Viewpoint: Reflections on the Match Process AAMC Reporter: April 2014

[Espadaleader]

Viewpoint: Reflections on the Match Process
AAMC Reporter: April 2014
...
So what has changed in the Match process that creates such angst among student affairs deans and faculty advisers across the country? Finding placement for those students who remain unmatched is increasingly difficult because of the larger number of competitive applicants competing for unfilled positions. Although the SOAP, which was introduced in 2012, works quite well for more competitive students who go unmatched, the deafening silence for students with academic difficulties is almost unbearable. More and more, student affairs deans are faced with advising unmatched students who have no prospect for residency training upon graduation. We partner with these soon-to-be doctors in trying to find appropriate “bridge” positions in research or other degree-seeking programs that may or may not strengthen their applications for future Match seasons.
...
As a result, medical schools are re-examining promotion guidelines to determine if the relatively low attrition rate, typically less than 3 percent for most schools, makes sense in this increasingly competitive Match environment. How much time and energy should be invested in remediation for students who are unlikely to match into a residency? Are we setting students up for failure by promoting them once competencies are eventually achieved, especially in light of the additional student debt accumulated by such remediation? How do we tighten requirements for graduation while balancing the need for developmental, competency-based curriculum models and making the academic environment safe for failure, practice, and measured remediation?
...
Of course admissions offices also play a part in the equation, and many schools are reviewing those policies and guidelines as well. As we incorporate the culture of holistic review into admissions, are we selecting students who will perform well academically in our own programs? Were interpersonal “red flags” identified during the admissions interview that might have predicted students’ potential performance issues interacting with patients or successfully completing residency interviews? Should prematriculation programs be implemented to provide additional learning resources to accepted students identified as being at risk for academic or interpersonal issues in the admissions process?

https://www.aamc.org/newsroom/reporter/april2014/378174/viewpoint.html

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[notbobtrustme]

IMO, LCME graduates should get first crack at ACGME residencies. Basically, we would have two sets of matches. All programs would run an LCME match first and see what their programs look like then after this, add in non-LCME graduates to fill out their class.

Not sure if this would help unmatched applicants, but it certainly can't hurt.

 

[AlmostAnMD]

Makes some sense. Fortunately this hasn't been a problem for me, but listening to rumor/looking at our handbook, it's VERY, very difficult to fail out of medical school. Possible, but difficult. If you treat it like anything else probably 30 people in our class would have been dropped by now. Extrapolate that to most schools and suddenly the match becomes a bit easier, yes?

Also, I disagree with getting rid of the "holistic" review thing. I'm just an anecdote, but my undergrad GPA was very borderline competitive. I'm actually doing much better in med school than I did in undergrad!!! Go figure. Likewise, there are superstars of undergrad that, for reasons I can't explain, are struggling tremendously with the course load and probably fall into the category of people mentioned that would be dropped.

Just my opinion, but there isn't any excuse for failing anything (pending serious life circumstances, but that's not the reason most people fail, I suspect).

 

[DermViser]

Viewpoint: Reflections on the Match Process
AAMC Reporter: April 2014
...
So what has changed in the Match process that creates such angst among student affairs deans and faculty advisers across the country? Finding placement for those students who remain unmatched is increasingly difficult because of the larger number of competitive applicants competing for unfilled positions. Although the SOAP, which was introduced in 2012, works quite well for more competitive students who go unmatched, the deafening silence for students with academic difficulties is almost unbearable. More and more, student affairs deans are faced with advising unmatched students who have no prospect for residency training upon graduation. We partner with these soon-to-be doctors in trying to find appropriate “bridge” positions in research or other degree-seeking programs that may or may not strengthen their applications for future Match seasons.
...
As a result, medical schools are re-examining promotion guidelines to determine if the relatively low attrition rate, typically less than 3 percent for most schools, makes sense in this increasingly competitive Match environment. How much time and energy should be invested in remediation for students who are unlikely to match into a residency? Are we setting students up for failure by promoting them once competencies are eventually achieved, especially in light of the additional student debt accumulated by such remediation? How do we tighten requirements for graduation while balancing the need for developmental, competency-based curriculum models and making the academic environment safe for failure, practice, and measured remediation?
...
Of course admissions offices also play a part in the equation, and many schools are reviewing those policies and guidelines as well. As we incorporate the culture of holistic review into admissions, are we selecting students who will perform well academically in our own programs? Were interpersonal “red flags” identified during the admissions interview that might have predicted students’ potential performance issues interacting with patients or successfully completing residency interviews? Should prematriculation programs be implemented to provide additional learning resources to accepted students identified as being at risk for academic or interpersonal issues in the admissions process?

https://www.aamc.org/newsroom/reporter/april2014/378174/viewpoint.html

The guy who is apparently is an "Associate Dean for Student Affairs", says, "Students identified as at risk for going unmatched also need to be prepared to submit new personal statements during SOAP indicating why they think they went unmatched and highlighting strengths they could bring to a residency program. Maybe it's just me, but since when during the Scramble (SOAP), do students re-write personal statements specifically for it?"

My favorite part: "Finally, we need to serve as advocates for our students in the health care workforce. We need to be vocal supporters of increasing the number of residency training positions so this increased pool of applicants can find clinical training programs that meet the projected health care needs of our country. We must encourage more students to enter primary care specialties, providing a more robust network of preventive care specialists that may actually help reduce the cost of health care through early detection and management of chronic conditions. Last, we need to encourage students to practice in underserved communities by giving them the tools they need to address the disparities many patients face when trying to access health care, reinforcing the altruism of practicing medicine."

If this is advocating for students, I don't know what to say. Apparently he hasn't heard of NPs and their goal of taking over primary care (helped in part by govt.)

 

[Espadaleader]

The guy who is apparently is an "Associate Dean for Student Affairs", says, "Students identified as at risk for going unmatched also need to be prepared to submit new personal statements during SOAP indicating why they think they went unmatched and highlighting strengths they could bring to a residency program. Maybe it's just me, but since when during the Scramble (SOAP), do students re-write personal statements specifically for it?"

My favorite part: "Finally, we need to serve as advocates for our students in the health care workforce. We need to be vocal supporters of increasing the number of residency training positions so this increased pool of applicants can find clinical training programs that meet the projected health care needs of our country. We must encourage more students to enter primary care specialties, providing a more robust network of preventive care specialists that may actually help reduce the cost of health care through early detection and management of chronic conditions. Last, we need to encourage students to practice in underserved communities by giving them the tools they need to address the disparities many patients face when trying to access health care, reinforcing the altruism of practicing medicine."

If this is advocating for students, I don't know what to say. Apparently he hasn't heard of NPs and their goal of taking over primary care (helped in part by govt.)

@DermViser they keep saying this but they're standing in the back and allowing NPs take over primary care. Why do you think this is happening?

 

[Nidor]

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[DermViser]

@DermViser they keep saying this but they're standing in the back and allowing NPs take over primary care. Why do you think this is happening?

Bc it's not in their control (with NPs lobbying local state govts. to increase their scope of practice), and it's not in their job description to care. They have your money, and it looks really bad on them when their students don't match. They'd be happy to just shove you into a Family Medicine spot just for the purpose of saying that they "matched" all their U.S. seniors. Heck, even now if people only matched to a prelim or transitional year, they say that person "matched", not telling the full story. If you look carefully at the article, they're even advising competitive applicants to have backup plan specialties as well - 7th paragraph.

Also, many of these schools are state taxpayer funded so it's not surprising about giving lip service to "primary care", and "underserved communities", and wanting to "meet the projected health care needs of our country". The problem is that it's just that - lip service.

Meanwhile you have NPs and PAs who don't have to do a residency, pay much less in tuition money, have a better lifestyle as they're not expected to have the responsibilities as a doctor, with a relatively good ROI. They can even switch specialties if they get bored of one for too long.

 

[DermViser]

Have to advocate for the devil here.

Even though it would be more fair to LCME graduates, how do you justify to patients that the residents taking care of them where spared from competition based on where they studied? As a future physician should we not push for the broadest competition possible and let free market principle do the rest? Like we see now, a big difference in match rates between LCME graduates and non-LCME match rates because hospitals pick the candidates that function best in their program, as they should. Most of the time this is a LCME graduate, sometimes it is not.

Healthcare right now is nowhere close to being a free-market. The match itself is not free-market.

 

[circulus vitios]

My favorite part: "Finally, we need to serve as advocates for our students in the health care workforce. We need to be vocal supporters of increasing the number of residency training positions so this increased pool of applicants can find clinical training programs that meet the projected health care needs of our country. We must encourage more students to enter primary care specialties, providing a more robust network of preventive care specialists that may actually help reduce the cost of health care through early detection and management of chronic conditions. Last, we need to encourage students to practice in underserved communities by giving them the tools they need to address the disparities many patients face when trying to access health care, reinforcing the altruism of practicing medicine."

If this is advocating for students, I don't know what to say. Apparently he hasn't heard of NPs and their goal of taking over primary care (helped in part by govt.)

We need to advocate for our students by forcing them into bottom of the barrel specialties.

 

[Espadaleader]

Bc it's not in their control (with NPs lobbying local state govts. to increase their scope of practice), and it's not in their job description to care. They have your money, and it looks really bad on them when their students don't match. They'd be happy to just shove you into a Family Medicine spot just for the purpose of saying that they "matched" all their U.S. seniors. Heck, even now if people only matched to a prelim or transitional year, they say that person "matched", not telling the full story. If you look carefully at the article, they're even advising competitive applicants to have backup plan specialties as well - 7th paragraph.

Also, many of these schools are state taxpayer funded so it's not surprising about giving lip service to "primary care", and "underserved communities", and wanting to "meet the projected health care needs of our country". The problem is that it's just that - lip service.

Meanwhile you have NPs and PAs who don't have to do a residency, pay much less in tuition money, have a better lifestyle as they're not expected to have the responsibilities as a doctor, with a relatively good ROI. They can even switch specialties if they get bored of one for too long

No one in their right mind would go into primary care. Its not about the money. I just want a JOB. I've been reading your posts and @NickNaylor and everyone else. This is nuts. Medical Debt to Income ratio is increasing, NPs have full practice rights in 17 states, reimbursement is falling, and public opinion is in the toilet.

Look at this by The Atlantic http://www.theatlantic.com/health/a...or-seeing-a-nurse-instead-of-a-doctor/361111/

 

[DermViser]

We need to advocate for our students by forcing them into bottom of the barrel specialties.

Pretty much. That's exactly how I read it. With "student advocacy" like that... I guess it's easier than making ACTUAL changes to curriculum and teaching at your school.

 

[Nidor]

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[DermViser]

Fair enough, free market might be a bit big a term, but in the end, programs get a wide range of applications. From these they can select the candidates they view as most suited. They have several tools they can choose to use or not to use (USMLE, year of graduation, US/non-US, research, etc.), why limit their options by forcing them to pick LCME graduates first?

Bc all residency positions are funded by the federal government and thus our tax dollars. If you are a FMG, you're essentially bypassing our system.

No other country does what the United States does with respect to medical school and graduate medical education. It's nearly impossible for an American medical school graduate to go to Europe or Australia and do residency and practice. Only the US does this, and now the issue has been brought up re: brain drain from other countries who train their med students on their dollar only to come here.

 

[Nidor]

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[DermViser]

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[notbobtrustme]

Fair enough, free market might be a bit big a term, but in the end, programs get a wide range of applications. From these they can select the candidates they view as most suited. They have several tools they can choose to use or not to use (USMLE, year of graduation, US/non-US, research, etc.), why limit their options by forcing them to pick LCME graduates first?

LCME graduates are a known commodity. No one knows if Uncle Habab's Allopathy and Shrimp Kabob is worth anything, but an LCME graduate is a known quantity. Secondly, the system should be setup such that AMDs are preferred (even more so than today) because Uncle Sam has provided funding/loans/and GME money. FMGs bypass the entire system and backdoor themselves into our system because of our lax entry laws. The ACGME should ensure that every graduate who wants a residency can get a residency because unmatched AMDs are a much bigger deal than if a bunch of FMGs go unmatched. FMGs have an option of practicing in their own country, AMDs who fail to match don't.

 

[DermViser]

@Espadaleader, Just so @NickNaylor knows, you pasted part of your post into my quote. LOL.

There's a reason that students don't want to do primary care: usually that's defined as General IM, General Peds, and Family Medicine. It's not just bc of salary. It's also never-ending documentation, being a "gate-keeper" both for govt. and insurance companies, and too much information overload that it's hard to master it, getting dumped on by admissions by everyone else, etc. Not to mention how you're allowed to practice and procedures you are allowed to do is defined by others.

NPs have gotten to politicians about everyone, NPs, PTs, Pharmacists, Optometrists, etc. on working at the "top of their license". Every IM and Peds person I know wants to specialize. They are very well aware of where this is headed. Like I said, it isn't surprising to me, but for those who do go into Primary Care, no good deed goes unpunished.

Watch this: http://www.bloomberg.com/video/88992941-obama-health-law-huge-step-mundinger-says.html -- I like how she blows off med school debt, like it's no big deal and goes off into how NPs are perfect for primary care.

 

[circulus vitios]

The brain drain argument is a very valid one. The tax dollar one is not, it is a huge net win for the US if it can attract a fully trained MD from another country to come and work in the US. A young, healthy and talented person, willing to work and with typically around 20 years of education under their belt that the US didn't have to pay a cent for.

The fully trained MD from another country can't just come here and practice. He would have to repeat residency, which is funded by taxpayer dollars.

 

[DermViser]

The brain drain argument is a very valid one. The tax dollar one is not, it is a huge net win for the US if it can attract a fully trained MD from another country to come and work in the US. A young, healthy and talented person, willing to work and with typically around 20 years of education under their belt that the US didn't have to pay a cent for.

Wrong. The tax dollar argument is valid, bc a FMG can't practice in the U.S. independently without completing residency. This residency training is fully funded by the American tax payer. FMGs don't HAVE to practice medicine by emigrating to the U.S. They can very well practice in their home countries. It's 100%, their own choice.

 

[Nidor]

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[notbobtrustme]

Loving this, very interesting to hear some opinions on this topic.

Why should the taxpayer invest in graduate education at all? Because they need a steady stream of new doctors, for 'average joe', it makes no difference if this is a AMD or not, as long as the quality is good. I would argue that from the US perspective the extremely few AMD's that go unmatched are worth bringing in thousands of doctors from all over the world. The US has a problem when it comes to physicians with a huge forecasted shortage in the next decade. There are not enough residency positions to train the physicians needed to fill this shortage, a whole other issue that should be addressed. Sure some of the IMG's that do residency in the US return to their home country, a good amount stay too though.

Sure, it's no problem. They can have at the ACGME match after USMDs have their shot first, as would be the case in every single other non-****hole country in the world.

 

[Psai]

Loving this, very interesting to hear some opinions on this topic.

Why should the taxpayer invest in graduate education at all? Because they need a steady stream of new doctors, for 'average joe', it makes no difference if this is a AMD or not, as long as the quality is good. I would argue that from the US perspective the extremely few AMD's that go unmatched are worth bringing in thousands of doctors from all over the world. The US has a problem when it comes to physicians with a huge forecasted shortage in the next decade. There are not enough residency positions to train the physicians needed to fill this shortage, a whole other issue that should be addressed. Sure some of the IMG's that do residency in the US return to their home country, a good amount stay too though.

Physicians are among the biggest taxpayers out there. Many of the FMGs who come in are from Caribbean schools, aka people who wanted to get an MD degree but couldn't get into a US school. Also, I don't know about this whole physician shortage business when the job market is not very good for some fields like path but maybe there is in primary care.

 

[atomi]

The problem goes away instantly if the system were to allow students with deficiencies reasonable avenues to show improvement. Specifically the ability to retake borderline passing USMLE exams at least one more time.
Is it no surprise that students have trouble matching when we chain them to a 189 step 1 score? Sure, if the student takes the exam three times and scores 189, 190, and 191, maybe they aren't cut out for this. But that is totally different than a student who takes it twice and scores a 189 and then a 240. Those are two totally different types of students. But the system, as it is now, views them as identical for matching purposes.

The solution is not to weed out students who can't score 220+ in M1 and M2, but rather to give students a fighting chance to show improvement through hard work and persistence and give them a shot against foreign grads with excellent step scores who are typically favored for out-of-the-match positions.

 

[notbobtrustme]

Is it no surprise that students have trouble matching when we chain them to a 189 step 1 score? Sure, if the student takes the exam three times and scores 189, 190, and 191, maybe they aren't cut out for this. But that is totally different than a student who takes it twice and scores a 189 and then a 240. Those are two totally different types of students. But the system, as it is now, views them as identical for matching purposes.

this is ironic because a passing USMLE score is exactly that, a sign that you are competent in the basic sciences and can progress in your training. You can't pass "harder" because at it's core, Steps 123 are gateways not stratifiers.

A graduate who passed Step 1, Step 2 CK, and Step 2 CS, along with all other coursework, should be qualified for residency. THat's quite literally what med school is supposed to do, prepare graduates for residency. If the student has gotten trough all the requirements, then they should be qualified for residency. Sure, it's not going to be dermaneurosurgery, but at the same time, they should not go unmatched.

 

[atomi]

We need to advocate for our students by forcing them into bottom of the barrel specialties.

I have often wondered if it is no coincidence that schools that seem to push a primary care agenda onto their students also tend to be ones that mislead students about how to prepare for step 1, have minimal protected study time, and put in place mandatory attendance and frequent assessments throughout M2 to prevent students from studying for it early.

 

[DermViser]

Loving this, very interesting to hear some opinions on this topic.

Why should the taxpayer invest in graduate education at all? Because they need a steady stream of new doctors, for 'average joe', it makes no difference if this is a AMD or not, as long as the quality is good. I would argue that from the US perspective the extremely few AMD's that go unmatched are worth bringing in thousands of doctors from all over the world. The US has a problem when it comes to physicians with a huge forecasted shortage in the next decade. There are not enough residency positions to train the physicians needed to fill this shortage, a whole other issue that should be addressed. Sure some of the IMG's that do residency in the US return to their home country, a good amount stay too though.

Sorry, but it's quite well established that we have a physician maldistribution problem, not a physician shortage problem.

 

[Nidor]

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[atomi]

this is ironic because a passing USMLE score is exactly that, a sign that you are competent in the basic sciences and can progress in your training. You can't pass "harder" because at it's core, Steps 123 are gateways not stratifiers.

A graduate who passed Step 1, Step 2 CK, and Step 2 CS, along with all other coursework, should be qualified for residency. THat's quite literally what med school is supposed to do, prepare graduates for residency. If the student has gotten trough all the requirements, then they should be qualified for residency. Sure, it's not going to be dermaneurosurgery, but at the same time, they should not go unmatched.

The other part of the solution would be to reform the curriculum to include internship training and have the MD degree mean something in and of itself at to at least allow graduates to have a skill set to practice in a limited scope similar to the GPs of days past and at least be able to earn a living and stay in clinical medicine while seeking a residency position. Similar to the way dentists and veterinarians can graduate from school and actually be able to work some place other than Applebee's.

 

[DermViser]

I have often wondered if it is no coincidence that schools that seem to push a primary care agenda onto their students also tend to be ones that mislead students about how to prepare for step 1, have minimal protected study time, and put in place mandatory attendance and frequent assessments throughout M2 to prevent students from studying for it early.

It's easy to push a primary care agenda on your students when your med students score low on the USMLE Step 1 on average (which they can just blame the students instead of looking at what the school is doing). Not surprising at all that they're behind the curve in that regard by not recording lectures, mandatory attendance, 9 to 5 classes, etc. Board review books (which everyone has access to the same ones) don't help when your faculty don't cover the topics in the first place.

That being said OSU has an "Independent Study Pathway" in the first 2 years, so I could see one using that curriculum effectively to study for Step 1: http://medicine.osu.edu/students/curriculum/medicine1/pages/index.aspx

 

[Nidor]

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[DermViser]

The problem goes away instantly if the system were to allow students with deficiencies reasonable avenues to show improvement. Specifically the ability to retake borderline passing USMLE exams at least one more time.
Is it no surprise that students have trouble matching when we chain them to a 189 step 1 score? Sure, if the student takes the exam three times and scores 189, 190, and 191, maybe they aren't cut out for this. But that is totally different than a student who takes it twice and scores a 189 and then a 240. Those are two totally different types of students. But the system, as it is now, views them as identical for matching purposes.

The solution is not to weed out students who can't score 220+ in M1 and M2, but rather to give students a fighting chance to show improvement through hard work and persistence and give them a shot against foreign grads with excellent step scores who are typically favored for out-of-the-match positions.

Looking at that article, it seems like the solution he's advocating is weeding out the class earlier, long before MS-4:

• "medical schools are re-examining promotion guidelines to determine if the relatively low attrition rate...makes sense in this increasingly competitive Match environment."
• "How much time and energy should be invested in remediation for students who are unlikely to match into a residency?"
• "How do we tighten requirements for graduation"

 

[DermViser]

AAMC disagrees, but they are naturally super biased.
Either way, I do agree that there is a huge maldistribution problem in the US physician workforce, but since you have a shortage of PCP; from a societies perspective it matters little if this shortage is filled with AMD or IMG's, as long as its filled.

The AAMC is never going to say we have more than enough doctors. Also, "society" could really care less if there are more specialists than generalists. Govt. bodies want more generalists, bc they cost the system less money than specialists.

 

[circulus vitios]

Also, you're crazy if you think that foreign medical graduates are going to get a job or set up a practice in rural America. There's not exactly a "little India" community or whatever in Bum****, KS. They commonly head straight for the large cities where they can find comfort in their ethnic communities.

 

[Nidor]

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[Nidor]

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[DermViser]

Well, that's not true, because many visa's are set up that in order for a FMG to stay in the US they are required to work in underserved areas for a couple years.

(seems like a fair way to pay back some of those tax dollars that went into their residency training to me?)

Yes, and the moment their obligation is over, they pack up and head straight to urban major cities, just like everyone else.

 

[atomi]

AAMC disagrees, but they are naturally super biased.
Either way, I do agree that there is a huge maldistribution problem in the US physician workforce, but since you have a shortage of PCP; from a societies perspective it matters little if this shortage is filled with AMD or IMG's, as long as its filled.

Of course we have a maldistribution problem. This is what happens when you have a profession that uses licensing boards to tightly control the supply and thereby secure artificially high incomes for all board certified physicians. Naturally this system creates a hyper-competitive environment because of the protected incomes (which are found in virtually no other industry) and results in the admission of highly ambitious students, mostly raised in wealthy metropolitan environments, who seek to return to wealthy metropolitan environments and view medical school and residency as a stepping stone to get there and are thereby willing to train in the southeast or midwest and lie by saying they are interested in practicing in the region and rural environments. Poor, rural and non-gentrified urban environments aren't exactly known for producing students who go to elite colleges and score highly on the MCAT.

This is evidenced by the fact, that in virtually every other industry, the highest paying jobs are in big cities. In medicine, the lowest paying jobs are there. Radiologists, Rad-oncs, and other specialists can't even get jobs in many of these ares because the competition is so fierce for the location. They'll take a training position in the middle of Kansas with a smile on their face and go on about how much they love it there and want to stay there after they finish. But when it comes time to look for jobs, you can't pay them all the money in the world to stay.

Also, you're crazy if you think that foreign medical graduates are going to get a job or set up a practice in rural America. There's not exactly a "little India" community or whatever in Bum****, KS. They commonly head straight for the large cities where they can find comfort in their ethnic communities.

I disagree. Rural communities are often filled with foreign trained physicians because the homogeneous group of American medical graduates all gravitate to NYC, Boston, DC metro, Chicago, and coastal CA/OR/WA. They may complain about how uncultured it is and despise living there, but they take the jobs.

 

[DermViser]

I am intrigued DermViser, why do you feel the US Healtcare system is so much more expensive then those of other countries?

More advanced treatments cost more money. Americans always want the best, most advanced treatments and drugs for their health problems. Up to now, care has not been effectively rationed like it is in other countries. Pack that with ridiculous tuition costs for American medical students, even at state universities, it's not surprising at all.

 

[DermViser]

I disagree. Rural communities are often filled with foreign trained physicians because the homogeneous group of American medical graduates all gravitate to NYC, Boston, DC metro, Chicago, and coastal CA/OR/WA. They may complain about how uncultured it is and despise living there, but they take the jobs.

I'm perfectly ok with that. It's our version of:

(I'm obviously j.k.)

 

[Nidor]

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[circulus vitios]

That makes sense, thanks for sharing. Why do you believe the outcomes aren't better? (and on a population level, quite a bit worse, then for other countries?) Not trying to be malignant or anything, its just something I've been trying to understand for a while now and I feel like you have a very different but well founded view then me on several topics.

More technical or more expensive treatment doesn't necessarily result in a better outcome. Just look at some of the robotic surgery procedures that per the literature offer little to no benefits over other methods that cost much less money.

 

[DermViser]

That makes sense, thanks for sharing. Why do you believe the outcomes aren't better? (and on a population level, quite a bit worse, then for other countries?) Not trying to be malignant or anything, its just something I've been trying to understand for a while now and I feel like you have a very different but well founded view then me on several topics.

Bc we're not currently paid based on "outcomes". We don't have a P4P scheme for reimbursement (yet). Just look at how P4P has effectively destroyed the teaching profession.

Look at this article here: http://www.nytimes.com/2014/04/28/us/politics/health-laws-pay-policy-is-skewed-panel-finds.html

• Factors far outside the control of a doctor or hospital — patients’ income, housing, education, even race — can significantly affect patient health, health care and providers’ performance scores,” said Dr. Christine K. Cassel, the president of the organization. The Obama administration commissioned the study, but is not entirely comfortable with the recommendations, officials acknowledged. The existing policies of the National Quality Forum and the government say performance scores should generally not be adjusted or corrected to reflect differences in the income, race or socioeconomic status of patients.

So even when his own commission tells him the findings the govt. still doesn't want to believe it.

 

[DermViser]

More technical or more expensive treatment doesn't necessarily result in a better outcome. Just look at some of the robotic surgery procedures that per the literature offer little to no benefits over other methods that cost much less money.

I think they've done studies though about if you add up the total cost - hospital stay and followup (w/ and w/o robotic).

 

[tantacles]

This is certainly anecdotal, but a fourth year who failed Step I the first time and got a 198 on the second try matched without any difficulty this year into psych in an extremely competitive location.

On the other hand, one of our top graduates with >230 Step I scores went unmatched (before SOAP) due to failing to rank anything except for dermatology. He was not the only one who applied to a competitive field and went unmatched.

We make this all out to be about academic competitiveness, but in reality, there are some huge issues with expectations among students that need to be addressed.

 

[DermViser]

We need to advocate for our students by forcing them into bottom of the barrel specialties.

Pretty much. Can't tarnish a med school name - gotta keep those dollars flowing: http://primarycareprogress.org/blogs/16/355
"Rumor on the street is that some deans across the country received political heat because a large number of their students did not match last year. The deans’ solution? They told their students to interview for family medicine as a worst case scenario back-up plan. We’ll double check this rumor with our new interns this summer."