Petition to Address Residency Shortages

[Mass Effect]

the government already can't afford to spend on healthcare even with tthis doctor 'shortage'. what do you think will happen when they add even more doctors? salaries will tank, autonomy will tank even more b/c they can always find someone to replace you.

We are a very, very long way from that scenario, especially considering that many doctors can open their own office and charge cash for their services.

from my experience, there is no shortage in big cities esp on the 2 coasts

No shortage of what exactly and by big cities are you referring only to LA and NY? The only over-saturation I'm aware of is pathology and radiology. I don't believe there's over-saturation of PCPs, OBGYNs, neurologists, derms, psychiatrists, or most sub-specialists

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[BDUS]

the government already can't afford to spend on healthcare

Can they relocate funds. Less on other areas such as military

 

[Psai]

Assuming a mean of 228 and a SD of 21, a 262 is the 97th percentile. The 99th is a 265.

Both scores are fantastic.

i thought that it wasn't normally distributed

 

[anbuitachi]

Can they relocate funds. Less on other areas such as military

they can but they wont. i doubt US will decrease military funding when other countries like china are drastically increasing funding for military

 

[anbuitachi]

We are a very, very long way from that scenario, especially considering that many doctors can open their own office and charge cash for their services.



No shortage of what exactly and by big cities are you referring only to LA and NY? The only over-saturation I'm aware of is pathology and radiology. I don't believe there's over-saturation of PCPs, OBGYNs, neurologists, derms, psychiatrists, or most sub-specialists

It doesn't apply for some specialties, but can't deny that it is hard to find jobs there. I think if there were a shortage, there'd be no probs finding jobs in those locations.

 

[Mass Effect]

It doesn't apply for some specialties, but can't deny that it is hard to find jobs there. I think if there were a shortage, there'd be no probs finding jobs in those locations.

The vast majority of doctors have no problem finding jobs in big cities. Not sure what you're talking about.

 

[IlDestriero]

The vast majority of doctors have no problem finding jobs in big cities. Not sure what you're talking about.

I don't think that is true at all.
Desirable jobs in desirable cities are quite competitive.

 

[Mass Effect]

I don't think that is true at all.
Desirable jobs in desirable cities are quite competitive.

In my inbox right now, I have 3 emails sent within the last 10 days about jobs in my field in metro cities and I'm a resident. And according to those I know who are about graduate residency, they've told me the same. Spanning three different specialties, they're going to Boston, NYC, and Chicago.

 

[IlDestriero]

Well I can tell you the anesthesia market, for good jobs, is not wide open in desirable locations, though you can probably get a job. I've see fellows married to other specialists who had to move to other cities because their spouse couldn't get a job in my popular city when their training was completed. Every field will be different, but the best jobs will be competitive in whatever field you want.
We had a couple dozen applicants for a couple jobs that weren't even advertised anywhere. Perhaps they found other jobs in the area, but not as faculty in a premier specialty hospital.

 

[NotAProgDirector]

i thought that it wasn't normally distributed

Not sure why it wouldn't be.

http://www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf

 

[the argus]

I don't think that is true at all.
Desirable jobs in desirable cities are quite competitive.

Well I can tell you the anesthesia market, for good jobs, is not wide open in desirable locations, though you can probably get a job. I've see fellows married to other specialists who had to move to other cities because their spouse couldn't get a job in my popular city when their training was completed. Every field will be different, but the best jobs will be competitive in whatever field you want.
We had a couple dozen applicants for a couple jobs that weren't even advertised anywhere. Perhaps they found other jobs in the area, but not as faculty in a premier specialty hospital.

Of course desirable jobs in desirable cities are competitive, but that has nothing to do with overall job prospects. Not everyone will get a faculty position at a premier institution. This has always been the case, and is true across all professions. Janitorial positions are competitive at desirable places in desirable locations, does that mean janitorial job prospects are poor?

I don't know what job prospects are like outside my specialty, and I'm just about to start residency so I have no personal experience in this. But nothing you have said means that overall job prospects are poor.

Yes the best jobs are competitive, this is nothing new.

 

[IlDestriero]

I didn't say that job prospects were poor, I said that I disagreed that the vast majority of doctors have no problem finding decent jobs in desirable cities, especially if they are a specialist or subspecialist. Sub specializing has rewards and drawbacks, there are fewer of you out there, but you can't just drop anchor anywhere.

 

[deleted158872]

I've see fellows married to other specialists who had to move to other cities because their spouse couldn't get a job in my popular city when their training was completed.
We had a couple dozen applicants for a couple jobs that weren't even advertised anywhere.

Tell me which specialties are THIS competitive?

 

[IlDestriero]

EP, IR, general cards (had offers for 1/2 what he took in amother less desirable city), anesthesia-pain, ENT-laryngology, peds anesthesia at a children's hospital. There are just the ones I've seen in our fellows and faculty in the last few years.
Everyone gets jobs, even in anesthesia where the market is changing, assuming you have no red flags and a clean malpractice history, but the key, and sometimes the challenge, is to find a good job, and one that meets your professional goals. Specialists can't just go work anywhere or hang a single and start cashing checks. The market has to be there, and may be already saturated.
As the saying goes you can have money, lifestyle or location. Pick two.

 

[Mass Effect]

I didn't say that job prospects were poor, I said that I disagreed that the vast majority of doctors have no problem finding decent jobs in desirable cities, especially if they are a specialist or subspecialist. Sub specializing has rewards and drawbacks, there are fewer of you out there, but you can't just drop anchor anywhere.

But you just said "well I can tell you the anesthesia market, for good jobs, is not wide open in desirable locations, though you can probably get a job," which is all I'm saying. I know nothing about anesthesia, but based on the emails I get about jobs in my field and based on the senior residents in my field and others and the job prospects they have, I'm just saying that getting a job as a physician, even in desirable locations, is possible. It may not be at a premiere academic institution, but that wasn't the discussion. As for subspecialists, I was talking about things like rheum and endocrine, which seem to be in demand all over the country, based on job postings.

 

[IlDestriero]

In anesthesia the difference between a good job and "a job" can exceed 200k.
If you want to work for a management company as a cog in the wheel lining the pockets of your venture capitalist and hedge fund owners you can do that for 3 or 350, but the guys that owned the group that sold out to the management company for 7 figures each last year were making over 500 for the same work.
I guess that's a job though.
There are lots of job postings in anesthesia for desirable cities like LA or NY, etc. But there's a reason they are posted at all, and never seem to fill. Word of mouth and networking tend to be how most good jobs are identified and filled.
As an aside, some places are required to post positions, but they are often already filled.
Every field will be different and things tend to be cyclical as well. If the world is your oyster, great. It was like that in anesthesia 10 years ago for an above average applicant. How many radiologists are doing more than one fellowship now? How many even considered that 5 years ago.
PS management companies are a cancer that's speaking in medicine today. Maybe the mba in medical management is the future cash cow.

 

[IlDestriero]

What's better than derm hours and pay? Zero clinical work managing an army of physician employees or "junior partners" for 30% of gross.

 

[W19]

In anesthesia the difference between a good job and "a job" can exceed 200k.
If you want to work for a management company as a cog in the wheel lining the pockets of your venture capitalist and hedge fund owners you can do that for 3 or 350, but the guys that owned the group that sold out to the management company for 7 figures each last year were making over 500 for the same work.
I guess that's a job though.
There are lots of job postings in anesthesia for desirable cities like LA or NY, etc. But there's a reason they are posted at all, and never seem to fill. Word of mouth and networking tend to be how most good jobs are identified and filled.
As an aside, some places are required to post positions, but they are often already filled.
Every field will be different and things tend to be cyclical as well. If the world is your oyster, great. It was like that in anesthesia 10 years ago for an above average applicant. How many radiologists are doing more than one fellowship now? How many even considered that 5 years ago.
PS management companies are a cancer that's speaking in medicine today. Maybe the mba in medical management is the future cash cow.

Are you saying this is not a good salary by anesthesia standard?

 

[IlDestriero]

Are you saying this is not a good salary by anesthesia standard?

Not if you're running from 7-5 covering 4 CRNAs, placing blocks in lightening speed on the holding area, while dealing with PACU stuff, emergencies, signouts, etc. and taking a call a week or so without a guaranteed post call day off.
I make more working much less.
Good job vs bad job.
Many faculty have significant benefits as well that are very valuable. PP groups have other benefits of being self employed with deductions, retirement plans, etc that can be very valuable. The cogs at the management companies get the minimum benefits that they can offer and still put asses in the seats. They're not offering Cadillac benefit packages, retirement annuities, tuition programs for your kids, etc.
Every offer needs to be completely evaluated.
I think we're drifting pretty far off course now.

 

[DermatoFIGHT]

What's better than derm hours and pay? Zero clinical work managing an army of physician employees or "junior partners" for 30% of gross.

What are derm hours and pay though? Seems to vary heavily from place to place. The pace in derm isn't much of a lifestyle, it is quite exhausting seeing 60-100 patients each day and documentation isn't simple documentation as everyone fantasizes it is. Hours I see in derm are 8-6. Same hours in any clinic specialty though.

 

[PL198]

What are derm hours and pay though? Seems to vary heavily from place to place. The pace in derm isn't much of a lifestyle, it is quite exhausting seeing 60-100 patients each day and documentation isn't simple documentation as everyone fantasizes it is. Hours I see in derm are 8-6. Same hours in any clinic specialty though.

let's not play games. there's a reason it's a top 2-3 competitive specialty.

 

[DermatoFIGHT]

let's not play games. there's a reason it's a top 2-3 competitive specialty.

Obviously anything with money is going to be competitive.

Specialty interests (clearly by PURE COINCIDENCE ) varies when those reimbursement cuts happen or new technology makes them a big winner. GI? Cards? Interventional Pain? IR? Rads? Anesthesia? ER?

 

[anbuitachi]

In my inbox right now, I have 3 emails sent within the last 10 days about jobs in my field in metro cities and I'm a resident. And according to those I know who are about graduate residency, they've told me the same. Spanning three different specialties, they're going to Boston, NYC, and Chicago.

Im confused. what does your post has to do with it being competitive or not. Were they job offers, or were they just emails telling you there is an opening? If the same 3 emails are sent to every resident in the country... or even state/city, it really doesn't seem that much. I'm not saying there are no jobs, cause of course there will be jobs when ppl retire. But its very competitive

 

[deleted158872]

there are plenty of spots

can we say that 4 years from now?

https://www.aamc.org/newsroom/newsreleases/335244/050213.html
According to results of the survey, released during the Center’s 9th Annual Physician Workforce Research Conference, first-year medical school enrollment is projected to reach 21,434 in 2017-18. This number represents a 30 percent increase above first-year enrollment in 2002-03, the baseline year used to calculate the enrollment increases that the AAMC called for in 2006.

https://www.aamc.org/newsroom/newsreleases/374000/03212014.html
According to the most recent AAMC Survey of Medical School Enrollment Plans, U.S. medical school (M.D.) enrollment will increase to 21,349 students by 2018. Combined with the larger n"umber of graduates from osteopathic schools (D.O.), which also are expanding to address the shortage, as well as increasing numbers of international graduates entering the Match, there may be too few residency positions for all the newly graduated doctors in the not-too-distant future.

 

[PL198]

can we say that 4 years from now?

https://www.aamc.org/newsroom/newsreleases/335244/050213.html
According to results of the survey, released during the Center’s 9th Annual Physician Workforce Research Conference, first-year medical school enrollment is projected to reach 21,434 in 2017-18. This number represents a 30 percent increase above first-year enrollment in 2002-03, the baseline year used to calculate the enrollment increases that the AAMC called for in 2006.

https://www.aamc.org/newsroom/newsreleases/374000/03212014.html
According to the most recent AAMC Survey of Medical School Enrollment Plans, U.S. medical school (M.D.) enrollment will increase to 21,349 students by 2018. Combined with the larger n"umber of graduates from osteopathic schools (D.O.), which also are expanding to address the shortage, as well as increasing numbers of international graduates entering the Match, there may be too few residency positions for all the newly graduated doctors in the not-too-distant future.

there isn't a shortage now and there won't be a shortage then.

 

[Slack3r]

What's better than derm hours and pay? Zero clinical work managing an army of physician employees or "junior partners" for 30% of gross.

Personally, I think the "grass is greener" in derm is pretty overblown. Most places I've been, the attendings are still working 7-730am to 4 or 5pm. Yes, it's not surgery hours, but it's pretty comparable to every other outpatient specialty (and even lots of inpatient specialties).

And as for compensation, most of the recruiting offers I've seen have been around $300k, and these are bait-and-switch private equity offers for positions in the literal middle of nowhere. Expect less in any major city, and even less if you're doing academics. And good luck finding a full-time dermpath or Mohs position anywhere, least of all in a city.

 

[68PGunner]

You don't want to increase the residency slots unless you want physician salaries to be five figures in the future. However, it's a crime that 5-8% of US medical graduates go unmatched while FMGs are filling up training slots. Any program that elects to make such decision should have its federal funding rescinded forever. We don't have a physician shortage nor do we have a residency shortage. Our current issue is about proper appropriation of resources and execution -- simple things that could be fixed with the right authorities in power.

 

[Mad Jack]

Agreed. More than 10,000 PGY1 spots were not filled by US Seniors in the 2015 match. Despite all the AMA/AAMC fearmongering about lack of residency spots, too many new allopathic schools opening etc... there are plenty of spots for US allopathic grads. It is true that non-US allo's will probably feel more of a squeeze as the new batch of med schools starts graduating.

Well, given the merger, osteopathic student interests are kind of a factor now too. So you've got to look at total ACGME+AOA+milmatch+SF match-(allo+osteo)=net excess positions to determine how close we are to having too few residencies in the combined system, which is to say, not nearly as many as we could have.

 

[Wordead]

You don't want to increase the residency slots unless you want physician salaries to be five figures in the future. However, it's a crime that 5-8% of US medical graduates go unmatched while FMGs are filling up training slots. Any program that elects to make such decision should have its federal funding rescinded forever. We don't have a physician shortage nor do we have a residency shortage. Our current issue is about proper appropriation of resources and execution -- simple things that could be fixed with the right authorities in power.

With your scenario then we need to force more US grads to apply to those residencies that mostly IMGs are applying for now. Sound good to you? We can just set it up so that anyone who doesnt match gets distributed to rural family med residencies. Problem solved.

 

[68PGunner]

With your scenario then we need to force more US grads to apply to those residencies that mostly IMGs are applying for now. Sound good to you? We can just set it up so that anyone who doesnt match gets distributed to rural family med residencies. Problem solved.

The solution is very simple. National match should only be limited to US grads. SOAP should only be open to US unmatched grads. Leftovers are then open game.

 

[68PGunner]

With your scenario then we need to force more US grads to apply to those residencies that mostly IMGs are applying for now. Sound good to you? We can just set it up so that anyone who doesnt match gets distributed to rural family med residencies. Problem solved.

If a US grad is ignorant enough to opt for unemployment rather than a rural med residency, he/she probably deserves to be miserable.

 

[laricb]

The solution is very simple. National match should only be limited to US grads. SOAP should only be open to US unmatched grads. Leftovers are then open game.

Then we wouldn't have great doctors in the US

 

[68PGunner]

The solution is very simple. National match should only be limited to US grads. SOAP should only be open to US unmatched grads. Leftovers are then game.

Then we wouldn't have great doctors in the US

I'm curious to your rationale for such outlandish statement.

 

[laricb]

I'm curious to your rationale for such outlandish statement.

I'm curious to your rationale for such outlandish statement.

When you get you're feet wet then come talk to me about who should or shouldn't be aloud in the match.

 

[68PGunner]

When you get you're feet wet then come talk to me about who should or shouldn't be aloud in the match.

FAIL.

It's a privilege to be a part of this country and to practice medicine here. When you and your ancestors haven't done anything to contribute to this country, you should be thankful of leftovers.

 

[laricb]

FAIL.

Great response

 

[68PGunner]

Great response

Learn proper English.

 

[W19]

If a US grad is ignorant enough to opt for unemployment rather than a rural med residency, he/she probably deserves to be miserable.

You can't force people to do something they don't want to do... Many of these 5% that don't match were not realistic about their chances... They are (were) applying to specialties that they had no business in applying to...

 

[laricb]

FAIL.

It's a privilege to be a part of this country and to practice medicine here. When you and your ancestors haven't done anything to contribute to this country, you should be thankful of leftovers.

*****, I am an American Citizen, Was that better

 

[deleted158872]

You don't want to increase the residency slots unless you want physician salaries to be five figures in the future. However, it's a crime that 5-8% of US medical graduates go unmatched while FMGs are filling up training slots. Any program that elects to make such decision should have its federal funding rescinded forever. We don't have a physician shortage nor do we have a residency shortage. Our current issue is about proper appropriation of resources and execution -- simple things that could be fixed with the right authorities in power.

given the US curriculum teaching towards the USMLE and the enormous priority that US students are given over IMG/FMG, unmatched students only have themselves to blame. even if national spots are open only for AMGs, these 5-8% still won't match.

also, you should know that it's actually already exponentially harder for IMG/FMG to match than for US grads, for example: for AMG, there's not even a cut-off Step score to match IM, but some programs out there require a minimum of 250 for IMG to even be considered!

 

[68PGunner]

You can't force people to do something they don't want to do... Many of these 5% that don't match were not realistic about their chances... They are (were) applying to specialties that they had no business in applying to...

Consequently, my rationale for limiting SOAP initially to US unmatched grads.

 

[W19]

Consequently, my rationale for limiting SOAP initially to US unmatched grads.

I agree with you that US students should come first, not sure your suggestion is the way to go about it...

 

[68PGunner]

given the US curriculum teaching towards the USMLE and the enormous priority that US students are given over IMG/FMG, unmatched students only have themselves to blame. even if national spots are open only for AMGs, these 5-8% still won't match.

also, you should know that it's actually exponentially harder for IMG/FMG to match than for US grads, for example: for AMG, there's not even a cut-off Step score to match IM, but some programs out there require a minimum of 250 for IMG to even be considered!

Doesn't matter. Priority should be given to US grads on all levels especially when US federal money is used to fund these programs.

 

[Wordead]

The solution is very simple. National match should only be limited to US grads. SOAP should only be open to US unmatched grads. Leftovers are then open game.

Doesn't matter. Priority should be given to US grads on all levels especially when US federal money is used to fund these programs.

What is your goal? To make it easier for YOU to match.

What is the goal of policy? To produce the best physicians to care for our citizens.

There might be a disconnect between the two.

 

[68PGunner]

What is your goal? To make it easier for YOU to match.

What is the goal of policy? To produce the best physicians to care for our citizens.

There might be a disconnect between the two.

Nope, my goal is to prioritize US grads especially when US federal money is used to fund these residencies. US grads should deserve at least a second chance for initially making the wrong decision.

Finally, I am curious to why people think that US med schools are incapable of producing good physicians relative to their foreign counterparts.

 

[Wordead]

Nope, my goal is to prioritize US grads especially when US federal money is used to fund these residencies. US grads should deserve at least a second chance for making the wrong decisions initially.

Finally, I am curious to why people think that US med schools are incapable of producing good physicians relative to their foreign counterparts.

Read my previous post

 

[deleted158872]

Nope, my goal is to prioritize US grads especially when US federal money is used to fund these residencies. US grads should deserve at least a second chance for initially making the wrong decision.

it sounds like you want 100% of US grads to become physicians the moment they step foot into med school, even if they do horribly in med school.
also, if the future were guaranteed to that extent, some students would just party through med school knowing they'd be doctors either way.
do you stop to think about their competence as future doctors and patients' safety?
as a patient, i always want to be treated by the best doctors regardless of their nationalities

i am one who values talents rather than meaningless birth place.

US students already come first, and that is predicted to remain the case for years to come.

Finally, I am curious to why people think that US med schools are incapable of producing good physicians relative to their foreign counterparts.

interesting how you even drew this premise from nowhere.
objectively speaking, there are many world-class med schools in first-world English speaking countries that are simply better than SOME U.S. ones.

 

[68PGunner]

Read my previous post

I read your post. Your main argument is about producing the best physician available for American citizens. It still doesn't answer my question as to why do you think unmatched US grads are possibly inferior to foreign med grads. Like Maruko had alluded to earlier about a possible reason for unmatched US grads, I personally think that unmatched US grads who didn't initially match because of outlandish expectations deserve a second chance to compete among their US respective peers for a residency spot.

My explanation is really simple. When a program is being funded by US federal money, it needs to have the best interest of US taxpayers, meaning prioritizing training slots for US med grads. If you are a US abiding citizen who pays federal tax, you need to accept this as a new hurdle and limit your application to only US med schools.

 

[laricb]

Nope, my goal is to prioritize US grads especially when US federal money is used to fund these residencies. US grads should deserve at least a second chance for initially making the wrong decision.

Finally, I am curious to why people think that US med schools are incapable of producing good physicians relative to their foreign counterparts.

You score a 34 on the MCAT get into a US School, I score a 29 and go onto SGU. I then achieve a 250 on my step 1 test, you score a 220 we are both US Citizens, but you feel I shouldn't have a shot at residency. Sounds like a problem in our system

 

[Wordead]

I read your post. Your main argument is about producing the best physician available for American citizens. It still doesn't answer my question as to why do you think unmatched US grads are possibly inferior to foreign med grads. Like Maruko had alluded to earlier about a possible reason for unmatched US grads, I personally think that unmatched US grads who didn't initially match because of outlandish expectations deserve a second chance to compete among their US respective peers for a residency spot.

My explanation is really simple. When a program is being funded by US federal money, it needs to have the best interest of US taxpayers, meaning prioritizing training slots for US med grads. If you are a US abiding citizen who pays federal tax, you need to accept this as a new hurdle and limit your application to only US med schools.

You dont think there are any foreign grads that are better than the matched americans, much less the unmatched ones? Yes, some of the unmatched are those with unreasonable expectations but there are plenty of people who simply should not have a spot.