Episode 91: There aren’t enough residency positions for graduating medical students? It depends on the state; the forecast is grim.

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Download transcript: Stop Cutting Residency Positions

 More Medical Students Than Residency Positions

As you may know and have probably heard there is becoming an increasing discrepancy between the number of graduating medical students and the number of positions available for internships in residences.

It’s a terrible thing to be in medical school graduate and be unemployed and not be able to get a job. This is a disturbing topic. I’ve had a considerable amount of fought before doing a podcast because I wanted to make sure I got my numbers right.

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Texas’ Medical Student Projection

Now, I’ve finally found a graph. It’s not national but it will give you an idea. I want to give you a sample from Texas and if you could find a better reference nationally to give you this specific data please give it to me and I will certainly share it again with the podcasted community. The text is hospital association in Texas Higher Education coordinating board. Hosted a forum, they got a couple of million dollars to establish new first year residency positions.

In 2012, they had a report that is available online and they said it already in 2014 there were 63 less slots available for graduating medical schools compared to the number of 4th year graduating Texas doctors. Let me be real clear what I’m saying here.

A lot of people will go to a different state to apply and attend a residency. A lot of U.S. citizens or even foreign nationals, they go to medical schools outside of the United States. What we’re talking about now is a coming crisis where people graduating in medical school within their own state can’t even get a job. Even if they all stayed in the same state, they’re being forced to go elsewhere.

Florida Grows Medical Schools – Not Residencies

Florida is actually the worst. There are medical schools popping up everywhere and this goes back several years when the AAMC said, “Hey, we need to boost the number of medical school graduates by 30%.” Texas did that but the residency growth is much slower and more expensive, believe it or not, than a medical school and its rate has only been 15% growth since then. It’s outpacing it by twice as much and the number of graduating medical schools is quickly overtaking it. This is projected to happen nationally. This is alarming.

You may be experiencing this already, but this has real life implications such as the number of applications you should put in for your residency and the number of interviews you should go to. I think everything is going to start doubling. If you aren’t already just a stellar student then I think you need to double everything right off the bat.

I’ve been down that road, had to switch programs. I know what it feels like to not match. I know what it feels like to match to your number one choice. Man, you need a lock and load on this and go to a lot more residencies if you are below average in your medical school class. That is my advice.

Projections of Unemployed Doctors

By 2016, the number is projected to jump to almost 200. 180 it says here, but I’m looking at the graph that I will include in the show. It’s for this episode. I’ve researched the actual 69 page paper that this council put out and this has happened before which id surprising, a little bit in 2007. It was about 112 more graduates than there were residency slots. That’s not that long ago. It’s happened a little bit before then, but the trajectory from 2014 and 15 and what’s projected on our into the future is much worse.

A lot of this corresponds with the economic recession, that when it dovetailed. The problem is that the government is broke. If you are watching our national debt that we’re in such a crisis, it can barely keep the federal government running. Dating back, most of the funding has all originated from healthcare dollars, affordable care act. Really, it doesn’t have room for funding GME. It’s said it’s priority that established a commission and have yet to been given their $3 million to startup. They haven’t had one teleconference to-date. It’s what I read in the publication that’s recent. This is all 2013 literature, and so the government is failing graduate medical education direly right now. It’s terrible.

Graduate Medical Education Funding

Why do we need government funding and why are politics involved? The reason is because apparently, and I have trouble believing this, I could use your help. Residency education is expensive, it’s estimated that an internal medicine residency program can cause between $100,000 to $130,000 per resident per year. Sustaining a program is a valid concern. You can’t just popup a new program and then abandon it. You need commitment from the payers. Keiser Permanente is one of the largest healthcare organizations to first to become an accountable care organization as I’ve mentioned earlier on the podcast.

They have a mechanism with their own instruments plan and funding to pay, though they’re private for residency education. There are a lot of intangibles. It’s a sad day ladies and gentlemen when a resident has to start doing research to justify his own job. What I mean by that is I am actually … I started a paper, it’s just in a very early draft form but I’ve written a bunch of papers as a resident, to do a cost analysis on residency. Because residents have other benefits besides just graduating a doctor that can go and practice in your state.

Residents Aren’t a Total Wallet-Suck

There are more tangible benefits for the program and for the hospital system that they worked in, and I need help brainstorming what these things are. Perhaps I could put together a survey, a programs directors, hospital administrators, even the finance department or development offices on what we truly bring in monetarily to justify our jobs. It’s a sad day we are there. Some benefits that had been touted for us being around is that having a residency program saves money on recruitment because there are heavy placement costs. Often times recruiters and headhunters will get 20% of the based salary, that could be $60,000 to land somebody and hire a doctor. It’s expensive.

If you graduate from a program and you’re there for years, it’s like the best interview on the plant. Programs like to keep their graduates because they know what they’re getting. Also, in addition to that, the doctors that stay in the area and graduate there had their patients that are already familiar with them, that’s an invaluable thing, kind of hard to judge in a monetary sense.

I think we might actually have to go to the American people in this research study and start by them and say, “How do you feel about residents not being able to be trained here? What value do you think they bring to the community.” And survey them and pick their brain on how you think having a residency program helps monetarily to justify our own job. I know that’s very weak argument and question. It’s sad, it’s pathetic, the paper might just come to nothing even. It’s at risk of not having a good answer to this.

Let’s Help Tackle This, MMC!

I simply cannot believe that I cost $140,000 to them and I bring nothing here to the community, because I can guarantee you. I know I’ve seen lots of patients that would have personally glad to meet me and whom I represented by institution in such a positive lie that they told me, “I like coming here a whole lot better than these other hospitals.” And they would name other hospitals that they’ve been to because we listen.

I think that there’s a lot of intangible things there because residents and medical students even spend more time with the patients than the attendants get and we develop better rapport. Perhaps a study could look at the retention of patients in their loyalty to a particular hospital chain based on their relationship with the residents compared to the attendants.

I think there might really be something there. They could lose a lot of business if we weren’t there and we’re like the rest of the busy attendants that don’t spend 5 minutes talking to their patients.

People will also argue that if you’re in a primary care residency, you can expand your primary care access in that area. They say relatively inexpensively which is a oxymoron. It’s hard to get anybody to really commit and say that we are all that expensive without really doing the math.

I literally had our board of directors speak to our department recently and he was saying how expensive we were and stuff, and we just don’t buy it. It doesn’t pass the sniff test. I think there are a lot of things that we bring to a hospital being residents and it’s a sad day, ladies and gentlemen, we had to justify our jobs. But we are there, perhaps on mastermind community is what is needed during this day and age when you’ve got medical students out there that aren’t going to have a job. It’s already happening and I’m looking for some national numbers. If you could find a good reference on that shoot me that. If you’re interested in doing some research, I’ve gotten several other residents and medical students and even in undergraduate on a publication. If you want to beef-up your application, that sideline, little things wouldn’t hurt either.

I’m crazy enough to probably be setting some record of 20 scholarly activities as a residents and counting, I have a year and a half left. It wouldn’t surprise me if I hit 25 or 30 because I wrote two papers this week. I’ve gotten quite good at it, I’m no ordinary resident.

All right folks, you have a great day. You’ve been listening to the medical school podcast and God speed on your next exam.

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