary for rural jobs won't do much. Like I would never in a million years work in a rural place (unless it was just for residency and I could leave afterwards).

What should be done is recruit more rural students to med school and encourage city schools to create rural tracks to train these rural students- likes Tufts and Tulane and other schools have now. And then things could be done to expose students to rural health while in school- like Tulane requiring all students to do their family med rotation in rural Louisiana, Mississippi, and Alabama

This is definitely a good idea.

 

[Mad Jack]

Congress could easily adjust Medicare to fund new residency positions and defund others. Medical students will accept primary care spots or be unemployed, thats the whole point. If you cut the number of specialists positions, you make them more competitive. If the match rate for orthopedic surgery dropped to 20%, there would be a hell of lot less people applying. It will take a couple of cycles of students going unmatched and feeling that pain for people to get the message.

New primary care residency positions should be placed at rural hospitals. This will help solve the rural healthcare shortage.

But is that the best way to build the healthcare system of tomorrow? Because those PCPs are going to need specialists to refer to. And if we're cutting positions to the point that there's not enough specialists to go around, they'll be in even more demand, and have even less reason to ever leave the cities. Plus a nurse can just as easily refer to a specialist as a physician can, and they're being trained far more rapidly than we could shift our GME from urban to rural, and will likely flood the market with primary care providers, forcing a lot of those new PCPs into a market that is too competitive for them to provide the services they were trained for.

 

[FiveOClock]

But is that the best way to build the healthcare system of tomorrow? Because those PCPs are going to need specialists to refer to. And if we're cutting positions to the point that there's not enough specialists to go around, they'll be in even more demand, and have even less reason to ever leave the cities. Plus a nurse can just as easily refer to a specialist as a physician can, and they're being trained far more rapidly than we could shift our GME from urban to rural, and will likely flood the market with primary care providers, forcing a lot of those new PCPs into a market that is too competitive for them to provide the services they were trained for.

There is no best way to fix the mess that has been made of healthcare in this country. Once the pork stops flowing, someone is going to get screwed no matter what, thats just a fact of the situation. Our jobs as future physicians is to ensure that the people getting screwed are not the doctors or patients.

Right now there is a major PCP shortage. I doubt we would end up with too many PCPs. If there are too many in one area, the market will force them to the rural periphery, which is the whole point.