The Match Is Heating Up - Part II

[exPCM]

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http://www.aamc.org/data/aib/aibissues/aibvol9_no3.pdf

http://www.aacom.org/resources/bookstore/Documents/college_growth_report_2008.pdf
Look at the above graphs (allopathic on top and osteopathic below) and imagine what is going to happen in the residency match each and every year - the competition for spots is going parabolic.
The number of resident positions is basically static as Medicare has capped their funding of GME slots. There were 22,427 first year slots in the match last year.

 

[medicinesux]

Holy D.O.!!! In 1998, there were 2745 D.O's in the first year class. This year there are 5096. That is almost a 100% increase in about a decade.😱

IMG's will be squeezed BIG time. Both foreign and USIMG's. Some of those carib schools pump out 3 classes of 200-300 students year in and year out. Going to a carib school and being able to land ER, gas, or rads will become increasingly difficult to almost impossible. Heck, if residency slots don't increase some of those new offshore grads could be unemployed just like many law school grads are right now. More AMG's will have to compete for limited specialty slots. Hence, more AMG's will be relegated to primary care and stuck at 150K salaries (thanx to Obamacare and NP's multiplying faster than bacteria undergoing binary fission) while debt loads continue to climb to insane levels. Good times👍


Nightmare scenario: Coming out of Tufts Med with 350K in debt and having to settle for Family Practice in some run down skanky Brooklyn community hospital when you were so sure you would be landing that sweet derm spot at Mass General.

 

[exPCM]

Holy D.O.!!! In 1998, there were 2745 D.O's in the first year class. This year there are 5096. That is almost a 100% increase in about a decade.😱

IMG's will be squeezed BIG time. Both foreign and USIMG's. Some of those carib schools pump out 3 classes of 200-300 students year in and year out. Going to a carib school and being able to land ER, gas, or rads will become increasingly difficult to almost impossible. Heck, if residency slots don't increase some of those new offshore grads could be unemployed just like many law school grads are right now. More AMG's will have to compete for limited specialty slots. Hence, more AMG's will be relegated to primary care and stuck at 150K salaries (thanx to Obamacare and NP's multiplying faster than bacteria undergoing binary fission) while debt loads continue to climb to insane levels. Good times👍

Nightmare scenario: Coming out of Tufts Med with 350K in debt and having to settle for Family Practice in some run down skanky Brooklyn community hospital when you were so sure you would be landing that sweet derm spot at Mass General.

I agree. That 2745 number you posted for 1998 is telling.
I think within 5-7 years most Carribbean schools will be on ventilators as their graduates will be unable to get US residency slots due to being crowded out by US allopathic and osteopathic grads.
I think your nightmare scenario has a very high probably of coming true for some graduates this year and in the next few years.

 

[Frugal Traveler]

I wonder who will be writing the next Flexner report?

Neither a DO nor MD school can increase class size so fast and still produce quality graduates. Pumping out "doctors" is one thing, but being worthy to serve the suffering is another.

 

[gstrub]

Going to a carib school and being able to land ER, gas, or rads will become increasingly difficult to almost impossible. .

Good. F them.

 

[Taurus]

Yup, it's gonna suck entering as an FMG in 2013.

 

[Shosha]

Good. F them.

Any particular reason for your apparent hatred?

 

[EternalMD]

I wonder who will be writing the next Flexner report?

Neither a DO nor MD school can increase class size so fast and still produce quality graduates. Pumping out "doctors" is one thing, but being worthy to serve the suffering is another.

And yet if we don't do it, nurses will surely pump out even more poor quality MD-equivalents (as per obamacare) as they are already doing. I'd rather have a poorly training MD/DO than a poorly trained nurse

 

[Coastie]

medicinesux,

I like your style, and you're spot on. This massive increase in number and tuition of crappy schools is very law-school-esque, and they don't have to worry about DNP's!

I think unmatched ms4's should be able to work as PA's/NP's indefinitely until they are able to land spots. At least give them a nice paying job....Will residency acceptance be the new BIG LAW of medicine in 2020?

Holy D.O.!!! In 1998, there were 2745 D.O's in the first year class. This year there are 5096. That is almost a 100% increase in about a decade.😱

IMG's will be squeezed BIG time. Both foreign and USIMG's. Some of those carib schools pump out 3 classes of 200-300 students year in and year out. Going to a carib school and being able to land ER, gas, or rads will become increasingly difficult to almost impossible. Heck, if residency slots don't increase some of those new offshore grads could be unemployed just like many law school grads are right now. More AMG's will have to compete for limited specialty slots. Hence, more AMG's will be relegated to primary care and stuck at 150K salaries (thanx to Obamacare and NP's multiplying faster than bacteria undergoing binary fission) while debt loads continue to climb to insane levels. Good times👍


Nightmare scenario: Coming out of Tufts Med with 350K in debt and having to settle for Family Practice in some run down skanky Brooklyn community hospital when you were so sure you would be landing that sweet derm spot at Mass General.

 

[Taurus]

The FMG's probably don't want to hear this:

What the Health Care Bills Do (and Don't Do) for Primary Care

Yes, the big health-care bills moving through Congress include a few measures to increase the number of primary-care doctors. No, those measures probably aren't enough to satisfy the demand for primary-care projected by medical educators and others, Kaiser Health News reports

Medicare payments to primary-care docs would be boosted by 10% under the the House and Senate bills. And about 1,000 residency positions (which are funded through Medicare) would be redistributed to hospitals that commit to creating more primary-care residencies. [How are they going to redistribute residencies? What specialties will have spots taken away from them?]

But bigger plans to increase the number of primary-care docs aren't likely to get very far, because they'd be too expensive. For example, the article cites a proposal from Harry Reid to expand the number of Medicare-funded residency slots by 15,000, or about 15%, with an emphasis on training more primary care doctors. But the $10 billion price tag means that's not likely to be part of the big health-care overhaul.

"I don't see anything in the legislation that will greatly increase the primary care pipeline," the primary-care doctor who chairs the Council on Graduate Medical Education, a group that advises Congress, told KHN.​

 

[Saga1]

http://www.cogme.gov/cogmeletter.htm

According to that article there has too high a growth in sub specialization residencies and a reduction in primary care residencies. Redistribution of funds would basically create more residency positions and fewer fellowship programs, that is actually good news for FMGs...I think.

 

[Coastie]

http://www.cogme.gov/cogmeletter.htm

According to that article there has too high a growth in sub specialization residencies and a reduction in primary care residencies. Redistribution of funds would basically create more residency positions and fewer fellowship programs, that is actually good news for FMGs...I think.

Reduce anesthesia spots for residency and increase primary care spots. No argument here👍

They should have mandatory practice management/econ courses promoting capitalism in these PCP residencies. If a PCP knew anything about biz, they could be rollin'. It's this tie to medicare/medicaid which screws them over..

 

[Good Solutions]

Reduce anesthesia spots for residency and increase primary care spots. No argument here👍

They should have mandatory practice management/econ courses promoting capitalism in these PCP residencies. If a PCP knew anything about biz, they could be rollin'. It's this tie to medicare/medicaid which screws them over..

I like your thinking.


But back to the topic at hand I believe this is a good thing. We do need more physicians. Why are we permitting educational rotations to be used on PAs? or CRNAs? or DNPs? These educational experiences although minimal and even at times less intense could potentially be maximized to train more physicians.

The schools we are creating aren't any worse than other American schools. I really don't see where the citation of poorer quality is coming from. You often hear about the 'qualified' american students who can't make it in the US and go over seas, but now that they have the opportunity to stay stateside that makes them less qualified than before? That doesn't add up to me.

This is what I predict: If there is no fixing of the residency cap, what will happen is a resurgence of General Practitioners (Those who only do an intern year). This is good. I would prefer to see a GP over a DNP or PA any day for my primary care needs. Insurance might have a hard time working with them but you can bet they will be scooped up quickly by federal health clinics, prisons, and urgent cares. However, many will simply open up their own cash only primary care venue that is a hybrid urgent care/PC office.

 

[Saga1]

Reduce anesthesia spots for residency and increase primary care spots. No argument here👍

They should have mandatory practice management/econ courses promoting capitalism in these PCP residencies. If a PCP knew anything about biz, they could be rollin'. It's this tie to medicare/medicaid which screws them over..

I don't know if it's a reduction in anesthesia spots, or a reduction in fellowship funding to accomadate more PGY 1 spots in primary care.

 

[NotAProgDirector]

No one is talking about reducing anesthesia (or any fellowship) funding spots. The "resdistribution" mentioned is this: When a program closes or decreases in size voluntarily, the funding slots that were attached to that program are "lost". Personally, I would think they would just evaporate away, but apparently someone is counting them. The redistribution is taking these "orphaned" slots and giving them to other programs to use. Proponents suggest that this doesn't increase the cost of GME funding, which is of course ridiculous because an unfillable slot costs $0.

 

[Saga1]

This is what the COGME letter says

[FONT=Arial, Helvetica, sans-serif]"Likewise, current GME trends are not consistent with a more cost effective primary care-based health care system. Between 2002 and 2006, despite a Medicare GME payment cap, teaching hospitals increased subspecialty training positions by nearly 25% but reduced family medicine training by almost 3%.3 Since the GME cap was put in place in 1996, primary care internal medicine positions in the annual student Match have fallen by 57%, primary care pediatric positions by 34%, and family medicine by 18%. [7] It is unclear how many of these are being filled outside of the Match and how many have disappeared. While some teaching hospitals maintain a commitment to primary care, to Medicare's goals and to the health of the public, the overall picture suggests that financial concerns have affected the majority of teaching hospitals' decisions about selection of training positions.".

and

"
[FONT=Arial, Helvetica, sans-serif]Recommendation 4 of the 19th COGME report calls for making accountability for the public's health the driving force for graduate medical education. The nearly $10 billion spent annually on GME can no longer afford to be bent to the needs of hospitals. We appreciate the need to help teaching hospitals with the problems of workforce and financial solvency that GME currently serves, but we cannot afford the byproduct of an overly-specialized and expensive physician workforce. With modification the byproduct of GME funding could be a reshaping of the role of teaching hospitals in meeting the needs of the public. Clearly, 25% growth in subspecialty training when there is no societal imperative for this makes this dependence even more explicit and at odds with societal needs."

I understand what you are saying and that redistribution is only occuring with 'orphan' slots at the moment, but is it not possible GME funding will be more aggressively directed towards primary rather than specialization residency, considering this is what's stated on the COGME site?
.

 

[NotAProgDirector]

[FONT=Arial, Helvetica, sans-serif]Since the GME cap was put in place in 1996, primary care internal medicine positions in the annual student Match have fallen by 57%, primary care pediatric positions by 34%, and family medicine by 18%.

This is manipulating statistics for their own benefit.

In 1990, there were 4796 Cat IM spots and 340 PCT spots. In the mid 90's, primary care was all the rage (managed care and all). Thus, in 1996, there were 4654 Cat IM spots and 566 PCT spots. Note that the number of cat spots decreased, as they were converted into primary care spots. There was a very small gain of about 80 total slots per year, but mostly this was shifting Cat -> PCT.

Fast forward to 2009, and now the slots are 4922 Cat and 247 PCT. Although there has been a slight decrement overall, mostly what programs have done is switch primary care spots back to categorical spots. Remember that you can absolutely become a general internist by training in a categorical program, so this wildly high percentage drop in PCT training really is reporting a small absolute drop, and a shift towards cat IM which can also be applied to primary care in the long term.

[FONT=Arial, Helvetica, sans-serif]Clearly, 25% growth in subspecialty training when there is no societal imperative for this makes this dependence even more explicit and at odds with societal needs[/B]."

There is some disagreement about whether there is a societal imperative for more subspecialists. Americans like seeing specialists for their healthcare. It's not cost effective, and we can argue whether it's a good idea or not. Americans like to claim that there are too many specialists, and then want to see one without any wait if they get sick.

 

[Saga1]

Thanks for your input. If you don't mind me asking, what changes do you see happening to residency seats say within the next 5-10 years?

 

[Hernandez]

something else to keep in mind. the aoa on average only filled about half of their spots for the last many years, so there is another 1200 spots that can be filled. The ACOI (osteopathic IM) is already starting to see an upswing in their numbers in the last 3 years, which I'm presuming has more to do with the massive increase in DO grads.

 

[exPCM]

something else to keep in mind. the aoa on average only filled about half of their spots for the last many years, so there is another 1200 spots that can be filled. The ACOI (osteopathic IM) is already starting to see an upswing in their numbers in the last 3 years, which I'm presuming has more to do with the massive increase in DO grads.

Yes, this is true but there are mitigating factors.
1) Only DOs can apply to these programs.
2) The rate of increase in DO grads is increasing almost parabolically.
3) What % of this apparent increase in DO spots is just a conversion of pure allopathic slots into slots that are dual accredited AOA/ACGME without an increase in actual resident positions - look at this link and see how many of these slots are actuallly at ACGME sites:
http://www.do-online.org/index.cfm?PageID=sir_match08res

 

[Taurus]

This shouldn't be a surprise to anyone following this topic.

Med School Applications Flat; Number of Slots Grows a Bit

The 2009 figures are out today from the Association of American Medical Colleges: 42,269 applicants for 18,390 first-year slots. That compares to 38,443 applicants for 16,221 slots in 1999.

Despite the long-term stability, there are some year-to-year variations. Between 2008 and 2009, the number of applicants didn't change much. But there are about 350 more first-year students this year, largely because four new med schools seated their first entering classes (some existing schools also expanded their first-year classes).

The new schools are affiliated with Florida International University, Texas Tech and the University of Central Florida; a fourth school, the Commonwealth Medical College, in Pennsylvania, is independent.​