unmatched+underserved=GME regulations problem?

[rayoflite]

How can these 2 categories coexist? We all know there are severely underserved areas and we also know we have unmatched eligible residency candidates. How come the total number of FM spots has been dropping instead of rising since I think 2002?
Is creating more residency positions to meet the needs too difficult and should the accrediting process be reviewed?
Or do the authorities not care?
If the GME regulations stay the way they are -ignorant to growing numbers of unmatched and underserved, then we as caring physicians should be grateful for the nursing associations expanding their rights to provide care independently. And I am not joking at all - if we can afford to waste physician-power while not supplying the demand for health-care then thank God for people with common sense who (unlike us apparently) understand that caring for people is better than not caring at all.

---

Members don't see this ad.

 

[awdc]

I think the reason why FM spots have decreased is because of declining interest in FM and inability to fill those spots. And perhaps some positions aren't very attractive to begin with.

http://www.aafp.org/fpm/20070400/news.html
http://www.aafp.org/online/en/home/residents/match/summary.html

And according to the tables and graphs, it seems FM spots have been declining even before 2002.

Also, if I'm not mistaken, recently (a year or two ago) hospitals were allowed to shift GME funding around as well. Instead of funding unfilled positions, some decided to shift the resident funding to other specialties where positions would be filled.

I don't think the problem is with GME funding issues. The bigger problem seems to be interest in FM. There may be unmatched individuals in FM but there are certainly unfilled positions as well.

What's disturbing is that if the number of FM positions were the same as it was in 1998, the number of U.S. seniors matching into FM would have only filled 33.6% of positions.

 

[rayoflite]

I would agree that there are unfilled positions in the match. However, none of them stay open very long. And I am positive that if someone threw in another 300 positions right now they would go very quickly. Also, while I understand the concern about low interest among USMGs - hey, physician is a physician and after 3 years of residency everybody can blend in with the surrounding society no matter where they're from.

 

[Faebinder]

The number of residency spots has been on hold since the Clinton adminstration has put the cap on increasing residency spot (they also put the cap on funding for switching residencies). The decline in the number of positions in FM is a result of shift of positions from FM to other specialties.

FM will continue to be harder and harder to match into until it becomes almost like IM unless the number of residencies is allowed to increase, in which case we might see an temporary increase or a halt in the drop of FM spots. The number of residencies will not be allowed to increase anytime soon... not with a war going on for sure and a budget from hell.

If Universal Healthcare is forced into full existance, Family Medicine will become one of the most indemand jobs out there and we'll see a growth of the field.

My prediction... We wont get universal healthcare (good)... Residency spots will continue to decline (bad and somewhat good). Next year, FM positions will drop by around 70 spots. Kent will continue to get weekend calls from opiate addicted patients until he retires and maybe even afterwards.

 

[thedman888]

I think the reason why FM spots have decreased is because of declining interest in FM and inability to fill those spots. And perhaps some positions aren't very attractive to begin with.

http://www.aafp.org/fpm/20070400/news.html
http://www.aafp.org/online/en/home/residents/match/summary.html

And according to the tables and graphs, it seems FM spots have been declining even before 2002.

Also, if I'm not mistaken, recently (a year or two ago) hospitals were allowed to shift GME funding around as well. Instead of funding unfilled positions, some decided to shift the resident funding to other specialties where positions would be filled.

I don't think the problem is with GME funding issues. The bigger problem seems to be interest in FM. There may be unmatched individuals in FM but there are certainly unfilled positions as well.

What's disturbing is that if the number of FM positions were the same as it was in 1998, the number of U.S. seniors matching into FM would have only filled 33.6% of positions.

that's usually how it is, i wouldnt be surprised if say EM becomes more and more saturated and the interest or demand starts to dwindle in the next several years.
disturbing? not really, the trend? yes definitely

 

[deleted87716]

Kent will continue to get weekend calls from opiate addicted patients until he retires and maybe even afterwards.

If that ever happens, I'm getting an unlisted phone number.

 

[DropkickMurphy]

If that ever happens, I'm getting an unlisted phone number.

But I can still PM you for refills right?

 

[ajce9]

Maybe FM should increase residency slots in selected underserved areas.
This would help keep the midlevels from filling those spots.

FM cannot use the same strategy as Derm to increase their popularity.

The more FM cuts residency slots, the more mid levels will replace them.

I'm not putting this in here to start another debate about mid level and FM. So, please keep this post on track about residency slots.

But, It's a common fact that many FM practices use mid-levels because they cannot find or afford another physician in their office. They can't find an FM because they can't pay them enough. But they can pay the mid-level.

 

[Static Line]

Maybe FM should increase residency slots in selected underserved areas.This would help keep the midlevels from filling those spots.

FM cannot use the same strategy as Derm to increase their popularity.

The more FM cuts residency slots, the more mid levels will replace them.

I'm not putting this in here to start another debate about mid level and FM. So, please keep this post on track about residency slots.

But, It's a common fact that many FM practices use mid-levels because they cannot find or afford another physician in their office. They can't find an FM because they can't pay them enough. But they can pay the mid-level.

The problem is that Slick Willie capped residency slots to 1996 or 1997 medicare levels. Any FM program in existence at that time simply can't grow in numbers, even if they wanted to. It is easier to create a new residency training program than lift that cap.

And someone correct me if I am wrong but I believe that if a FM residency slot goes unfilled a certain number of years in a row then that slot is taken away and that program looses that position altogether. Hense, mid levels will be more needed if FM continues to loose slots.

Of course this is only my understanding. Some of you with more experience may be able to correct me if I am wrong but I thought this is the way it works.

 

[Faebinder]

The problem is that Slick Willie capped residency slots to 1996 or 1997 medicare levels. Any FM program in existence at that time simply can't grow in numbers, even if they wanted to. It is easier to create a new residency training program than lift that cap.

And someone correct me if I am wrong but I believe that if a FM residency slot goes unfilled a certain number of years in a row then that slot is taken away and that program looses that position altogether. Hense, mid levels will be more needed if FM continues to loose slots.

Of course this is only my understanding. Some of you with more experience may be able to correct me if I am wrong but I thought this is the way it works.

You are perfectly correct on every single sentence. It's only going to get uglier. Creating a new program rather than increasing slots is insane... We all know it takes an arm and a leg to get something approved through ACGME.

 

[ajce9]

If that is the case, and it certainly seems it is, then FM can only grow in demand and over time salaries will only go up.

Here are some possibilities:

1. The obvious shortage will increase the pay scale. I say this because no matter how hard mid-levels try they will not be able to replace a physician.

2. There will be a need for the FM to supervise the mid-levels on much more complicated level. Therefore that creates a consult fee, or a consultant fee.
Like in the role of a Medical Director.

3. Only other thing that can happen that would go against FM is if the specialist started hiring mid-levels to act as primary care and refer the patient to them in the same office. This would create a medical home (as aafp has proposed) and still give the patient access to the most needed specialist care. If this trent takes place, FM could be in trouble unless they take a proactive role and create those medical homes.

Basically physicians need to work more closely together in order to create better patient care. Right now they just compete with each other.

Also, even though the residency slots are capped out, the total number of slots can be redistributed. So a certain residency program can choose to move a couple of their slots to rural locations.