I can't believe we are having this discussion again. It always starts with exPCM and the "Table of IMG doom". Then McGillGrad gets all upset. Then the screaming starts. Deja vu.
It is not my table. It is from the AMA news and the data comes from the AAMC and AACOM
Regardless:
1. All of this is based upon this presumed "physician shortage", which is really interesting if you think about it. First of all, it's hard to predict exactly how many physicians we need. Second, if we generate enough physicians to manage the fattest part of the baby boomer bubble, we will have too many physicians when they die off. All previous predictions of physician shortages or oversupply have been crap. I expect this one is too.
2. Allo med schools have increased class size, and a few new ones have opened. Although they explain their increases on the AAMC call for more doctors, it's probably all about more tuition. The overall increase in allo spots is small, but real.
3. The DO explosion is new, and adds a new variable to the match.
4. The question of whether AMG's are "better" than US IMG's is pretty silly. The major carb schools produce quality docs. Some of them score well on the boards -- I think it's an overstatement to suggest that "most" do. Med school application processes are not perfect -- some students accepted into US allo programs do poorly. Whether programs are going to prefer AMG's depends upon the program. I agree that many programs favor AMG's -- some take them almost uniformly. Some programs take IMG's uniformly, although as suggested this may be because they would want AMG's but can't get them. So, I think it's fair to say that all other things being equal, an AMG will have a sigificant advantage over a US IMG. As the US IMG becomes "better" than the AMG, it's impossible to know when the scales equal out -- and will depend on the field and the program.
5. Whether DO > US IMG or US IMG > DO is also very field and program dependent.
6. I do not see the number of residency slots increasing any time soon. I could be wrong. I have no idea if the DO world will try to increase slots.
7. As DO and Allo programs increase their class sizes, students who would have gone to the carib but now get into a US school will not. Hence, the number of carib students may decrease, or the quality of carib students will decrease, or the number of carib schools will decrease, or some combination.
8. More applicants + equal slots = more competitive match for everyone. I expect that DO's and IMG's will feel more pressure in the match, due to increased competition, but so will allo MD's (but perhaps to a lesser extent).
9. Assuming this all comes to pass, one of two things will happen: IMG's/DO's will get squeezed out of the match OR lower performing US allo's will get squeezed out of the match (or both).
10. If lower performing US allo's get squeezed out of the match, there will be immense pressure put on the health care system to fix the problem. The AAMC will certainly "deal" with the issue. How they would do so is anyone's guess. They could force a two stage match -- first stage US allo grads, then everyone else. Or it could be US citizens first, then everyone else. Or they could adjust visa laws to prevent foreign grads from getting any spots until all US grads have spots (This is my personal favorite, since Congress controls visa laws where they would have to sue the NRMP to change the match). Who knows? But if Congressperson X's son doesn;t get a residency in anything after successfully graduating from medical school and passing the USMLE's, and foreign grads do, heads are going to roll.
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