Short Takes On News & Events

The ‘Yawning’ Chart Med School Students Fear

By Ankita Rao

February 13th, 2013, 10:40 AM

Medical school students call this chart the “jaws of death.”

The graph from the Association of American Medical Colleges displays a yawning gap between the increasing number of med school grads looking for residencies and the number of residency slots available to them.

Source: National Residency Match Program

“This is the only time in the history of the U.S. that we are going to see a decrease in practicing physicians,” said Dr. Atul Grover, chief public policy officer of the AAMC, who was speaking on a panel at the American Medical Association’s National Advocacy Conference on Tuesday in Washington, D.C.

Grover said that medical schools have responded to the physician shortage projected by the AMA by increasing admissions, but residency programs have not been able to follow suit.

Graduate medical education, from medical schools to residency programs, is partially subsidized by the government through Medicare, making it vulnerable to cuts to the federal program. Medicare payments cover 21 percent of the cost incurred to train interns and residents, but teaching hospitals absorb the rest. If the scheduled budget cuts from sequestration go into effect next month, some say the physician shortage in the U.S. could go from bad to worse because fewer doctors will complete residency, and thereby, their training.

“It’s a threat — having to go on with our training without knowing if we can complete our career,” said Amy Ho, a third year student at The University Of Texas Southwestern Medical Center in Dallas.

Ho, who was at the AMA conference, said she became involved with AMPAC, a bipartisan political action committee of the AMA to help figure out how to fix this problem.

She said her peers are now tailoring their careers to find the specialties and geographic locations that will result in better pay and lifestyle. But their strategy might not make up for those left without  residency positions on match day.

Thomas Ricketts, a professor of health policy and management at the University of North Carolina at Chapel Hill, said the budget cuts would negatively affect an aging population. He said state governments, health systems, communities and entrepreneurs should join Congress in encouraging medical education.

Meanwhile, the effort to train more physicians has found bipartisan support. Rep. Aaron Schock (R-Ill.) and Rep. Allyson Schwartz  (D-Pa.) introduced a bill to lift the 1997 legislation that capped the number of residency slots available. Their bill would create 15,000 new GME slots around the country.

But without a consensus, the jaws of death will clamp down sooner rather than later.

“We might not just cut supply here, we might cut quality,” Ricketts said.

3 Responses to “The ‘Yawning’ Chart Med School Students Fear”

  1. oncdoc says:

    You can’t just create residency training slots out of thin air and expect any kind of quality. I have seen this recently when a small community hospital in our region started an Internal Med program. Not pretty! This expansion will be very expensive as well.
    After they force the creation of 15000 residency slots, I suppose they will try to force specialty societies to open more fellowship training positions.
    I believe that the “doctor shortage” idea is either imaginary or greatly exaggerated and designed by the govt and hospitals to aid in flooding the market with providers therefore forcing them to enter into employment contracts for much less $.

  2. The elderly are already facing a worst case workforce nightmare. Internal medicine has had only 1400 entering primary care for 15 class years. At 30 class years this is only 42,000 for the maximal possible IM primary care workforce. This is a cut in half compared to the year 2000. It is a dagger for geriatric populations doubling from 2010 to 2030. Geriatrics is also not a solution as 75 – 80% of geriatricians are found in 3400 zip codes with top concentrations of workforce. only 20 – 25% are found in 30,000 zip codes where 68% of the elderly are found. As these age 65 to 100 populations age and become less mobile and can transport least, the incredibly poor distribution of primary care, ERs, rehab, and other needs will take a toll. ERs, retail, and urgent care are also concentrated where workforce is concentrated – where elderly are less likely to be found due to higher costs of living which they tend to avoid.

    The statements made continue to highlight the problem of workforce leaders that do not understand the basics of workforce. Workforce cannot be magically produced. It takes 30 years for changes to result – after any interventions. For example the only real expansion of FM was 1970 to 1980 when the grads reached 3000 per year – a level still present in FM. FM has reached a maximum of about 91,000 active and will remain so. HRSA projected 144,000 for 2020 – an impossible number due to a stagnant 3000 per year. HRSA projected 155,000 for IM primary care – also impossible with 1400 entering a year and 24,000 lost to hospitalist workforce and others lost after graduation away from primary care.

    Also as Chen and Phillips demonstrated, the rearrangement of GME to rural locations and to so called primary care training did not result in the goals of the design. Primary care interventions pure for primary care result are FM with 90% remaining in primary care for a career at top volume, activity, and years. This 24 Standard Primary Care Years per FM graduate compares to about 6 – 7 for the national average for 28,000 PC capable graduates and less than 5 Standard Primary Care Years for IM, PA, and NP. You cannot expand a workforce that is less than average in primary care contribution and make headway on a primary care deficit caused by expansions of dilute primary care solutions while failing to expand the most specific primary care solutions.

  3. Justin says:

    This graph looks misleading to me. AAMC is lumping foreign medical students with U.S. medical students but only including U.S.-based residency positions. Show me this graph for U.S. medical students, and I bet you’re likely to see supply and demand much more in line. Also, why do you think AAMC would publicize this chart? Do you think they have some stake in promoting the allocation of additional gov’t-subsidized residency slots?

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