turquoiseblue

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Just wanted an update on the bill for 15,000 residency slots. Did it pass or what happened? I searched for it on google and this site and can't find anything recent. I think i love that bill (as long as i finally get a spot! :D)
 

Law2Doc

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Just wanted an update on the bill for 15,000 residency slots. Did it pass or what happened? I searched for it on google and this site and can't find anything recent. I think i love that bill (as long as i finally get a spot! :D)
What are you talking about? There isn't going to be any major increase in residency slots in the near term.
 

turquoiseblue

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JeffLebowski

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Wow, 15,000? They want to DOUBLE the amount of residency slots? That sounds like a terrible idea.
 

Law2Doc

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thanks Dr. Yoda for the nice informative website...

i guess it was at least referred to the committee of finance for now....
:xf: lol...i just like to hope...even when there's no hope at all. :D
It's a non-starter bill. 99% are. Politicians float these things to appease their constituents, but there's no real expectation they will become law, or even, as the case here, make it out of committee. You have to realize that the AAMC, AMA and other physician lobby groups would be opposed to this bill, at it runs the risk of creating gluts, as happened in law decades ago, and also runs afoul of the AAMC's stated goal of filling US needs with US students. In a year where US grads numbers approximated the number of residencies, this bill pretty clearly would mean 15,000 seats for non-US folks, which isn't going to be popular in Congress, once it's spelled out to them. It also is a VERY EXPENSIVE proposal (if you assume a cost of $100,000 per resident, 15,000 times this is a very big number -- a big taxpayer hit and something that is only going to be seen as immediately benefiting folks who are going to go on and become rich doctors. It's not a taxpayer friendly plan).

Once US med school slots exceed the number of residency slots, and the offshore degree mills start folding, you can expect the number of residency seats to increase modestly, if there's money to pay for them.
 

Taurus

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Once US med school slots exceed the number of residency slots, and the offshore degree mills start folding, you can expect the number of residency seats to increase modestly, if there's money to pay for them.
Even without the bill, I predict that there will be a significant increase in residency spots, although they will be funded by the institutions themselves and not Medicare. If you add on 32 million more insured Americans, the hospitals will collect more revenue which they can then use to create more residency spots to handle the increased workload. I highly doubt that the existing residency workforce can adequately tackle such a large increase in patient load. Furthermore, it makes more sense to create more residency spots than hire more attendings (where would they come from?) or midlevels like PA's and NP's. A resident will cost an institution ~100k per year after you include salary and benefits (yeah, residency pay sucks that much). You can work a resident 80 hours (or more) without paying them more. Midlevels will ask for 60-70k to start (for PA's and NP's) and as much as 120k or more for midlevel anesthesia providers (for AA's and CRNA's). The rule of thumb is that you double the salary to figure the total cost of an employee. So a PA or NP could easily cost an institution 120-140k per year. After 40 hours, many midlevels will start asking for overtime pay. So it makes much more sense to have residents do the work instead of anyone else. The question is, how many more residency spots will be created? Who knows. But I doubt it will be an additional 15,000.
 

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It's a non-starter bill. 99% are. Politicians float these things to appease their constituents, but there's no real expectation they will become law, or even, as the case here, make it out of committee. You have to realize that the AAMC, AMA and other physician lobby groups would be opposed to this bill, at it runs the risk of creating gluts, as happened in law decades ago, and also runs afoul of the AAMC's stated goal of filling US needs with US students. In a year where US grads numbers approximated the number of residencies, this bill pretty clearly would mean 15,000 seats for non-US folks, which isn't going to be popular in Congress, once it's spelled out to them. It also is a VERY EXPENSIVE proposal (if you assume a cost of $100,000 per resident, 15,000 times this is a very big number -- a big taxpayer hit and something that is only going to be seen as immediately benefiting folks who are going to go on and become rich doctors. It's not a taxpayer friendly plan).

Once US med school slots exceed the number of residency slots, and the offshore degree mills start folding, you can expect the number of residency seats to increase modestly, if there's money to pay for them.
Actually AAMC and a lot of other physicians organizations were pushing for the bill, not against it. The bill would have come to 10 billion dollars over 10 years, which is not really that much. Once the increase in demand occurs and supply is not met, the govt/market will have no choice but to give mid levels more and more power.

The idea behind wanting to keep the workforce supply low in order to keep salaries and demand high will backfire and result in more power to midlevels (as we are already starting to see). The only way this would not happen would be if the doctors lobby was really powerful, which obviously it is not.

Finally the 15000 slots were not for first year slots, but overall slots.
 
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Hospitals are always "loosing money", I know since I have worked in a couple of hospitals in good areas where >90% of the patients have good private insurance and they still say so. I don't think any will willingly open residency positions since they need that medicare funding that they are so used to.
 

Law2Doc

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Actually AAMC and a lot of other physicians organizations were pushing for the bill, not against it. ...

Finally the 15000 slots were not for first year slots, but overall slots.
As for the first sentence above, see the press releases by the AAMC starting in about '05. They are for US med schools filling all US residency slots. This proposal makes that more difficult. I can't see them backing it until US med school grads outnumber residency slots.

As for your second statement, it costs just as much whether we are talking first year slots or overall slots. It's still $100k+ x 15000, which is a very big number and not saleable to taxpayers once it's explained to them that it would largely be going to non-US educated folks.

This is a nonstarter. It looks good for these congressional players to be able to turn to their constituents and say -- I tried to pass a bill to give you better access to doctors but it was shot down. Nobody expects it to actually go anyplace. It's for "good guy, little effort" credit. Sort of like inviting someone to a party after you find out they are going to be out of town, so you can bank the credit for the invite. Lots of bills are like this. This is one of them. Don't lose sleep hoping for it to happen.
 

Law2Doc

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Hospitals are always "loosing money", I know since I have worked in a couple of hospitals in good areas where >90% of the patients have good private insurance and they still say so. I don't think any will willingly open residency positions since they need that medicare funding that they are so used to.
Agreed. Residents are a great deal to hospitals when they are being given $100k for each one and are able to make money on their labor. It's less of a good deal when they have to pay out money for them. I don't see hospitals jumping to enlist more of them at their own dime. Many places are short staffed as is but you don't see anybody rushing to fill unfunded slots. Doesn't really happen. And if they were such money makers, you'd think they would.

Also bear in mind it's not just the salary of residents that are costs. You also have overhead (malpractice insurance, call rooms, G&A), and training costs. They make decent money on residents because they get six digits and on top get whatever money the resident generates through his/her work. But don't kid yourself that it's still a boon if you are solely relying on business generation.
 

Taurus

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Agreed. Residents are a great deal to hospitals when they are being given $100k for each one and are able to make money on their labor. It's less of a good deal when they have to pay out money for them. I don't see hospitals jumping to enlist more of them at their own dime. Many places are short staffed as is but you don't see anybody rushing to fill unfunded slots. Doesn't really happen. And if they were such money makers, you'd think they would.

Also bear in mind it's not just the salary of residents that are costs. You also have overhead (malpractice insurance, call rooms, G&A), and training costs. They make decent money on residents because they get six digits and on top get whatever money the resident generates through his/her work. But don't kid yourself that it's still a boon if you are solely relying on business generation.
If not residents, then who will take on the extra patient load? Hire more attendings? This is the most costly option. Hire more midlevels? Cheaper than attendings but they're more expensive than a resident and won't work 80 hours a week without demanding overtime pay. Your cheapest option is more residents. You can't work your existing residents harder because there are the caps on new admissions and total patient load a resident is allowed to carry, not to mention the 80 hour rule. Something's got to give and the solution is create more residency spots, which can be funded from the newly insured patients.
 

wagy27

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Maybe there is more need in primary care, but how would the distribution of these spots go? Personally, i don't to see any more residents in my speciality (rad onc) and I know many of my colleagues in subspecialties feel the same way. we'd rather keep the supply low compared to the demand and hopefully be able to demand a premium for our services.
 

turquoiseblue

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As for the first sentence above, see the press releases by the AAMC starting in about '05. They are for US med schools filling all US residency slots. This proposal makes that more difficult. I can't see them backing it until US med school grads outnumber residency slots.

As for your second statement, it costs just as much whether we are talking first year slots or overall slots. It's still $100k+ x 15000, which is a very big number and not saleable to taxpayers once it's explained to them that it would largely be going to non-US educated folks.
If you do a little math, it seems doable:

If residents are the cheapest mode:
100K x 15000 = $1,500,000 = That is not a lot of money in terms of what the government has. there are far many people than that in the United States so if they pay taxes its less than $1 per year.

Then again a PA and sometimes NP's can do anything a resident can for much cheaper than $100k, so we'd have to account for how many of them there are into the equation (i dont have their numbers so i can't).

there are a total of 25,520 current spots in the match. where 17,127 are US grads, so there are tons more spots left over. The rest would go to the IMG's i guess, because at this time, the US needs more doctors than the medical schools can produce. Funding 15,000 would create room for all the other FMGs that are applying with left over spots, until med schools in the US start producing more US med students.
 

Saga1

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As for the first sentence above, see the press releases by the AAMC starting in about '05. They are for US med schools filling all US residency slots. This proposal makes that more difficult. I can't see them backing it until US med school grads outnumber residency slots.
Read press releases from a more recent date. Here's just one article I found.

http://www.aamc.org/newsroom/pressrel/2009/091020.htm
"As a result, the AAMC supports the "Resident Physician Shortage Reduction Act" (S.973/H.R.2251), which increases the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots). "

http://www.aamc.org/workforce/aging-workforce-ad.pdf
This is on the AAMC webpage

Every article I have read from May 2009 (when S. 973 was introduced) and SA 2909 was being heavily supported by the AAMC. Even Atul Grover gave a talk on lack of residency slots. Aside from the AAMC, AAIM supported one of the bills asking for a 15000 slot increase.
http://www.im.org/PolicyAndAdvocacy/PolicyIssues/Workforce/Pages/ActionAlertContactYourSenatorstoSupportIncreasingResidencyTrainingSlots.aspx

As for your second statement, it costs just as much whether we are talking first year slots or overall slots. It's still $100k+ x 15000, which is a very big number and not saleable to taxpayers once it's explained to them that it would largely be going to non-US educated folks.
Are you telling me that they would rather pay taxes for other institutions compared to more doctors?

This is a nonstarter. It looks good for these congressional players to be able to turn to their constituents and say -- I tried to pass a bill to give you better access to doctors but it was shot down. Nobody expects it to actually go anyplace. It's for "good guy, little effort" credit. Sort of like inviting someone to a party after you find out they are going to be out of town, so you can bank the credit for the invite. Lots of bills are like this. This is one of them. Don't lose sleep hoping for it to happen.
I can assure you that slots will go up, I don't know by how many but the media is riding on this (both the left and right) and eventually there will be a good increase in primary care slots mostly.
 
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JeffLebowski

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If you do a little math, it seems doable:

If residents are the cheapest mode:
100K x 15000 = $1,500,000 = That is not a lot of money in terms of what the government has. there are far many people than that in the United States so if they pay taxes its less than $1 per year.

Then again a PA and sometimes NP's can do anything a resident can for much cheaper than $100k, so we'd have to account for how many of them there are into the equation (i dont have their numbers so i can't).

there are a total of 25,520 current spots in the match. where 17,127 are US grads, so there are tons more spots left over. The rest would go to the IMG's i guess, because at this time, the US needs more doctors than the medical schools can produce. Funding 15,000 would create room for all the other FMGs that are applying with left over spots, until med schools in the US start producing more US med students.
Dude $100,000 x 15,000 is $1.5 billion, not $1.5 million.
 

turquoiseblue

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Dude $100,000 x 15,000 is $1.5 billion, not $1.5 million.
oops. but still..if my calculations are correct, there are 138 million taxpayers (in 2007..i dont know the current number). so $1.5 billion/138 million taxpayers = $10.95 per taxpayer per year to implement 15,000 spots--not a whole lot of dough at all! and to think you'd pay it monthly that comes to 91 cents per month!
 
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nedi292

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Expanding US Medical Residency Programs

http://www.thepetitionsite.com/1/expanding-us-medical-residency-progra...ms-programs


This petition is seeking for Congress to increase the number of Medical Residency positions in the US by a) funding more positions, and b) redefining residencies to allow more positions.
The Balanced Budget Act of 1997 froze the number of medical residents eligible for funding at 1996 levels, although various programs managed to increase residencies by obtaining grants and using alternative funding.
In 2006, there were 21,659 positions available. 19,349 graduating medical school seniors applied to the match (the system for filling the positions), leaving 2310 positions to be filled by US citizens who graduated from international medical school, and non-citizen graduates of international medical schools.
Since then, US Medical schools have been called upon to increase class size to provide for an anticipated physician shortage. In 2010 there were 22,809 positions (all information here is from The National Residency Match Program, advance data tables, 2010 Match), and 23670 seniors applying , leaving 861 without the possibility of a position. In fact, the situation is worse as 4704 positions went to US citizens who graduated from international medical school, and non-citizen graduates of international medical schools; leaving 4121 Graduating US Seniors without a position. The vast majority of this number have student debt and at the current level of available residencies they will never find a position as medical schools continue to increase class size.

------read further:D
 

BlondeDocteur

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Expanding US Medical Residency Programs

http://www.thepetitionsite.com/1/expanding-us-medical-residency-progra...ms-programs


This petition is seeking for Congress to increase the number of Medical Residency positions in the US by a) funding more positions, and b) redefining residencies to allow more positions.
The Balanced Budget Act of 1997 froze the number of medical residents eligible for funding at 1996 levels, although various programs managed to increase residencies by obtaining grants and using alternative funding.
In 2006, there were 21,659 positions available. 19,349 graduating medical school seniors applied to the match (the system for filling the positions), leaving 2310 positions to be filled by US citizens who graduated from international medical school, and non-citizen graduates of international medical schools.
Since then, US Medical schools have been called upon to increase class size to provide for an anticipated physician shortage. In 2010 there were 22,809 positions (all information here is from The National Residency Match Program, advance data tables, 2010 Match), and 23670 seniors applying , leaving 861 without the possibility of a position. In fact, the situation is worse as 4704 positions went to US citizens who graduated from international medical school, and non-citizen graduates of international medical schools; leaving 4121 Graduating US Seniors without a position. The vast majority of this number have student debt and at the current level of available residencies they will never find a position as medical schools continue to increase class size.

------read further:D
Those numbers are complete fabrications. There were slightly over 17,000 US seniors in the match for 22,000+ positions.
 

turquoiseblue

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one thing that I hope is that they don't add just those "going nowheresville" nondesignated prelim positions....they should make it so that it is a full residency and the resident actually become a doctor in the end. otherwise its just cheap labor and not an education.
 

turquoiseblue

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Expanding US Medical Residency Programs

http://www.thepetitionsite.com/1/expanding-us-medical-residency-progra...ms-programs


This petition is seeking for Congress to increase the number of Medical Residency positions in the US by a) funding more positions, and b) redefining residencies to allow more positions.
The Balanced Budget Act of 1997 froze the number of medical residents eligible for funding at 1996 levels, although various programs managed to increase residencies by obtaining grants and using alternative funding.
In 2006, there were 21,659 positions available. 19,349 graduating medical school seniors applied to the match (the system for filling the positions), leaving 2310 positions to be filled by US citizens who graduated from international medical school, and non-citizen graduates of international medical schools.
Since then, US Medical schools have been called upon to increase class size to provide for an anticipated physician shortage. In 2010 there were 22,809 positions (all information here is from The National Residency Match Program, advance data tables, 2010 Match), and 23670 seniors applying , leaving 861 without the possibility of a position. In fact, the situation is worse as 4704 positions went to US citizens who graduated from international medical school, and non-citizen graduates of international medical schools; leaving 4121 Graduating US Seniors without a position. The vast majority of this number have student debt and at the current level of available residencies they will never find a position as medical schools continue to increase class size.

------read further:D
I agree with improving funding so we don't have this stupid cap over our heads (sounds like a pun)...but your numbers on us senior grads without a position are incorrect. you may want to change them on your petition.
Here are the correct numbers (see here:http://www.nrmp.org/data/advancedatatables2010.pdf on page 4):

1078 US seniors did not match. .14,992 US seniors matched.
16,070 US seniors applied.
22,809 PGY1 and 2,711 PGY2 positions were available (total of 25,520 positions).
1749 US citizen IMG's matched (1946 didn't). 2881 nonUS citizen IMG's matched (4365 didn't).

now if only 2881 nonUS citizen IMG's matched i dont see how 9000 visas could exist?? (which i thought was the case from reading another post about it, but now it mathematically doesn't work out....)

im kind of curious how many visa spots exist. is it 2881 (as many nonUS citizen IMG's that matched?) if that could be clarified maybe it won't seem like such a mess (at least to me).
 

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one thing that I hope is that they don't add just those "going nowheresville" nondesignated prelim positions....they should make it so that it is a full residency and the resident actually become a doctor in the end. otherwise its just cheap labor and not an education.
I think people have been over this with you in previous threads Turq. . . Most of those "going nowheres" are actually going somewhere, they are going to whatever subspecialty they matched into and never wanted to be "designated." They just wanted to get their intern year out of the way as it is a requirement and a nondesignated spot is all they need. If a resident is unfortunate enough to match into a nondesignated spot without having secured a complete residency then yes, they are at the mercy of their own performance to have the program offer them a spot the next year. But they would have known that ahead of time if they were half conscious during the application/interview process.
 

turquoiseblue

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I dont know how true or reliable this info is , but I just read somewhere from someone (a random forum poster who seems to be an MD at least) that thinks they're pretty well informed about the current health care law passed by Obama that was recently passed is that the government cut out the money to fund the residency slots and put that money to funding midlevel NP and PA's.