Why are residency slots increasing?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

MacGyver

Membership Revoked
Removed
15+ Year Member
20+ Year Member
Joined
Aug 9, 2001
Messages
3,757
Reaction score
7
http://www.nrmp.org/res_match/matchday03.pdf

We already have more than enough slots to cover all US medical grads, both MD and DO. Why do the number of total residency slots continue to increase each year?

Now, this year, the NRMP is reporting a total increase of 450 more slots than last year.

I think the answer to this is money. Medicare funding for residencies is a major cash cow, funded at $100,000 per year per resident.

Too many hospitals are seeking new residency positinos when they really dont need them to serve patients.

The ACGME needs to put a cap on residency slots, EXCEPT FOR MEDICALLY UNDERSERVED AREAS.
 
What?!? Hospitals pay residents a measly 10 dollars or less an hour and they get reimbursed a hundred grand a year? Are you sure? Man, where's the market economy in that?

By the way, with the population getting larger and older it's pretty clear that there'll be a need for more doctors in the future.

Some of us foreigners are mighty happy that US schools don't produce enough docs to cover these training spots.
 
Yup its 100k per resident per year from medicaire. Its just one of the last cash cows for hospitals to tap in order to minimize red ink.
One of the consequences of the resident lawsuit for better wages and working conditions is that the number of rez spots would jump dramatically if hospitals were to allow a more equitable sharing of the loot with residents.
 
I feel it is to our benefit as upcoming physicians as well as our patients that there are an increasing # of residency spots- residents take care of cheap labor for hospitals in exchange for the training opportunity, considering medicare reimbursment versus resident salaries. Is medicare compensation per resident to hospitals the same regardless if the person is an American grad or a IMG/ FMG? I'd think that with the 80-hour work week guidelines and desparate need for PCP's that there need to be more capable hands and minds available. I have yet to see a hospital that has a detrimentally high resident/patient ratio.

Congratulations to all in the 2003 match! 🙂

-F.C.

(Future) PGY-1, Surgery 2003
 
The number of post-graduate medical training positions (residency & fellowship positions) were fixed in the mid-1990's. Therefore, any increase in the number of positions is not paid for by medicare.

The increase is due to a combination of new acgme rules that crack-down on excessive resident work-hours and hospitals growing and requiring more residents to care for their patients.

Most of the new positions are 1-year prelims that get the most bang-for-the-buck for the hospitals.
 
The reimbursement for residents at teaching hospitals is a little more complicated than that. Medicare pays for graduate education directly and indirectly. The Medicare Direct Graduate Medical Education (DGME) reimbursement is based on the calculated cost of graduate medical education in 1985 (the year the Bill was made into Law) and the percentage of Medicare patients seen at the hospital. The Medicare Indirect Medical Education (IME) payment to teaching hospitals is based on a complex forumla that takes into account the greater costs of patient care in teaching hospitalsthan in non-teaching hospitals and calculates an additional payment amount that is added to each Medicare reimbursement. For 2003, the IME is a 5.5% increase to the medicare reimbursement for each 10% increase in the hospital's doctor-to-bed ratio due to having a teaching program. This means that the reimbursement from medicare is directly related to the number of residents in the hospital, the number of Medicare patients treated as a percentage of the whole, and the number of reimbursable procedures performed. There is no direct amount that can be calculated. From a recent article from Minnesota Medicine (Vol 86/No. 2) a study was done at Hennepin County Medical Center in Minneapolis, a 400-bed hospital with 280 residents in 10 programs regarding graduate medical education revenue and costs.

The calculated Medicare DGME payment for 2000 was $6,136,000. The Medicare IME payment for 2000 was $13,584,000. Other revenues included payments from Medicaid (state payments) and other grants. Total revenues for graduate medical education was $28,833,000.

The article gave costs for resident salaries ($10,341,000), resident benifts ($1,312,000), Faculty teaching salaries ($11,355,000), and additional support and overhead for a total cost of $50,532,000 leaving a funding gap of $21,699,000. The hospital accounts for their graduate medical educaiton program as almost a $30 million dollar loss for the year 2000.

Of course there are unmeasured benefits of having the residents and the monetary benefits were not included in this article or compared with replacing the residents with an appropriate number of trained staff.
 
I believe there are also medicare resident funding disparities between graduates of US medical schools and FMGs. I was quite concerned about this during the entire match process. Thankfully I (USFMG)was not impacted adversely.

PM&R had a 10% increase in residency spots over last year. Personally, I would like to keep the current low/moderate supply and moderate/high demand for physiatrists so I hope this trend doesn't continue.
 
Top