US Shortage of Physicians

[vonburen]

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I'm an entering M1, and apart from the pseudoincrease (MD seat expansion ~I believe of around 20-30% and DO seat increase I believe somewhere around 80%) with no appreciable residency spot increases, I don't really see policy makers or any kind of legislation addressing this issue.

Is there something in the ACA or policy in the pipeline that is going to address this serious looming problem. I won't bother citing all the statistics of what we're facing, as I'm sure most are already aware.

 

[evilbooyaa]

Based on what I know of the ACA, I don't foresee a larger percentage increase in residency spot applications after this legislation. Taxpayers don't want to pay for future 'rich' doctors to get trained more than they already do. With the increase in AMGs from MD/DO schools, IMGs are going to have the door tighten if not completely close on them.

 

[secants]

FYI GME funding, the money used to pay residents, will most likely take a cut March 1 due to the budget sequestration. Don't know how that will effect residencies but it will either decrease resident salaries or force hospitals to cap or decrease spots. As for the shortage, the AMA is trying to increase the number of medical students but the problem of the PCP shortage isn't really being addressed directly. They are modestly increasing reimbursements from PCPs but who knows if that's enough to increase actual numbers going into primary care.

Worth checking out: http://savegme.org

 

[ManaPool]

You guys are forgetting the AOA and ACGME merge.

 

[JShephard]

You guys are forgetting the AOA and ACGME merge.

It's just a unified application. I doubt the current feelings towards the degrees will change, nor the $ allocated to the residency programs.

The IMGs will be pushed out.

 

[ManaPool]

It's just a unified application. I doubt the current feelings towards the degrees will change, nor the $ allocated to the residency programs.

The IMGs will be pushed out.

But if AOA opens its residencies to ALL Allopathic students, then they have a bunch that go unfilled and this would increase spots for IMGs. This will in turn battle the physician shortage to some extent and gain them better recognition.

 

[JShephard]

But if AOA opens its residencies to ALL Allopathic students, then they have a bunch that go unfilled and this would increase spots for IMGs. This will in turn battle the physician shortage to some extent and gain them better recognition.

More MDs, more DOs, the same amount of residency spots (just with a unified application) = less spots for everyone - IMGs will be the last ones to get a shot. There won't be lots of unfilled spots - there are hardly any now.

 

[88845]

More MDs, more DOs, the same amount of residency spots (just with a unified application) = less spots for everyone - IMGs will be the last ones to get a shot. There won't be lots of unfilled spots - there are hardly any now.

I'm very interested in seeing the Match day statistics this year. With the "all in" policy in place I'm willing to bet that the IMG match rate might reach above 60% due to the absence of pre-matches but with an overall decreasing trend in the future save for superstars.

 

[JShephard]

I'm very interested in seeing the Match day statistics this year. With the "all in" policy in place I'm willing to bet that the IMG match rate might reach above 60% due to the absence of pre-matches but with an overall decreasing trend in the future save for superstars.

Yeah, but that data won't mean anything - since it's post pre-match, there is nothing to compare it to - except for AMG match rates.

 

[88845]

Yeah, but that data won't mean anything - since it's post pre-match, there is nothing to compare it to - except for AMG match rates.

I suspect it will reveal a better picture of how many IMGs/FMGs are successful in gaining residency spots, either via matching or pre-matching. I've always thought it to be closer to 60% or above for the last 20 years or so but, of course, all of that will be changing in the near future.

 

[CDI]

I suspect it will reveal a better picture of how many IMGs/FMGs are successful in gaining residency spots, either via matching or pre-matching. I've always thought it to be closer to 60% or above for the last 20 years or so but, of course, all of that will be changing in the near future.

I would guess it to be even higher this year, 70?. The pre-match really skewed things in the past. Some community hospitals seem to know their role though, and still stayed out of the match even this year, but its WAY less.

I think some of the mediocre/lower tier programs will get stung though. They won't be able to lock up a single top tier IMG like they were able to in the past.

 

[badasshairday]

There is no shortage. MD's at the lead with an army of PA/NP's is all that is needed going forward.

 

[JShephard]

There is no shortage. MD's at the lead with an army of PA/NP's is all that is needed going forward.

It seems like we should just swallow this scenario and figure out how to make it work.

 

[notbobtrustme]

It seems like we should just swallow this scenario and figure out how to make it work.

Don't go into primary care.

 

[JShephard]

Don't go into primary care.

Hell no. Talk about a nightmare in 10 years - who knows what that field will look like then.

 

[yehhhboiii]

Hell no. Talk about a nightmare in 10 years - who knows what that field will look like then.

I've been hearing some talk about how primary care physicians are going to start seeing increases in their reimbursements with the emphasis shifting from procedures to preventative care. But even so, the future doesn't look very bright.

 

[mimelim]

The physician shortage will not be solved by adding more residency positions. People don't want to go to rural areas to practice. Even if you add more spots, if people who are trained don't go to the areas where there are less physicians, you won't address the problem.

 

[ManaPool]

The physician shortage will not be solved by adding more residency positions. People don't want to go to rural areas to practice. Even if you add more spots, if people who are trained don't go to the areas where there are less physicians, you won't address the problem.

IMGs would want to go rather than not match, right?

 

[mimelim]

IMGs would want to go rather than not match, right?

Not sure what you mean. Of course people would fill the residency spots. The problem is they won't set up shop in areas with low numbers of physicians. They will gravitate to the big cities like they are right now.

 

[PrideNeverDie]

no IMGS

AMGs + NP/PAs ... USA! USA! USA!

 

[CDI]

Not sure what you mean. Of course people would fill the residency spots. The problem is they won't set up shop in areas with low numbers of physicians. They will gravitate to the big cities like they are right now.

If they gravitate to big cities, its just less money in their pocket. You also have to consider the fact that more people in general gravitate towards big cities anyways. There's always a balance going on.

Also part of the reason non-US IMGs are still interested is because theres some type of Visa/rule/whatever where they can stay in the US after residency is completed - as long as they specifically serve in underserved areas. Many would be glad to take up that opportunity.

There are several residency programs which offer the H1 Visa so that the IMG can stay beyond residency and work anywhere. Those are very few in number and extremely competitive (I've heard of 2 IMGs, both got scores above 270, and decided against a Top 3 program because they found a program which granted them that specific visa.)

For non-US IMGs its pretty clear-cut. Either you score high, are competitive and land a visa, or you stay back. On the other hand US-IMGs are the ones who will be in limbo as this gets tougher as they are just trying to come home and won't necessarily have a job waiting for them when they return.

 

[mimelim]

If they gravitate to big cities, its just less money in their pocket. You also have to consider the fact that more people in general gravitate towards big cities anyways. There's always a balance going on.

While there are more people in the cities, when people talk about the physician shortage, they are talking about the lack of new physicians going to rural areas. Major cities get saturated/oversaturated and yes, most people are willing to take a significant pay cut to stay in a city.

Also part of the reason non-US IMGs are still interested is because theres some type of Visa/rule/whatever where they can stay in the US after residency is completed - as long as they specifically serve in underserved areas. Many would be glad to take up that opportunity.

It is a requirement that they work for 3 years in an underserved area and then they can do whatever they want. I know 6 fellows who have done or are doing this. Prior to graduating fellowship they all have jobs lined up post-3 year commitment, all either returning to where they trained or to another major city.