Wow- Med Student Pipeline

[exPCM]

This year represents the first time that the 18,000 mark has been crossed for number of newly enrolled med students per AAMC's new report.
See: http://www.aamc.org/newsroom/pressrel/2008/enrollmentdata2008.pdf

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[Law2Doc]

This year represents the first time that the 18,000 mark has been crossed for number of newly enrolled med students per AAMC's new report.
See: http://www.aamc.org/newsroom/pressrel/2008/enrollmentdata2008.pdf

Yeah, unless residency slots get increased, the increase in US enrollment is going to leave very few spots for non-US folks in a few years. This has long been the AAMC's goal -- to make US schools generate adequate bodies to meet US healthcare needs.

 

[yaah]

I wonder if this will serve to make med schools themselves actually more competitive. Not in terms of admissions, but in terms of coursework. Because you can bet that not all of the students responsible for the increase in attendance want to go into primary care (which is likely the goal of the AAMC). So people are going to try to distinguish themselves the only way that many of them know how - by sabotage if not actual cheating. Likely only from a small part of the class, to be sure, but viruses like these tend to spread. I hope I'm wrong.

 

[jumpingjax]

Alot of these positions are DO schools taking peoples money and allowing "anyone" admission.

For example, there is a DO school in Tampa florida that accepts applicants with a ~20 MCAT score. Scary stuff.

 

[yaah]

Alot of these positions are DO schools taking peoples money and allowing "anyone" admission.

For example, there is a DO school in Tampa florida that accepts applicants with a ~20 MCAT score. Scary stuff.

I have thought about this as well - I tend to wonder what will happen in 5 years or so when these applicants start becoming graduates. And a lot of the newer med schools have the highest tuitions. It's going to be interesting.

 

[exPCM]

The points brought up by the posters above make me wonder if we will indeed see an increase in the diagnosis of gunnerhea among med students.

 

[PeepshowJohnny]

It is definitely going to be interesting. The competitiveness dial for residencies looks like it's going to be turned up to 11.

 

[Law2Doc]

I wonder if this will serve to make med schools themselves actually more competitive. Not in terms of admissions, but in terms of coursework. Because you can bet that not all of the students responsible for the increase in attendance want to go into primary care (which is likely the goal of the AAMC). So people are going to try to distinguish themselves the only way that many of them know how - by sabotage if not actual cheating. Likely only from a small part of the class, to be sure, but viruses like these tend to spread. I hope I'm wrong.

I'd say there's no question in my mind that this will happen. There will be US grads who will be "forced" down into spots previously snagged by offshore grads. (and no, this increase isn't largely from DO schools as a prior poster suggested, the allo schools are all increasing 10-15% and adding new schools as well, so this is a huge chunk of the growth). So there will be larger and larger percentages of each school that simply won't be competitive for specialties as the increase in admissions will be folks who have to take non-specialty slots. Should lead to more competition, not necessarily for the folks going into specialties vs not, but particularly at the bottom of each class, as there's perceived to be a big difference between going into FP in a metropolitan suburb versus going into it in trailerparkville US. Should also lead to the need for a ton more applications and interviews at the residency application stage.

Not to mention the upheaval in competition when the NBME finally messes around with the Step exams and residencies have to find something else to focus on for residency applications. Glad not to be starting med school a few years from now.

 

[exPCM]

The AAMC data is only for allopathic schools.
Osteopathic schools have a separate association (AACOM): http://www.aacom.org/resources/bookstore/Documents/college_growth_report_2008.pdf
Although I know that FMGs can be fine physicians, I like the idea of seeing more AMGs and less FMGs in US taxpayer funded residency positions.

 

[medicinesux]

anything to make a buck nowadays- let's open even more med schools while driving even more americans into six figure debt! One only needs to look at the gazillion number of law schools that are raping tens of thousands of people each year of their futures to see where the road medicine is headed. Ever wonder why there are no offshore law schools? Just check out jdunderground.com and see the misery newly minted law grads are facing to get a taste of what the future of medicine holds if you don't believe me.
Should get really interesting seeing more people competing for the table scraps that is left of medicine in the near future. Can you imagine the pain of paying back 300-400K and up in student loans and making a measly 100-150K in primary care? Maybe it hasn't hit you yet but someday it will. Perhaps when you are on call and get called back to the hospital at 3 AM on Christmas Eve and have to miss your kids opening Santa's presents it will (donated by Goodwill of course since you are still paying back those loans to the newly formed State of Southern North Dakota State School of Osteopathy that bilked you out of 60K a year).
Like I've said before, give me a job paying 50-100K with no debt offering a good lifestyle that I actually enjoy to the above scenario anyday.

 

[medicinesux]

Glad not to be starting med school a few years from now.

Hate to break it to you but this will affect you in more ways than you could presently imagine. What do you think is going to happen when this massive glut of med school students graduate? Yep, you guessed it- expect your salary to go nowhere for the next 10-20 years. Nothing is better than wage stagnation when your workload and stress level mount even further! Good times lie ahead when Joe the Plumber's annual salary begins to equal that of a primary care physician. It is almost like the US dollar falling liking a crater against the Euro- the pay of so many other professions is beginning to come up to par with that of a physician that it makes medical compensation laughable.

 

[exPCM]

Hate to break it to you but this will affect you in more ways than you could presently imagine. What do you think is going to happen when this massive glut of med school students graduate? Yep, you guessed it- expect your salary to go nowhere for the next 10-20 years. Nothing is better than wage stagnation when your workload and stress level mount even further! Good times lie ahead when Joe the Plumber's annual salary begins to equal that of a primary care physician. It is almost like the US dollar falling liking a crater against the Euro- the pay of so many other professions is beginning to come up to par with that of a physician that it makes medical compensation laughable.

President Clinton and Congress enacted a resident cap in the 1990's. The cap effectively freezes Medicare funding for residency slots and thus residency slots are relatively static. Since you can not really practice medicine without residency training/licensure/board certification, the resident cap currently prevents an overall glut of practicing physicians. However the AAMC is lobbying strongly to lift the cap. (see: http://www.aamc.org/advocacy/library/washhigh/2007/031607/start.htm )
The AAMC's initial ploy is to see if they can get the cap lifted in states with a "shortage of resident physicians" but their goal is clearly to eliminate the cap altogether. However with this nation's huge budget deficit the government really doesn't have the money to fund more residency spots and therefore I believe the cap will likely remain in place.

 

[yaah]

None of you should worry, I'm sure that one of the "solutions" will be to have the government forgive your med school debt if you choose to go into primary care.

 

[Law2Doc]

Hate to break it to you but this will affect you in more ways than you could presently imagine. What do you think is going to happen when this massive glut of med school students graduate? Yep, you guessed it- expect your salary to go nowhere for the next 10-20 years. Nothing is better than wage stagnation when your workload and stress level mount even further! Good times lie ahead when Joe the Plumber's annual salary begins to equal that of a primary care physician. It is almost like the US dollar falling liking a crater against the Euro- the pay of so many other professions is beginning to come up to par with that of a physician that it makes medical compensation laughable.

Um, you miss the point. There can be no glut because there's a cap on residencies. The goal is to increase US med schools to equal that number, not to increase residencies to match. Once the two numbers are the same, no more offshore doctors will be let in. The US medical education will meet the US needs -- the AAMC's stated plan.

But no, there won't ever be a massive glut of med school graduates (as there debatably is in law) because they won't go over the ceiling of residency slots. This is why it's different than law -- in law there is no ceiling. There is no residency slots -- lawyers come right out of school and into law firms, solo practice, government, etc. So the profession is ill equipped to know how many lawyers are needed, and pretty much admits 60-70% of all bar exam takers each sitting. But since they are going into potentially infinite places the only ceiling is what the market will bear. Medicine did it right. There can never be more doctors than planned, because no med school is going to accept more people than it can put into a residency. The only ones who are going to feel the pain are the non-US med schools, which will be bumped out under the current plan.

 

[NonTradMed]

Hate to break it to you but this will affect you in more ways than you could presently imagine. What do you think is going to happen when this massive glut of med school students graduate? Yep, you guessed it- expect your salary to go nowhere for the next 10-20 years. Nothing is better than wage stagnation when your workload and stress level mount even further! Good times lie ahead when Joe the Plumber's annual salary begins to equal that of a primary care physician. It is almost like the US dollar falling liking a crater against the Euro- the pay of so many other professions is beginning to come up to par with that of a physician that it makes medical compensation laughable.

How can there be a glut of new doctors if there isn't a corresponding increase in residency spots? Right now, the empty residency spots are being filled by nonUS grads (and DO students), but once US MD slots are increased, these residency spots will go to those US students.

And anyways, wasn't there a freeze on US med school spots for almost 20 years starting from the early 1980's? I remember there were predictions of a physician 'glut' so there was a freeze on increasing enrollment. From what I remember, the number of medical students stayed at ~16k from the early 1980's until the mid-90s. While it would be great if there continued to be a enrollment freeze, it's hardly realistic to assume they would never increase physician enrollment since the US population has increased substantially in the last 30 years. Also, if you haven't noticed, when a need isn't being met, others step forward. Not enough primary care docs? PAs and NPs step in. Not enough MD students in residency spots? FMGs and DOs take those slots.

Um, you miss the point. There can be no glut because there's a cap on residencies. The goal is to increase US med schools to equal that number, not to increase residencies to match. Once the two numbers are the same, no more offshore doctors will be let in. The US medical education will meet the US needs -- the AAMC's stated plan.

But no, there won't ever be a massive glut of med school graduates (as there debatably is in law) because they won't go over the ceiling of residency slots. This is why it's different than law -- in law there is no ceiling. There is no residency slots -- lawyers come right out of school and into law firms, solo practice, government, etc. So the profession is ill equipped to know how many lawyers are needed, and pretty much admits 60-70% of all bar exam takers each sitting. But since they are going into potentially infinite places the only ceiling is what the market will bear. Medicine did it right. There can never be more doctors than planned, because no med school is going to accept more people than it can put into a residency. The only ones who are going to feel the pain are the non-US med schools, which will be bumped out under the current plan.

It's also (I think) cheaper to start up a new law school than a new MD med school because there's a lot of expensive requirements including how much money to have at hand, and clinical rotations which need to be set up. DO schools have an easier time because their financial requirements are less.

 

[Faebinder]

Are you guys sure you know what you are all talking about?

Everyone here is claiming that the number of grads coming out of AMG allopathic schools is going to exceed the number of residency slots or even catch up.

Are you taking into account the fact that the slots are going up due to private fundings without even the federal cap going up?

Page 15 of the NRMP report states this:

Total positions in:

2004 - 21192 went up to 21454 in 2005 etc etc etc

So in 2005 it went up by 262 then 2006 went up by a further 205 then 186 in 2007 then 395 in 2008.

On the other hand the number of new graduates allopathic AMG on page 17.

The number of newly graduates increased from 2004 to 2005 by 71 then in 2006 increased by 194 then 165 in 2007 and then 25 ONLY in 2008.

I can safely conclude that the number of new graduating allopathic AMGs will never catch up with the number of residency spots.. heck the number of residency spots is slowly outgrowing the AMG allopathic new graduates...

But..

If you want to count OLD graduates and DOs... then the game will definitely change.. especially the DOs... they are growing so fast (such as 313 extra new graduates apply in 2008). I dont even know if there is a cap on the DO residencies.

The people truly screwed are the foreign grads.. especially the carribbean schools and any foreign school that forces the student to take a loan from the US... cause for them.. the spots will get tighter due to increased competition from true FMGs and DOs and old AMGs.

 

[exPCM]

Are you guys sure you know what you are all talking about?

Everyone here is claiming that the number of grads coming out of AMG allopathic schools is going to exceed the number of residency slots or even catch up.

Are you taking into account the fact that the slots are going up due to private fundings without even the federal cap going up?

Page 15 of the NRMP report states this:

Total positions in:

2004 - 21192 went up to 21454 in 2005 etc etc etc

So in 2005 it went up by 262 then 2006 went up by a further 205 then 186 in 2007 then 395 in 2008.

On the other hand the number of new graduates allopathic AMG on page 17.

The number of newly graduates increased from 2004 to 2005 by 71 then in 2006 increased by 194 then 165 in 2007 and then 25 ONLY in 2008.

I can safely conclude that the number of new graduating allopathic AMGs will never catch up with the number of residency spots.. heck the number of residency spots is slowly outgrowing the AMG allopathic new graduates...

But..

If you want to count OLD graduates and DOs... then the game will definitely change.. especially the DOs... they are growing so fast (such as 313 extra new graduates apply in 2008). I dont even know if there is a cap on the DO residencies.

The people truly screwed are the foreign grads.. especially the carribbean schools and any foreign school that forces the student to take a loan from the US... cause for them.. the spots will get tighter due to increased competition from true FMGs and DOs and old AMGs.

Yes, Medicare instituted a resident cap in 1996. This has led to a relative stasis in total number of residency spots. There have been mild increases in residency spots due to some residencies obtaining private or state funding ( http://www.ama-assn.org/amednews/site/free/prl20130.htm) . The med school enrollment increases will totally overwhelm those mild increases. In addition the stability of private and state funding is questionable (for example the UTMB spots cited in the article may be in jeopardy after Hurricane Ike and many state budgets are being cut due to the economy).
To assume that NRMP spots going up means residency spots are increasing is very misleading. NRMP spots will naturally go up as more specialties are joining the NRMP who previously had matches outside the NRMP (for example Neurosurgery has just joined the NRMP this year - http://www.nrmp.org/ ). ENT joined the NRMP in 2006 (added ~275 spots to NRMP total) and Neurology joined in 2007 (added ~575 spots to NRMP total). The Emergency Medicine and Anesthesiology residencies have converted many of their positions from advanced PGY-2 to categorical PGY-1 (see table 3 http://www.nrmp.org/data/resultsanddata2008.pdf).
Finally many programs used to give out a lot of their positions outside the match (the so-called prematch). The NRMP has really cracked down on this. In 2000 more than 3000 1st year spots were offered outside the match ( http://www.aamc.org/newsroom/pressrel/2000/000316.htm ). Starting in the 2004 timeframe the NRMP changed their rules to "Beginning with the 2004 Match, all sponsoring institutions participating in the NRMP Main Match must register and attempt to fill all their positions in the Match except for those specialties or programs participating in other national matching programs." (see: http://www.cordem.org/news/2002/aug-sept/nrmp.pdf). I understand that the NRMP has been putting the hammer down to enforce the all positions in the match rule.
Personally I think that any residency program that participates in the NRMP and is still doing "prematches" for PGY-1 positions should immediately be reported to the NRMP for disciplinary action.

 

[Faebinder]

Yes, Medicare instituted a resident cap in 1996. This has led to a relative stasis in total number of residency spots. There have been mild increases in residency spots due to some residencies obtaining private or state funding. To assume that NRMP spots going up means residency spots are increasing is very misleading. NRMP spots will naturally go up as more specialties are joining the NRMP who previously had matches outside the NRMP (for example Neurosurgery has just joined the NRMP this year - http://www.nrmp.org/ ). ENT joined the NRMP in 2006 (added ~275 spots to NRMP total) and Neurology joined in 2007 (added ~575 spots to NRMP total). The Emergency Medicine and Anesthesiology residencies have converted many of their positions from advanced PGY-2 to categorical PGY-1 (see table 3 http://www.nrmp.org/data/resultsanddata2008.pdf).
Finally many programs used to give out a lot of their positions outside the match (the so-called prematch). The NRMP has really cracked down on this. In 2000 more than 3000 1st year spots were offered outside the match ( http://www.aamc.org/newsroom/pressrel/2000/000316.htm ). Starting in the 2004 timeframe the NRMP changed their rules to "Beginning with the 2004 Match, all sponsoring institutions participating in the NRMP Main Match must register and attempt to fill all their positions in the Match except for those specialties or programs participating in other national matching programs.” (see: http://www.cordem.org/news/2002/aug-sept/nrmp.pdf). I understand that the NRMP has been putting the hammer down to enforce the all positions in the match rule.
Personally I think that any residency program that participates in the NRMP and is still doing "prematches" for PGY-1 positions should immediately be reported to the NRMP for disciplinary action.

Mmm.. makes sense and explains much. But I still have to point out that neurology specialty joining NRMP added PGY-2s mostly. Also, when you add a specialty to NRMP (such as neurosurgery) you also expect to add the allo AMG 1st time applicants and those increase on the list as I calculated.... so it's balancing out on that match list. The number of new positions openned I presume are hospital funded mostly.

 

[Taurus]

While it sucks for future med students that class sizes are increasing 30% by 2012 over 2004 numbers, I think overall it's a good thing to have US grads filling those unfilled spots than IMG's. Nothing against IMG's, but I think that US grads will fight harder for our profession against other groups such as NP's and CRNA's who would like nothing better than to cherry pick the best things about medicine for themselves. Many blame the FMG's who filled anesthesiology spots 15 years ago for the decline in anesthesiology today. That maybe simplistic, but there is probably some truth to it. I believe that the aggressive actions of the NP's were one reason for the increase in medical school enrollment. The next step is hopefully an increase in residency spots, preferably primary care, because that's what this country needs.

 

[Miami_med]

This largely won't hurt the people who would have been US FMGs, because those people will now get in to US medical school with the increase in spots. There may be an even lower tier that now can't find a spot at graduation. Those people would have never gone at the present now though, so it's irrelevant. The IMGs will feel it. I'm at a school that has long been an IMG pipeline into the US, and I do wonder if we could see the end of, or atleast a change in, that.

 

[Law2Doc]

...
On the other hand the number of new graduates allopathic AMG on page 17.

The number of newly graduates increased from 2004 to 2005 by 71 then in 2006 increased by 194 then 165 in 2007 and then 25 ONLY in 2008.

I can safely conclude that the number of new graduating allopathic AMGs will never catch up with the number of residency spots.. heck the number of residency spots is slowly outgrowing the AMG allopathic new graduates...
...

Um, the massive "voluntary" increase in allo seats was advocated by the AAMC in 2005, and schools did not substantially start increasing their classes until the following year. So while new graduates did not increase much through 2008, the increase is now in the pipeline. Expect the number of new graduates to be substantially higher starting with 2010 and so on. You are basically looking at the trickle that showed up before the tsunami and declaring it safe. So no, do not "safely conclude that the number of new graduating allopathic AMGs will never catch up with the number of residency spots", you should actually just safely conclude that you looked at the wrong snapshot for the information. You need to focus on enrollment a few years further down the pipeline. The wave is coming, you are just focusing on the calm before the storm for your data.

 

[Law2Doc]

This largely won't hurt the people who would have been US FMGs, because those people will now get in to US medical school with the increase in spots. There may be an even lower tier that now can't find a spot at graduation. Those people would have never gone at the present now though, so it's irrelevant. The IMGs will feel it. I'm at a school that has long been an IMG pipeline into the US, and I do wonder if we could see the end of, or atleast a change in, that.

That may be true, and certainly that is the AAMC's goal -- to have more US generated doctors for which we have quality control. This should wipe out a lot of the offshore schools though.

 

[NotAProgDirector]

Starting in the 2004 timeframe the NRMP changed their rules to "Beginning with the 2004 Match, all sponsoring institutions participating in the NRMP Main Match must register and attempt to fill all their positions in the Match except for those specialties or programs participating in other national matching programs.”

Due to impressive pushback by programs, this rule was abandonded and never implemented. There is no NRMP "hammer" to make programs fill through the match. The rest of the argument is completely valid.

 

[exPCM]

Due to impressive pushback by programs, this rule was abandonded and never implemented. There is no NRMP "hammer" to make programs fill through the match. The rest of the argument is completely valid.

Aprogdirector,
Thank you for the correction. I have been misinformed regarding the "all positions in the match" rule. FYI, there are no residency programs at my local hospital so I rarely get to talk to any program directors. I personally would like this rule put back in place because I feel the "prematch" discriminates against US senior medical students.

 

[NotAProgDirector]

An "all in" rule would be more fair overall, but there would be some downsides:

1. Programs that take large numbers of IMG's argue that it would be impossible to get all of their visas in place if they waited until match day, and would be chronically short in July and August.

2. Off cycle US grads would be unable to start early, unless you made a rule that spots starting October - February could be given away outside the match. But if you do this, some creative IMG programs might simply try to shift their training year to fit this schedule, and still prematch.

Overall, I agree with you, and would favor an all-in system.