I should preface this with: I'm just commenting cause I like your opinions now and had a discrepancy on a few minor things. Don't read this as argumentative cause 1) I'm tired from our last thread and 2) I agree 99% with you on this.
within 5 years, there will be more DOs and American MD grads than residency spots. ACGME IM has damn near filled before the scramble the last several years. it's only going to get worse.
The "goal" for expansion among allopathics is 30% within the 10 year period of 2009-2018. Thats an increase of 15,300 to ~20,000 (the actual AAMC projection is 19,123 so clearly I'mrounding up somewhere). Obviously DOs are repopulating like rabbits, but they're at ~4,000 now. We're not going to reach the 6,000 we're predicted to be at 7 years from now in 2018. But thats my personal feeling on that last part, the projection is 6,000. At that point the ACGME residencies spots are predicted to be at 24,500. (since the funding of residencies tied to medicare patient rate in 1997 they have still increased at an average rate of just over 200 spots per year and this has held just as true nowadays. And thats not taking the before and after and dividing it. Thats a trend seen year-to-year in the NRMP). Adding them all together we do have a 1-2 thousand person overflow. But then again the AOA is scheduled to have 3 thousand spots by then. Their money comes from the same source though I'm not 100% sure how that source works. Its fuzzy, and I'll get to that below.
at the rate they're making new schools, they'll have to have a 50-100% increase in spots in the next decade,
Well thats a bit of hyperbole there. We're not doubling our size any time soon, and thats exactly what a 100% increase is. We're increasing <50% if projections are right. Obviously they should scale back on schools, no doubt. And they should scale up on residency spot creations, do doubt. But you know that your suggestion is a bit sensationalist for the sake of being eye catching rather than pragmatic.
shenanigans. There has not been an increase in approved FUNDED spots since 1997. they're may be an increase in spots, but I do not believe that the funding is coming from the government.
$230 million dollars (which is very little) per year additional funding for the next few years was passed only a year or two ago. And a lot of reallocation. Oh lots of that. Yes, its mostly reallocation and cut backs on how much each residency pays to the hospital itself so that new ones can be funded. You can't add 2,000 new residencies to the NRMP alone in the last 10 years without having some funding. You're right that no true reform of the system has happened since 1997, but the system in 1997 wasnt a locked system in absolute funding. It does eventually lock the numbers per hospital, but it only locks relative funding since there are ways to expand residency numbers nationally which expands absolute funding every year. And because of that its just nowhere near the money we need; and has required a lot of it is funny accounting and money shifting, while very little of it is actual new funds.
Yes, because people want to spend $250k+ to be forced into an AOA FP/IM/Pysch residency.
hahaha. I never said they were good (but hey, dont hate on AOA IM! That might actually be good). I simply said they were there. People were doubting they exist.
doubtful, you know that compared to medical school tuition, residencies don't line people pockets enough to make it worth it.
Yes, the amount of money each resident brings in is a deeply and closely protected secret that varies with each hospital and their individual algorithms the gov't gave then. It's also been repeatedly leaked by hospital administration and estimated once by the AAMC that each resident brings in 45,000-90,000 per year per resident for the hospital. beyond what they're getting paid. That works out pretty well if you have 300 or 500 residents in a major hospital. Hell it works out well if you have 40 in a small site. Money is money. That much more than med school money. It may be a drop of water in a sea of debt to these hospitals, but its still good money. I get the feeling that its not *enough* for hospitals though, while the smaller amount med schools collect goes to getting scrooge mcduck-like swimming pools of gold dubloons
2015 is going to be a fun year, I'm glad I finished up before this crap started.
Totally agree with you now even though I'm still in the system, I'm out right when it starts getting bad at least.
no, you're missing the big picture.
I live by stats and public press releases. It means I often miss the picture. You have to hold my hand through stuff sometimes. I'm sorry.
There are roughly 23000 spots each year for residents, there ~3300 DO grads a year (about to be over 4000 with all these schools) right now there are 16,500 MD grads a year, by 2015 there will be ~1800, by 2017 they want 22000. so withing 5-7 years there will be 26000 graduating from american medical schools with only 23000 residency spots? I'm glad I won't have to go through match to deal with the cluster-**** that's going to be. They already have 35,000 applicants each year for the match when you factor in the 2000 american grads who are re-entering the match, IMG, FMGs, 5-th pathway and canadians.
Yea. Some of the numbers are off by a bit, but I addressed it above. The projections turn ugly in 2018. Though the projections of students are lower than what you said, the projections of residency spots are higher, and you left out the AOA match entirely (its not like 100% of DOs go to the ACGME). But your point remains, ultimately, true. The projections do exceed the residency spots by 2018. Just not by the amount to estimated out.
1) built in fellowships is not standard for IM, 2) after seeing many different residencies out there, we also need to be increasing the quality of the residencies spots, not just the quantitity, 3) I'll be honest that in my opinion, when I was looking at pulm-cc fellowships, half of the hospitals had no buisness having a fellowship due to lack of volume, frequently shipping out their sicker pts to university centers, etc, etc.
It is done sometimes though. And the AOA has a few of them that are built in with the internal med included. So does the ACGME, which has a few (heme/onc comes to mind because I have looked into these programs a lot for my own interest). Not common, but they happen. But as my edited comment says. Big foot in my mouth. I only checked one and then made an assumption. And the ones listed as new do have considerable amounts of later-PGY fellowships. So i got my facts all wrong there in the residencies (fellowships) I was referring to originally. Points two and three are completely correct and I'm glad you said them. Residencies and fellowships shouldnt exist where there isnt sufficient training. IDK if there is a bigger issue (not enough places where the demand would be sufficient) but I assume its mostly laziness and creating programs where they dont have business belonging. Thats sad.
