Update - The Med Student Pipeline Is Exploding

[exPCM]

---

Members don't see this ad.

The 2009 Medical School Enrollment Survey, just released by the AAMC (Association of American Medical Colleges), finds that first-year enrollment will reach 20,281 by 2015, a 23 percent increase above 2002. Survey results also indicate that enrollment is on track to reach the 30 percent increase, called for by the AAMC by 2018.

Some other key findings:

* Combined first-year M.D. and D.O. enrollment in 2015 is expected to increase by 36 percent above 2002, putting great pressure on the supply of residency positions, which have not kept pace with expansion efforts.
* 49 percent of medical schools are instituting or considering initiatives to encourage students to enter primary care.
* 40 percent of schools have targeted expansion efforts to help serve rural and underserved communities and increase the number of underrepresented minorities in medicine.
* While the recession has slowed growth at schools primarily in existence before 2002, this year only 12 schools indicated plans to reduce enrollment due to financial pressures.
http://www.aamc.org/newsroom/presskits/09enrollmentsurvey.pdf
Comment: "There are more spots in American medical schools, and more new schools starting up to feed the physician supply pipeline. But that gain is unlikely to translate into more practicing doctors because the U.S. capacity for residency programs is staying flat."
( see: http://www.healthleadersmedia.com/c...l-School-Spots-Wont-Increase-Physician-Supply )
I think the fight for competitive spots in the NRMP is going to become like a UFC match.

 

[medicinesux]

Has anyone heard if the University of Phoenix opened up a D.O. School yet?

 

[glade]

You can see how controlled the income of physicians is. Under a free market, if you needed more primary care physicians, the pay would go up. But it won't, since reimbursements are fixed. So medical schools are left basically whoring for people to go into primary care fields, by "fast tracking" them or bribing them with free tuition. There's a vast shortage of general surgeons and yet every year general surgeons are reimbursed less for procedures. Wow, what a smart move! I wonder why there are fewer general surgeons! Me so smart! I go run Medicare!

 

[bronx43]

You can see how controlled the income of physicians is. Under a free market, if you needed more primary care physicians, the pay would go up. But it won't, since reimbursements are fixed. So medical schools are left basically whoring for people to go into primary care fields, by "fast tracking" them or bribing them with free tuition. There's a vast shortage of general surgeons and yet every year general surgeons are reimbursed less for procedures. Wow, what a smart move! I wonder why there are fewer general surgeons! Me so smart! I go run Medicare!

They don't have to increase general surgeons' reimbursement rates. They simply have to decrease those of higher paying fields. You make one look less appealing and the other will fill up.

 

[Slack3r]

They don't have to increase general surgeons' reimbursement rates. They simply have to decrease those of higher paying fields. You make one look less appealing and the other will fill up.

Yup. It's a race to the bottom, folks. If anyone thinks the govt is going to increase reimbursements in the age of "explosive healthcare spending", they're seriously deluding themselves.

 

[JaggerPlate]

Yup. It's a race to the bottom, folks. If anyone thinks the govt is going to increase reimbursements in the age of "explosive healthcare spending", they're seriously deluding themselves.

Yup. Quite the opposite actually ... they are guaranteed to decrease reimbursements. If doctors want to exploit the fact that they are on the good end of the "supply/demand" seesaw, they are going to have to remove themselves from the insurance game, accept cash only, and try their hardest to compete. Is it fair to have to compete with a government??? A entity that doesn't have to play by the rules? No, but if enough docs wise up (especially those guys in primary care) ... who knows???

 

[peppy]

I am skeptical about how long it will really be viable for physicians to practice cash-only as government tries to reshape healthcare. Consider that as things currently stand the government has done its best to try to limitphysician-owned ambulatory surgical centers because of supposed "unfair competition" and I think it is completely plausible that they will find more ways to force doctors to operate within their system in the future.

 

[peppy]

Has anyone heard if the University of Phoenix opened up a D.O. School yet?

I am a DO myself, and I feel like that's only a very slight exaggeration. It frustrates me that in the last few years the leaders of the profession seem to be trying to churn out as many DOs as possible without any regard for if there are decent rotations or residencies available for all their students...much less any consideration for how sustainable it is to keep ramping up enrollment every year. Just because physicians are in demand right now doesn't mean the demand is infinite.
If things don't change, there will come a point when the market will simply be saturated and we will have a lot of people with a lot of debt who can't get jobs.

 

[glade]

Yup. It's a race to the bottom, folks. If anyone thinks the govt is going to increase reimbursements in the age of "explosive healthcare spending", they're seriously deluding themselves.

Right, that's how the government "cuts" healthcare costs. They just pay doctors less and go "wow, we 'saved' billions of dollars!" And agreed with JaggerPlate, the solution is cash only, or at least tell the Medicare/Medicaid patients to get lost.

 

[bronx43]

Right, that's how the government "cuts" healthcare costs. They just pay doctors less and go "wow, we 'saved' billions of dollars!" And agreed with JaggerPlate, the solution is cash only, or at least tell the Medicare/Medicaid patients to get lost.

Haha, dumping Medicare patients has been a topic well discussed in this forum. The consensus is that it's simply not that easy.
Medicine was never a free market, and in the current system can never be a free market. In fact, why would you ever want it to be? A free market means the only thing that inhibits supply is the saturation of demand. If medicine was a completely free market, it would be like law. Take the current boom of medical schools and multiply it by ten. I rather get my compensation cut a bit than have to worry about not finding a job.

 

[JaggerPlate]

I am skeptical about how long it will really be viable for physicians to practice cash-only as government tries to reshape healthcare. Consider that as things currently stand the government has done its best to try to limitphysician-owned ambulatory surgical centers because of supposed "unfair competition" and I think it is completely plausible that they will find more ways to force doctors to operate within their system in the future.

I think that 5-10 years after 2014 will be the best time, if ever, for these concierge models to thrive. Lots of people in PC fields are doing it already, and of course it's risky, but if 32 million are added to a strained system ... there is going to be a HUGE rift and even more differentiation/tiers. I really think that people who can afford concierge care, aren't going to want to sit in crowded, DMV, style clinics, and smart docs will capitalize on this.

Furthermore ... I can't even get into the restrictions on physician owned hospitals. It literally makes me sick. I've never ranted on anything more on this site. ASCs may actually be okay for a while, but adopting the attitude of "laying low because I'm not screwed by Obama yet" is a poor defense. Of course the liberals want all docs to be salaried employees, essentially working in 3-4 HUGE managed care chains. They want to eliminate the business aspect, and they would love to see private practice go away completely. The biggest risk comes from something like they are trying in Mass ... where all docs that accept any form of insurance are forced to accept a % of government insurance. I think I'd call it quits at that point.

It's all up in the air at the moment ... we'll see what happens, and what tweaks will be made in the future.

 

[JaggerPlate]

I am a DO myself, and I feel like that's only a very slight exaggeration. It frustrates me that in the last few years the leaders of the profession seem to be trying to churn out as many DOs as possible without any regard for if there are decent rotations or residencies available for all their students...much less any consideration for how sustainable it is to keep ramping up enrollment every year. Just because physicians are in demand right now doesn't mean the demand is infinite.
If things don't change, there will come a point when the market will simply be saturated and we will have a lot of people with a lot of debt who can't get jobs.

I have mixed feelings on the issue, and, frankly, can see it from both POV (the AOA/COCAs and practicing DOs).

 

[morning]

I am a DO myself, and I feel like that's only a very slight exaggeration. It frustrates me that in the last few years the leaders of the profession seem to be trying to churn out as many DOs as possible without any regard for if there are decent rotations or residencies available for all their students...much less any consideration for how sustainable it is to keep ramping up enrollment every year. Just because physicians are in demand right now doesn't mean the demand is infinite.
If things don't change, there will come a point when the market will simply be saturated and we will have a lot of people with a lot of debt who can't get jobs.

It could definitely happen. It certainly happened with law. A lot of people will think "oh, they'd never let me fall $250k into debt with no prospect of residency..." but yes, they would.

Don't want to slag DOs - because it's certainly not their fault the schools are working on doubling enrollment by 2014 - but my guess is that once all MD residency slots are filled with American students and there are still MD students left needing residencies, the next demographic on the allopathic chopping block (after IMGs) will be DOs.

And then after that, if enrollment keeps climbing and no new residencies open up...we'll have a tiered medical school system like law.

They could at least give MDs the courtesy of allowing them to practice as PAs without a residency.

I've still got a ways to go before med school so it's pretty worrying and something I feel really passionate about. Opening up new schools sounds great to pre-meds but it doesn't help ANYONE if they don't adjust residency slots in proportion.

 

[bronx43]

It could definitely happen. It certainly happened with law. A lot of people will think "oh, they'd never let me fall $250k into debt with no prospect of residency..." but yes, they would.

Don't want to slag DOs - because it's certainly not their fault the schools are working on doubling enrollment by 2014 - but my guess is that once all MD residency slots are filled with American students and there are still MD students left needing residencies, the next demographic on the allopathic chopping block (after IMGs) will be DOs.

And then after that, if enrollment keeps climbing and no new residencies open up...we'll have a tiered medical school system like law.

They could at least give MDs the courtesy of allowing them to practice as PAs without a residency.

I've still got a ways to go before med school so it's pretty worrying and something I feel really passionate about. Opening up new schools sounds great to pre-meds but it doesn't help ANYONE if they don't adjust residency slots in proportion.

Residency slots won't change unless they have to. Hospitals don't gain that much from having more residents running around. Sure, they get free labor, but they also can't bill for residents' services. Therefore, having a few more residents isn't enough of a value add for them to actively pursue it.

Medical schools, on the other hand, are just cash cows. 45k/year from 500-800 students pulls you 20-30 million/year, the majority of which is profit. Quite a few students have to be burned before either less students are willing to go into it, or legislation is passed to reduce loan burdens.

 

[glade]

Residency slots won't change unless they have to. Hospitals don't gain that much from having more residents running around. Sure, they get free labor, but they also can't bill for residents' services.

Aw, you med students are so cute. Didn't you know that hospitals get tens of thousands of dollars profit per year per resident? I think the average salary is something like 40K and hospitals get something like 150K funding. Not to mention that every major hospital in the U.S. runs on resident power. Residents do all the crap that nobody else will do. They do secretarial work, they place orders, they constantly monitor patients, they assist on procedures, they transport patients, they do phlebotomy, they discharge patients, they obtain reports from other hospitals ...I could go on, but I have better things to do.

Bottom line is that residency has almost nothing to do with training physicians. Most of what you learn as a physician is on your own time. You go to residency solely to ensure that hospitals function. Residency is about 75% a total waste of time and anyone who says otherwise is a tool.

 

[hurdlepup]

Bottom line is that residency has almost nothing to do with training physicians. Most of what you learn as a physician is on your own time. You go to residency solely to ensure that hospitals function. Residency is about 75% a total waste of time and anyone who says otherwise is a tool.

Hmmm.... This seems pretty jaded. Are you currently in the middle of your residency?

Any tips on how to avoid your current residency situation, or do you really feel that residency is an actual total waste of time? Also, what year/specialty are you?

 

[facetguy]

You know the overall job market must really suck when so many are trying to enter medicine during a time of such uncertainty regarding its future. Some may interpret that as a tacit willingness to take whatever is offered reimbursement-wise.

 

[Slack3r]

It could definitely happen. It certainly happened with law. A lot of people will think "oh, they'd never let me fall $250k into debt with no prospect of residency..." but yes, they would.

Don't want to slag DOs - because it's certainly not their fault the schools are working on doubling enrollment by 2014 - but my guess is that once all MD residency slots are filled with American students and there are still MD students left needing residencies, the next demographic on the allopathic chopping block (after IMGs) will be DOs.

And then after that, if enrollment keeps climbing and no new residencies open up...we'll have a tiered medical school system like law.

They could at least give MDs the courtesy of allowing them to practice as PAs without a residency.

I've still got a ways to go before med school so it's pretty worrying and something I feel really passionate about. Opening up new schools sounds great to pre-meds but it doesn't help ANYONE if they don't adjust residency slots in proportion.

Opening up residency slots really only serves to create a new problem. More residents equals (eventually) more practicing physicians. Then we'll just over-saturate other fields like we already see with pathology or fields like law. Then everyone "not going into it for the money, but for the stable job" will need to find a new tag-line.

 

[bronx43]

Aw, you med students are so cute. Didn't you know that hospitals get tens of thousands of dollars profit per year per resident? I think the average salary is something like 40K and hospitals get something like 150K funding. Not to mention that every major hospital in the U.S. runs on resident power. Residents do all the crap that nobody else will do. They do secretarial work, they place orders, they constantly monitor patients, they assist on procedures, they transport patients, they do phlebotomy, they discharge patients, they obtain reports from other hospitals ...I could go on, but I have better things to do.

Bottom line is that residency has almost nothing to do with training physicians. Most of what you learn as a physician is on your own time. You go to residency solely to ensure that hospitals function. Residency is about 75% a total waste of time and anyone who says otherwise is a tool.

Like clockwork, the douche will chime in. I never said residents added nothing to the hospital. But, what funding a couple of additional residents bring to the overall balance sheet of the hospital isn't worth the finagling for additional Medicare funding - especially with the looming cloud of urgency over health care spending. Unless they get pressure to open up spots, PDs aren't actively looking to accept more residents. No hospital will urge their residency programs to accept more people just for the few hundred thousands of dollars they may get from Medicare.
Medical schools, on the other hand, are capable of generating far more revenue and profit. The abundance of caribbean med schools attest to this. Opening up a medical school not only brings your institution more prestige, but it's an attractive source of additional revenue.

 

[glade]

PDs don't get to choose how many residents they have. Actually, your entire latest post doesn't have anything to do with how things actually work. "A" for effort, however.

 

[bronx43]

PDs don't get to choose how many residents they have. Actually, your entire latest post doesn't have anything to do with how things actually work. "A" for effort, however.

How things work... like the disconnect between advent of new medical schools and the lack of corresponding residencies? Or the financial draw that medical schools provide? What part is absent from whichever reality you live in?

 

[glade]

Like everything. I don't think you actually know anything about what's going on, based on what you're writing. For example, you talked about Caribbean schools. Caribbean schools do whatever they want. They open and close all the time. They're diploma mills, which is why people generally don't consider Caribbean grads to be good. Sure, they might be, but it's a total crap shoot because there's no quality control. I know Caribbean grads and they will admit readily to this, where basically their class sizes fluctuate all the time. They start out with a certain number, lose half their class, suddenly add fifty more people mid-semester, lose some more ...whatever. But that's totally irrelevant to any U.S. residency. Caribbean grads just happen to be out there, but nobody is saying "OMG, better create more spots for them!!" or "let's NOT create spots for them just to screw them!!" It's like saying that Major League Baseball is creating new expansion teams as a result of the fact that Icelanders are playing baseball. It's utterly irrelevant.

 

[bronx43]

Like everything. I don't think you actually know anything about what's going on, based on what you're writing. For example, you talked about Caribbean schools. Caribbean schools do whatever they want. They open and close all the time. They're diploma mills, which is why people generally don't consider Caribbean grads to be good. Sure, they might be, but it's a total crap shoot because there's no quality control. I know Caribbean grads and they will admit readily to this, where basically their class sizes fluctuate all the time. They start out with a certain number, lose half their class, suddenly add fifty more people mid-semester, lose some more ...whatever. But that's totally irrelevant to any U.S. residency. Caribbean grads just happen to be out there, but nobody is saying "OMG, better create more spots for them!!" or "let's NOT create spots for them just to screw them!!" It's like saying that Major League Baseball is creating new expansion teams as a result of the fact that Icelanders are playing baseball. It's utterly irrelevant.

It's really great to see that you know exactly what you're talking about, but you missed the point, naturally. The point about Caribbean medical schools isn't the fact that residencies aren't opening up for them. It's an example of the financial incentive for schools to capitalize on the supply of students willing to pay for a medical degree. The issue at hand is the increasing number of American medical schools, the increases in enrollment, and the relatively stagnant residency spots.
"A" for effort, though. "D" for reading comprehension.

 

[glade]

That's great, champ, but you were talking about how opening up a medical school "brings your institution more prestige," which implies that you think that medical schools are tied to "other" institutions. And that only occurs with U.S. schools. Caribbean schools are just randomly set up by anyone. "A" for effort again, though.

Oh, in case you didn't get it yet, my point is that your posts on this subject are a mixture of things that are either "false" or "half-true but irrelevant" or "true but doesn't lead to the conclusion you say it does."

 

[bronx43]

That's great, champ, but you were talking about how opening up a medical school "brings your institution more prestige," which implies that you think that medical schools are tied to "other" institutions. And that only occurs with U.S. schools. Caribbean schools are just randomly set up by anyone. "A" for effort again, though.

"D" for reading comp, again, buddy. Aren't you glad you don't have to take the MCAT again? I was referring to the increase in American medical schools. Caribbean schools were solely used as an example for financial incentive.

Irrelevant how? True, but leading to which conclusion?

In case you haven't gotten it already, my point is that you have a problem with comprehension - as evidenced by your last two posts.

 

[glade]

Yeah, but you're just proving my point because everything you write, like I said, is a mixture of random half-truths and unrelated facts. Sure, it's absolutely true that Caribbean schools churn out diplomas for money. Sure, it's semi-true that American schools set up medical schools for prestige. Meanwhile, that's all that is, a bunch of random true and false and semi-true statements that you included in a post that has nothing to do with anything. If you want to talk about the MCATs, if this was the writing section I'd say that you have no thesis and also you can't write. But "A" for effort.

 

[bronx43]

Yeah, but you're just proving my point because everything you write, like I said, is a mixture of random half-truths and unrelated facts. Sure, it's absolutely true that Caribbean schools churn out diplomas for money. Sure, it's semi-true that American schools set up medical schools for prestige. Meanwhile, that's all that is, a bunch of random true and false and semi-true statements that you included in a post that has nothing to do with anything. If you want to talk about the MCATs, if this was the writing section I'd say that you have no thesis and also you can't write. But "A" for effort.

Nothing to do with anything? The topic of this thread is increase in number of medical students. How is the prestige and financial incentive for new schools to pop up irrelevant?

 

[glade]

For a variety of reasons.

- What NEW medical schools are popping up? So while there is a presitge value in having a medical school attached to your institution (true), it's irrelevant as it relates to the topic.

- If there is financial incentive in increasing seats (true), how does that relate? I mean, by that isolated statement, one would presume that every school would indiscriminately increase seats without regard to anything and the increases would be far greater than they are currently. So, yes, there's something going on, but not anything you've explained in any way.

Actually, what was far more interesting with the original post was the additional data, about the push for primary care physicians.

 

[morning]

Opening up residency slots really only serves to create a new problem. More residents equals (eventually) more practicing physicians. Then we'll just over-saturate other fields like we already see with pathology or fields like law. Then everyone "not going into it for the money, but for the stable job" will need to find a new tag-line.

It's either train more doctors or get overrun by nurse practitioners. The idea that keeping residency spaces static is going to keep the medical market from becoming saturated is a pipe dream.

 

[MedicineDoc]

Residency is about 75% a total waste of time and anyone who says otherwise is a tool.

Maybe your residency I used to go to a residency like yours before switching to my current residency. Day and night. I didn't learn a damn thing in the first one and was worked so hard with bs notes and other worthless crap with hardly anytime off I was too tired to learn on my own either. Total opposite now. One on one with attendings of various specialties including Er, ent, sugery, ob gyn ortho, peds, derm, sports med, endocrine, nephrology, neuro, cards, urology, moonlighting on my own, scripts with my name on them for moonlighting and none telling me I need to go faster, cognitive behavioral therapy, gyn and icu, pulmonology, and more. All one month rotations one on one with friendly specialists who answer all questions as you work with them day to day.

 

[hurdlepup]

Maybe your residency I used to go to a residency like yours before switching to my current residency. Day and night. I didn't learn a damn thing in the first one and was worked so hard with bs notes and other worthless crap with hardly anytime off I was too tired to learn on my own either. Total opposite now. One on one with attendings of various specialties including Er, ent, sugery, ob gyn ortho, peds, derm, sports med, endocrine, nephrology, neuro, cards, urology, moonlighting on my own, scripts with my name on them for moonlighting and none telling me I need to go faster, cognitive behavioral therapy, gyn and icu, pulmonology, and more. All one month rotations one on one with friendly specialists who answer all questions as you work with them day to day.

Where is this place? What specialty?

...plus, you switched residencies? In the end, it seems to have worked out well, but how was the process of switching and how did you decide where to go?

 

[MedicineDoc]

Where is this place? What specialty?

...plus, you switched residencies? In the end, it seems to have worked out well, but how was the process of switching and how did you decide where to go?

I switched from an I'm prelim year at the university of Kentucky for neuro to family medicine at Trover western Kentucky regional medical center. We are an unopposed fm hospital with a 25 bed icu. One resident per rotation with specialist one upper level and an intern for family medicine hospital rotations. Moonlighting starts beginning of second year and can be as much as 60 hours for 65 per hour in our urgent care center or 100 per hour in Er.

 

[hurdlepup]

I switched from an I'm prelim year at the university of Kentucky for neuro to family medicine at Trover western Kentucky regional medical center. We are an unopposed fm hospital with a 25 bed icu. One resident per rotation with specialist one upper level and an intern for family medicine hospital rotations. Moonlighting starts beginning of second year and can be as much as 60 hours for 65 per hour in our urgent care center or 100 per hour in Er.

Cool! Thanks. Will that still let you do Neuro or did you change your mind to FM?

 

[MedicineDoc]

Cool! Thanks. Will that still let you do Neuro or did you change your mind to FM?

I didn't like neuro or uk. That place blows. I'm happy with my decision. I got my life back and I learn alot every day. I will get three weeks vacation not including weekends and 1 week cme. I will get all the weekends off this month doing outpatient peds except the last one where I will moonlight inthe care center for 20 hours for 1300 dollars. Feel like I got my life back even if I do work hard at times it's more like a job than a cult which is what uk Internal medicine and neuro seemed like to me. Weekends off were so rare there they called them golden weekends. Talk about wasted years especially with the piss poor teaching and super heavy scut.