WSJ article on Residency spots vs. Medical school spots

[chessknt]

http://online.wsj.com/article/SB10001424127887324096404578356544137516914

This provides a nice summary of what has been long recognized in the field. Although we can all hope that Senators Schock and Schwarz are successful, the reality of the situation is that the SOAP threads of the future are going to get much busier.

Do you think this knowledge will have an impact on premeds?

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[HIJay]

http://online.wsj.com/article/SB10001424127887324096404578356544137516914

This provides a nice summary of what has been long recognized in the field. Although we can all hope that Senators Schock and Schwarz are successful, the reality of the situation is that the SOAP threads of the future are going to get much busier.

Do you think this knowledge will have an impact on premeds?

absolutely not. i know too many kids still have rosy and peachy outlook. they are too naive and refuse to learn from people ahead of them and think by the time they get to med school and ready for residency, things will improve and change.

sometime, people learn the lesson the hard and expensive way. nothing you can do anymore except to provide them with your own advice, experience and wisdom and show them the facts and numbers.

 

[molten]

Even a fifth grader would realize that more med-schools cannot mean more doctors if spots for the final training that makes a doctor remain the same.

 

[kecmd]

I hope so it does. I am one of those unemployable Americans who went abroad for school and I am looking at a 3rd attempt at the match and some very impatient creditors. The message should be to avoid Carib schools now and be aware of the residency situation before you enter into a US school in the next few years.

 

[mass1]

agreed. def avoid carib schools now if you can.

 

[Paddington]

Judging from the SOAP thread, it was quite a brutal match this year. AMGs with clean records and good scores were failing to match into fields like Family Medicine, Internal Medicine, and Pediatrics.

 

[wholeheartedly]

Do you think this knowledge will have an impact on premeds?

As a non-trad premed, this does concern me quite a bit.

 

[45408]

The number of federally funded residencies has been frozen since 1997.

LOL, and people say that the AMA has a "monopoly" on how many physicians are out there it's our own damn federal government keeping the supply on lockdown.

 

[HIJay]

While federal funding has been stable, the spots keep increasing as institutions continue to add residency spots each year. That being said, sooner than later, the number of US grads will come close to the number of residency spots. At that time, it makes sense for the government (through Medicare), to essentially ensure that the # of residency spots = # US grads and that all FMG/IMG can only get spots after all US grads are taken care of. We have an obligation to protect US grads, who go to AAMC accredited schools, a large number of which receive government funds.

makes sense to me. i think if a student borrowed and took out US federal loans, then it would be the best interest for the US govt to ensure that person has a spot in residency, to guarantee the loan pay back, otherwise the medical school loan bubble will be bursting soon with so many students with 100-200k of loans if not more and without a job that can pay it back.

 

[SeekerOfTheTree]

makes sense to me. i think if a student borrowed and took out US federal loans, then it would be the best interest for the US govt to ensure that person has a spot in residency, to guarantee the loan pay back, otherwise the medical school loan bubble will be bursting soon with so many students with 100-200k of loans if not more and without a job that can pay it back.

I agree with this. Don't see Canada and Australia lining up to give us residency spots.

 

[goofball]

For US Allo grads, will this really become an exigent issue in the next few years? I would think that IMGs and DO's applying to Allo residencies would be the first to get axed.


Regardless, I'll tell my kids not to bother with medicine. Dentistry will probably be a much smarter bet by then.

 

[laricb]

While federal funding has been stable, the spots keep increasing as institutions continue to add residency spots each year. That being said, sooner than later, the number of US grads will come close to the number of residency spots. At that time, it makes sense for the government (through Medicare), to essentially ensure that the # of residency spots = # US grads and that all FMG/IMG can only get spots after all US grads are taken care of. We have an obligation to protect US grads, who go to AAMC accredited schools, a large number of which receive government funds.

So a US Med Student who scores a 200 on his step 1 should take a position over a US img who scores 240 or better what a healthcare system we will end up with....

 

[chessknt]

So a US Med Student who scores a 200 on his step 1 should take a position over US img who scores 240 or better what a healthcare system we will end up with....

You are equating Step scores to clinical ability (which is not really easy to measure), please don't.

He does have a point though, US allo grads are in real danger of this and yoru pleas wil lfall on deaf ears as our politicians have shown minimal interest in protecting physicians in any way, let alone even less empowered medical students.

I would recommend extreme caution for anyone entering this field--the debt you incur makes not landing a residency equivalent to a catastrophic life event that can't be forgiven through bankruptcy.

 

[laricb]

You are equating Step scores to clinical ability (which is not really easy to measure), please don't.

He does have a point though, US allo grads are in real danger of this and yoru pleas wil lfall on deaf ears as our politicians have shown minimal interest in protecting physicians in any way, let alone even less empowered medical students.

I would recommend extreme caution for anyone entering this field--the debt you incur makes not landing a residency equivalent to a catastrophic life event that can't be forgiven through bankruptcy.

I only state step 1 scores because there is so much emphasis put on med students when they apply for residency positions. I was also placing both students on equal ground when it came to clinical ability...

 

[septoplasty]

I only state step 1 scores because there is so much emphasis put on med students when they apply for residency positions. I was also placing both students on equal ground when it came to clinical ability...

If you looked at it statistically, there aren't a whole lot of Caribbean students who get 240s. Infact, When I took the dang thing, the median was 222 and 1 SD was 20 points. So you expect to see Caribbean kids 1SD above norm every time?

As HIJAY said, the pictures are rosy. The outlook isn't.

 

[molten]

Even a fifth grader would realize that more med-schools cannot mean more doctors if spots for the final training that makes a doctor remain the same.

What I mean is, how could this decision pass when the idea behind the decision was to meet doctor-shortage?

 

[goofball]

What I mean is, how could this decision pass when the idea behind the decision was to meet doctor-shortage?

Was it the idea behind the decision? I think a lot of schools just made new medical schools either for money, for the hell of it, or to boost the profile of their institution.

 

[molten]

Was it the idea behind the decision? I think a lot of schools just made new medical schools either for money, for the hell of it, or to boost the profile of their institution.

Maybe you're right. I don't know. The article however opens with the following sentence:

"U.S. medical schools are expanding to meet an expected need for more doctors due to the federal health law."

 

[gutonc]

Maybe you're right. I don't know. The article however opens with the following sentence:

"U.S. medical schools are expanding to meet an expected need for more doctors due to the federal health law."

I am shocked, SHOCKED, that a journalist might not know WTF they're talking about.

 

[gutonc]

Was it the idea behind the decision? I think a lot of schools just made new medical schools either for money, for the hell of it, or to boost the profile of their institution.

The first and the last. Mostly the first though.

It's not rocket science folks. If people are willing to give $50K+/y to for-profit off-shore schools then why not ask them pay only $45K for a real, live 'Mercan Med Skule? It's basically like printing money.

Every 6 new students buys you somebody to lecture to the M1/2s and an administrative drone. For a class of 100, you only need half a dozen of those folks, let's be generous and say 8. Throw in a director/dean or three at 4 tuitions a year. You're still looking at nearly $2M/y in pure profit.

I'm pissed I didn't think of it first.

 

[NotAProgDirector]

It's not clear that there is a doctor shortage at all. Some research suggests that there is a doctor maldistribution (both geographically and specialty wise), and that physician work expands to fill schedules.

All of this is complicated, and no way to be "certain" either way.

 

[Noegrus]

It's not clear that there is a doctor shortage at all. Some research suggests that there is a doctor maldistribution (both geographically and specialty wise), and that physician work expands to fill schedules.

All of this is complicated, and no way to be "certain" either way.

This is definitely an important issue. Ophthalmologists bemoan a shortage of ophthalmologists and how that is going to hamper care for the aging populace. Meanwhile, on the anesthesiology forum, an ophthalmologist from LA was telling us how tough it is for ophthalmologists to live in LA because the market is super-saturated and thus there is extreme competition for patients. The issue is a constant discussion in the young ophtalmologists' forum.

 

[chessknt]

It's not clear that there is a doctor shortage at all. Some research suggests that there is a doctor maldistribution (both geographically and specialty wise), and that physician work expands to fill schedules.

All of this is complicated, and no way to be "certain" either way.

But with the expansion of medical care to more people under the ACA, assuming the role of an MD as a PCP continues to exist, should require more MDs. Even if they are maldistributed, you can't specialty hop without going through residency again so there is still a shortage of some types of MDs, even if there is an overall appropriate number of total MDs. I have no doubt that any future expansion of Medicare GME residency funding will go to FM (and possibly IM) spots, so one could argue that there is a shortage and that it needs to be addressed at the government level.

 

[michaelrack]

But with the expansion of medical care to more people under the ACA, assuming the role of an MD as a PCP continues to exist,QUOTE]

That's a pretty big assumption.

 

[NotAProgDirector]

Plus, there's the interesting problem of the baby boomers. As they retire, become older, and have medical issues, there will be more need for physicians. But, after they pass away, we may need less physicians.

Or maybe we need more NP/PA's.

When you look at history, it seems that we occilate from being convinced we have a physician shortage, to being certain we have a physician oversupply -- depends upon what data you look at, and what answer you "want" politically.

 

[Jessipeds]

Judging from the SOAP thread, it was quite a brutal match this year. AMGs with clean records and good scores were failing to match into fields like Family Medicine, Internal Medicine, and Pediatrics.

yes it was. I was lucky to match to a program I really liked, but I personally know way too many people who didn't match this year. And should have.

 

[Silent Cool]

Plus, there's the interesting problem of the baby boomers. As they retire, become older, and have medical issues, there will be more need for physicians. But, after they pass away, we may need less physicians.

Or maybe we need more NP/PA's.

When you look at history, it seems that we occilate from being convinced we have a physician shortage, to being certain we have a physician oversupply -- depends upon what data you look at, and what answer you "want" politically.

Yup, this is absolutely true. See the surplus of Anes. and Rads in the 90's. I thin most of these predictions are total bunk.

 

[Somnus Tuto]

the guys who start these non ACGME-accredited med school for profit, they live here in my neck of the woods. Cared for a patient at Greenwich hospital in Greenwich, CT, only like one of the wealthiest zip codes in the country. She kept bragging about how her husband owns one of the schools that makes "you doctors". guy is like a gazillionaire. She went home in a chaffeur-driven Bentley, likely to one of the many $20 million mansions Greenwich is famous for.

And there's no end in sight to this unbridled capitalism and exploitation

 

[Silent Cool]

the guys who start these non ACGME-accredited med school for profit, they live here in my neck of the woods. Cared for a patient at Greenwich hospital in Greenwich, CT, only like one of the wealthiest zip codes in the country. She kept bragging about how her husband owns one of the schools that makes "you doctors". guy is like a gazillionaire. She went home in a chaffeur-driven Bentley, likely to one of the many $20 million mansions Greenwich is famous for.

And there's no end in sight to this unbridled capitalism and exploitation

Somnus,

Would you mind telling me the names of some of these people? Also, am I correct in that you are referring to DO schools (non-ACGME accredited)?

thanx
😎

 

[DoctwoB]

My question is: Even if the funding was there, can the US medical system support many more residents without significantly diluting the training experience?

Essentially every university medical center and most major private hospitals have a residency in every field their population can support. Many other hospitals without residency programs have residents that rotate through (and thus allow for a larger residency program elsewhere). My thought is that while there are undoubtedly programs that could accommodate an extra resident here or there, trying to boost spots by 10-20% across the system would likely (1) dilute the learning experience at most hospitals and (2) lead to the creation of marginal programs without a sufficiently large patient base. What do those of you with more experience think?

The elderly/sick population may be increasing, but we're also much better at reducing length of stay and doing outpatient procedures then we used to be.

 

[Somnus Tuto]

Somnus,

Would you mind telling me the names of some of these people? Also, am I correct in that you are referring to DO schools (non-ACGME accredited)?

thanx
😎

meant to say LCME (for med schools), not ACGME (residencies/fellowships)

No, this is not in reference to DO schools but non-accredited carribean schools.
as far as I'm concerned, DO = MD for all (or most) intents and purposes

I'll give you a name if you promise not to send them a letter bomb

 

[Paddington]

most major private hospitals have a residency in every field their population can support. Many other hospitals without residency programs have residents that rotate through (and thus allow for a larger residency program elsewhere).

That's only true in the Great Lakes region and in the Northeast. The residency programs basically reflect distribution of U.S. population circa 1950. If you go to the Southeast or the Western U.S., residency programs are few and far between. There's a lot of potential for clinical education sites.

 

[NotAProgDirector]

That's only true in the Great Lakes region and in the Northeast. The residency programs basically reflect distribution of U.S. population circa 1950. If you go to the Southeast or the Western U.S., residency programs are few and far between. There's a lot of potential for clinical education sites.

If a new program opens, then new slots are funded. The "cap" everyone is talking about is only on existing programs. So actually funding is not stopping a new program from opening.

 

[Raryn]

If a new program opens, then new slots are funded. The "cap" everyone is talking about is only on existing programs. So actually funding is not stopping a new program from opening.

You'd know better than me, but that surprises me. Everything I've read basically says the distribution of spots funded by medicare is the same as in 1997, except when hospitals have merged and managed to move spots around.

What's to stop schools currently from just making shell corporations to get new spots with residents that just rotate at their hospitals (and maybe 1-2 new ones?). Or simply designating one of their other hospitals the "home hospital" for a new program?

 

[NotAProgDirector]

Apparently (and not surprisingly) it's more complicated than I thought.

http://www.azsenate.gov/Committee_Program_Presentations/Graduate Medical Education.pdf

This has nothing to do with me / my program / my state, but in the middle of page 2:

Medicare Funding and Position Caps

Federal law caps the number of residents Medicare supports at 1996 levels. Rural
teaching hospitals are capped at 130 percent of 1996 levels. However, there are several
exceptions to these caps. According to the Centers for Medicare and Medicaid Services (CMS),
urban hospitals, under limited circumstances, can apply for an increase in their cap for new
residency programs, and hospitals in rural areas may receive an increase to their FTE caps for
any newly approved programs. Hospitals may train more residents than the caps, but they will
not receive additional Medicare payments for the residents. Therefore, without CMS approval,
funding to increase residencies must come from sources other than Medicare.

So, apparently most programs can't increase in size, but some can get new slots for new programs. I have no idea what the criteria / limits on this are, but I stand corrected -- sounds like most new programs would not be CMS funded.

 

[Raryn]

Apparently (and not surprisingly) it's more complicated than I thought.

http://www.azsenate.gov/Committee_Program_Presentations/Graduate Medical Education.pdf

This has nothing to do with me / my program / my state, but in the middle of page 2:



So, apparently most programs can't increase in size, but some can get new slots for new programs. I have no idea what the criteria / limits on this are, but I stand corrected -- sounds like most new programs would not be CMS funded.

As I understand it, those new slots are generally only redistributed ones, not truly new spots. For example, if a program closes, CMS can move those spots to a new one (or expand a current one). I don't think they have the right (or the funding) to increase the total number.

 

[dantt]

As I understand it, those new slots are generally only redistributed ones, not truly new spots. For example, if a program closes, CMS can move those spots to a new one (or expand a current one). I don't think they have the right (or the funding) to increase the total number.

Not necessarily true. Word on the street was hopkins opened up 1-2 derm spots next year from increased research funding...

 

[gutonc]

Not necessarily true. Word on the street was hopkins opened up 1-2 derm spots next year from increased research funding...

Different issue. Those are institutionally funded spots, not CMS funded. It's mostly a semantic issue though.

Plenty of programs will sponsor more spots than they have CMS funding for. That money can come from departmental or institutional funds.

 

[Paddington]

I think it's pretty obvious that overall residency funding by the federal gov't has been capped for some time.

 

[thedrjojo]

What other career has a near 95% employment rate after graduation??? Doctors out of medical school still have one of the greatest if not the greatest employment rate... its still going to be greatly appealing to go to medical school...

 

[IMvrach]

Great point. And it's 95% among US seniors. Considering that those who don't match reapply, likely more broadly and successfully, eventually it's pretty close to 100%. Any other profession has much much higher fraction of people who are forced to change their career.

What other career has a near 95% employment rate after graduation??? Doctors out of medical school still have one of the greatest if not the greatest employment rate... its still going to be greatly appealing to go to medical school...

 

[Paddington]

It's an idiotic point though. You invest a lot in college just to go to medical school. If you fail to achieve that, your often stuck with a ****ty degree that doesn't lead to a decent job. If you've made it far enough to get into medical school and then graduate from medical school, you would think that for 8 years and perhaps a few hundred thousand dollars spent that you should be able to get a job.

 

[IMvrach]

Ok, suppose someone does PhD in biology or master in linguistics. What do you think one's chances to find job matching one's education? There is no career path which guarantees employment. Medicine is as close as it gets.

It's an idiotic point though. You invest a lot in college just to go to medical school. If you fail to achieve that, your often stuck with a ****ty degree that doesn't lead to a decent job. If you've made it far enough to get into medical school and then graduate from medical school, you would think that for 8 years and perhaps a few hundred thousand dollars spent that you should be able to get a job.

 

[Silent Cool]

Ok, suppose someone does PhD in biology or master in linguistics. What do you think one's chances to find job matching one's education? There is no career path which guarantees employment. Medicine is as close as it gets.

Dentistry. Pharmacy. Nursing. PA. Should I go on?

 

[IMvrach]

Nurses would not agree with you.
http://money.cnn.com/2013/01/14/news/economy/nursing-jobs-new-grads/index.html

Dentistry. Pharmacy. Nursing. PA. Should I go on?

 

[Silent Cool]

Nurses would not agree with you.
http://money.cnn.com/2013/01/14/news/economy/nursing-jobs-new-grads/index.html

Well why then does everyone complain about "overpaid" nurses and nurses practicing medicine?

 

[gutonc]

Well why then does everyone complain about "overpaid" nurses and nurses practicing medicine?

Mostly because they don't know WTF they're talking about.

And to your previous point, pharmacy is turning into the law school of the medical world. The # of graduates each year is rapidly approaching parity with the number of practicing pharmacists.

 

[deleted307836]

Well why then does everyone complain about "overpaid" nurses and nurses practicing medicine?

What does that have to do with their job market though?

Also pharmacy is in no way as stable as medicine. The pharmacy match for residencies is apparently brutal with many going unmatched, and the job market is pretty atrocious for them right now as well partly due to the the hugely increased number of pharmacists graduating each year. Don't know anything about dentistry.

 

[Silent Cool]

Mostly because they don't know WTF they're talking about.

And to your previous point, pharmacy is turning into the law school of the medical world. The # of graduates each year is rapidly approaching parity with the number of practicing pharmacists.

Yeah, I've heard about the pharmacy market softening quite a bit. But even so--all of my pharm friends are gainfully employed. Even the new grads.

 

[Silent Cool]

On the whole, however, I agree. Medicine has an especially high guarantee of job security and availability. And even the "crappiest" fields still offer a relatively nice income. #medicineforthewin. It just sucks for these new grads who have invested so much time and effort into becoming physicians that the required residency training is now becoming hard to obtain.