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TO MANY PHYSICIANS
Now that is a problem .
Now that is a problem .
MDs are MDs ...or not ????
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But is this cut-back something everyone knows is coming or what?? When will it happen?
Or is it happening year by year?
Still, I have a really hard time believing there are too many doctors. With the rising demands for treatment and the population getting older, the need for treatment must grow and grow. And I keep hearing about nurses doing physicians jobs - that must be a sign of a lack of doctors (obviously in primary care).
Renovar, everything you said in there screamed house officer, I think. It seems like hospitals can't hire docs without turning them into monsters, do you know what I mean? If they offered more sucky one-year positions and less residencies, all the problems would be solved. By god, let's hope that never happens, eh?
Is there a law that says Hospital X can't hire pre-residency doctors as house staff to do the dirty work??
IRON DUKE, I hear 'ya!!
Or is it happening year by year?
Still, I have a really hard time believing there are too many doctors. With the rising demands for treatment and the population getting older, the need for treatment must grow and grow. And I keep hearing about nurses doing physicians jobs - that must be a sign of a lack of doctors (obviously in primary care).
Renovar, everything you said in there screamed house officer, I think. It seems like hospitals can't hire docs without turning them into monsters, do you know what I mean? If they offered more sucky one-year positions and less residencies, all the problems would be solved. By god, let's hope that never happens, eh?
Is there a law that says Hospital X can't hire pre-residency doctors as house staff to do the dirty work??
IRON DUKE, I hear 'ya!!
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Ok I think we have some misunderstanding. I need to clarify the following vocabulary that I use:
Residents, in the US, means MDs who just finished medical school but are not considered full doctors, they are in the training process that helps them secure licensure as well as board certification. This process is called "residency." Now, residents can be called other names, the most common one being "house staff" or "house officer" as you mentioned.
"Residency" training in the US is typically in NMRP-certified hospitals, through a process known as a "match". Without going into much detail, the matching process pairs up medical students who entered the match with NMRP-certified hospitals in the various specialties. The match is a "contract", ie. if you matched at hospital X for specialty Y, you have to go, and the hospital has to hire you for the duration of the residency. Under the NMRP rules, these hospitals can't go "hire" residents themselves, other than those from the match. So in essence, if you get into a "residency", you are guaranteed the training to become a full doctor in that field provided that you pass all your licensure and specialty board exams. Most major academic centers in the US participate in the NMRP. Of course, there is something called "moonlighting" which I wont even get into.
Fellows, on the other hand, are those doctors who have finished residency, and are receiving some sort of specialization training. Fellows are full doctors, and have completed their licensure and are board certified.
The question regarding cutback: please read my post above in response to SkipIntro. According to COGME, the country do not need more doctors, in fact, has a surplus of physicians. However, there is a need of physicians in the primary care specialties (medicine, peds, ob/gyn, family practice, among others), while specialty medicine such as plastic surgeons and orthopedic surgeons are in surplus. As hard as it is to believe, according to COGME the number of medical school graduates in the US is suffice to meet the demands of AMerican population early this century, it just needs to be restructured so that more AMG's go into primary care and less go into specialty medicine.
Since according to COGME, the overall number of practicing physicians at present time is surplused, it will attempt to cut the residency slots in the US in an attempt to normalize the number of practicing physicians. The 140->110 cut will affect mostly FMG's who graduated from medical schools abroad but seek residency training in the US. (please read my definition of "residency" above if you are still confused.)
Yes, there is a rising "demand' in certain sectors of medicine. However, there are also shrinking resources devoted to health care in this country. IN the advent of HMO's, cost-cutting and economizing seems to be the trend because, after all, it's a business. Imagine if you are an HMO running a business. Lets say, for argument's sake, an MD's salary is $100k, an NP's salary is $50k, and a PA's salary is $50k. Would you go out and hire 10 MD's? or would you go out and hire 5 MD's, 4 NP's and 2 PA's that's going to do the same work as the 10 MD's? Silly? Insulting? Of course! But it's true. In most primary care setting, NP's and PA's can do most things MD can do, at a substantially lower cost. That's why HMO's take advantage of that fact. The reason why more and more NP's and PA's are working in primary care is because HMOs want to make a profit, not because there is a shortage of physicians.
As far as the cuts are concerned: from my understanding, the proposal to cut from 140% AMGs to 110% AMG's is set on 1996, and is gradual, meaning every year it will cut some slots until the target 110 is reached.
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Renovar,
I'm not totally unfamiliar with the match and that whole application process. Honestly, I really like the concept. And I guess I know what you mean about MD's not being considered full docs until after residency.
But........ It would be a different ball game if a hospital could hire a "pre-doc" for , say, only 3 months to do whatever they felt he should do - no teaching, no road to licensure. That's basically the situation here. So surprisingly for socialist Scandinavia it's turning into a free market. From what I've heard doctors negotiate their hours and pay over the phone before accepting. Some rural regions (like Northern Sweden) will pay a handsome salary.
However, I don't think a fresh-out-of-med school MD is in the position to ask for more than a nurse, do you?
Maybe that scenario sounds a bit out-landish to you. You're probably thinking, why would docs ever agree to those positions if they could land residencies, right? Well, if they cut back residencies that much, you'd have a lot of unemployed docs ("pre-docs" if you will) willing to take these jobs.
Anyway, the way I read your post, there won't be a dramatic 40% cut one year. It's a long-term policy. That's good news, I guess.
Later.
I'm not totally unfamiliar with the match and that whole application process. Honestly, I really like the concept. And I guess I know what you mean about MD's not being considered full docs until after residency.
But........ It would be a different ball game if a hospital could hire a "pre-doc" for , say, only 3 months to do whatever they felt he should do - no teaching, no road to licensure. That's basically the situation here. So surprisingly for socialist Scandinavia it's turning into a free market. From what I've heard doctors negotiate their hours and pay over the phone before accepting. Some rural regions (like Northern Sweden) will pay a handsome salary.
However, I don't think a fresh-out-of-med school MD is in the position to ask for more than a nurse, do you?
Maybe that scenario sounds a bit out-landish to you. You're probably thinking, why would docs ever agree to those positions if they could land residencies, right? Well, if they cut back residencies that much, you'd have a lot of unemployed docs ("pre-docs" if you will) willing to take these jobs.
Anyway, the way I read your post, there won't be a dramatic 40% cut one year. It's a long-term policy. That's good news, I guess.
Later.
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Well, in some sense, I think an MD who just get out of med school should ask for a lot of money - true. But for the amount of hours these residents do for their meager amount of money they get is ridiculous. Consider a fresh out of law-school lawyer or a fresh out of business-school grad, how much their initial salary are and how much they work (ie. pay per hour). The pay per hour ratio for some hospitals is below minimum wage in some hospitals. Is this fair for these residents who has undergone so much training and has given up so much?
I think the residency cuts in this country is steep to be sure, but not steep enough to affect any AMG's. (ie. still virtually any AMG's make it out of an American medical school will get a residency) so I can't see the "pre-doc" thing happening. DUde it gotta suck in Scandinavia...
And I must mention, these residency cuts are NMRP-sponsored residency only. Now that does include virutally all academic hospitals and most prominent metropolitan hospitals. This, however, does not include some hospitals in rural or suburban sites that are not registered by the NMRP. Many FMGs who can not match through the NMRP match will generally end up going to one of those places. Resident contracts with these hospitals are not set in stone by the NMRP and thus can be negotiated by either party. These hospitals need their supply of residents to make their bottomline meet, while the unmatched medical graduates would be happy just to be at a residency so they will be on their way to becoming a doc. So a desperate alliance, of some sort.
Anyways, I still think that there are enough openings out there so that outstanding FMG's can still do it the normal way.
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Not entirely true. Hospitals can offer contracts straight off to IMGs, called "pre-match" or "out-of-match" contracts, which the candidate signs and subsequently pulls out of the match. A large proportion of IMGs get their residencies through this process. Now the NRMP as of 2004 will not allow hospitals that go through the match to fill positions out of the match, but that will just lead to hospitals filling 100% out of the match (which many of them already do).
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Renovar,
Thanks, again, for your responses. It's clear you've put a lot more thought into what you say than do many posters on this forum, and I, at the very least, appreciate that, although I'm sure others do as well.
I guess it all depends on how much creedence you put, ulitmately, into the COGME reports. While I think they do an excellent job at summarizing the overall problem, they were fully unable to foresee the subsequent public backlash and frustration with the HMO based system. Likewise, the facts are that, although these suggestions where made 6-7 years ago, the actual number of residency spots has increased in lieu of decreased, as was recommended by the report. (I posted data on this already.)
Now, onto to my opinions (please note that) about whether or not there are too many doctors in the U.S. First off, I'll offer you an anecdote. When I was living in Atlanta, I had to wait three months before I could see an endocrinologist for a potential thyroid problem I was having. Even going to see a generalist would often result in long hours in the waiting room reading year-old magazines, because my internist would overbook patients - the only way he could make money due to the cost-containment measures of collective bargaining with insurance companies.
(Okay, back to the facts...)
Secondly, cities like El Paso, Texas are desperate for their own medical school.
http://www.borderlandnews.com/stories/borderland/20020418-190667.shtml
Recently, Florida State University chartered a medical school - the first new medical school in the U.S. since 1978. Clearly there is a need in certain areas of the country where there are already real doctor shortages, and in which new doctors don't necessarily want to practice.
What is the COGME forecast for the physician/population ratio based on? Do people really want to see an CRNP or PA in lieu of a doctor? What does the public really feel about this?
Further, I would not argue your points about cheap source of labor... but, why do you need to hire doctors then? Isn't it because of their knowledge-base and training is critical in filling the void in large hospitals? Or, is it simply because they are willing to do the scutwork to get the training and ultimately licensure? Is the system truly broken or is it simply being taken advantage of? And, what about the 531% increase in non-U.S. citizens coming for the purpose training, many of whom never return to their native countries? (Data in the COGME 11th report)
And, what about D.O. schools?
http://archfami.ama-assn.org/issues/v8n6/ffull/fsa8021.html
Also, I hear you about the push to get people into primary care, but I just don't think that reality backs that up. Too many doctors are still going into specialties, as opposed to taking the primary track - even IMGs and now even D.O.s! (see above link)
Do you REALLY think that simply limiting the number of residencies is going to solve all of these problems?
(Now, the hard question...)
If so, how? Won't this simply add to the now forecasted shortage of doctors, especially in the currently underserved areas?
P.S. I actually have a slew of tests coming up over the next three weeks. I will be back during break, but I can't promise too much more contribution in that time. Priorities, priorities! Maybe we can start a new thread on this subject since we've drifted from the original debate?
Thanks, again, for your responses. It's clear you've put a lot more thought into what you say than do many posters on this forum, and I, at the very least, appreciate that, although I'm sure others do as well.
I guess it all depends on how much creedence you put, ulitmately, into the COGME reports. While I think they do an excellent job at summarizing the overall problem, they were fully unable to foresee the subsequent public backlash and frustration with the HMO based system. Likewise, the facts are that, although these suggestions where made 6-7 years ago, the actual number of residency spots has increased in lieu of decreased, as was recommended by the report. (I posted data on this already.)
Now, onto to my opinions (please note that) about whether or not there are too many doctors in the U.S. First off, I'll offer you an anecdote. When I was living in Atlanta, I had to wait three months before I could see an endocrinologist for a potential thyroid problem I was having. Even going to see a generalist would often result in long hours in the waiting room reading year-old magazines, because my internist would overbook patients - the only way he could make money due to the cost-containment measures of collective bargaining with insurance companies.
(Okay, back to the facts...)
Secondly, cities like El Paso, Texas are desperate for their own medical school.
http://www.borderlandnews.com/stories/borderland/20020418-190667.shtml
Recently, Florida State University chartered a medical school - the first new medical school in the U.S. since 1978. Clearly there is a need in certain areas of the country where there are already real doctor shortages, and in which new doctors don't necessarily want to practice.
What is the COGME forecast for the physician/population ratio based on? Do people really want to see an CRNP or PA in lieu of a doctor? What does the public really feel about this?
Further, I would not argue your points about cheap source of labor... but, why do you need to hire doctors then? Isn't it because of their knowledge-base and training is critical in filling the void in large hospitals? Or, is it simply because they are willing to do the scutwork to get the training and ultimately licensure? Is the system truly broken or is it simply being taken advantage of? And, what about the 531% increase in non-U.S. citizens coming for the purpose training, many of whom never return to their native countries? (Data in the COGME 11th report)
And, what about D.O. schools?
http://archfami.ama-assn.org/issues/v8n6/ffull/fsa8021.html
Also, I hear you about the push to get people into primary care, but I just don't think that reality backs that up. Too many doctors are still going into specialties, as opposed to taking the primary track - even IMGs and now even D.O.s! (see above link)
Do you REALLY think that simply limiting the number of residencies is going to solve all of these problems?
(Now, the hard question...)
If so, how? Won't this simply add to the now forecasted shortage of doctors, especially in the currently underserved areas?
P.S. I actually have a slew of tests coming up over the next three weeks. I will be back during break, but I can't promise too much more contribution in that time. Priorities, priorities! Maybe we can start a new thread on this subject since we've drifted from the original debate?
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Hi!
Can't say that I have read all the replies that go back and forth, but I guess that I've got the idea. No matter what you say it is a comparison between the AMGs vs. IMGs.
Well, in my humble opinion- there isn't that big difference.
First of all, you just can't put all the IMGs in one category. There is the developed, the less developed and the undeveloped world. Each has its different schools, systems and style. So, it isn't the same everywhere (as it is not the same everywhere in the U.S)
Are the AMGs better?? I don't think so; but they might have been luckier to have had relatively better systems. But these are all small things- medicine is solely about learning the basics right and knowing when and how to apply them. AMGs might have been exposed to modern methods that make their learning easier, the good IMGs will get there; know the information- maybe the harder way, but they will...
Are the IMGs better?? You can't say these or those are better- as long as you fit in the criteria of a medical student (Hardworking, able to manage stress, certain level of intelligence) you can do fine whether you graduate from the U.S or the never, never land..
Besides, we are living in the globalization era- where all the decent systems are a like. I am an International student in a PBL system which is as far as I know is a North American system-will this make me an AMG or IMG?? So, there is no real line drawn.... It's all about you, not where you've graduated from
Can't say that I have read all the replies that go back and forth, but I guess that I've got the idea. No matter what you say it is a comparison between the AMGs vs. IMGs.
Well, in my humble opinion- there isn't that big difference.
First of all, you just can't put all the IMGs in one category. There is the developed, the less developed and the undeveloped world. Each has its different schools, systems and style. So, it isn't the same everywhere (as it is not the same everywhere in the U.S)
Are the AMGs better?? I don't think so; but they might have been luckier to have had relatively better systems. But these are all small things- medicine is solely about learning the basics right and knowing when and how to apply them. AMGs might have been exposed to modern methods that make their learning easier, the good IMGs will get there; know the information- maybe the harder way, but they will...
Are the IMGs better?? You can't say these or those are better- as long as you fit in the criteria of a medical student (Hardworking, able to manage stress, certain level of intelligence) you can do fine whether you graduate from the U.S or the never, never land..
Besides, we are living in the globalization era- where all the decent systems are a like. I am an International student in a PBL system which is as far as I know is a North American system-will this make me an AMG or IMG?? So, there is no real line drawn.... It's all about you, not where you've graduated from
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