Anyone here against expanding GME?

[mats7]

More GME would increase the ceiling for expanding class sizes, increase the labor supply without addressing distribution in rural and urban areas, and there doesn't seem to be a doctor shortage at all.

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[DrHalsey]

Better solution is to offer shortened Medical School programs. Selling myself into slavery for 4 years + residency + fellowship is just too long.

 

[username456789]

The trials and tribulations of our lawyer colleagues should be a cautionary tale.

 

[repititionition]

to answer your question, "yes".

 

[mats7]

The trials and tribulations of our lawyer colleagues should be a cautionary tale.

I was surprised that despite all of the shouting about so many law schools, there are only 200. Medical schools aren't far off at 172, with more being planned.

 

[username456789]

I was surprised that despite all of the shouting about so many law schools, there are only 200. Medical schools aren't far off at 172, with more being planned.

If the United States only needed six Whoozawutzit Technicians at a time, and continued to churn out five per year, that would still be way too many.

 

[Jabbed]

I was surprised that despite all of the shouting about so many law schools, there are only 200. Medical schools aren't far off at 172, with more being planned.

Average law school class is ~500 people. Most med programs are closer to ~100.

 

[Dr. Death]

I'm very against expanding GME.

 

[FindMeOnTheLinks]

The AMA isn't against expanding GME. Rule #1: never attempt to argue over GME with your AMA indoctrinated classmates on the class Facebook page.

 

[Lord Humongus]

Completely against it. Aren't there something like 30,000 residency spots vs 20,000 graduating US medical students? Even with currently planned school expansion, those numbers will never cross. Please do not believe AAMC propaganda that US med students are "threatened" by a stagnant number of residencies. The only people threatened are AAMC bureaucrats who wish to keep on a course of heedless school expansion to increase the size of their fiefdom, regardless of what it means for the careers of their graduates. Them, and of course the third world doctors who selfessly want to leave their physician saturated nations in Africa and South Asia to help us deal with our doctor shortage. Because that's the only thing increasing GME would do at this point: increase the number of FMGs.

Keep this in mind: the government and insurance/hospitals are hell bent on making the independent practice of medicine an impossibility. Employee model is the future, and there is nothing you can do about it. It's been decided in high places. In an employee model, your wage is determined completely by supply and demand. Why are EM doctors currently getting $300/hr despite being a fungible commodity? Because of supply vs demand. So just realize that by expanding GME and thus allowing in thousands of additional FMGs every year you're shifting the balance of power against your future self and in favor of your hospital CEO when it comes time to determine your compensation and autonomy.

 

[JoeyB]

A worthwhile read

http://www.nejm.org/doi/full/10.1056/NEJMp1511707?af=R&rss=currentIssue

 

[JoeyB]

Oh and to answer the question, I'm not in favor of GME expansion. I don't think the facts support a need for it. See the above linked article for details.

 

[67552931811]

The government is already watering down my future wages enough. I guess we should just flood the market and make things worse, amiright?

 

[tiedyeddog]

Really isn't that hard to match SOME residency spot somewhere as a US grad.

 

[allantois]

Completely against it. Aren't there something like 30,000 residency spots vs 20,000 graduating US medical students? Even with currently planned school expansion, those numbers will never cross. Please do not believe AAMC propaganda that US med students are "threatened" by a stagnant number of residencies. The only people threatened are AAMC bureaucrats who wish to keep on a course of heedless school expansion to increase the size of their fiefdom, regardless of what it means for the careers of their graduates. Them, and of course the third world doctors who selfessly want to leave their physician saturated nations in Africa and South Asia to help us deal with our doctor shortage. Because that's the only thing increasing GME would do at this point: increase the number of FMGs.

Keep this in mind: the government and insurance/hospitals are hell bent on making the independent practice of medicine an impossibility. Employee model is the future, and there is nothing you can do about it. It's been decided in high places. In an employee model, your wage is determined completely by supply and demand. Why are EM doctors currently getting $300/hr despite being a fungible commodity? Because of supply vs demand. So just realize that by expanding GME and thus allowing in thousands of additional FMGs every year you're shifting the balance of power against your future self and in favor of your hospital CEO when it comes time to determine your compensation and autonomy.

Look at where creating a shortage in the number of anestesiology residencies got the field: development of an alternative anesthesia provider - CRNA

Also I don't understand the FMG hate: immigrants are a lot more entrepreneurial than Americans and are more likely to open their own businesses.

As to the comment about ER physician compensation: it is not a supply and demand issue. A physician's income is determined by the revenue he generates to the hospital.

 

[Lord Humongus]

A worthwhile read

http://www.nejm.org/doi/full/10.1056/NEJMp1511707?af=R&rss=currentIssue

Excerpt:

On the other hand, current legislative proposals backed by the AAMC and others to expand Medicare GME by 15,000 positions would necessarily widen the position–graduate gap and dramatically increase the demand for IMGs from other countries and for U.S. IMGs who graduate from medical schools in the Caribbean.

Dafuq...the are pushing legislation to increase GME by 15,000 from today's 30,000...a 50% increase! That's insanity. I think I am becoming paranoid, but between this, the ACA, and the destruction of private practice it seems like there is a concerted effort to turn physicians in the USA into poorly paid corporate peons.

 

[Psai]

Look at where creating a shortage in the number of anestesiology residencies got the field: development of an alternative anesthesia provider - CRNA

Also I don't understand the FMG hate: immigrants are a lot more entrepreneurial than Americans and are more likely to open their own businesses.

As to the comment about ER physician compensation: it is not a supply and demand issue. A physician's income is determined by the revenue he generates to the hospital.

Every single thing you said here is wrong.

 

[allantois]

Every single thing you said here is wrong.

If you watch Fox News, then I guess I'm wrong

 

[Psai]

If you watch Fox News, then I guess I'm wrong

How does fox news have anything with you not knowing what you're talking about?

 

[FindMeOnTheLinks]

I thought rule #1 was never join or pay any attention to the AMA?

About 75% of my classmates never heard that rule apparently. "I can get Netter's flash cards for free???? I'm in!!!"

 

[Postictal Raiden]

Excerpt:


Dafuq...the are pushing legislation to increase GME by 15,000 from today's 30,000...a 50% increase! That's insanity. I think I am becoming paranoid, but between this, the ACA, and the destruction of private practice it seems like there is a concerted effort to turn physicians in the USA into poorly paid corporate peons.

Such an expansion would destroy the profession for good. Doubt it'll happen thought because that's a huge financial commitment for the gov't.

 

[Lord Humongus]

Such an expansion would destroy the profession for good. Doubt it'll happen thought because that's a huge financial commitment for the gov't.

One can only hope. But everyone should certainly take note that the AAMC and AMA are huge backers of this proposal. For all our powerlessness, the one thing we can do is withhold our support from these groups as they are clearly the enemy of the rank and file physicians and exist purely for the benefit of their own executive leaderships. Increasing their influence by becoming members ourselves is nothing less than offering to pay for the rope that will be used to hang you.

 

[Ironjaw]

Anyone know the AOA's position on this?

 

[Brorthopedic]

Anyone know the AOA's position on this?

Whichever position that generates more money for them

 

[Stagg737]

Look at where creating a shortage in the number of anestesiology residencies got the field: development of an alternative anesthesia provider - CRNA

Also I don't understand the FMG hate: immigrants are a lot more entrepreneurial than Americans and are more likely to open their own businesses.

As to the comment about ER physician compensation: it is not a supply and demand issue. A physician's income is determined by the revenue he generates to the hospital.

1. Nurse anesthetists have been around for over 100 years and were practicing autonomously before doctors even had anesthesiology residencies. The development of CRNAs was not because there was a shortage of anesthesiologists, but because nurses had been doing it so long and were losing their own autonomy in the field. The only reason CRNAs can practice autonomously is because the education required to get that license is far more in depth than any other licensure a nurse would get. Even with that, the vast majority of CRNAs still work under an anesthesiologist and several states don't legally allow them to practice without physician supervision.

2. It doesn't matter how entrepreneurial they are if the system doesn't allow for independent businesses. If they want to do FM or psych they could probably stay independent. If they want to do IM or anything having to do with a hospital though (which in my experiences most FMGs do because of how complex it is to navigate our healthcare system), they won't be able to do that. Besides, why would any of us want the U.S. to start hiring more FMGs in place of people trained here unless they were that much better (which some are).

3. Are you really going to argue that generating more revenue for a hospital isn't going to increase the hospital's demand for that type of physician?

 

[journey2md]

Completely against it. Aren't there something like 30,000 residency spots vs 20,000 graduating US medical students? Even with currently planned school expansion, those numbers will never cross. Please do not believe AAMC propaganda that US med students are "threatened" by a stagnant number of residencies. The only people threatened are AAMC bureaucrats who wish to keep on a course of heedless school expansion to increase the size of their fiefdom, regardless of what it means for the careers of their graduates. Them, and of course the third world doctors who selfessly want to leave their physician saturated nations in Africa and South Asia to help us deal with our doctor shortage. Because that's the only thing increasing GME would do at this point: increase the number of FMGs.

Keep this in mind: the government and insurance/hospitals are hell bent on making the independent practice of medicine an impossibility. Employee model is the future, and there is nothing you can do about it. It's been decided in high places. In an employee model, your wage is determined completely by supply and demand. Why are EM doctors currently getting $300/hr despite being a fungible commodity? Because of supply vs demand. So just realize that by expanding GME and thus allowing in thousands of additional FMGs every year you're shifting the balance of power against your future self and in favor of your hospital CEO when it comes time to determine your compensation and autonomy.

In the allopathic match there are around 26,500 first year positions. There are around 18,000 U.S. allopathic seniors in the match another 1500 U.S. allopathic previous graduates, around 3000 D.O. seniors, 8000 U.S. citizens who attended medical school abroad and around 10000 non-citizens who attended medical school abroad. Because residency programs are filtering applicants by year of graduation and USMLE score, there number of U.S. previous graduates who are not matching is getting larger and larger each year.

Last year St. Georges in Grenada matched 870 graduates into residency positions, the majority of which were U.S. citizens. When the match is unified and all D.O. students will have to compete against U.S. and foreign MD graduates, I expect some major problems on the D.O. side. If residencies still filter graduates, the bottom D.O. students may not fare well against many top foreign medical graduates both citizen and non-citizen.

 

[journey2md]

One can only hope. But everyone should certainly take note that the AAMC and AMA are huge backers of this proposal. For all our powerlessness, the one thing we can do is withhold our support from these groups as they are clearly the enemy of the rank and file physicians and exist purely for the benefit of their own executive leaderships. Increasing their influence by becoming members ourselves is nothing less than offering to pay for the rope that will be used to hang you.

Where did you read that the AMA were backers of this proposal? Since the AMA is the second highest campaign contributor for Congress, and Congress would have to vote on this bill, I would think that it would have already passed if the AMA was behind it.

 

[journey2md]

Really isn't that hard to match SOME residency spot somewhere as a US grad.

Tell that the 700 U.S. allopathic seniors, and 1000 previous U.S. allopathic graduates from last year's match. As a D.O. student, there is almost a 100 percent chance at matching somewhere, that is until the unified ACGME/AOA match that is planned for 2018. If a unified match results in 20-30% of D.O.'s being unmatched (which is entirely possible), I expect that the entire system might be in for an overhaul.

 

[Dredge]

2. It doesn't matter how entrepreneurial they are if the system doesn't allow for independent businesses. If they want to do FM or psych they could probably stay independent. If they want to do IM or anything having to do with a hospital though (which in my experiences most FMGs do because of how complex it is to navigate our healthcare system), they won't be able to do that. Besides, why would any of us want the U.S. to start hiring more FMGs in place of people trained here unless they were that much better (which some are).

Increasing residency spots doesn't result in IMGs being hired instead of US meds. At best they might get hired in addition to those US grads. FWIW I'm a Canadian med student in Ireland.

 

[gmbz]

Lets back your numbers up with some data please.

Tell that the 700 U.S. allopathic seniors, and 1000 previous U.S. allopathic graduates from last year's match. As a D.O. student, there is almost a 100 percent chance at matching somewhere, that is until the unified ACGME/AOA match that is planned for 2018. If a unified match results in 20-30% of D.O.'s being unmatched (which is entirely possible), I expect that the entire system might be in for an overhaul.

 

[Stagg737]

Increasing residency spots doesn't result in IMGs being hired instead of US meds. At best they might get hired in addition to those US grads. FWIW I'm a Canadian med student in Ireland.

I was referring to post-residency positions and the idea that FMGs/IMGs would be more 'entrepreneurial' than U.S. graduates. Not the ability of FMGs to place into residency positions.

 

[Stagg737]

Tell that the 700 U.S. allopathic seniors, and 1000 previous U.S. allopathic graduates from last year's match. As a D.O. student, there is almost a 100 percent chance at matching somewhere, that is until the unified ACGME/AOA match that is planned for 2018. If a unified match results in 20-30% of D.O.'s being unmatched (which is entirely possible), I expect that the entire system might be in for an overhaul.

Yes, except many of those people don't match because they apply to programs or fields they are not competitive for and end up scrambling in somewhere after the match. Matching =/= placing. You're also completely ignoring the politics of medicine with your assumptions. If you really think residencies that were previously AOA are going to suddenly start accepting FMGs over DOs, or even favoring U.S. MDs over DOs then you're kidding yourself. A shift like you're suggesting will take years to occur, and even then I don't FMGs will be favored over DOs in most situations. That's just my 2 cents though.

 

[Dredge]

I was referring to post-residency positions and the idea that FMGs/IMGs would be more 'entrepreneurial' than U.S. graduates. Not the ability of FMGs to place into residency positions.

Yeah I didn't understand the poster's "entrepreneurial" point either lol. But I'm not sure I understand how more IMGs doing residency would result in anymore IMGs getting fellowship in an unfair way.

 

[Stagg737]

Yeah I didn't understand the poster's "entrepreneurial" point either lol. But I'm not sure I understand how more IMGs doing residency would result in anymore IMGs getting fellowship in an unfair way.

I don't think it's unfair, just unnecessary. The physician 'shortage' isn't a shortage, but rather a poor distribution. There are plenty of cities and towns which are over-saturated with physicians, and plenty of places that have extremely limited access to care. If an IMG wants to come over and dedicate their career to working somewhere with limited access, I've got no problem with that. However, there are already plenty of residency spots to accommodate the number of U.S. graduates, so expanding GME really isn't necessary. Finding a way to get more physicians practicing in areas with physician shortages is.

I wonder about this a lot for the surgical subspecialties. When my MD students interview at your formerly-AOA residencies, and come with 5 or 10 peer reviewed publications, versus DO students with one or none, what happens?

A few things with that:

1. A large number of formerly AOA residencies are still going to require their residents to have training in OMM before beginning. From what I understand, this was part of the agreement hatched out with the LCME when the merger was forming. Supposedly if MD students want to apply for those residencies, they'll have to at least expose themselves to a certain level of OMM to be accepted into those programs. So they can bring their 5-10 pubs, it won't matter if they don't have OMM training. As to whether or not this will remain true for surgical fields or for a significant time period, idk. However, from what I've heard (from a COCA board member), DOs will not be struggling to match any more than they do now after the merger, at least not at first.

2. From what I understand, most of the DOs I've heard of that go into a surgical subspecialty already go to an ACGME residency. This is because from what I've seen/heard there are far less programs with fellowships or which feed into fellowships on the AOA side than the ACGME side. So DOs shooting for subspecialties are already matching ACGME, at least that is how alumni from my school have done it.

3. I do think that some fields will be more difficult for DOs. Ortho being a big one, as it's highly competitive and from what I've heard a pretty significant number of them match up pretty well to ACGME programs. So I could definitely see MD applicants that couldn't get into the old ACGME programs going after AOA programs. Other fields, like ophthalmology, won't be an issue. I've talked to several DO students shooting for ophtho, and almost all of them said that the AOA programs were extremely weak, and that if they didn't get into an ACGME program they'd actually likely choose another field. So in a field like that, I doubt there will be a lot of MD candidates scrambling to get into those programs. But maybe their ignorance towards how good the program actually is will lead them to apply. I don't know.

Another thing to keep in mind, AOA programs value different things on the CV than ACGME programs do. Obviously it varies from field to field, but currently I've been told most AOA programs don't particularly care about research. Once again, I don't know if that will change after the merger, but pretty much anything anyone other than COCA and LCME board members or residency directors say at this point is speculation, so we'll just have to wait and see.

 

[Anicetus]

Pumping out more doctors will eventually shove more people into the rural/needy areas and into less competitive residencies to fill more of those spots. I say keep expanding!! The desirable cities and residencies are already getting insanely competitive so doctors will get forced to allocate into those needy areas or face being jobless in a saturated city.

 

[Dredge]

I don't think it's unfair, just unnecessary. The physician 'shortage' isn't a shortage, but rather a poor distribution. There are plenty of cities and towns which are over-saturated with physicians, and plenty of places that have extremely limited access to care. If an IMG wants to come over and dedicate their career to working somewhere with limited access, I've got no problem with that. However, there are already plenty of residency spots to accommodate the number of U.S. graduates, so expanding GME really isn't necessary. Finding a way to get more physicians practicing in areas with physician shortages is.

So, you're kind of moving the goal posts here. First you mentioned about how you don't want foreign trained doctors taking fellowships that US grads could be taking, that is definitely not the same argument as saying you are concerned with a maldistribution of trained physicians in your country after doctors have completed their training in the States. In fact, if you are actually really concerned about distribution, increasing medical school spots in the first place wasn't going to solve anything, regardless of any change to residency positions. The problem is that no one want's to live in these areas, IMG and US grad alike. I'm Canadian we invented the concept of unequal distribution of trained doctors lol. However, increasing the number of residency positions with a preference to the fields that are most needed (primary care and general surgery) like those two bills have proposed will result in more trained physicians looking for work and necessarily branching out to the under-served areas to fill their roster of patients.

 

[Mjolner]

3. I do think that some fields will be more difficult for DOs. Ortho being a big one, as it's highly competitive and from what I've heard a pretty significant number of them match up pretty well to ACGME programs. So I could definitely see MD applicants that couldn't get into the old ACGME programs going after AOA programs. Other fields, like ophthalmology, won't be an issue. I've talked to several DO students shooting for ophtho, and almost all of them said that the AOA programs were extremely weak, and that if they didn't get into an ACGME program they'd actually likely choose another field. So in a field like that, I doubt there will be a lot of MD candidates scrambling to get into those programs.

If you think an MD who applied to EVERY ACGME Ortho or optho or whatever program is going to not apply to a former AOA program that's now ACGME, you're nuts. There is always a gradient in quality or training, and if at the end of the day you're an ACGME trained (insert competitive specialty here), there will be plenty of USMD grads to take that spot.

 

[Dr. Death]

Y'all are freaking me out. Somebody tell me gen surg will still be accessible to DO's

 

[FiveOClock]

What we need to do is require DOs to enter primary care, as they're mission statements indicate. This would immediately help alleviate the primary care access problem. Secondly, we should create residency positions that offer special deals where completing that residency has a concomitant minimum number of years to serve in a rural/underserved community (so your match becomes dependent on this, but you would get financial benefits during residency in return). Even better, increase the number of medical school positions that have a primary-care required rider attached to them as well as rural service requirements. Finally, close residencies that are funded by US taxpayers to IMG.

 

[username456789]

Pumping out more doctors will eventually shove more people into the rural/needy areas and into less competitive residencies to fill more of those spots. I say keep expanding!! The desirable cities and residencies are already getting insanely competitive so doctors will get forced to allocate into those needy areas or face being jobless in a saturated city.

This is an absolutely terrible idea. Unless you want to exponentially increase your debt to income ratio.

In the not so distant future, you will likely realize how silly it was that you ever posted that.

 

[PL198]

This is an absolutely terrible idea. Unless you want to exponentially increase your debt to income ratio.

In the not so distant future, you will likely realize how silly it was that you ever posted that.

god forbid ways be thought of to incentivize going to those "needy" areas

nope just pump out more, dilute down the talent pool and pay everyone a whole lot less, seems logical

 

[Stagg737]

So, you're kind of moving the goal posts here. First you mentioned about how you don't want foreign trained doctors taking fellowships that US grads could be taking, that is definitely not the same argument as saying you are concerned with a maldistribution of trained physicians in your country after doctors have completed their training in the States. In fact, if you are actually really concerned about distribution, increasing medical school spots in the first place wasn't going to solve anything, regardless of any change to residency positions. The problem is that no one want's to live in these areas, IMG and US grad alike. I'm Canadian we invented the concept of unequal distribution of trained doctors lol. However, increasing the number of residency positions with a preference to the fields that are most needed (primary care and general surgery) like those two bills have proposed will result in more trained physicians looking for work and necessarily branching out to the under-served areas to fill their roster of patients.

I never made the argument that I don't want foreign trained doctors taking fellowship positions that U.S. grads could take. Not sure where you got that...

Edit: I see where you got that impression. I should have said post-training positions I guess? I was referring to the fact that independent practices in the U.S. are becoming increasingly more difficult to maintain, and that it's basically impossible for certain fields/subspecialties. Entrepreneurship can only go so far when one is hand-cuffed by the system and has limited financial resources.

If you think an MD who applied to EVERY ACGME Ortho or optho or whatever program is going to not apply to a former AOA program that's now ACGME, you're nuts. There is always a gradient in quality or training, and if at the end of the day you're an ACGME trained (insert competitive specialty here), there will be plenty of USMD grads to take that spot.

I guess that just depends on the individual. I would rather go to a program in another field that will train me to be a strong physician than a sub-par program in my #1 field where I won't be prepared to practice on my own when I finish. That's just me though. And like I said, MD applicants won't be able to apply to many former AOA programs unless they meet the OMM requirements, which will likely drive quite a few of the people in more competitive fields away. Like I said though, it's all speculation at this point, so we'll just have to wait and see.

What we need to do is require DOs to enter primary care, as they're mission statements indicate. This would immediately help alleviate the primary care access problem. Secondly, we should create residency positions that offer special deals where completing that residency has a concomitant minimum number of years to serve in a rural/underserved community (so your match becomes dependent on this, but you would get financial benefits during residency in return). Even better, increase the number of medical school positions that have a primary-care required rider attached to them as well as rural service requirements. Finally, close residencies that are funded by US taxpayers to IMG.

LOL at the bolded. While we're at it, why don't we require all MD schools whose mission is to train rural physicians or students from a certain state to practice in those areas? Why not require schools whose mission is to train physicians that will work in underprivileged minority communities to only allow their graduates to see underprivileged minority patients? Because the idea of legally forcing all graduates to practice in a certain area just because of a mission statement is ludicrous. Other than that I actually agree with your other suggestions and I think providing greater incentives would be far more successful than forcing people to work in areas where they will be miserable.

 

[Anicetus]

This is an absolutely terrible idea. Unless you want to exponentially increase your debt to income ratio.

In the not so distant future, you will likely realize how silly it was that you ever posted that.

Since when has life ever been fair? Just like some people weren't competitive enough to get into medical school, some people just aren't competitive enough to get to work in the desirable cities/situations. More people every year in med school have aspirations to NOT work in these needy rural areas. If I'm forced to allocate to these areas due to my poor performance as a medical student, I'll take that as my punishment.

 

[username456789]

Since when has life ever been fair? Just like some people weren't competitive enough to get into medical school, some people just aren't competitive enough to get to work in the desirable cities/situations. More people every year in med school have aspirations to NOT work in these needy rural areas. If I'm forced to allocate to these areas due to my poor performance as a medical student, I'll take that as my punishment.

Oh don't worry, by that point, your crippling debt and your 5 figure salary as a physician will be more than enough punishment.

I really don't think you get it. Like, at all. Know any law school grads? You clearly have no clue how self destructive your idiotic plan is. You can thank me later for saving you from your ignorance.

 

[Lord Humongus]

Since when has life ever been fair? Just like some people weren't competitive enough to get into medical school, some people just aren't competitive enough to get to work in the desirable cities/situations. More people every year in med school have aspirations to NOT work in these needy rural areas. If I'm forced to allocate to these areas due to my poor performance as a medical student, I'll take that as my punishment.

You don't get it. Doctors are a fungible commodity. It's not like "the best" ones practice in the big cities while the "underperformers" are exiled and forced to work in BFE. The ones who choose to practice in the underserved areas do so for one of two reasons: they personally prefer working in those areas, or they want to make more money than they could in the large saturated metros. In many specialties the difference in salary between a popular coastal metro area and rural Texas/SE is as much as 300k.

So let's say we try to solve the distribution problem by the sledge hammer approach of flooding the market with thousands of foreign doctors. All of those foreign doctors will want to work in the cities, just like their American counterparts. The increased saturation will drive wages and job security in the cities even lower, forcing some physicians at the margin to leave the big city and seek (financially) greener pastures in the middle of nowhere. But this will happen only at the margins; in order to force enough doctors out of the city to make a significant dent in the shortage elsewhere you will have to keep flooding those city markets until more and more city based physicians hit their absolute pain point. But everyone remaining will be worse off. It's just like heat transfer: the water in a pot gets uniformly hotter as heat is applied, not just the fraction of the water on the bottom of the pot. And even as the water gets boiled off, the temperature does not decrease.

What will be the upshot of this? Simply that practicing medicine will be one of the worst career options a reasonably intelligent individual could take. You options as a physician under such a scenario would be to take an absolutely awful, poorly paid and insecure position in a completely flooded major city or a better paid, more secure job but in an awful, middle of nowhere crap hole. Diarrhea soup or a **** sandwich. Is this really what you want to be rewarded with after you sacrifice the entirety of your fleeting youth to become a physician?

 

[jw3600]

I see they've gotten cheaper. When I was in school, it was a whole copy of Netter's text book. I think I was the only one who refused, mainly because I already had bought a copy.

In retrospect, glad I did. They are a joke of an organization, and certainly do not represent my interests.

This is pretty much how I feel about the AOA. When people say that they are our "advocates" and have a "vested interest" in our profession, I feel like the Jews being told the Nazis "represent our interest."

 

[Dr. Death]

That escalated quickly ^

 

[Law2Doc]

Average law school class is ~500 people. Most med programs are closer to ~100.

Well the "average" law school class is actually nowhere near that big -- actually only a couple law schools are that size. But the real difference is the length of the pipeline. Law school is only 3 years and there's no residency, so you end up with 2-4 classes of new lawyers in the time it takes to school and train one new class of doctors.

 

[Redpancreas]

Better solution is to offer shortened Medical School programs. Selling myself into slavery for 4 years + residency + fellowship is just too long.

I agree and don't know why it's not done. Hard nosers on here always respond with the snide "might as well call yourself an NP then" but if we can shorten the amount of schooling needed (AND NOTE, not the actual residency or fellowship training time) but the undergrad and preclinical time, I think it should be done. Frankly, medical school curriculum can be started after high school assuming students have a solid foundation in biology, chemistry, and physics which many do. All that's needed is to maybe have a 1-2 year period after high school where students can simply take (or many can retake) their BCPMs. You can still take a couple electives in this time. There's really no need for a major of study if your plan is to apply to medical school. I'm not saying you eliminate majors for pre-mess but you should be able to apply without one so long as you've completed your BCPM and some electives like economics, philosophy, psychology, further math, etc. I think the real time wasters are upper level biology we take. They're pretty much the same thing we take during medical school anyways. Then after the 1-2 year period, students take the MCAT and apply once they've gotten their scores back. That could potentially shorten the process by 2 years.

You could even go more extreme by teaching the BCPM in 11th-12th years which is where most of us gunners realistically mastered them and start medical school right after high school. I know this can be done because I have friends who left high school early or took off right after high school to pursue their medical education abroad and have since come back with 250+ step scores. In addition, I know a couple smart doctors who pushed their kids to get into medical school early (18-19 y/o) and they're managing the curriculum well enough.

Anyways, there's always going to be the issue of maturity but frankly there's no hard evidence to support one way or the other so we are basically stuck in this status quo which inconveniently sticks because it lets universities eat more of our tuition money.

 

[Dredge]

Edit: I see where you got that impression. I should have said post-training positions I guess? I was referring to the fact that independent practices in the U.S. are becoming increasingly more difficult to maintain, and that it's basically impossible for certain fields/subspecialties. Entrepreneurship can only go so far when one is hand-cuffed by the system and has limited financial resources

Ok, I think I get you.

Oh don't worry, by that point, your crippling debt and your 5 figure salary as a physician will be more than enough punishment.

In what country have you ever heard of an attending level physician ever making less that 6 figures?

You don't get it. Doctors are a fungible commodity

You're right. Our salaries are very much dependent on supply..

The increased saturation will drive wages and job security in the cities even lower

And the lower wages will be because of increased competition. I get it we all got to eat, but it's pretty hard to make claims about other people's "selflessness" as you call it when you want to keep your salary up not by being better than the competition but rather by preventing the competition.

You options as a physician under such a scenario would be to take an absolutely awful, poorly paid and insecure position in a completely flooded major city or a better paid, more secure job but in an awful, middle of nowhere crap hole. Diarrhea soup or a **** sandwich.

Your entitlement is showing..