which candidate supports increasing residency slots

[ahoymate]

As I'm sure you all may know, US medical school enrollment is increasing, while residency positions are not increasing. Considering the US government keeps advertising there is a shortage of doctors, simply increasing the number of US med grads doesn't help the cause, but increasing the number of residency positions would.

Which candidate (Romney or Obama) is more likely to support increasing the number of residency positions available? That would help both US medical grads as well as IMG grads.

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[evilbooyaa]

I would be interested in this as well, but I think it is a moot point and something that neither candidate is going to publicly comment on.

 

[Renaissance Man]

No candidate has specifically mentioned residency funding (at least not in the debates or from what I have read). However, Medicare pays a large portion of residency training programs. I doubt either candidate is looking to substantially increase the amount of money given to programs; I would just hope for a funding to keep up with inflation.

 

[ahoymate]

the doctor shortage is not being helped by increasing medical school enrollment across the nation. what would help the doctor shortage is if there is an increase in residency positions, and I wonder when politicians will understand that.

 

[munchymanRX]

the doctor shortage is not being helped by increasing medical school enrollment across the nation. what would help the doctor shortage is if there is an increase in residency positions, and I wonder when politicians will understand that.

If they can solve the problem by granting NPs more autonomy, then they're going to do that. It's cheaper than funding more residency positions.

 

[Houmd]

Obama's mentality is NOT to increase spending on GME, I doubt Romney thinks any differently either but here's some 30second google research

http://www.boston.com/news/health/blog/2011/02/doctor_training.html

http://www.beckershospitalreview.co...ble-bind-over-cuts-to-residency-programs.html

http://blog.al.com/sweethome/2011/02/obama_budget_would_cut_pediatr.html

 

[calvnandhobbs68]

Neither? Nobody cares except medical students.

 

[theseeker4]

Neither? Nobody cares except medical students.

Yeah, sadly it is a political non-starter to increase funding for doctor education. Doctors are rich anyway after all, why does there need to be any taxpayer money going to them at all? Better to "stop overpaying" for services.

 

[cbrons]

Neither? Nobody cares except medical students.

very true

 

[DoctwoB]

Sure funding is limiting residency slots, but so are both practical issues and specialty groups.

First the practical issues: Most major hospitals that provide the volume and diversity of pathology needed to support residents already have them. Adding additional residents to already saturated programs diminishes the quality of training for everyone, while creating new programs at marginal hospitals may provide sub-standard training.

Secondly the specialty supply issue: Even if our hospitals could support more derm, neurosurgery, ENT, and Ortho residencies, do you think those specialty groups would support opening more programs? This increases the supply of said docs, reducing job offers, salary, etc. To be blunt, it is good for docs in a given specialty to have a shortage. The only downside is when said shortage creates a gap for someone to try to enter your turf (optometrists into eye surgery, NAs into anesthesia, etc.), but that is a long-term issue, while getting paid more due to being in demand is a short term issue. Guess which one wins? And while we could add more primary care residencies, where most of the "shortage" (aka maldistribution) lies, its not like US residents are filling up the current primary care slots.

While limiting spots sucks when your on the outside looking in, its great when on the inside looking out. Those on the outside aren't looking to pour more money into residency training, and those on the inside are happy being in demand. With no real lobby on either side to boost residency slots, its just not going to happen.

Finally, the US doctor "shortage" is not an issue that will be solved by supply alone. The issue isn't really that there aren't enough doctors, the issue is that there aren't enough doctors that want to live in crappy areas and accept medicaid (aka crappy reimbursement)
Tools like boosting loan-forgiveness and medicaid/care reimbursement in underserved areas will work much better then boosting overall supply.

 

[startswithb]

My man.
http://schock.house.gov/news/documentsingle.aspx?DocumentID=305910

Washington, Aug 6 - Congressman Aaron Schock (R-IL) has introduced bipartisan legislation to address the physician shortage facing the United States. The Resident Physician Shortage Reduction and Graduate Medical Education Accountability Act, H.R. 6352, will create 15,000 new Graduate Medical Education (GME) slots around the country. The Association of American Medical Colleges estimates that in 2015, the country will have 62,900 fewer doctors than needed.

 

[DoctwoB]

My man.
http://schock.house.gov/news/documentsingle.aspx?DocumentID=305910

Washington, Aug 6 - Congressman Aaron Schock (R-IL) has introduced bipartisan legislation to address the physician shortage facing the United States. The Resident Physician Shortage Reduction and Graduate Medical Education Accountability Act, H.R. 6352, will create 15,000 new Graduate Medical Education (GME) slots around the country. The Association of American Medical Colleges estimates that in 2015, the country will have 62,900 fewer doctors than needed.

While encouraging, remember that the vast majority of bills never make it out of committee, much less get put to a vote.

 

[thuc]

that's a great start tho. thanks for sharing that. I'll start stalking that bills progress now.

http://www.govtrack.us/congress/bills/112/hr6352

sent from my iPhone

 

[theseeker4]

Sure funding is limiting residency slots, but so are both practical issues and specialty groups.

First the practical issues: Most major hospitals that provide the volume and diversity of pathology needed to support residents already have them. Adding additional residents to already saturated programs diminishes the quality of training for everyone, while creating new programs at marginal hospitals may provide sub-standard training.

Secondly the specialty supply issue: Even if our hospitals could support more derm, neurosurgery, ENT, and Ortho residencies, do you think those specialty groups would support opening more programs? This increases the supply of said docs, reducing job offers, salary, etc. To be blunt, it is good for docs in a given specialty to have a shortage. The only downside is when said shortage creates a gap for someone to try to enter your turf (optometrists into eye surgery, NAs into anesthesia, etc.), but that is a long-term issue, while getting paid more due to being in demand is a short term issue. Guess which one wins? And while we could add more primary care residencies, where most of the "shortage" (aka maldistribution) lies, its not like US residents are filling up the current primary care slots.

While limiting spots sucks when your on the outside looking in, its great when on the inside looking out. Those on the outside aren't looking to pour more money into residency training, and those on the inside are happy being in demand. With no real lobby on either side to boost residency slots, its just not going to happen.

Finally, the US doctor "shortage" is not an issue that will be solved by supply alone. The issue isn't really that there aren't enough doctors, the issue is that there aren't enough doctors that want to live in crappy areas and accept medicaid (aka crappy reimbursement)
Tools like boosting loan-forgiveness and medicaid/care reimbursement in underserved areas will work much better then boosting overall supply.

For the practical issue of major hospitals being full, are they really? Are all hospitals with the diversity and volume to support a quality residency program in any given specialty really saturated with residents already? I imagine the top programs in the most desirable locations could be, but do you really think every hospital that is appropriate for a residency program in a given area already has one, and that it has enough filled slots that adding more would actually hurt resident education?

 

[BA11]

Nobody cares about medical students, they simply want to make our future career less rewarding and more inefficient.

 

[pkwraith]

Medical students are part of the bloc of 18-26 year olds, aka non-voters. Maybe half of my school voted, and that's because it's in a politically important state.

Bottom of the story is no one will give more than lip service to medical students and residents if they don't vote.

 

[calvnandhobbs68]

Medical students are part of the bloc of 18-26 year olds, aka non-voters. Maybe half of my school voted, and that's because it's in a politically important state.

Bottom of the story is no one will give more than lip service to medical students and residents if they don't vote.

They aren't a big enough voting block to matter even if they do vote and they're spread out over every single state. Also, residents don't care just medical students. Residents already have a slot...why would they give a crap if there are more or less.

So no, nobody would care about the medical student vote even if we all voted.

 

[NotAProgDirector]

I hate to point it out, but this legislation is basically a piece of classic gov't pork.

First, 1/3 of the positions are reserved for programs that are already over their cap. So, it's basically free money to programs that have expanded, and are doing fine. So, 1/3 of these "slots" don't actually do anything other than give money to hospitals for doing what they are already doing, no new positions.

Next, the other 2/3 of slots are allocated by a priority system. The first priority is to those states / areas with a new medical school opening, or where a branch campus has opened since 2000. This is silly. If a new medical school is opening on Long Island, that doesn't mean that NYC needs more residency slots. If the gov't were to actually want to open new slots, they should do so in areas that need physicians to work, as docs are more likely to settle wherever they train.

 

[startswithb]

I hate to point it out, but this legislation is basically a piece of classic gov't pork.

First, 1/3 of the positions are reserved for programs that are already over their cap. So, it's basically free money to programs that have expanded, and are doing fine. So, 1/3 of these "slots" don't actually do anything other than give money to hospitals for doing what they are already doing, no new positions.

Next, the other 2/3 of slots are allocated by a priority system. The first priority is to those states / areas with a new medical school opening, or where a branch campus has opened since 2000. This is silly. If a new medical school is opening on Long Island, that doesn't mean that NYC needs more residency slots. If the gov't were to actually want to open new slots, they should do so in areas that need physicians to work, as docs are more likely to settle wherever they train.

This is why more experts are needed in the legislative process!! Are physicians even advising this?

 

[Law2Doc]

This is why more experts are needed in the legislative process!! Are physicians even advising this?

Experts wouldnt help. Nobody cares what the good advice would be. The people fronting the bill want something that on it's face seems palatable to the public (purporting to address a shortage), while at the same time trying to bring more federal money into their state. The hurdle, and why these bills always fail, is that at it's root you are funneling taxpayer money to a group that the typical voter perceives as too well off as is. Welfare for the poor struggling fledgling doctor is not a popular stance. Nobody really cares about the smartest way to do something -- it's about costs and votes.

Bottom line is they aren't going to create a huge number of new residency slots. And the shortage is more one of distribution than number anyhow -- there isn't a doctor shortage in NYC, and adding more residency slots won't make the NYC derm hopeful relocate to rural Wyoming.