The Future of Residency in the USA

[Clarus]

Anyone in the loop in terms of the future of residency spots in the USA? I know for the past 7-9 years, more medical schools have opened up around the country (both DO & MD), along with off-shore schools as well, with increased medical schools classes and graduates. From what I've heard and seen, residency spots are not growing as rapidly to sustain the growing number of graduates but I was hoping that would change in the next 3-4 years. It seems like it's about time for that change to be made.

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[citykid92]

From what I understand, you are right that schools have opened up around the country/offshore and that residency spots have not really increased. I don't know the full details, but I know that residency is largely funded through Medicare and that this funding has not increased in a while (I think since the 90's), hence the lack of growth. However, there are still fewer graduating US MDs and DOs (definitely MD's, not 100% sure about DOs) than there are residency spots every year. Basically anyone who graduates in decent standing from a US MD & US DO will match unless they screw themselves over with a terrible match list/unrealistic specialty. The real losers in this change are FMGs and IMGs who try to get US residencies. In general, FMGs and IMGs get last licks at residency spots, so they will be the ones who have a harder and harder time matching in the US.

source: http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

TLDR: More schools, same residency spots more or less. Non-issue for US MD's and DO's who graduate in good standing and don't screw up application process, much bigger issue for FMG and IMG.

 

[CLB_MD]

I wish we could go back to the 90s, before this insane competition for med school and residencies began. 60% of my family members are FMGs (came to USA between 80s and 90s), and some managed to complete their residencies at Hopkins, Harvard, and Duke. This probably would not be the case if they were applying for residency today.

 

[Clarus]

From what I understand, you are right that schools have opened up around the country/offshore and that residency spots have not really increased. I don't know the full details, but I know that residency is largely funded through Medicare and that this funding has not increased in a while (I think since the 90's), hence the lack of growth. However, there are still fewer graduating US MDs and DOs (definitely MD's, not 100% sure about DOs) than there are residency spots every year. Basically anyone who graduates in decent standing from a US MD & US DO will match unless they screw themselves over with a terrible match list/unrealistic specialty. The real losers in this change are FMGs and IMGs who try to get US residencies. In general, FMGs and IMGs get last licks at residency spots, so they will be the ones who have a harder and harder time matching in the US.

source: http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

TLDR: More schools, same residency spots more or less. Non-issue for US MD's and DO's who graduate in good standing and don't screw up application process, much bigger issue for FMG and IMG.

True. It does suck a lot of IMGs and FMGs who are trying to come to the States. Might be even tougher now that Donald Trump is Present too. I'm sure they'd keep a quota with that and hoping that US IMGs also get some kind of preference in terms of residency conditions improving for them. That's the real kicker. To be honest, I myself was considering a school off-shore and hoping that more US residencies open up in the future.

 

[piii]

True. It does suck a lot of IMGs and FMGs who are trying to come to the States. Might be even tougher now that Donald Trump is Present too. I'm sure they'd keep a quota with that and hoping that US IMGs also get some kind of preference in terms of residency conditions improving for them. That's the real kicker. To be honest, I myself was considering a school off-shore and hoping that more US residencies open up in the future.

Yeah no. There is no quota for US IMGs.. residencies definitely don't prefer them or maintain a quota. They are the lowest on the totem poll in the US.

 

[sliceofbread136]

For a us md matching into something will likely remain not being an issue. We will start pushing out imgs from the less competitive spots. It will likely become increasingly more difficult to find a competitive/desirable residency spot

 

[JPSmyth]

Sorry what's the differencebetween IMG and FMG?

 

[darkjedi]

Sorry what's the differencebetween IMG and FMG?

IMGs are American students that were either not competitive enough or too impatient to successfully apply to US MD schools and made the unwise decision to pursue their medical education in places like the Carribean.

FMGs, at least the ones that successfully match here, tend to be the best and brightest from foreign countries, like Israel Australia, the UK, and India. Some of them are already attendings in their respective fields but need to do residency in the US in order to practice here.

 

[Lawpy]

Sorry what's the differencebetween IMG and FMG?

IMG = US citizen who goes to medical school abroad and hopes to match back to US residency

FMG = foreign citizen who goes to medical school abroad and hopes to match to US residency

Imternational students who matriculate and attend a US medical school are considered AMGs like US MD and US DO students although they may have some visa problems when matching.

IMGs are American students that were either not competitive enough or too impatient to successfully apply to US MD schools and made the unwise decision to pursue their medical education in places like the Carribean.

FMGs, at least the ones that successfully match here, tend to be the best and brightest from foreign countries, like Israel Australia, the UK, and India. Some of them are already attendings in their respective fields but need to do residency in the US in order to practice here.

^ beat me to it. Although not all IMGs are weak. Some may go to schools in Canada, UK, Australia for various reasons (like research programs, dual citizenship/family reasons etc.).

 

[Med Ed]

Anyone in the loop in terms of the future of residency spots in the USA? I know for the past 7-9 years, more medical schools have opened up around the country (both DO & MD), along with off-shore schools as well, with increased medical schools classes and graduates. From what I've heard and seen, residency spots are not growing as rapidly to sustain the growing number of graduates but I was hoping that would change in the next 3-4 years. It seems like it's about time for that change to be made.

The NRMP publishes tons of data, both current and historical, on the match. This past year there were 27,860 PGY-1 positions offered in the main match, with 17,057 US allopathic seniors successfully matching. That leaves a gap of 10,803 spots. Granted, a lot of those positions are in fields like FM, IM, peds, and psych, with a healthy dose of prelim-surgery spots.

Osteopathic success had edged up recently, moving from 74.7% in 2012 to 80.3% in 2016.

The bottom line is that this is a slowly evolving process, and there is still a large amount of slack in the overall system for US allopathic seniors.

 

[darkjedi]

^ beat me to it. Although not all IMGs are weak. Some may go to schools in Canada, UK, Australia for various reasons (like research programs, dual citizenship/family reasons etc.).

Canadian graduates are not considered IMGs since the US and Canada have reciprocity in regards to their training. It's actually harder to get into a Canadian MD school than US since there are way fewer of them. There are only a handful of American applicants a year from the more reputable UK and Australian schools, but they are usually more successful than Caribbean grads.

 

[DNC127]

The COCA (accrediting body for D.O. schools) has a current resolution to be passed that would make the requirements for DO school rotations the same as MD school rotations as far as number of ward based rotations. This should slow down the growth of DO schools, and may cause some who are trying to get started up drop off because there are only so many ward based rotations to be had for DO students. It will be interesting to see how this effects DO school expansion.

 

[Lawpy]

Canadian graduates are not considered IMGs since the US and Canada have reciprocity in regards to their training. It's actually harder to get into a Canadian MD school than US since there are way fewer of them. There are only a handful of American applicants a year from the more reputable UK and Australian schools, but they are usually more successful than Caribbean grads.

didn't know about US-Canada reciprocity, so that's interesting stuff. are special programs like Sackler, Duke-NUS etc. treated as equivalents to US medical graduates? or are they US IMGs?

They are used interchangeably and do not technically have any difference. Previously they were used for IMG as US citizens who graduated from off-shore schools and FMG (Foreign) for non US citizens who graduated from off-shore schools

http://www.ecfmg.org/certification/definition-img.html
Definition of an IMG
ECFMG and its organizational members define an international medical graduate (IMG) as a physician who received his/her basic medical degree or qualification from a medical school located outside the United States and Canada. The location of the medical school, not the citizenship of the physician, determines whether the graduate is an IMG. This means that U.S. citizens who graduated from medical schools outside the United States and Canada are considered IMGs. Non-U.S. citizens who graduated from medical schools in the United States and Canada are not considered IMGs.

that's surprising. I thought the IMGs were still categorized into US IMGs and non-US IMGs in the NRMP reports and related documents?

 

[darkjedi]

didn't know about US-Canada reciprocity, so that's interesting stuff. are special programs like Sackler, Duke-NUS etc. treated as equivalents to US medical graduates? or are they US IMGs?

The partnership programs like Duke-NUS typically award a US MD. Sackler students are considered IMGs for which I have heard mixed things about in regards to their match.

 

[BurghStudent]

Where does it say a program must prioritize an FMG over an MD or DO applicant? Some programs have been taking FMGs for decades, whereas others are not familiar with DOs.

What I'm saying is, there won't be a unilateral shift, and there are no guarantees.

As you put more applicants into the pool, you risk a higher unmatched rate UNLESS somehow the added applicants are focused on those specialties that have the lowest fill rate every year (hint, it's not derm). Statistically, every residency position becomes more difficult to attain.