Any unemployed physicians out there? # of MD graduates =/= residency spots

[gutonc]

We don't have a physican shortage as much as we have a physician distribution problem. If it was more lucrative (financially and otherwise) for people to practice in rural areas, they would. But as smq123 points out, being the only (insert specialty here) in a XXX mile radius just blows.

As an example, I am an academic oncologist and live in the largest city in a geographically large state that is otherwsie largely rural (25% of the people in the state live in this metro area and another 25% live within 50 miles of it). There are plenty of oncology groups in the state although they're concentrated in the western half. There are some rural groups however that simply refuse to take any sort of consult call simply because they'd be on solo 24/7/365 call for a 50-100 mile radius and that would just suck. They have answering services for their patients of course, but any time a hem/onc emergency rolls into their local ED after hours or on the weekend, the calls come to us...200-300 miles away...in the only academic medical center in the state. If half a dozen oncologists from this town were to relocate where they're more needed in the state, this area certainly wouldn't be hurting for them and the patients in those rural areas would be much better served.

So how do you fix this problem? I'm not smart enough to come up with a lot of ideas, but changing the loan repayment/forgiveness programs to include specialists willing to practice in rural areas (not just Primary Care) would be helpful as a start.

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[BlondeDocteur]

What gutonc describes is a global problem (except unlike in most countries, rural US physicians can outearn their urban counterparts).

Doctors are by definition highly educated professionals. Rural areas in general have lower average educational levels than do urban areas. Who would they socialize with? What schools would their children attend, and what opportunities would be available at those schools? Would they fit in politically, religiously, culturally?

I'll make it quite personal. Let's pretend I finish residency and move back to my home state in the mid-South to practice. Physician compensation there is quite high. \

But would any of the amazing friends I've made overseas or in New York fly in to visit? Would my future kids be exposed to the incredible ideas, rigorous expectations, opportunities (Asian languages? harpsichord teachers? art history in Florence?) the private schools in NY or even Seattle offer? Would my husband, a member of an ethnic minority, feel comfortable there? All we cook at home is Thai food-- where could we buy fresh galangal? It's not that I am embarrassed of where I came from, or that I think life there isn't worth living or something. But I will, with 100% certainty, never move back. No financial inducement would be enough to sacrifice everything that makes me 'me.'

I imagine a good number of docs feel the same way. Even if you come from a small town and had every intention of practicing there when you went off to college/med school, medical training will have changed you. Very few (mostly DO) schools are in rural areas, so you will have lived in a city for your schooling. Fewer (mostly FM) residencies are in rural areas, so you will have lived in a city for your training. You'll have gotten used to things like good Chinese takeout, more than 1 movie theater, dry cleaning open till 10PM. Suddenly the prospect of moving back to your hometown feels like rewinding your life by a decade-- and your 30-yo self just knows so much more than your 18-yo self did.

 

[lipomas]

I don't know - my experiences in the city have convinced me even more that I do not want to live in a city. If I had to live or work in a city I would seriously consider quitting medicine. There are all kinds of opinions on this subject - not all doctors want to be self-styled citizens of the world who live in cities. Many people have a brief state in their mid-20s where they want to save the world, live with others in big cities, be close to cultural things, etc. Many of them then awake and realize it isn't for them. Others stay in that state until they reach a later age. Some never get out of it.

Me? I want a yard. I like the outdoors. I don't like crowds. I don't like lots of noise. I like having a car and being able to park it somewhere. I consider myself enlightened. I am not missing anything that I really enjoy. I also do not consider myself culturally inferior to someone just because I make these choices. I get my fill of culture by going to the city. I probably see more concerts and cultural events than many city people. I probably don't eat as much Thai food or fusion cuisine though. And do not confuse lower educational levels with lower intelligence. There is correlation, yes, but it is not uniform.

The life you describe in your fourth paragraph would be something that would make me consider gouging my eyes out with a blunt instrument. But that doesn't mean it isn't for you. To each his or her own. I woudl suggest though, that if your friends are truly amazing and worth keeping they would come visit you. That never ceases to amaze me. Why do so many people who live in cities think that the world ends when you leave downtown? And why do get togethers among friends have to occur there?

 

[Marry2Pod]

..............

 

[lipomas]

The investment that an IMG puts into medical school is the same as US graduates and as such they deserve similar consideration for residency.

Is it really? 4 years college + 4 years med school all at many many thousands of dollars a year? Are you sure?

 

[bronx43]

Is it really? 4 years college + 4 years med school all at many many thousands of dollars a year? Are you sure?

I think he/she is talking about Caribbean graduates - IMGs. FMGs are the ones who were educated in a different, cheaper system.

 

[glamqueen]

IMGs deserve to get a residency just as much as US graduates. Just because they did not go to school in the US doesn't mean that they aren't equally qualified nor does it mean they are not good clinicians. Granted their could be horrible IMG and US students just the same. I wish that residency programs were fairer to IMGs - They have completely different standards for IMGs than they do for US students even though they take the SAME USMLE exam and do just the same. The investment that an IMG puts into medical school is the same as US graduates and as such they deserve similar consideration for residency. If there is a shortage of primary care physicians, why not add more residency positions and give some IMGs a chance to get what they have also worked so hard for to achieve.

Why would this be, though? Why shouldn't the U.S. favor U.S.-educated doctors? U.S.-educated doctors (no matter the citizenship) don't demand equal treatment in other country's medical systems, so why should we give equal treatment to people educated outside our borders? It seems it really does make more sense to favor people educated within our U.S. system of medical education i.e. MD and DO schools, because our country regulates those systems vs. an education system not regulated by our licensing bodies. Sorry, but I don't understand this argument. We are not as favored when compared with anybody else's (other countries) in-country educated doctors, so why would anyone expect us to put foreign or American doctors who were educated outside our systems on equal standing with people who were?

 

[Socrates25]

IMGs deserve to get a residency just as much as US graduates. Just because they did not go to school in the US doesn't mean that they aren't equally qualified nor does it mean they are not good clinicians. Granted their could be horrible IMG and US students just the same. I wish that residency programs were fairer to IMGs - They have completely different standards for IMGs than they do for US students even though they take the SAME USMLE exam and do just the same. The investment that an IMG puts into medical school is the same as US graduates and as such they deserve similar consideration for residency. If there is a shortage of primary care physicians, why not add more residency positions and give some IMGs a chance to get what they have also worked so hard for to achieve.

Wrong. IMGs can go back to their own country. United States already takes in more FMGs than all other nations on earth combined. We are doing MORE THAN OUR FAIR SHARE. American grads should get first crack at residency slots.

The reason IMGs want to come here is the $$$$. They are far more needed in their home countries.

For the americans who went to foreign schools, its because they are weaker students so therefore they do NOT "deserve" the same residency opportunities as the american grads who are stronger students.

 

[cretulescu]

Dude, you've never even been to medical school, let alone experienced residency. I think his/her post is right on. After all the crap I've been through, I would hate for them to increase residency spots because that will bring our salaries down. What in the world do you know about throwing away a decade and a half of your life away? Someone who has 300+ posts because his KID is in medical school (LOL) has no right whatsoever to insult and call a physician "vile", "selfish" and "sick".

But then again, in just one paragraph, you have reinforced the opinions of many physicians/med students/residents about the general public: you are CLUELESS.

I think you doctors are dumb! you use very much memory and ignore intelligence! plus you should not be payed so much because people sometimes die if they can t see a doctor! you shouldn t play with people s lives! intelligence should be payed much better...

 

[danzman]

I think you doctors are dumb! you use very much memory and ignore intelligence! plus you should not be payed so much because people sometimes die if they can t see a doctor! you shouldn t play with people s lives! intelligence should be payed much better...

I nominate this for post of the year.


"you shouldn t play with people s lives! intelligence should be payed much better..."
Will now be my sig.

 

[danielmd06]

Without going into enough detail to identify myself, I will tell you that I have observed academic medicine (second hand) for the past 30 years. I hold a law degree and advanced degrees in public policy and business. While I wouldn't know a kidney if you slapped me with one, I know a damned sight more about the economy and the law than the economic and legal imbeciles who fill the ranks of the medical profession.

I was appalled by Wagy's post because the evidence that we are about to see a severe shortage of physicians is practically overwhelming. In some places people with jobs and insurance can't get access to medical care right now. Innocent people who are injured in accidents can't get to a general surgeon. This is horrifying.

...Finally if any of you think you are really suffering in medical school I would suggest that you follow around a New York cop or a soldier in Afghanistan. You'll be counting your many blessings.

I'm a bit surprised that a mature adult who is not a physician would make such vitriolic comments on a portion of these forums specifically meant for physicians. Of course you are entitled to your own opinion but I see no reason to express it with a lack of civility in this (or any) environment. While I may not agree with wagy's post verbatim, he is certainly entitled to his opinion without being called names.

Furthermore, your gross generalizations about physicians being "economic and legal imbeciles" are blatantly offensive. But then again, "out of the overflow of the heart the mouth speaks."

Do you truly find physicians to be more venal than lawyers (!), pharmaceutical companies, insurance companies, nurses, or frankly, anyone else? On the contrary, most physician's are reimbursed much less than they could expect in the private sector for comparable amounts of education, total hours worked, and level of responsibility incumbent on being a doctor. Which often means that most (including myself) chose this path with an "above-average" amount of altruism and goodwill towards our fellow man.

Next, I think smq (and the subsequent posters) summed up the situation regarding physician "shortage" and answered your melodramatic and sensationalized statements quite matter of factly. I agree that rural maldistribution and the various barriers to medical care are difficult issues that certainly won't be resolved by slashing Medicaid, Medicare, or increasing numbers of mid-levels (who merely repeat the migration patterns of physcians).

I share your sentiments about the unenviable situations that many Americans, including our police forces and our brave soldiers, endure. However, I would like to point out that these individuals made their choices about a career path as all of us have and minimizing what medical professionals sacrifice by comparing them to others who sacrifice more, differently, or less does little to cement your arguments one way or the other.

And last but not least, congratulations to your daughter on being accepted to medical school!

 

[DrJosephKim]

This is one of the main reasons why physicians are choosing to pursue non-clinical jobs and careers. You don't need residency experience for many of these types of jobs and you can still make enough to pay your loans.

The government needs to allocate more funds to help residency programs. Until that happens, we'll continue to face a major physician shortage in this country.

 

[eagleface]

As many have said before, simply adding residency spots is not the solution. Many of us in subspecialties or fellowships do not want to see additional spots. Why would I, in a specialty that graduates 120 or so a year, want more graduates in my specialty. With limited numbers we can demand higher compensation. We can treat more patients per physician and increase revenue. These are good things.

Not to bump up an old thread, but there are those in every licensed profession who want to do this, and it is ILLEGAL. It is a crime to restrict the supply of a profession for any reason other than to protect the public! Check the antitrust laws and judicial opinions and you'll see that licensing to increase wages could result in pretty hefty fines.

Most physicians that I know strongly oppose restricting supply to boost wages, temporarily by the way. The same can be said for most lawyers, engineers, etc. It's always only a few insecure people who actually want to "guild" and "gouge".

For the americans who went to foreign schools, its because they are weaker students so therefore they do NOT "deserve" the same residency opportunities as the american grads who are stronger students.

Socrates' initial premise might be correct, but his second premise has his namesake rolling over in his grave and it's a shame he didn't say that about 2400 years ago because it could have made him vomit hemlock. Why should undergraduate grades evaluate a prospective resident when steps 1 and 2 of the USMLE are a far more accurate gauge of his/her prospective abilities? The best applicant is the one who is the best at the present time and not between 4 and 8 years in the past.

 

[Law2Doc]

... Why should undergraduate grades evaluate a prospective resident when steps 1 and 2 of the USMLE are a far more accurate gauge of his/her prospective abilities? ...

the creators of the USMLE don't consider them useful "gauges of prospective abilities", so you shouldn't either. They have been in the works to try and change the timing of the test so nobody uses them for this purpose. These tests were designed merely as pass fail tests of a minimum level of medical knowledge. Residencies have been using them to compare applicants simply because there is nothing else standard to use, but few consider them actual aptitude tests, and probably would be happy to latch onto something else once the USMLE is revised. I'm not saying anything undergrad related is of value, just that you shouldn't exalt the USMLE to something it's not. You can be a great or lousy doctor, and Step 1 isn't going to predict this in any real way.

 

[fishsnack]

Why should undergraduate grades evaluate a prospective resident when steps 1 and 2 of the USMLE are a far more accurate gauge of his/her prospective abilities? The best applicant is the one who is the best at the present time and not between 4 and 8 years in the past.

USMLE Steps 1 and 2 are NOT the best gauge for future quality as a physician. Work ethic and intelligence are far more valuable in that regard, and these are arguably more consistently present in those that did things right the first time around. Many FMGs spend months preparing for these tests, some even attend schools that are basically glorified USMLE prep courses. This all leads to poor comparison. Regardless, as a residency program, why deal with these uncertainties when you can just hire US trained people.

 

[eagleface]

USMLE Steps 1 and 2 are NOT the best gauge for future quality as a physician. Work ethic and intelligence are far more valuable in that regard, and these are arguably more consistently present in those that did things right the first time around. Many FMGs spend months preparing for these tests, some even attend schools that are basically glorified USMLE prep courses. This all leads to poor comparison. Regardless, as a residency program, why deal with these uncertainties when you can just hire US trained people.

Then the problem is with the exam itself. Why have a licensing exam at all if it doesn't test ability to perform? Imagine if a driver's license test didn't purport to measure driving ability. You make a good point about poor undergraduate records suggesting an inconsistent work-ethic, but I wouldn't doubt it if they ended up testing well. If someone worked hard enough to learn all of the material for the licensing exam, they wouldn't be more likely throw it away by slothfulness during residency than anyone else.

Regardless, as a residency program, why deal with these uncertainties when you can just hire US trained people.

Cost and availability. You want services to be as cheap as possible without hurting the quality of the care and you want to increase the supply of quality care. If the quality is there, then there's no reason to uniquely restrict residency spots for foreigners or Americans who went to foreign schools. If the quality is unknown, then the quality should be tested accurately.

 

[fishsnack]

Then the problem is with the exam itself. Why have a licensing exam at all if it doesn't test ability to perform? Imagine if a driver's license test didn't purport to measure driving ability. You make a good point about poor undergraduate records suggesting an inconsistent work-ethic, but I wouldn't doubt it if they ended up testing well. If someone worked hard enough to learn all of the material for the licensing exam, they wouldn't be more likely throw it away by slothfulness during residency than anyone else.


Cost and availability. You want services to be as cheap as possible without hurting the quality of the care and you want to increase the supply of quality care. If the quality is there, then there's no reason to uniquely restrict residency spots for foreigners or Americans who went to foreign schools. If the quality is unknown, then the quality should be tested accurately.

Learning "all the material for the licensing exams" does not a good doctor make. Thats the point, and you're missing it.

 

[Law2Doc]

... Why have a licensing exam at all if it doesn't test ability to perform? Imagine if a driver's license test didn't purport to measure driving ability...

um, a drivers license doesn't tell you who is a better driver than others. It's also a "meets the bare minimum" type test. I think you are missing the point of licensing exams (both the Steps and at the DMV) -- they are threshold tests, not aptitude tests.

 

[handwriting]

That's why LORs and interviews exist.

 

[Arcan57]

um, a drivers license doesn't tell you who is a better driver than others. It's also a "meets the bare minimum" type test. I think you are missing the point of licensing exams (both the Steps and at the DMV) -- they are threshold tests, not aptitude tests.

The Steps are fundamentally different animals than the SATs. This is abundantly clear to residents taking Step 3. I don't know of any doctor that would claim their clinical ability is better than another doctor's on the basis of their Step 3 result assuming that both had passing scores.

Depending on changes to the USMLE exams, I could see a future where the various specialties offered aptitude exams designed to assist them in picking residents, administered sometime near the beginning of 4th year.

 

[kiki the alto]

I find this discussion absolutely fascinating because I'm coming from a unique perspective. I'm a US Grad of a fantastic medical school who very simply is trying to change specialty. I was less happy and less suited to Specialty A and needed a change. I went out on a limb and now I've successfully gotten back in the game, but not without a lot of worry. When we consider the effects of changing numbers of residency positions and "squeezing out" FMG/Caribbean Grads, are we taking into account the (admittedly low) number of us who need a residency to have a career as much as you US Seniors do? Would these schemes and plans squeeze me out too...thus leaving a perfectly bright, qualified american doc out in the cold just because I didn't choose right the first time?

 

[eagleface]

There is nothing illegal or wrong about trying to keep the number of resident spots limited. There are some specialties currently facing a glut of graduating residents and many have to go into a fellowship or multiple fellowships to get a subsequent attending position. Some for example (nucs) have minimal job opportunities. So the reality is that we need to regulate residency positions to the number of positions needed; otherwise, we simply end up with a bottleneck at the end of residency rather than the prior to residency.

It's perfectly legal to restrict supply to protect the public because genuine trade is not restrained, but it's a violation of antitrust laws to restrict the supply for purposes of increasing the price or wages. For any case where interstate commerce would be involved, see 15 U.S.C. § 1. If the other would-be residents aren't qualified enough to serve the public adequately, then they can be denied residency, but you can't just deny residency because they'll exert a downward pressure on wages or increase job competition. That's how D.O.'s won license rights largely:

http://journals.lww.com/academicmed...transformation_of_osteopathic_medical.13.aspx

 

[Droopy Snoopy]

One might argue that the qualifications are subjective and with over 90% of US grads matching this year, we have enough qualified physicians.

One might, but then again one might also be oblivious of the fact that in many areas of the country it takes one 5-6 months to see dermatology, one has to drive 250+ miles to see a pain specialist, and one's emergency room is manned overnight by a nurse practitioner with an ATLS course and a prayer.

 

[UnemployedPGY3]

Growing more hopeless by the day. Hopeless, coming from someone who went on 20+ radiology interviews. My profile description follows:
I'm a really intelligent hard working woman from the south. Was asked to resign from my program in midwest, with offering me 6 mo+ salary and benefits, if I waived my rights to sue.
The program (and whole field of radiology) was hit hardest with budget cuts early on. There was a dire shortage of faculty when it came to learning the basics (GI, CT) I tried, the program tried, but the staff were spread too thin. An attending grilled me and beat me down for not knowing body CT (scheduled at the end of PGY2) and he vented about how dumb I was to everyone within earshot.

Worked for a famous board review company after (confidential)

I've interviewed in another field, interviews, no match. The interviews were at prestigious institutions. There are hardly ANY pgy2 spots left.

Now I am reduced to no income, credit card revoked, and got desperate enough to apply for minimum wage jobs. My CV goes in the garbage. I am a US student from a blue collar family. I rocked step 1 and 2. I've passed step 3.
Really starting to regret becoming an MD. I will be homeless soon unless someone gives me a chance.

 

[NotAProgDirector]

I am somewhat surprised at your story. It doesn't really belong on this thread. Thoughts:

1. You seem to blame your problems in radiology on your program. Sure, radiology might be spread thin -- but so are other fields. It used to be in academic medicine that you were paid to teach -- you were held to a lower productivity standard since academic medical centers had other sources of revenue. But those sources have dried up, and faculty are more beholden to their RVU's. In any case, your performance was clearly part of the problem, and acknowledging that is an important part of moving onwards.

2. Not sure what you're looking for. No one is going to give you a PGY-2 position in IM or FP. Sure, you did a prelim year but that was at least 1-2 years ago. You're going to need a PGY-1 position for at least 3-6 months to refresh and prove you are ready for the responsibility of a PGY-2. In FP you may not get any credit for your PGY-1 at all. And if you did a TY, you will get minimal IM credit.

3. If you're not interested in IM/FP, then you need to be more specific about what you're looking for. You would likely be a very competitive PM&R resident.

4. If you interviewed but didn't match at "prestigious institutions", perhaps you need to interview at slightly less prestigious institutions?

Feel free to PM me if you'd rather not discuss here.

 

[Raryn]

2. Not sure what you're looking for. No one is going to give you a PGY-2 position in IM or FP. Sure, you did a prelim year but that was at least 1-2 years ago. You're going to need a PGY-1 position for at least 3-6 months to refresh and prove you are ready for the responsibility of a PGY-2. In FP you may not get any credit for your PGY-1 at all. And if you did a TY, you will get minimal IM credit.

Not necessarily. Her case is probably different because she washed out of her rads program, but I know of at least one person who did an IM prelim year, did two years of radiology, decided they hated radiology (thus quit the program), and got accepted as a PGY2 transfer in internal medicine (to the same program he did his prelim originally, 2-3 years prior). Assuming you did a pgy1 prelim year in internal medicine, you very well can get full credit for it... but it's certainly not guaranteed.