The Med Student Pipeline Is Exploding

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
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.

I think this is going to be the crux of the matter. Increasing medical school admissions is simply going to change the bottleneck.

Currently, the biggest block for the average American pre-med is getting into a medical school. The number I most remember hearing is that, discounting all pre-meds who self select out before senior year, about half of those applying get in.

If one is fortunate enough to get into an American medical school, they've (statistically) already won the biggest battle. 90%+ plus of those who enter complete medical education (with the biggest % of those leaving are elective, not forced). 92% of U.S. seniors match into their preferred specialty (this does not account for self selection out of applying for competitive specialties though).

If the pipeline explodes, what happens? We some of the burden for U.S. seniors from "getting in" to "getting the specialty they want". Is that a bad thing? Personally, I would welcome this change.

I'm biased since I'm one of the biggest critics of current medical school admissions. Essentially, I've met too many ideal pre-med applicants turn into below average med students while the all star students and residents had to apply multiple times for admissions and perhaps go international. By no means is this the rule, but it happens far too commonly for me.

So let's let as many in as we can and let them battle it out for prime residency slots. One of the strongest factors in getting a good residency slot is being a US allopathic student and we give that distinction basically just based on MCAT and Undergraduate grades.

Members don't see this ad.
 
I wouldn't want to be a med student 10 years from now that's for sure.

Unless they increase residency slots, it will be next to impossible to get into anything non-primary care.
 
Seems to me that more med school slots will mostly help primary care. This will be especially true if the government makes a reasonable choice (won't hold my breath) and increases the residency slots for primary care and leaves specialist slots alone.
 
I wouldn't want to be a med student 10 years from now that's for sure.

Unless they increase residency slots, it will be next to impossible to get into anything non-primary care.

I think that's the idea behind the whole thing. More PCP's to counteract the calculated shortage. I wonder if it'll work?
 
There is nothing stopping the government from designating residency spots. I.E. Increase residency spot and label them designated "To Be Given Only To Primary Care Programs". That's just common sense which is uncommon with the government.
 
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.

I agree with your post. In addition the AMA has now requested that the ACGME prohibit all discrimination against IMGs in residency selection. From a practical standpoint this will mean that an IMG applying to residency who scores even 1 point higher on the USMLE than an AMG applying to the same residency will now be able to sue for discrimination if the AMG is selected and they are not. Being a US grad will no longer be an allowable advantage in competing for a residency spot. The bolded statements are from the latest issue of AMA news.
Issue: Some residency programs will not accept graduates of international medical schools.
Proposed action: Ask the Accreditation Council for Graduate Medical Education to make IMG status a prohibited discrimination. [ Adopted ]

link:http://www.ama-assn.org/amednews/2008/07/07/prsl0707.htm
 
I agree with your post. In addition the AMA has now requested that the ACGME prohibit all discrimination against IMGs in residency selection. From a practical standpoint this will mean that an IMG applying to residency who scores even 1 point higher on the USMLE than an AMG applying to the same residency will now be able to sue for discrimination if the AMG is selected and they are not. Being a US grad will no longer be an allowable advantage in competing for a residency spot. The bolded statements are from the latest issue of AMA news.
Issue: Some residency programs will not accept graduates of international medical schools.
Proposed action: Ask the Accreditation Council for Graduate Medical Education to make IMG status a prohibited discrimination. [ Adopted ]

link:http://www.ama-assn.org/amednews/2008/07/07/prsl0707.htm
The AMA can ask all they want until they are blue in the face but unless the ACGME acts then it's all rhetoric.
 
I think that's the idea behind the whole thing. More PCP's to counteract the calculated shortage. I wonder if it'll work?

I don't think it's necessarily a bad thing to increase enrollment.

The group that will suffer the most are the FMG's.

However, that just means that more US grads will take their place.

I believe that US grads who become PCP's are more likely to stay in this country, fight for our profession, and get politically involved than many FMG's. Many anesthesia people believe that anesthesiology is self-imploding because back in the 80's-90's many slots went unfilled. FMG's took them and haven't fought very hard for the profession.
 
There are two major extremes of residency programs out there. One that needs an FMG because they want the work done with ZERO complaints and nothing is better than to take a J-1 visa candidate that has been through residency in their own country. The other extreme is the university style program that needs residency placement for their graduates; they will favor US seniors anytime and anyday.

Not only is the AMA being rude by asking university programs to care less about their own students compared to foreign graduates, they are also unrealistic by asking the universties to not favor their graduates who hold over 250k loans.

AMA... go away and do something useful. Asking for equal footing once in residency is fine but asking for equality before being accepted to residency is overstepping boundries. Try fixing student loans first before asking for equality.

I fully agree that FMGs do not fight for the specialty as hard as US seniors and depleting US seniors from a specialty is a way of reducing the specialty's progression/improvement. There are multiple of reasons for this, J-1 which makes the FMG have to leave, when you are on an H1/J1 you are less likely to complain and stir political issues in a hospital, it takes a while for a foreigner to get assimilated and frankly they dont know what is what in the US system for many years (note I did not say they are not motivated or not willing to do it, they are just unable to do it).

Anesthesia suffered from this and the aftermath is happening now. FM is currently suffering from this. The question is though which was first... lack of US seniors that made the specialty not progress or the specialty lack of progress/income that made the US seniors not want to train in it.
 
Last edited:
Okay time to to be not especially politically sensitive for a minute.

In my opinion, increasing the number of AMG (and, by extension, people who have lived in this country for considerable time) will have a positive effect on the overall health of this country.

What do I base this on? A considerable (not the majority, but they're definitely not rare) section of our population who, do to their own biases or prejudices are less likely to have a positive relationship with any doctor who speaks to them with any form of an accent or they perceive as "foreign."

Once again, this is far from my own personal believes and honestly the majority of patients I see don't seem to particularly care what nationality or accent their doctor has. However, I have definitely have seen the patients who are less compliant and more difficult to deal with because they don't like having a particular doctor. They say they don't follow their PCP's directions because "I can't understand his accent" (this is particularly funny when the patient has a strong regional accent but I digress). I've heard parents on peds complain on the phone (when they don't think anyone's hearing them of course) that "Yeah they stuck me with some off the boat doctor"

Once again, this isn't common. I could list lots more examples about patients tell me how great Dr. Ramachandran or Dr. Xu or Dr. Mohammed (where these are were born, raised, and taught internationally) but it definitely happens, and this is only account for the people who make their biases and prejudices known and open.

Now the real question is "Is their bias just a scapegoat?" I think in some part, definitely. It's easy to blame the fact that you're not taking your seizure medications because you don't have a good relationship with your Chinese neurologist, but that completely removes personal responsobility from the matter. However, you can't argue with results. It's not inconceivable that one "good old boy" is going to take the weight loss and exercise advice from a doctor who he perceives as being another "good old boy" more seriously.

That said, this idea is not without precedent. I mean, the whole "Underrepresented Minority status" for med school admission is brought up because there's a belief that by increasing the number of African American, Native American, and Hispanic students enrolled these students are more likely to practice with members of their community and minorities are more likely to have a better relationship with a doctor of the same ethnic group.

Aren't we doing the same thing here? Nothing against the FMG here on a visa. I don't begrudge him anything. But let's say we're worried about people practicing in say, a rural area of Alabama. We're much more likely to get a doctor to work there by giving a student FROM the rural south every advantage (Increasing med school enrollment and giving AMG's preference for residency positions) over a foreign medical graduate the majority of whom seem to prefer to practice in larger urban areas where they have more of a community sense.
 
Top