The Great Residency Crunch

[One Day MD]

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For all the current Caribbean US IMG students,

Do you think that all this talk about a residency crunch or great backlash against US IMGs, especially from the Caribbean, will take hold by 2016/2017? And to what extent? Are any of the top caribbean schools addressing this with their students? As students at the top caribbean schools, would you strongly caution a prospective student from attending Ross/SGU/etc based on the current trends/forecasts in medicine regarding the availability of residency positions? Will the "Residency Crunch" be most prominent in the most competitive specialties?

How about for schools like Ross that just signed a 10 year contract with Kern Medical Center for students to do clinicals there, or SGU's contact with NY Public Hospitals...From what you hear, do you think they will no longer prefer Carib. students who have worked there, assuming comparable stats to US MD/DO students?

 

[Shalashaska]

Good question, would be interesting to hear the opinion here as well as the people over at valuemd.com.

 

[ronathan]

For all the current Caribbean US IMG students,

Do you think that all this talk about a residency crunch or great backlash against US IMGs, especially from the Caribbean, will take hold by 2016/2017? And to what extent? Are any of the top caribbean schools addressing this with their students? As students at the top caribbean schools, would you strongly caution a prospective student from attending Ross/SGU/etc based on the current trends/forecasts in medicine regarding the availability of residency positions? Will the "Residency Crunch" be most prominent in the most competitive specialties?

How about for schools like Ross that just signed a 10 year contract with Kern Medical Center for students to do clinicals there, or SGU's contact with NY Public Hospitals...From what you hear, do you think they will no longer prefer Carib. students who have worked there, assuming comparable stats to US MD/DO students?

I'm kind of skeptical that of this whole "residency crunch" thing to begin with, because from what I have heard from people that I know who work in medical school administration, increased federal funding for residency programs was a large (albeit not very well publicized) part of the Health Care Reform Law. And its one of the parts of the law that has bi-partisan support, so its unlikely to get struck down even if the mandate is found unconstitutional. And frankly, it doesn't make sense to me that the AMA would encourage medical schools across the country to increase their respective number of students without simultaneously addressing the issue of available residency slots.

That all being said, this is a valid question, and one that you may want to bring up at your interview (if you haven't had one already), or simply contact Ross/SGU/etc's admissions office and ask.

 

[NotAProgDirector]

I'm kind of skeptical that of this whole "residency crunch" thing to begin with, because from what I have heard from people that I know who work in medical school administration, increased federal funding for residency programs was a large (albeit not very well publicized) part of the Health Care Reform Law. And its one of the parts of the law that has bi-partisan support, so its unlikely to get struck down even if the mandate is found unconstitutional. And frankly, it doesn't make sense to me that the AMA would encourage medical schools across the country to increase their respective number of students without simultaneously addressing the issue of available residency slots.

That all being said, this is a valid question, and one that you may want to bring up at your interview (if you haven't had one already), or simply contact Ross/SGU/etc's admissions office and ask.

Whether or not there will be a residency crunch in the future is an unanswered question, but IMHO not for the reasons you mention.

Yes, the health financing law had a minor increase in the possible number of residency spots -- but mostly for new, primary care, mostly outpatient training spots. It's not clear that these spots will even be created, nor that US grads will be terribly interested in them.

The AMA doesn't have much to do with this. Much of this is being driven by the AAMC. And, yes, they increased med school enrollment without increasing residency spots, presumably to cause a "crunch" and push carib schools to the margins. And, they did it because more students = more tuition.

 

[Skip Intro]

aProgDirector nailed it.

For a long time, the AAMC and COGME pushed this idea that there was a surplus of doctors. They, through this self-serving cartel, were able to limit the number of medical school spots for otherwise qualified applicants.

The immediate result of this was an overflow of these otherwise-qualified candidates into osteopathy schools and off-shore medical schools. Throughout the past twenty+ years, the differences in the number of spots for residency were shored-up through "loopholes", if you will, in allowing these graduates to enter residency in the U.S. and obtain unrestricted medical licenses.

Overall, this is good news for students who were on the margins but forced to seek alternate pathways to becoming a doctors. More allopathic spots in the U.S. means more U.S. college graduates will get a chance to become a doctor without pursuing a different route.

It is bad news for students who get spots in programs who shouldn't be there in the first place. Speaking from firsthand knowledge, I saw a lot of the latter fail or drop out anyway with huge debt and no degree behind their name.

I think, overall, the AAMC is scrambling trying to address the vast projected doctor shortage in the U.S. by the year 2020 (which is rapidly approaching). Too little too late? Maybe. But, yes, I think the spots for students going abroad (wherever that may be) will dwindle compared to what it has been.

So, if you graduate from a U.S. college in the next few years, can't get into a U.S. medical school (D.O. or M.D. granting), and intend to go "off-the-approved-map" to get your medical degree, I'd think long and hard before making that choice. Only the absolute cream of the crop is likely to follow the yellow brick road and make it all the way to Oz.

-Skip

 

[Skip Intro]

Just wanted to add...

Good question, would be interesting to hear the opinion here as well as the people over at valuemd.com.

For what it's worth, I believe you will overall find better information here. Personally (and this is just personally), I don't support the ValueMD forums or find them very useful.

My reasons? I find they heavily moderate and censor that forum (much more so than here) and, thus, somewhat limit the free-flow of good information. Likewise, you are more likely to find people who are self-selected for the Caribbean schools and therefore heavily biased in their favor over there.

On Student Doctor, you are more likely to find people from a wider range of backgrounds, and thus get a more honest opinion.

Just my opinion and $0.02.

-Skip

 

[NotAProgDirector]

I think, overall, the AAMC is scrambling trying to address the vast projected doctor shortage in the U.S. by the year 2020 (which is rapidly approaching).

It is interesting that the people predicting the "impending doctor shortage" are the same people who predicted the prior "physician oversupply", and are also the people in charge of adjusting said physician supply.

I'm not convinced that there is or will be a doctor shortage. First, one of the reasons they claim is the baby boomers retiring and needing more health care. Even if this is true, by the time you train and prepare physicians, the baby boomers will start dying. Once they all die, we would then have too many physicians.

Second, they quote the new health care law. And we'll all see what SCOTUS has to say about that shortly. Even if SCOTUS leaves the health care law entirely intact, it's still not clear that we need more physicians -- there's no way to pay for all of this new healthcare, and reimbursement rates are going to fall. When they do, each physician is going to try to find ways to do more to make up the difference -- or you'll see physicians refuse to accept Medicaid (or whatever the "baseline medical insurance" the gov't offers to people).

Plus, this doesn't address the physician geographic maldistribution problem, nor a physician specialty maldistribution problem.

For reals, we should be thinking of having techs do routine screening colonoscopies, not training gazillions of gastroenterologists.

 

[Shalashaska]

For what it's worth, I believe you will overall find better information here. Personally (and this is just personally), I don't support the ValueMD forums or find them very useful.

My reasons? I find they heavily moderate and censor that forum (much more so than here) and, thus, somewhat limit the free-flow of good information. Likewise, you are more likely to find people who are self-selected for the Caribbean schools and therefore heavily biased in their favor over there.

Wow, I truly had no idea about this. That being said Skip, what would you personally recommend to students like me who haven't applied to US schools yet with regards to the Caribbean schools?

 

[Skip Intro]

Wow, I truly had no idea about this.

"Selection bias." Heavily filtered. Heavily moderated. And, limited free-flow of information.

Not recommended.

That being said Skip, what would you personally recommend to students like me who haven't applied to US schools yet with regards to the Caribbean schools?

Two caveats:

(1) Don't believe everything you read. Ever. Especially on an Internet forum.
(2) Apply to U.S. schools first. There are a lot more open, a lot more opening, and more spots available for "near misses", contrary to when I applied.

-Skip

 

[Skip Intro]

For reals, we should be thinking of having techs do routine screening colonoscopies, not training gazillions of gastroenterologists.

Completely disagree.

What happens when they find a problem and/or something unexpected? Do they then call the gastroenterologist? No.

This is the "pick the low hanging fruit" that a lot of us in practice currently have a huge problem with. Sure, if there isn't an immediately identfiable problem, then everything is fine. But, what happens if there is? Do you then call the specialist? How is that fair to the consultant who's called?

This would be a system where doctors only handle all the tough cases and/or deal with complications. This is what PAs, CRNPs, CRNAs, optometrists, pyschologists, and (heck) even dental assistants want. This self-selects for complications. And, what happens when a specialist isn't immediately available?

I've already seen this "downward drift" occurring in patient care. And, it even happens when doctors perform or involve themselves in patient-care problems that is beyond their ability to deal with. Too often patients present late and/or beyond repair.

I think we need a system where people get adequate training to deal with problems when they arise, not "dumbing down" the system. If you don't know what to look for, you may miss something. And, this does a disservice to patients and the public alike.

Yes, I went a "non-traditional" route by going to Ross. But, I was otherwise qualified by proving that I could pass all the Steps, become licensed to practice independently, and also become board-certified in my specialty... all on the first attempt. I deal with problems that are, quite frankly, beyond the scope of mid-levels knowledge, training, and expertise all the time. And, these come up frequently, whether people want to believe it or not. I don't think we need a system where stuff will start falling into the cracks, or where we try to pick up the pieces after it does.

-Skip

 

[Unzbuzzled]

Completely disagree.

What happens when they find a problem and/or something unexpected? Do they then call the gastroenterologist? No.

This is the "pick the low hanging fruit" that a lot of us in practice currently have a huge problem with. Sure, if there isn't an immediately identfiable problem, then everything is fine. But, what happens if there is? Do you then call the specialist? How is that fair to the consultant who's called?

This would be a system where doctors only handle all the tough cases and/or deal with complications. This is what PAs, CRNPs, CRNAs, optometrists, pyschologists, and (heck) even dental assistants want. This self-selects for complications. And, what happens when a specialist isn't immediately available?

I've already seen this "downward drift" occurring in patient care. And, it even happens when doctors perform or involve themselves in patient-care problems that is beyond their ability to deal with. Too often patients present late and/or beyond repair.

I think we need a system where people get adequate training to deal with problems when they arise, not "dumbing down" the system. If you don't know what to look for, you may miss something. And, this does a disservice to patients and the public alike.

Yes, I went a "non-traditional" route by going to Ross. But, I was otherwise qualified by proving that I could pass all the Steps, become licensed to practice independently, and also become board-certified in my specialty... all on the first attempt. I deal with problems that are, quite frankly, beyond the scope of mid-levels knowledge, training, and expertise all the time. And, these come up frequently, whether people want to believe it or not. I don't think we need a system where stuff will start falling into the cracks, or where we try to pick up the pieces after it does.

-Skip

👍

 

[Skip Intro]

And, one more thing...

CRNPs, CRNAs, midwives, and PAs don't do a formal, structured residency either where they round and learn and go to lectures for 3-7 years and get yelled at and start to make mistakes that are corrected before they are made.

So, what happens when this "tech" who just graduated from a two-year PA program after doing four years of college is doing an unsupervised colonoscopy and misses a cancer? Who gets sued? That "tech"? Are they going to carry the same level of malpractice insurance too?

There are so many problems with this premise that it doesn't really merit serious consideration. And, to those places where CRNPs already practice independently, caveat emptor.

-Skip

 

[Staryy]

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