MD & DO What does the future look like post-Steps 1-3 P/F?

[Epilepsy365]

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There are two problems with this. The first is greed: the people in charge of deciding how many residents are in a program are the same people who would be losing income down the line. A young ortho program director has no incentive to overtrain the people who would be decreasing his paychecks in 10 - 15 years.

The second is the problem of volume, especially in the surgical fields. In many programs, cases are pretty limited. If you suddenly admitted 3x as many people, you're not going to have enough cases to go around and you're going to train unsafe surgeons. I heard about this happening at a neurosurgery program near me where they increased from 2 to 3 residents a year at the same time as their case volume stagnated. They ended up forcing two of the residents to take a research year to ensure that they would be able to get them enough cases.

Eventually, the market will correct that. Less money equals to less people going into surgery.

Honestly, PDs whine a lot about a ton of stuff. But, at some point, all the current PDs need to look at themselves in the mirror and ask what their Step 1 scores where when they applied for residency. My bet is that they were in the 210s to 220s.

No specialty is going to leave some broke doctor on the street. But, we're in the healthcare business, in which our priorities are to heal people and advance humanity through research. That's our primary mission, and the answer to make that mission a reality is to put passionate people in their right fields instead of letting the "lifestyle" and "money" clouding people judgment.

 

[Epilepsy365]

Not really. You would see tons of students going into more lifestyle friendly specialties such as FM.

I would be curious what the fellowship rates would be too, especially the IM fellowships. I bet less people would want GI as they do today.

A lot of people are going into FM for the lifestyle? Damn, don't we need that instead? What's the problem?

 

[Dantrolene FC]

A lot of people are going into FM for the lifestyle? Damn, don't we need that instead? What's the problem?

I never said there was anything wrong with that.

I was curious just which specialties students would be gunning for if they all paid the same.

I highly doubt derm would be as competitive as it is today if it only paid $200k.

 

[Epilepsy365]

There’s nothing wrong with that.

I was just which specialties students would be gunning for if they all paid the same.

I highly doubt derm would be as competitive as it is today if it only paid $200k.

I think the idea is that lifestyle and finance would be flexed to the #s of students going into certain specialties. For example, a hot field like Derm would suddenly accommodate the # of applicants, and increase the supply of dermatologists. Lifestyle and finance would decrease, pushing applicants away. In essence, it's no longer the right way to choose a specialty for the lifestyle and money. In this setting, a medical student would best choose a specialty that he or she enjoys and has a passion for.

I think it's an excellent idea that all PDs in the US should look at themselves in the mirrors and consider in order to increase healthcare access and bring down total healthcare cost. My guess is that overall physician burnout rate would decrease in the process as well.

 

[NotAProgDirector]

I have been thinking of an outrageous idea. Flex residency positions, where the number of specialty positions increase or decrease depending on demand. A few years would be insane, but ultimately a sharp increase in dermatologists or orthopeadic surgeons a few years would drive down compensation and result in a more sane market where income potentials would normalize accross specialties and differ by malpractice risk and hours worked, and people would realistically only go into stuff they want to go into which for the most part is probably primary care. ultimately making the supply of physicans more in sync with market demands.
This central planning of residency positions has not been very effective in alleviating shortages of particular specialties, nor has it been really beneficial to communities in terms of access or pricing. Its really a guild system that artificially limits training , controlled by people in the guild, the only real incentive they have is to keep on restricting positions, or increase positions when their specific procedures are at risk of being absorbed by another guild.

One could say the same thing about UGME as well i suppose.

Obviously there are many issues with the idea like quality control, volume of cases etc.

There are several problems with this idea. Practically, it's hard to just "increase spots". Current programs may not be able to handle more positions, and just starting a new program isn't easy. Then, it's also difficult to just decrease spots - who decides which spots get decreased, and programs design their staffing models based upon resident resources.

But perhaps more importantly, some studies in healthcare demonstrate that it is supply sensitive, not demand sensitive. If you're making widgets and the cost is high, in general increasing prodocution and adding more widgets to the market drives down prices. But in healthcare, multiple studies have shown this not to be true. Markets that have more cardiologists / cath labs aren't less busy or have lower prices -- they just do more cath's. The threshold for "who needs a cath" drops. So adding more dermatologists won't necessarily decrease costs / drive down salaries, it might just increase the number of people who are seen by dermatologists and have benign skin things removed.

 

[libertyyne]

There are several problems with this idea. Practically, it's hard to just "increase spots". Current programs may not be able to handle more positions, and just starting a new program isn't easy. Then, it's also difficult to just decrease spots - who decides which spots get decreased, and programs design their staffing models based upon resident resources.

But perhaps more importantly, some studies in healthcare demonstrate that it is supply sensitive, not demand sensitive. If you're making widgets and the cost is high, in general increasing prodocution and adding more widgets to the market drives down prices. But in healthcare, multiple studies have shown this not to be true. Markets that have more cardiologists / cath labs aren't less busy or have lower prices -- they just do more cath's. The threshold for "who needs a cath" drops. So adding more dermatologists won't necessarily decrease costs / drive down salaries, it might just increase the number of people who are seen by dermatologists and have benign skin things removed.

This is absolutely true, the rough outlines would be reverting back to a more apprenticeship model, so one resident be assigned to a single willing physician at smaller institutions that traditionally have not had residents, they could mandate core residency rotations be completed by the resident by finding a willing institution.

I did forget about those studies, but those studies imo are dependent on fee for service model. There would need to be changes in that aspect as well. I am also quite disheartened that it requires the fear of federal prosecutors to instill the desire to do the right thing in over-utilization of services and not intrinsic patient driven , or professional society /peer driven efforts.
reminds me of this video

 

[FindersFee5]

Eventually, the market will correct that. Less money equals to less people going into surgery.

Honestly, PDs whine a lot about a ton of stuff. But, at some point, all the current PDs need to look at themselves in the mirror and ask what their Step 1 scores where when they applied for residency. My bet is that they were in the 210s to 220s.

No specialty is going to leave some broke doctor on the street. But, we're in the healthcare business, in which our priorities are to heal people and advance humanity through research. That's our primary mission, and the answer to make that mission a reality is to put passionate people in their right fields instead of letting the "lifestyle" and "money" clouding people judgment.

How do you address the inadequate training aspect?