Squeeze Looms for Doctors

[deleted307836]

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Interesting article in the WSJ today: Link

Cliffs Notes:

- Number of US medical students graduating each year on track to grow by 5,000 by 2019

- At this rate, the number of MD/DO grads will exceed the number of residency positions by 2019

- Most residencies are federally funded by Medicare; about 10% are funded by hospitals or other sources. Medicare pays $9.5 billion per year to fund 94k positions

- The number of residency positions has stayed the same since 1997, despite significant growth in the US population since then, and in addition to an aging population of baby-boomers

- There is no residency increase on the horizon due to lack of funding; some proposals have even called to cut the amount of money given to residency programs

- IMG's will be largely phased out of American residencies as the number of American grads exceeds the number of residency positions

Any thoughts on this? For those looking at graduating in 2018 and beyond - how concerned are you?

 

[Guero]

Interesting article in the WSJ today: Link

Cliffs Notes:

- Number of US medical students graduating each year on track to grow by 5,000 by 2019

- At this rate, the number of MD/DO grads will exceed the number of residency positions by 2019

- Most residencies are federally funded by Medicare; about 10% are funded by hospitals or other sources. Medicare pays $9.5 billion per year to fund 94k positions

- The number of residency positions has stayed the same since 1997, despite significant growth in the US population since then, and in addition to an aging population of baby-boomers

- There is no residency increase on the horizon due to lack of funding; some proposals have even called to cut the amount of money given to residency programs

- IMG's will be largely phased out of American residencies as the number of American grads exceeds the number of residency positions

Any thoughts on this? For those looking at graduating in 2018 and beyond - how concerned are you?

This rate has already been exceeded for quite some time. These are all issues that have been looming for a while. Thankfully I was aware before I began pursuing pre-meds. I'm slightly concerned, but intend to do the very best I can to make myself competitive for the match (without throwing others under the bus).

Our system is in such a state of flux, I imagine the big changes will happen while we're attendings. And those changes are so vague at this point. The most specific thing I expect is for primary care reimbursement to rise while specialists' and subspecialists' reimbursements decline. But in the end, for me, compensation doesn't affect my desire to pursue medicine. I just want to enjoy going to work and getting paid to do something I love. As long as I can repay my loans, I'll be happy. That's probably going to become a huge issue as they alter reimbursements and loan/loan forgiveness regulations...

 

[gmcguitar4]

Yea it already exceeds it but there aer still a bunch of spots that aren't filled every year in primary care. So if in doubt, go family medicine!

Also, I feel like so much is going to change in the next 5-10 years that it is impossible to predict what will happen. They could open more residency spots. Also, the SGR rate could finally get the kabosh because medicare/medicaid spending has been much lower than predicted. I would say keep it all this in mind and follow it, but don't freak out..yet.

 

[deleted307836]

This rate has already been exceeded for quite some time.

Yea it already exceeds it but there aer still a bunch of spots that aren't filled every year in primary care.

Maybe I'm missing something obvious, but what do you two mean by this? As far as I can tell, the number of residency positions is currently larger than the number of MD/DO grads. However, I'm not sure how AOA residencies factor into this and if they are grouped in that 94k number.

 

[circulus vitios]

I love the comments. Bunch of dang 'ol Obamer communistcare fixin' to ruin medicine! ya'll best prepare to be seein' a robot doctor! Ayn Rand nutjobs.

"There are two novels that can change a bookish fourteen-year old's life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs."

 

[sinombre]

Maybe I'm missing something obvious, but what do you two mean by this? As far as I can tell, the number of residency positions is currently larger than the number of MD/DO grads. However, I'm not sure how AOA residencies factor into this and if they are grouped in that 94k number.

Yeah, the total number of applicants far exceeds the total number of residency positions (includes IMGs), but the number of MD/DO graduates does not.

 

[kimposibl]

I love the comments. Bunch of dang 'ol Obamer communistcare fixin' to ruin medicine! ya'll best prepare to be seein' a robot doctor! Ayn Rand nutjobs.

"There are two novels that can change a bookish fourteen-year old's life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs."

👍👍

First of all, we need to stop all the Medicare fraud; that'll have funds available for residency real quick. PPACA has recovered BILLIONS so far. Medicare is the FIRST to get billed for most new drugs or medical devices cuz the elderly - I mean Uncle Sam - is where the money's at.

 

[TheWeeIceMan]

I'd bet most of us will be long gone by the time this crunch starts seriously hurting AMGs. It's kind of sad though, since medicine seemed to be the final frontier of a profession that hasn't completely screwed itself by flooding the market with grads. In 20 years, this might not be the case.

 

[sinombre]

I'd bet most of us will be long gone by the time this crunch starts seriously hurting AMGs. It's kind of sad though, since medicine seemed to be the final frontier of a profession that hasn't completely screwed itself by flooding the market with grads. In 20 years, this might not be the case.

I might get flamed for saying this, but granting for-profit medical schools LCME accreditation probably isn't going to help.

 

[Guero]

I might get flamed for saying this, but granting for-profit medical schools LCME accreditation probably isn't going to help.

I feel a thread merge coming on now, lol.

 

[SoulinNeed]

Well, with the addition of AOA positions after the merger, we'll see how it goes. We also have to consider how many positions there will be after IMGs and FMGs get kicked out of the match, essentially.

 

[circulus vitios]

Well, with the addition of AOA positions after the merger, we'll see how it goes. We also have to consider how many positions there will be after IMGs and FMGs get kicked out of the match, essentially.

IMG and FMG students will never get kicked out of the match.

 

[darklabel]

Well last time i checked, there arent as many new medical schools down the pipeline, so hopefully the problem won't be exacerbated. Also, I doubt we'll have serious problems for a while. There are still tons of FM spots that either go unfilled or an IMG holds.

FM is always a safe bet and I think it will be beyond 2020 grads before even matching at FM becomes an issue. Its just now youre going to have a lot more stiff competition for everything else.

 

[Daodejing]

Well last time i checked, there arent as many new medical schools down the pipeline, so hopefully the problem won't be exacerbated. Also, I doubt we'll have serious problems for a while. There are still tons of FM spots that either go unfilled or an IMG holds.

FM is always a safe bet and I think it will be beyond 2020 grads before even matching at FM becomes an issue. Its just now youre going to have a lot more stiff competition for everything else.

You can take a look at the SOAP 2013 thread on the resident forums and see if that statement still holds water. Truth is things will be many times more competitive in 2017/2018 than they are right now for ALL specialties. There's really no point in anticipating things either which way, other than by working as hard as we can in med school.

 

[SoulinNeed]

IMG and FMG students will never get kicked out of the match.

Not officially, of course, but they are slowly getting squeezed out.

 

[Guero]

You can take a look at the SOAP 2013 thread on the resident forums and see if that statement still holds water. Truth is things will be many times more competitive in 2017/2018 than they are right now for ALL specialties. There's really no point in anticipating things either which way, other than by working as hard as we can in med school.

Well said. Also, if anyone gets antsy or fed up with our system once they've paid off their loans, other countries tend to gobble us UMGs up by the handful. I contacted the Irish Medical Council myself to inquire how receptive they are to US grads. They welcome us for full/dual citizenship with open arms. 😉 (I've visited Ireland, am a second generation descendant, and fell in love in case anyone's wondering; I didn't mention my ancestry when contacting them, though.) But beware of dual citizenship taxation. That's a whole 'nother bag.

Wow, I hope that wasn't too off topic...?

 

[darklabel]

You can take a look at the SOAP 2013 thread on the resident forums and see if that statement still holds water. Truth is things will be many times more competitive in 2017/2018 than they are right now for ALL specialties. There's really no point in anticipating things either which way, other than by working as hard as we can in med school.

I agree, we can aimlessly speculate but it will only be speculation.

You say work much harder, but you also have to define harder. For instance, as a US MD, you can fail the boards and still match into FM, so will the new standard be pass the first time? Get a little higher than the minimum passing?

The idea that MD and DOs from the US that do everything right and not match, even in FM, is absurd to me. 250+k in non-dischargable debt isn't something we should just say "work harder" for. The LCME and COCA need to sit down and stop allowing new med schools in the name of "doctor shortage" in the future without first addressing residency concerns.

 

[wholeheartedly]

The idea that MD and DOs from the US that do everything right and not match, even in FM, is absurd to me. 250+k in non-dischargable debt isn't something we should just say "work harder" for. The LCME and COCA need to sit down and stop allowing new med schools in the name of "doctor shortage" in the future without first addressing residency concerns.

👍

 

[Guero]

I agree, we can aimlessly speculate but it will only be speculation.

. . . The LCME and COCA need to sit down and stop allowing new med schools in the name of "doctor shortage" in the future without first addressing residency concerns.

Also well said. Most European physicians pay nothing for their med school (albeit commonly at the cost of being eliminated from/preselected for that discipline based upon high school scores).

 

[Daodejing]

I agree, we can aimlessly speculate but it will only be speculation.

You say work much harder, but you also have to define harder. For instance, as a US MD, you can fail the boards and still match into FM, so will the new standard be pass the first time? Get a little higher than the minimum passing?

The idea that MD and DOs from the US that do everything right and not match, even in FM, is absurd to me. 250+k in non-dischargable debt isn't something we should just say "work harder" for. The LCME and COCA need to sit down and stop allowing new med schools in the name of "doctor shortage" in the future without first addressing residency concerns.

I'm curious about this. Evidence? How does one fail the boards and then proceed to graduate from a medical school (unless you mean pass after multiple attempts)?

And I definitely don't mean work harder with the goal to pass or barely pass. That'd be silly. From what I've heart, the steps are relatively easy to pass as a student in US MD/DO. Doing well, however, is a measure of individual effort and using the right resources, nothing more.

 

[Guero]

I'm curious about this. Evidence? How does one fail the boards and then proceed to graduate from a medical school (unless you mean pass after multiple attempts)?

I imagine s/he was referring to the retakes...

 

[darklabel]

I'm curious about this. Evidence? How does one fail the boards and then proceed to graduate from a medical school (unless you mean pass after multiple attempts)?

And I definitely don't mean work harder with the goal to pass or barely pass. That'd be silly. From what I've heart, the steps are relatively easy to pass as a student in US MD/DO. Doing well, however, is a measure of individual effort and using the right resources, nothing more.

Haha yeah, sorry. Ill edit when Im on a computer.

 

[survivordo]

All of this news saddens me as I feel the uncertainty of the field will continue to push bright young students away from it and into other fields. I tell people "What other field can a student go into where they are essentially guaranteed to work independently, have daily interesting interactions, directly affect the outcomes of a person's life and pull down a 6 figure salary". I still think this is true but wonder for how long this will last.

 

[goofball]

US Allo getting out of medical school in 2017. I think I should be fine. If/when the crunch comes, first it will hit the IMGs. Then it will hit the Osteos applying to Allo residencies. Then, and only then will Allo grads really start to feel the pinch.

Maybe I'm wrong, and US Allo grads are already feeling the crunch?

All of this news saddens me as I feel the uncertainty of the field will continue to push bright young students away from it and into other fields. I tell people "What other field can a student go into where they are essentially guaranteed to work independently, have daily interesting interactions, directly affect the outcomes of a person's life and pull down a 6 figure salary". I still think this is true but wonder for how long this will last.

I'll tell my kids to become dentists and not bother with medicine.

 

[circulus vitios]

All of this news saddens me as I feel the uncertainty of the field will continue to push bright young students away from it and into other fields. I tell people "What other field can a student go into where they are essentially guaranteed to work independently, have daily interesting interactions, directly affect the outcomes of a person's life and pull down a 6 figure salary". I still think this is true but wonder for how long this will last.

I'd say only two out of those four criteria apply to medicine: direct affect and 6 figure salary.

 

[goofball]

I'd say only two out of those four criteria apply to medicine: direct affect and 6 figure salary.

Actually, fields like Pathology and Radiology arguable don't have a "direct affect." Also, many attendings make less than six figures after taxes and med school loans.

 

[jw3600]

Actually, fields like Pathology and Radiology arguable don't have a "direct affect." Also, many attendings make less than six figures after taxes and med school loans.

Your statement just exudes an inherent misunderstanding of salaries in this country.

 

[DrBowtie]

Actually, fields like Pathology and Radiology arguable don't have a "direct affect." Also, many attendings make less than six figures after taxes and med school loans.

You couldn't be more wrong about direct effect of those two fields.

 

[wholeheartedly]

You couldn't be more wrong about direct effect of those two fields.

👍

Yeah.

 

[Guero]

You couldn't be more wrong about direct effect of those two fields.

Hahaha! I LoLd at your signature. All of it seems so true. I'd get kicked out of residency for passing out in the viewing room if matched rads. I already catch myself nodding off when I borrow their computers if those at the nurses' stations in the ED are too busy.

 

[45408]

Your statement just exudes an inherent misunderstanding of salaries in this country.

He wasn't discussing salaries of other fields or how it relates to the rest of the country. The point is that after you pay taxes and loans, you could easily bring the median physician salary under $100K.

 

[Geebeejay]

He wasn't discussing salaries of other fields or how it relates to the rest of the country. The point is that after you pay taxes and loans, you could easily bring the median physician salary under $100K.

And I think the other poster was commenting that, by definition, the money you have after paying taxes and loans, is no longer your "salary". Instead, "salary" is the quantity of gross income you make, out of which taxes are paid from.

 

[deleted307836]

Some other interesting things to think about -- if funding for GME were magically increased, how would it be determined where to open those residencies and in what specialties? Or would current programs simply expand the number of positions they have? Would the focus be almost entirely on family medicine or other primary care specialties? Do hospitals have the capacity to increase their resident positions -- or even have a desire to do so? Would newer residencies suffer in quality to more established ones, especially if they are located in more rural areas, traditionally underserved areas?

 

[KGflyboy]

He wasn't discussing salaries of other fields or how it relates to the rest of the country. The point is that after you pay taxes and loans, you could easily bring the median physician salary under $100K.

That is incorrect terminology. If you are talking about taxes, you are referring to ney pay, which is definitely not the same as salary.

 

[Weewee]

I was just reading this thread and received this email:

The American Association of Colleges of Osteopathic Medicine Supports Bipartisan Legislation to Expand Medical Residency Positions

The American Association of Colleges of Osteopathic Medicine (AACOM) announces its support of the Training Tomorrow’s Doctors Today Act, legislation introduced by U.S. Representatives Aaron Schock (R-IL) and Allyson Y. Schwartz (D-PA) to address the nation’s physician workforce shortage and expand medical residency training positions in programs across the country.

"In the U.S. we are facing a significant physician shortage that will only increase in severity unless action is taken soon. Every eight seconds another Baby Boomer turns 65 so it’s incumbent upon us to ensure we have a prepared physician workforce in place to meet the growing health care demands on our country," said Representative Schock. "The primary way our country can address the physician shortage is by ensuring we increase the number of Graduate Medical Education slots. By doing so, we are increasing the number of medical school graduates who will receive hands on training in a patient setting to gain the experience needed to become a practicing physician."

The Training Tomorrow’s Doctors Today Act would increase the number of Medicare-funded graduate medical education (GME) positions by 3,000 each year, totaling 15,000 additional positions over the next five years. The legislation would give priority to hospitals in states with new medical schools and emphasize training in community-based settings. It would also require hospitals to train at least 30 percent of their residents in primary care and general surgery and require greater accountability and transparency by meeting specific performance measures.

The Balanced Budget Act of 1997, which currently is still in effect, capped the number of Medicare-funded residency positions. As osteopathic medical schools continue to graduate rising numbers of students, it is imperative to ensure that the number of medical residency positions increases simultaneously to continue training the nation's future physicians.

"The physician workforce shortage facing our nation, particularly in primary care, is a national crisis that requires comprehensive and cost-effective solutions," said AACOM President and CEO Stephen C. Shannon, D.O., M.P.H. "AACOM is pleased to offer its strong support of this critical legislation, which works to increase the training of the future physician workforce across the country while expanding access to patient care. AACOM commends Representatives Schock and Schwartz for their unwavering leadership on this issue."

 

[DrBowtie]

I was just reading this thread and received this email:

The American Association of Colleges of Osteopathic Medicine Supports Bipartisan Legislation to Expand Medical Residency Positions

The American Association of Colleges of Osteopathic Medicine (AACOM) announces its support of the Training Tomorrow’s Doctors Today Act, legislation introduced by U.S. Representatives Aaron Schock (R-IL) and Allyson Y. Schwartz (D-PA) to address the nation’s physician workforce shortage and expand medical residency training positions in programs across the country.

"In the U.S. we are facing a significant physician shortage that will only increase in severity unless action is taken soon. Every eight seconds another Baby Boomer turns 65 so it’s incumbent upon us to ensure we have a prepared physician workforce in place to meet the growing health care demands on our country," said Representative Schock. "The primary way our country can address the physician shortage is by ensuring we increase the number of Graduate Medical Education slots. By doing so, we are increasing the number of medical school graduates who will receive hands on training in a patient setting to gain the experience needed to become a practicing physician."

The Training Tomorrow’s Doctors Today Act would increase the number of Medicare-funded graduate medical education (GME) positions by 3,000 each year, totaling 15,000 additional positions over the next five years. The legislation would give priority to hospitals in states with new medical schools and emphasize training in community-based settings. It would also require hospitals to train at least 30 percent of their residents in primary care and general surgery and require greater accountability and transparency by meeting specific performance measures.

The Balanced Budget Act of 1997, which currently is still in effect, capped the number of Medicare-funded residency positions. As osteopathic medical schools continue to graduate rising numbers of students, it is imperative to ensure that the number of medical residency positions increases simultaneously to continue training the nation's future physicians.

"The physician workforce shortage facing our nation, particularly in primary care, is a national crisis that requires comprehensive and cost-effective solutions," said AACOM President and CEO Stephen C. Shannon, D.O., M.P.H. "AACOM is pleased to offer its strong support of this critical legislation, which works to increase the training of the future physician workforce across the country while expanding access to patient care. AACOM commends Representatives Schock and Schwartz for their unwavering leadership on this issue."

Few points:
1) 15,000 positions is really 15,000 training years. Wouldn't want to start training at one of those places in year 3 of the extra funding. No guarantees to finish.

2) Great more community based residency programs of questionable quality in primary care.

Applaud the effort, but not going to solve the problem.

 

[goofball]

Few points:
1) 15,000 positions is really 15,000 training years. Wouldn't want to start training at one of those places in year 3 of the extra funding. No guarantees to finish.

2) Great more community based residency programs of questionable quality in primary care.

Applaud the effort, but not going to solve the problem.

The IMGs will be happy if it passes, though.

 

[Ravizzle]

My Univeristy's pre-med advisor just emailed this misleading info to all the ppl on the pre-health listserv.

"Have you heard that residency positions are drying up in the US and, as a result, International Medical Graduates (IMGs) will have a more difficult time obtaining residencies, or won't be able to get into a residency at all? Dr. John Madden, MD (St George's University '81 and Director of the Office of Career Guidance at SGU) sheds some light on the facts about postgraduate training in the US as outlined by the Educational Commission for Foreign Medical Graduates (ECFMG)

FACT: In 2012 there were 613 more PGY1 positions offered through the National Resident Matching Program (NRMP) Main Residency Match than in 2011 and an increase of 3,400 since 2002.

FACT: 218 more US International Medical Graduates (IMGs) matched in 2012 than 2011, which continues a nine-year trend of increased matches for US IMGs.

MORE INFO: To learn more about the success of US graduates of foreign medical schools getting into US residencies, please visit
http://www.ecfmg.org/news/2012/03/2...the-2012-match/#sthash.E06nuCZg.ocL89s6S.dpbs "

This info is talking about last few years, has no mention of what the future prospects are, and will lead students to make uninformed choices that can potentially ruin their future. Way to go Pre-med advisor.

 

[goofball]

The only reason Caribbean match rates don't look completely abysmal is that attrition rates for Caribbean schools are through the roof. In US schools, over 90% of incoming M1s graduate.

 

[jw3600]

And I think the other poster was commenting that, by definition, the money you have after paying taxes and loans, is no longer your "salary". Instead, "salary" is the quantity of gross income you make, out of which taxes are paid from.

+1

He wasn't discussing salaries of other fields or how it relates to the rest of the country. The point is that after you pay taxes and loans, you could easily bring the median physician salary under $100K.

"Take home pay" of $8000/month is pretty damn good. I'm not even sure if it is fair to exclude money paid towards loans from take home pay. $8000/month after all taxes AND student loans is a great deal of money.

 

[Status Sciaticus]

+1



"Take home pay" of $8000/month is pretty damn good. I'm not even sure if it is fair to exclude money paid towards loans from take home pay. $8000/month after all taxes AND student loans is a great deal of money.

8000 a month after giving up (4+4+3 to 5) 11-15 years of income earning potential is not that much. UPS driver annual incomes average from 85,000- 100k+ and you can work right out of high school at that job...


so no, its not a great deal of money.

 

[jw3600]

Oh god the UPS truck driver schtick. Can't do this.

 

[KGflyboy]

8000 a month after giving up (4+4+3 to 5) 11-15 years of income earning potential is not that much. UPS driver annual incomes average from 85,000- 100k+ and you can work right out of high school at that job...


so no, its not a great deal of money.

Source please?

 

[circulus vitios]

8000 a month after giving up (4+4+3 to 5) 11-15 years of income earning potential is not that much. UPS driver annual incomes average from 85,000- 100k+ and you can work right out of high school at that job...


so no, its not a great deal of money.

What the hell are you smoking?

ITT: pre-med kid who has never worked a job in his life tells us we can make nearly 6 figures a year from ages 18-65 by driving UPS trucks.

 

[GUH]

It seems that one possible "solution" will be to decrease stipends for residents or, barring that, to begin allowing for self-funded or partially self-funded residency programs.

They could also shorten the total length of time it takes to educate a primary care physician.

I wouldn't be excited about either one but those seem to be expedient ways to address the gap.

 

[nysegop]

Why can't residency programs just self-fund? Residents could be considered employees rather than students. I see no reason why medicare should fund them (unless they are programs at public universities). It's always possible that residency salaries could be decreased. I know a lot of people will hate me for saying this, but I would rather do a low paying residency than no residency at all.

 

[nysegop]

8000 a month after giving up (4+4+3 to 5) 11-15 years of income earning potential is not that much. UPS driver annual incomes average from 85,000- 100k+ and you can work right out of high school at that job...


so no, its not a great deal of money.

JUST TO AVOID THE CONFUSION EVERYONE....

The average UPS driver salary is actually only $73,000 per year.

 

[KGflyboy]

JUST TO AVOID THE CONFUSION EVERYONE....

The average UPS driver salary is actually only $73,000 per year.

Please post a source if you are going to post numbers. I think the number you used is inflated.

Starting at $14/hour it would be really hard to make anywhere near the average you posted.

http://truck-driver-salary.org/ups-driver-salary/

 

[GopherMD]

JUST TO AVOID THE CONFUSION EVERYONE....

The average UPS driver salary is actually only $73,000 per year.

Even if it was that, that's BEFORE taxes.

 

[goofball]

Why can't residency programs just self-fund? Residents could be considered employees rather than students. I see no reason why medicare should fund them (unless they are programs at public universities). It's always possible that residency salaries could be decreased. I know a lot of people will hate me for saying this, but I would rather do a low paying residency than no residency at all.

It's not worth it for the hospital to fund residents until a few years into their residency. It only works if the government subsidizes it.