The Med Student Pipeline Is Exploding

[exPCM]

According to the current AMA news, medical schools are markedly increasing their enrollments such that there will 19909 allopathic and 5227 osteopathic students admitted in 2012.
This is a total of US medical school 25136 spots per year.
http://www.ama-assn.org/amednews/2008/06/23/prsb0623.htm

The number of Medicare funded resident spots was capped in 1997 and there are ~24000 first year residency spots.
http://www.amsa.org/tnp/articles/article.cfx?id=92
http://goliath.ecnext.com/coms2/gi_0199-6095908/BBA-impacts-on-hospital-residents.html

With the large U.S. budget deficits IMHO THE prospects for large increases in the cap on resident spots are slim at best. This is going to make the match much more competitive in the future as you have more and more medical students competing for a basically fixed number of spots. There clearly will not be enough residency slots for all the US allopathic, US osteopathic, US IMGs, and non-US IMGs who will be applying for the match.

I think it is going to be very rough for those medical students who graduate and are unable to get into a residency.

P.S. The following quote in the article I think is worth pondering
The number of first-year residency positions has grown only 4% over the past 10 years. Without residency slots increasing at the same rate as school seats, the larger U.S. classes will end up replacing international medical graduates in the residency pool, not expanding the total number of physicians, Salsberg said.

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[chrisisinnocent]

Long term this will hurt IMGs I think. If too many US grads do not match there will be a big political backlash (especially given the cost of med school in the US).

 

[Pir8DeacDoc]

If I'm in medical school outside the good ole USA then right now my sphincter tone just got a little higher. This shouldn't do much to American medical students. It might make things a little tougher on DO's.

This is interesting because I know my medical school and the other public med school in the state are both ramping up enrollment. I hadn't really considered the ramifications with residency spots.

 

[yaah]

The increase in medical students always seems to be accompanied by a rationale (from those who allow or promote the increase) that there is a shortage of primary care providers, and this will help that shortage. But what makes them think that increasing the number of med students will necessarily increase the number of students who go into primary care? I suspect that these new admits will have the same vocation for subspecialty and lifestyle fields that current med students do. They may even have MORE of a vocation for these fields because they may be applicants who have to take out more loans and spend more money to make themselves competitive.

"Remedies" like this to the lack of primary care physicians show a complete lack of foresight or attention to detail. Authorities would have far more success if they eliminated or lessened the excessive costs required to attain an MD/DO degree (through more subsidized loans, loan forgiveness for primary care, whatever). The evidence for this can be seen, in part, by looking at match lists for state schools who often have lower tuition. More primary care! But where is the increase in med students going to come from? While there will be some from public schools, I would wager the majority will come from private schools, with attendant private school tuition. Or it will be public schools admitting more out of state (expensive) students.

 

[Geri_Gal]

"Remedies" like this to the lack of primary care physicians show a complete lack of foresight or attention to detail. Authorities would have far more success if they eliminated or lessened the excessive costs required to attain an MD/DO degree (through more subsidized loans, loan forgiveness for primary care, whatever). The evidence for this can be seen, in part, by looking at match lists for state schools who often have lower tuition. More primary care! But where is the increase in med students going to come from? While there will be some from public schools, I would wager the majority will come from private schools, with attendant private school tuition. Or it will be public schools admitting more out of state (expensive) students.

If the powers that be want to increase the # of primary care docs, they need to increase compensation for said docs. Public med schools are expensive as well.

 

[Toohotinvegas33]

admitted in 2012.

They have a couple of years to increase the GME/OGME. I would be a little worried if they the class of 2012. Also I think that 24k spots is just the allopathic ones. There are a 2300~ position in the DO match and we only filled 1500~, leaving the majority of the fm/im programs unfilled.




http://www.natmatch.com/aoairp/index.htm

 

[OldPsychDoc]

Don't choose law school instead!

 

[RxnMan]

Law2Doc has been prophesizing this for years. GME slots will stay static and things will get more competitive quick.

With the number of people applying to med school (~40k/year), there will always be someone who is willing to run the risk of not Matching, or Matching into a speciality they don't like, just so that they can be a doc. I would also expect the number of people doing multiple residencies to go up.

...Also I think that 24k spots is just the allopathic ones. There are a 2300~ position in the DO match and we only filled 1500~, leaving the majority of the fm/im programs unfilled...

So you're saying that first US med seniors will be favored over FMGs, and later it will be MDs over DOs for US allo spots? I don't think that the remaining 800 seats will be enough anyways.

...They have a couple of years to increase the GME/OGME. I would be a little worried if they the class of 2012...

The loan deferrment pathway was just closed, so why would we expect GME to be increased?

 

[AmoryBlaine]

Who will feel pain:

FMGs >>>>>> DOs >>>>>>> MDs

 

[Taurus]

American MD's will feel pain too.

If you thought getting into derm, rads, ortho, etc is difficult now...

Just wait to see how it is 10 years from now if they don't increase residency slots.

 

[NonTradMed]

Also remember that DO students have their own residency spots to fill, the OP should not assume that all DOs will match into allo spots.

I think US med students are safe for a while. It's the FMGs which will feel the pain. And if there is enough complaining about the difficulties of matching after spending so much money on training US med students, I think there will be incentive to increase residency spots.

 

[exPCM]

Also remember that DO students have their own residency spots to fill, the OP should not assume that all DOs will match into allo spots.

I think US med students are safe for a while. It's the FMGs which will feel the pain. And if there is enough complaining about the difficulties of matching after spending so much money on training US med students, I think there will be incentive to increase residency spots.

I do not assume that all DOs will go into allopathic residencies. However the increase in number of osteopathic residency spots does not even come close to keeping up with the increase in DO grads.
http://www.amsa.org/tnp/articles/article.cfx?id=103

Another consideration is that the ACGME mandates that all physicians in allopathic residencies must be paid.
This is not true in osteopathic residencies where many residency positions are still unpaid. Think of the hardship this places on the residents who are working for zero pay.
See these programs for example:
http://opportunities.osteopathic.or...program_id=126242&hosp_id=118579&returnPage=1
http://opportunities.osteopathic.or...program_id=158939&hosp_id=136437&returnPage=1
http://opportunities.osteopathic.or...program_id=163919&hosp_id=119361&returnPage=1
http://opportunities.osteopathic.or...program_id=126042&hosp_id=118492&returnPage=1
http://opportunities.osteopathic.or...program_id=146377&hosp_id=119557&returnPage=1

Spending a lot of money on training does not guarantee a position. Just look at the situation for law school graduates.
http://online.wsj.com/public/article/SB119040786780835602.html

I think it is naive to think there is some residency fairy godmother that will automatically create more residency spots as medical student enrollment increases.
IMHO we will instead see ever more fierce competition in fields like radiology, orthopedics, etc. as more and more med students compete for a relatively fixed number of spots. Those who do not match may be forced to go into less competitive fields like psychiatry and FP.

 

[Shinken]

Never mind...

 

[GregsAnatomy]

This is not true in osteopathic residencies where many residency positions are still unpaid, particularly first year spots. Think of the hardship this places on the residents who are working for zero pay.
See these 10 programs for example:
http://opportunities.osteopathic.or...program_id=126242&hosp_id=118579&returnPage=1
http://opportunities.osteopathic.or...program_id=158939&hosp_id=136437&returnPage=1
http://opportunities.osteopathic.or...program_id=163919&hosp_id=119361&returnPage=1
http://opportunities.osteopathic.or...program_id=126042&hosp_id=118492&returnPage=1
http://opportunities.osteopathic.or...program_id=128193&hosp_id=118936&returnPage=1
http://opportunities.osteopathic.or...program_id=169820&hosp_id=118579&returnPage=1
http://opportunities.osteopathic.or...program_id=130774&hosp_id=119398&returnPage=1
http://opportunities.osteopathic.or...program_id=130311&hosp_id=119286&returnPage=1
http://opportunities.osteopathic.or...program_id=127067&hosp_id=118776&returnPage=1
http://opportunities.osteopathic.or...program_id=146377&hosp_id=119557&returnPage=1

You don't know what you're talking about. They say "0" because previously it was required that you do a standalone osteopathic rotating internship prior to beginning the residency in PGY-2 year. Those would be separate from the programs you have listed there and have their own attached salary.

There are however a few osteopathic dermatology residency programs that are unpaid or pay very little (~10K).

 

[gtleeee]

You don't know what you're talking about. They say "0" because previously it was required that you do a standalone osteopathic rotating internship prior to beginning the residency in PGY-2 year. Those would be separate from the programs you have listed there and have their own attached salary.

There are however a few osteopathic dermatology residency programs that are unpaid or pay very little (~10K).

True. No D.O.'s are in unpaid internships or residencies. Thank god.

 

[exPCM]

You don't know what you're talking about. They say "0" because previously it was required that you do a standalone osteopathic rotating internship prior to beginning the residency in PGY-2 year. Those would be separate from the programs you have listed there and have their own attached salary.

There are however a few osteopathic dermatology residency programs that are unpaid or pay very little (~10K).

I have corrected my post. I incorrectly included some OGME1 spots. However I still have listed 5 programs which are unpaid at the OGME2 level and higher. I stand by the fact that osteopathic programs allow residents to work for no pay. Do you disagree on the five programs I have listed? I bet I can find more if I put in the time.

 

[futuredo32]

I have corrected my post. I incorrectly included some OGME1 spots. However I still have listed 5 programs which are unpaid at the OGME2 level and higher. I stand by the fact that osteopathic programs allow residents to work for no pay. Do you disagree on the five programs I have listed? I bet I can find more if I put in the time.

Mt.Clemens Regional Medical Center currently has one Rads resident who is unpaid. Before each year starts, he has to write a check for the cost of his salary, insurance, etc. They have said repeatedly that they are willing to consider applicants for unpaid positions in the future as well.

 

[yaah]

Mt.Clemens Regional Medical Center currently has one Rads resident who is unpaid. Before each year starts, he has to write a check for the cost of his salary, insurance, etc. They have said repeatedly that they are willing to consider applicants for unpaid positions in the future as well.

Is that residency actually accredited? I find it hard to believe ACGME would accredit a fellowship program that behaves basically as a profit center in such a fashion. And if ACGME doesn't accredit you, you can't take board exams. I suspect that they are accredited though, but I can't believe there aren't rules against this.

There are pathology fellowship programs like this, where people pay (particular in dermpath) to do a "fellowship" at certain programs. Usually they are practicing in another country, so ACGME status doesn't matter, and they can return to their home country and say they trained with so and so.

 

[Winged Scapula]

Is that residency actually accredited? I find it hard to believe ACGME would accredit a fellowship program that behaves basically as a profit center in such a fashion. And if ACGME doesn't accredit you, you can't take board exams. I suspect that they are accredited though, but I can't believe there aren't rules against this.

There are pathology fellowship programs like this, where people pay (particular in dermpath) to do a "fellowship" at certain programs. Usually they are practicing in another country, so ACGME status doesn't matter, and they can return to their home country and say they trained with so and so.

Mt. Clemens is an Osteopathic program so ACGME has nothing to say about it. Here is the link to the Rads Residency program: http://www.mcrmc.org/body.cfm?id=77

No mention is made of AOA accreditation which seems a bit odd. Then again, offering an unfunded residency position, especially in such a popular field like Rads, seems rife for abuse.

 

[yaah]

Well, I have to claim ignorance on accreditation of DO programs - presumably AOA substitutes for ACGME? I mean, you have to apply for a medical license afterwards so you need some sort of accreditation. They say on the website they are "AOA approved" but is that for just the funded position, or for both the funded and unfunded? I know some people are desperate to get into radiology but sheesh. Even John Carter MD didn't have to pay for his ER residency training, he just did it for free.

 

[Winged Scapula]

Well, I have to claim ignorance on accreditation of DO programs - presumably AOA substitutes for ACGME? I mean, you have to apply for a medical license afterwards so you need some sort of accreditation. They say on the website they are "AOA approved" but is that for just the funded position, or for both the funded and unfunded? I know some people are desperate to get into radiology but sheesh. Even John Carter MD didn't have to pay for his ER residency training, he just did it for free.

And does AOA approved = AOA accredited?

I'm ignorant too. I cannot imagine doing a non-accredited program and I cannot imagine a program being accredited that offers an unfunded position. ANd not only is it unfunded, but as noted above, apparently the resident has to pay the cost of their education! Makes me wonder what he/she pays. After all, programs are always saying it costs X dollars to educate us. Are they making him pay $100K/year?

 

[NotAProgDirector]

The osteopathic medical system has it's own boards for certification.

A general overview can be found here.

The Dermatology's board, with the rules for board certification, is here.

Mt Clemens does not appear to be an approved training site, at least according to the list here.

 

[Winged Scapula]

The osteopathic medical system has it's own boards for certification.

A general overview can be found here.

The Dermatology's board, with the rules for board certification, is here.

Mt Clemens does not appear to be an approved training site, at least according to the list here.

Thanks for the links; we were talking about Mt Clemens having an unfunded Rads position not Derm. (I know how the rapid fire switching of topics is hard for you geezers to follow. )

It is listed here as being recognized by the AOCR.

 

[gtleeee]

I have corrected my post. I incorrectly included some OGME1 spots. However I still have listed 5 programs which are unpaid at the OGME2 level and higher. I stand by the fact that osteopathic programs allow residents to work for no pay. Do you disagree on the five programs I have listed? I bet I can find more if I put in the time.

23 years in the profession and have never heard of such a thing. Even back in the early 80s the AOA yearbook showed many slots that were unfunded but that simply meant that they were approved slots but would have to obtain funding in order to make them exist anywhere other than on paper. I have never once heard of anyone actually taking one of these unpaid "openings" It is easy to see how you got confused. You have to be familiar with how the AOA lays out it's GME on paper to make sense of these "unfunded positions". For instance, for decades the AOA will list in it's yearbook for instance 5 funded and 5 unfunded positions in a certain internship class. But of course there will be only 5 interns found there.

 

[exPCM]

23 years in the profession and have never heard of such a thing. Even back in the early 80s the AOA yearbook showed many slots that were unfunded but that simply meant that they were approved slots but would have to obtain funding in order to make them exist anywhere other than on paper. I have never once heard of anyone actually taking one of these unpaid "openings" It is easy to see how you got confused. You have to be familiar with how the AOA lays out it's GME on paper to make sense of these "unfunded positions". For instance, for decades the AOA will list in it's yearbook for instance 5 funded and 5 unfunded positions in a certain internship class. But of course there will be only 5 interns found there.

I am not confused and you really should take a closer look at the current reality. Residents are in fact in unpaid osteopathic residency positions. I have personally met several. If you are still in doubt you can look at the Pacific Hospital of Long Beach dermatology residency website( http://phlb.org/DermatologyResidency.asp) or call one of other programs I listed or call the Mount Clemens radiology program.
Note: The Mount Clemens program is approved by the American Osteopathic College of Radiology (see link below) http://www.aocr.org/residency/training_programs.asp

 

[Winged Scapula]

23 years in the profession and have never heard of such a thing. Even back in the early 80s the AOA yearbook showed many slots that were unfunded but that simply meant that they were approved slots but would have to obtain funding in order to make them exist anywhere other than on paper. I have never once heard of anyone actually taking one of these unpaid "openings" It is easy to see how you got confused. You have to be familiar with how the AOA lays out it's GME on paper to make sense of these "unfunded positions". For instance, for decades the AOA will list in it's yearbook for instance 5 funded and 5 unfunded positions in a certain internship class. But of course there will be only 5 interns found there.

Many programs will be funded for more positions than they actually offer.

However, the Mount Clemens Rads program is clearly different - it actually states that the unfunded position WILL be offered.

 

[gtleeee]

I thought something seemed kind of "not quite right". My own long ago but still remembered college and Medical School experience taught me that when someone throws a bunch of links and/or annotations at you then 8 times out of 10 they are trying to pull a quick one. First, I followed each of exPCM's links and found the results as detailed in table 1.




Table 1 (exPCM)


1.) NSUCOM/N Broward Hosp District - Dermatology Residency 9 residents in 9 funded positions
2.) TCOM (Texas) 2 unfilled and unfunded residency slots in cardiothoracic surgery
3.) Western/Arizona Dermatology - Dermatology Residency 3 filled but unfunded positions
4.) LECOM/Wellington Regional Med Center - Dermatology Residency program reports 2 residents in 2 unfunded positions

A.) Total of 5 residents in 5 unfunded slots




Then I followed every link of "Greg's Anatomy" and hence table 2 below. From this body of "evidence" LOL we see that 4-6 Dermatology residents are in unfunded residency slots throughout the country. It's an old pseudo- academic trick, throwing a bunch of links out there with the certainty that no one is going to bother laboriously checking them out. Note that for both of these gentlemen, the majority of the "links" they used to illustrate their point that hordes of D.O. residents are working for free are actually links pointing to fully funded slots in residencies throughout the country. As for the several unfilled and unfunded slots both of these gentlemen "discovered", as I said before I observed the AOA would do this even in the early 1980's, as it would establish a residency framework a year or 2 before it actually filled with residents. No mystery there.



Table 2 (Greg's Anatomy)



1) NSUCOM/N Broward Hosp District 8 fully funded positions
2) UNTHSCFW/TCOM/Plaza Medical Center 2 unfunded and unfilled residency slots
3) UNTHSCFW/TCOM/Plaza Medical Center 3 unfunded but filled residency slots (Dermatology)
4) Western/Arizona Dermatology 3 filled but unfunded Dermatology slots
5) Millcreek Community Hospital 8 funded positions and 7 residents in Orthopedic surgery
6) NSUCOM/N Broward Hosp District - Orthopedic Surgery Residency 4 fully funded positions with 4 residents in Orthopedic surgery
7) Pontiac Osteopathic Hosp Med Center (POH) - Orthopedic Surgery Residency 13 residents in 13 funded positions
8) Oklahoma State University Medical Center - Orthopedic Surgery Residency 8 residents in 8 funded positions
9) PCOM/Pinnacle Health Community General Osteopathic Hospital - Orthopedic Surgery 14 residents in 14 fully funded positions

10) LECOM/Wellington Regional Med Center - Dermatology Residency 2 residents in 2 unfunded positions




Of course the handful of unfunded and filled positions were the same links, so 3 of the links are identical for both of their "analytical studies")
I spent a great deal of time in an attempt to find any other unfunded residency slots in the AOA directory but was unable to find any others save a radiology slot at Mount Clemens that is filled and unfunded this year but will be funded in 2009. So, the reality is that a handful of Dermatology residents are laboring with no compensation. This is an outrage, whether it is 5, 6 or 600. Those unfunded slots should never have been allowed in the first place if they could not pay the residents. I can only hope that as a point of pride the AOA and the respective Osteopathic Colleges and hospitals involved in these programs will find ways forthwith to compensate these unfortunate residents. However, as opposed to the thousands of residents in programs throughout the country (both ACGME and AOA), it is far from the "bell of doom" exPCM and Greg's Anatomy tried to ring, (with little success). Surely these gentlemen will not attempt another "ringer" such as this any time soon. It takes too much time to track down the BS. No hard feelings...) Have a good one.

 

[exPCM]

I thought something seemed kind of "not quite right". My own long ago but still remembered college and Medical School experience taught me that when someone throws a bunch of links and/or annotations at you then 8 times out of 10 they are trying to pull a quick one. First, I followed each of exPCM's links and found the results as detailed in table 1.




Table 1 (exPCM)


1.) NSUCOM/N Broward Hosp District - Dermatology Residency 9 residents in 9 funded positions
2.) TCOM (Texas) 2 unfilled and unfunded residency slots in cardiothoracic surgery
3.) Western/Arizona Dermatology - Dermatology Residency 3 filled but unfunded positions
4.) LECOM/Wellington Regional Med Center - Dermatology Residency program reports 2 residents in 2 unfunded positions

A.) Total of 5 residents in 5 unfunded slots




Then I followed every link of "Greg's Anatomy" and hence table 2 below. From this body of "evidence" LOL we see that 4-6 Dermatology residents are in unfunded residency slots throughout the country. It's an old pseudo- academic trick, throwing a bunch of links out there with the certainty that no one is going to bother laboriously checking them out. Note that for both of these gentlemen, the majority of the "links" they used to illustrate their point that hordes of D.O. residents are working for free are actually links pointing to fully funded slots in residencies throughout the country. As for the several unfilled and unfunded slots both of these gentlemen "discovered", as I said before I observed the AOA would do this even in the early 1980's, as it would establish a residency framework a year or 2 before it actually filled with residents. No mystery there.



Table 2 (Greg's Anatomy)



1) NSUCOM/N Broward Hosp District 8 fully funded positions
2) UNTHSCFW/TCOM/Plaza Medical Center 2 unfunded and unfilled residency slots
3) UNTHSCFW/TCOM/Plaza Medical Center 3 unfunded but filled residency slots (Dermatology)
4) Western/Arizona Dermatology 3 filled but unfunded Dermatology slots
5) Millcreek Community Hospital 8 funded positions and 7 residents in Orthopedic surgery
6) NSUCOM/N Broward Hosp District - Orthopedic Surgery Residency 4 fully funded positions with 4 residents in Orthopedic surgery
7) Pontiac Osteopathic Hosp Med Center (POH) - Orthopedic Surgery Residency 13 residents in 13 funded positions
8) Oklahoma State University Medical Center - Orthopedic Surgery Residency 8 residents in 8 funded positions
9) PCOM/Pinnacle Health Community General Osteopathic Hospital - Orthopedic Surgery 14 residents in 14 fully funded positions

10) LECOM/Wellington Regional Med Center - Dermatology Residency 2 residents in 2 unfunded positions




Of course the handful of unfunded and filled positions were the same links, so 3 of the links are identical for both of their "analytical studies")
I spent a great deal of time in an attempt to find any other unfunded residency slots in the AOA directory but was unable to find any others save a radiology slot at Mount Clemens that is filled and unfunded this year but will be funded in 2009. So, the reality is that a handful of Dermatology residents are laboring with no compensation. This is an outrage, whether it is 5, 6 or 600. Those unfunded slots should never have been allowed in the first place if they could not pay the residents. I can only hope that as a point of pride the AOA and the respective Osteopathic Colleges and hospitals involved in these programs will find ways forthwith to compensate these unfortunate residents. However, as opposed to the thousands of residents in programs throughout the country (both ACGME and AOA), it is far from the "bell of doom" exPCM and Greg's Anatomy tried to ring, (with little success). Surely these gentlemen will not attempt another "ringer" such as this any time soon. It takes too much time to track down the BS. No hard feelings...) Have a good one.

Let's see:
1) Your first argument was that you were an experienced doctor with 23 years experience and I was confused and that there were no unpaid residents: we have now established you were wrong and there are unpaid/unfunded residents
2) Your next argument is that you followed all my links and that there are only five unfunded unpaid residents in the country. Again this is not correct either.
I will just give 2 of the links to blow that out of the water:
The first is the Pacific Hospital of Long Beach Demrmatology residency:
http://phlb.org/DermatologyResidency.asp
which has six approved unfunded slots with four listed as filled
The second is the NSUCOM Broward dermatology residency
http://opportunities.osteopathic.or...program_id=126242&hosp_id=118579&returnPage=1
with nine approved spots and eight filled. If you look carefully, three of these are unfunded unpaid OGME2 spots, three are OGME3 spots with pay of 10000 per year, and two are OGME4 at a pay of 12500 per year. You cannot call that "fully funded". I certainly do not.
So in summary with just two links I have found 7 unpaid residents and 5 grossly underpaid residents (10000 or 12500 per year). Before you reply please go back and read the data. FYI, Greg's anatomy just copied links I already posted.
I agree that AOA members should be outraged and it is sad that this is allowed to go on when the ACGME would not accredit unfuded unpaid allopathic residency spots.

 

[Winged Scapula]

I spent a great deal of time in an attempt to find any other unfunded residency slots in the AOA directory but was unable to find any others save a radiology slot at Mount Clemens that is filled and unfunded this year but will be funded in 2009.

You might want to read that again:

"MCRMC has an unfunded PGY 2 position available July 1, 2009.
The next available position for a funded PGY 1 resident will be July 1, 2009."

They are still offering an unfunded position next year. Whether or not what appears to now be AOA-approval means that they will no longer offer PGY-1 or above positions as unfunded is unknown. I suspect they now have funding for one position per year but continue to offer the unfunded position.

 

[gtleeee]

You might want to read that again:

"MCRMC has an unfunded PGY 2 position available July 1, 2009.
The next available position for a funded PGY 1 resident will be July 1, 2009."

They are still offering an unfunded position next year. Whether or not what appears to now be AOA-approval means that they will no longer offer PGY-1 or above positions as unfunded is unknown. I suspect they now have funding for one position per year but continue to offer the unfunded position.

But the AOA has for decades had unfunded slots referred to in the "big book". It's always been that way. Because as I carefully explained before these seats are not FILLED, nor most likely will they be. These openings are created so they can be used several years down the road when funding IS available.
All this silliness over 5-7 unpaid dermatology residents is a bit much. With exPCM and "GregsAnatomy" doing this like they just broke the Watergate scandal. I am out. Have a good one.)

 

[Tired]

The increase in medical students always seems to be accompanied by a rationale (from those who allow or promote the increase) that there is a shortage of primary care providers, and this will help that shortage. But what makes them think that increasing the number of med students will necessarily increase the number of students who go into primary care?

Easy.

(1) The subspecialties actively resist expansion of residency slots, because it hits us in the pocket book. The primary care specialties will give residency accredidation to any chump with a clinic and three patients.

(2) It's a lot easier to expand the medicine specialties than the procedural specialties. 50 residents can learn about heart murmurs from the one guy with aortic regurg. But you can't train 50 General Surgeons on the one guy with cholecystitis.

 

[futuredo32]

You might want to read that again:

"MCRMC has an unfunded PGY 2 position available July 1, 2009.
The next available position for a funded PGY 1 resident will be July 1, 2009."

They are still offering an unfunded position next year. I suspect they now have funding for one position per year but continue to offer the unfunded position.

What you posted is correct. They sent out an email to some students, maybe just the ones based at the hospital for rotations or maybe more, but the gist of the email was about the new fellowships they have and also stated that they are always willing to consider applicants for unpaid positions in any of their programs, but radiology is the only program that I know of that has a resident actually paying their own salary, insurance, etc.

 

[MacGyver]

So are the unfunded residency programs accredited or not?

 

[Winged Scapula]

But the AOA has for decades had unfunded slots referred to in the "big book". It's always been that way. Because as I carefully explained before these seats are not FILLED, not most likely will they be. These openings are created so they can be used several years down the road when funding IS available.

That's not a problem. We're not talking about programs that are approved for more positions than they fill. No one cares about those. And its not a DO thing...ACGME programs also are sometimes approved for more positions than they have funding for/offer in the match. The difference is that they don't offer them to residents as unpaid or lowly paid ($10-$12.5K/year) positions or ask the resident to PAY them.

All this silliness over 5-7 unpaid dermatology residents is a bit much. With exPCM and "GregsAnatomy" doing this like they just broke the Watergate scandal. I am out. Have a good one.)

Why is this silly? I don't care if its ONE position. As it is, residents are sanctioned slave labor and a situation like this, especially with Derm and Rads, two very competitive residencies, is prime for abuse.

I have to wonder why you wouldn't care. As an attending DO physician, I would expect you to have more interest in seeing people junior to you being treated fairly. YOU have much more power than medical students and residents and should be appalled that stuff like this happens. Whether its 5 or 6 Derm residents, 1 Rads resident, or whatever, this situation should not exist, IMHO.

 

[DarthNeurology]

The difference is that they don't offer them to residents as unpaid or lowly paid ($10-$12.5K/year) positions or ask the resident to PAY them.

Why is this silly? I don't care if its ONE position. As it is, residents are sanctioned slave labor and a situation like this, especially with Derm and Rads, two very competitive residencies, is prime for abuse.

I have to wonder why you wouldn't care. As an attending DO physician, I would expect you to have more interest in seeing people junior to you being treated fairly. YOU have much more power than medical students and residents and should be appalled that stuff like this happens. Whether its 5 or 6 Derm residents, 1 Rads resident, or whatever, this situation should not exist, IMHO.

While I detest medical student abuse, why necessarily would say a D.O. who is a dermatology resident making $10,000/year or maybe nothing be a situation for abuse? I.e. there aren't that many dermatologic emergencies, and when they finish they don't have to take much/any call. I know many medical students who would gladly pay $20,000 a year to do a dermatology residency considering how people seem to be attracted to them these days.

I have seen surgery residents who are payed say $50,000/year or so who get reamed daily, which must be worse than what a dermatology resident gets. How does making more money translate into respect?

If anything a paying customer should be respected. Many medical students pay $35-40,000/year while doing basically clerical and busy work on rotations to be treated very poorly and the fact that we payed to be harassed is not lost on us, believe you me.

Don't tell me about the wonderful education of clinical years, I learned mostly by reading journal articles. But, residents DO get more "education" as they are managing patients. You could say that the "education" a resident receives will allow them to earn a high salary and start to charge residents making $45,000/year say $40,000 tuition so they net only $5,000! Who to say that isn't fair?

 

[Shinken]

And does AOA approved = AOA accredited?

Yes, it's basically saying the same thing.

 

[Shinken]

This is an interesting discussion.

Is it abuse if the people freely submit to it? I mean, you have to apply and match and sign the contract to attend an unfunded program, it's not like it's forced or that people have few other choices. Unfunded programs in the DO world are not "many" as was suggested but rare.

I'm sure there are a lot of people that want to be dermatologists so badly that they would attend an unfunded (but accredited) derm program. Personally, I wouldn't attend an unfunded program at all, but if someone wants to, let them.

 

[exPCM]

This is an interesting discussion.

Is it abuse if the people freely submit to it? I mean, you have to apply and match and sign the contract to attend an unfunded program, it's not like it's forced or that people have few other choices. Unfunded programs in the DO world are not "many" as was suggested but rare.

I'm sure there are a lot of people that want to be dermatologists so badly that they would attend an unfunded (but accredited) derm program. Personally, I wouldn't attend an unfunded program at all, but if someone wants to, let them.

Bingham's syndrome is quite rare. DO residents going through unpaid residencies has been occurring for years and is not rare IMHO. However at this juncture I am not about to take the time to dig up and list additional unfunded spots besides those that are already listed above.

 

[DarthNeurology]

This is an interesting discussion.

Is it abuse if the people freely submit to it? I mean, you have to apply and match and sign the contract to attend an unfunded program, it's not like it's forced or that people have few other choices. Unfunded programs in the DO world are not "many" as was suggested but rare.

I'm sure there are a lot of people that want to be dermatologists so badly that they would attend an unfunded (but accredited) derm program. Personally, I wouldn't attend an unfunded program at all, but if someone wants to, let them.

I guess it is all a matter of supply and demand. For example, if there were 500 D.O. students competing for say 40 highly coveted residencies in subspecialty X then in a way the PDs could be justified by charging residents to enter the program as much as the "market" would bear, such as perhaps even $60-100,000 dollars a year to attend the residency. Now, obviously greed of the private institution would look bad, but would it be unethical considering all of the shady stuff that happens in medicine?

The hospitals could say that the money they receive from residents is used to treat uninsured patients or something like that. I don't think anyone would be "outraged" for the D.O. residents considering that they would have high salaries presumably as attendings and could pay it off.

Obviously if say the price for attending a dermatology residency was say 1 million dollars a year then fewer if any would choose this option, but at a cost of $10-20,000 per year many would take out the loan to do it. It just matters what the balance point is in the market.

In the end it makes the salary of residents look pretty good at $45,000 a year considering that residency IS where you actually learn medicine and also considering that you are supervised in what you are doing, i.e. you don't shoulder the majority of the responsibility on paper (although in real life residencies you may).

Considering that residency is a mix of education and work and opens the doors to being an attending one day I think the average yearly salary of $45,000 is fair, especially considering apparently that some D.O. students pay to go to residency, especially if you want to do underserved work and have huge loans to pay off.

However, what about high paying specialties like Dermatology or Radiation Oncology?? If those residents were charged $40,000 per year and had to take out loans AND this money went to help underserved patients in say a clinic I was running at the hospital I sure wouldn't be losing any sleep at night. In the end the hospital would make $40,000 per year instead of losing this amount, a net of $80,000 times say maybe 20 residents in such field and you see this could help fund other things at any hospital.

 

[gtleeee]

That's not a problem. We're not talking about programs that are approved for more positions than they fill. No one cares about those. And its not a DO thing...ACGME programs also are sometimes approved for more positions than they have funding for/offer in the match. The difference is that they don't offer them to residents as unpaid or lowly paid ($10-$12.5K/year) positions or ask the resident to PAY them.



Why is this silly? I don't care if its ONE position. As it is, residents are sanctioned slave labor and a situation like this, especially with Derm and Rads, two very competitive residencies, is prime for abuse.

I have to wonder why you wouldn't care. As an attending DO physician, I would expect you to have more interest in seeing people junior to you being treated fairly. YOU have much more power than medical students and residents and should be appalled that stuff like this happens. Whether its 5 or 6 Derm residents, 1 Rads resident, or whatever, this situation should not exist, IMHO.

To say that then you did not read my post. I said this outrage was unacceptable regardless of how many D.O. residents it concerned. And I said a lot more concerning this. Go back and read. I meant in my third post that I was "out" on this topic in this forum.

 

[Winged Scapula]

To say that then you did not read my post. I said this outrage was unacceptable regardless of how many D.O. residents it concerned. And I said a lot more concerning this. Go back and read. I meant in my third post that I was "out" on this topic in this forum.

Thank you for the clarification...you are right, in your 3rd post you do agree that this is unacceptable. I am sorry I misunderstood.

(btw, I knew what you meant by being "out" on the topic)

 

[coldweatherblue]

so by the time I graduate I'll be taking out loans to pay for residency, while taking out more loans so that I'll be able to make the repayments on my med school loans, which I'll no longer be able to defer.

 

[Blade28]

so by the time I graduate I'll be taking out loans to pay for residency, while taking out more loans so that I'll be able to make the repayments on my med school loans, which I'll no longer be able to defer.

While I understand the second part of your (possibly tongue-in-cheek) sentence, why would you be taking out loans to "pay" for residency?

 

[coldweatherblue]

While I understand the second part of your (possibly tongue-in-cheek) sentence, why would you be taking out loans to "pay" for residency?

Winged Scapula, DarthNeurology, and others were discussing possible implications of a few current unpaid-dermatology residency spots, including charging future residents "tuition" in order to cover part of the costs of their training. It seems ridiculous to me as I stare tentatively at my currently-unsigned promissory note from Sallie Mae to cover MS1. And yes my post was tongue in cheek.

 

[Shinken]

DO residents going through unpaid residencies has been occurring for years and is not rare IMHO.

I wasn't saying that this hasn't been occurring for years, I was saying that residencies that are unfunded are rare. Those unfunded residencies might have been around for years (I don't know) but those programs are rare. Most DO programs are funded, usually through Medicare. To think otherwise is ludicrous.

The last thing I want is another "SDN myth" to be perpetuated and people believing the myth blindly without any information.

We already have too many myths that are exaggerations based on real incidents:

- All DO students go DO because they couldn't get into MD

- All DOs have to constantly explain their degrees to all their patients

- All DO residencies are poor quality

Now, I can see another ridiculous myth starting on SDN: Some DO residencies are unfunded...which will become...Many DO residencies are unfunded...which will become...Most DO residencies are unfunded.

After a few months or years we'll have someone with a screen name of "MedLover2" with 2 posts to his name posting a thread titled "Is it true DO residents don't get paid?"

Please note I'm not upset at you, I'm simply trying to clarify my point. I'm not denying that there are a handful of DO residencies that are unfunded (mainly derm) and may have been unfunded for years. However, that's the exception and not the rule. The last thing we ("we" as in DOs) need is another myth to scare off the potential good-quality applicants to DO schools that come to SDN for advice and information.

 

[Blade28]

Winged Scapula, DarthNeurology, and others were discussing possible implications of a few current unpaid-dermatology residency spots, including charging future residents "tuition" in order to cover part of the costs of their training.

As stated above, these unfunded residency spots are VERY rare.

 

[coldweatherblue]

As stated above, these unfunded residency spots are VERY rare.

If you heard my original post in the tone in which I intended it to be heard, you would understand what I meant. I know unpaid positions are rare... that's why I said "a few current unpaid dermatology residency spots". I'm not actually worried about having to pay for residency, it just seemed like a funny hypothetical situation. Not funny if it actually happened.... but you gotta find humor somewhere.

 

[Faebinder]

i have been holding back in stating my opinion but here comes.

All this talk about new medical schools and higher number of medical students graduating is fine compared to residency slot is fine but if you look at nrmp statistics you will see the number of residency slots is ALWAYS rising above the number of US seniors at a steady level.. even in the last few years.

NRMP's first graph shows you the total number of applicants exploding wrt the number of PGY1 slots.

NRMP says this on page 14:

Although the number of positions offered in 2008 increased by 381 in 2008, the total number of active applicants grew
by 793 to 28,737. Of that total, 20,940 were matched to PGY-1 positions, 426 more than last year. Because the
increase in positions is not keeping pace with applicant growth, the match rate for all applicants continued to decline,
from 78.0 percent in 2005 to 75.1 percent in 2006, 73.4 percent in 2007, and 72.9 percent in 2008.

But NRMP is not saying despite showing it on graphs and tables is that the number of US seniors (allopathic MDs) per residency slot has not changed since 1990!! (page 19 on nrmp). It continues to fluctuate around 1.42 meaning that US seniors will never have an issue and there will always be more slots than them.

The two major explosions are clear, FMGs and IMGs. Those will suffer a lot. As far as the US seniors are concerned... everything is fine.

This would all be true if we assumed that a US senior doesn't mind which position they get and if they had to scramble to an FM or Prelim then they would be happy. You might start seeing more US seniors in residencies that used to be fully FMGs/IMGs but they will not feel any sort of explosion.

 

[exPCM]

i have been holding back in stating my opinion but here comes.

All this talk about new medical schools and higher number of medical students graduating is fine compared to residency slot is fine but if you look at nrmp statistics you will see the number of residency slots is ALWAYS rising above the number of US seniors at a steady level.. even in the last few years.

NRMP's first graph shows you the total number of applicants exploding wrt the number of PGY1 slots.

NRMP says this on page 14:



But NRMP is not saying despite showing it on graphs and tables is that the number of US seniors (allopathic MDs) per residency slot has not changed since 1990!! (page 19 on nrmp). It continues to fluctuate around 1.42 meaning that US seniors will never have an issue and there will always be more slots than them.

The two major explosions are clear, FMGs and IMGs. Those will suffer a lot. As far as the US seniors are concerned... everything is fine.

This would all be true if we assumed that a US senior doesn't mind which position they get and if they had to scramble to an FM or Prelim then they would be happy. You might start seeing more US seniors in residencies that used to be fully FMGs/IMGs but they will not feel any sort of explosion.

The effects of the US med school enrollment expansion (allopathic & osteopathic) have not yet come into full effect as the expansion is not yet complete. However it is clear that the inflow of med students will be much higher than ever before seen. I think it is speculative to say that for US seniors everything will be fine. Is it fine if you want to be a radiologist and end up not matching and going into FP because of the increased competition for a static number of radiology resident spots? Also there are some residency programs in which FMGs are now in leadership positions. For example UAMS radiology has at least six residents who do not have MD or DO degrees but instead are IMGs with MBBS degrees (3 in class of 2008 and 3 in class of 2011 - see http://www.uams.edu/radiology/education/residency/diagnostic/current_faces.asp). Do you really think there were no qualified US seniors who did not match into radiology in those years and that the FMGs got into spots which otherwise would have gone unfilled? I think it is not wise to assume that the order of selection for residency programs is always US MDs first, US DOs second, US IMGs third, and FMGs last. This is simply not the case from what I have seen.

 

[Taurus]

I think it is not wise to assume that the order of selection for residency programs is always US MDs first, US DOs second, US IMGs third, and FMGs last. This is simply not the case from what I have seen.

I have been pointing this out as well. Will a residency director pick a US MD who is the last in his class over a super-qualified FMG with 99% scores on steps 1-2, 5 publicatioins, etc? I don't think so.

Unless there are more residency slots, I predict that there will be an overflow of maybe up to 500 or more US MD's who can't match into residencies once the impact of the increase in enrollment is fully felt.

What happens to this overflow? I predict that we'll need to create a new pathway for them. Similar to the midlevel role, except higher.