Doctor Shortage in America???

[econoclast]

Just heard this snippet on Bloomberg radio...
Paraphrasing...
There is a shortage of physicians in America. In large part due to the way we train med school graduates in the Residency programs. Residency programs are administered by a non-profit Residency Matching organization but paid for by the Federal government and the number of Residents has been CAPPED for the past 15 years. Because there is a fixed number of Residencies available, med schools turn away qualified applicants because they know that there won't be Residencies available for them after graduation.

Huh?

I may have some of this muddled...I was driving in some nasty traffic at the time....but I'm certain that I have the thrust of this correct.

I really don't have time to dig into this topic myself today. Anyone here familiar with the details of how doctors are trained here in the US? In particular the details or post med-school Residency?

Any information is appreciated.

[RC]

1. We do limit the number of new doctors to keep their pay high.

Too many doctors would dilute the profit margin of the medical business. The supply and demand thingy.

[Nuclear Unicorn]

2. Is that a government thing of a preofessional organization thing?

If the latter those who want to be doctors but are denied should form a separate professional organization and compete.

Monopolies are never good for consumers.

[RC]

15. New and wannabe doctors are in debt up to their necks

The American Medical Association has deep pockets and well paid lobbyists.

[SharonAnn]

19. The AMA has always restricted the number of Medical colleges and students per college.

They have always lobbied Congress to support this restriction.

They have caused the problem and gotten Congress to support it by limiting Residencies, etc.

We could solve this, but apparently we don't want to.

[hunter]

21. There's not much left of the AMA.

It's like the American Automobile Association.

Time was every other driver had a triple-A membership, but those days are long past.

The numbers are so dismal the AMA is padding them with students and other deeply discounted membership categories. Many physicians wouldn't join the AMA if it was free -- they already get too much crap in the mail and don't want more.

Essentially the AMA has become a marketing tool, mostly for the big pharmaceutical companies. They've been bought.

The big pharmaceutical companies and the health insurance industries have far more political clout than the dwindling membership of the AMA.

[4th law of robotics]

25. I've heard that and it makes sense

but I've never seen evidence of that other than hearsay.

I mean you have to be selective for that kind of job so it's inevitable that many people will be kept out. But is there evidence that more people are being kept out than are necessary?

[pscot]

3. There appears to be no shortage

of back surgeons.

[porphyrian]

4. The shortage is with general practitioners.

The way the system is now, the only way you can afford to go to school to become a doctor is to get paid well once you graduate in order to handle the student loans (assuming you don't come from a rich family). The lowest paid doctors are the ones we need the most - general practitioners. So, we have most people becoming doctors as specialists (surgeons, OB/GYN's, whatever), which is fine, but they don't do regular check-ups or physicals, which is what most people need outside of emergencies. Further, many insurance companies require referrals from GP's to specialists for their work to be covered. So, the majority of GP"s are older and approaching retirement, meaning that they are taking on less new patients and maybe dismissing some that they have at the same time that the Boomer generation is going into retirement and beginning the biggest strain ever on our healthcare system, especially in retirement states such as Florida. This isn't something that no one was aware of until now, this is something that no one has adequately addressed yet. Meanwhile, who loses?

We need to radically change our healthcare system (maybe by actually implementing the ACA and letting it work) or we are all fucked, and I mean yesterday.

As far as residencies and such go, it is important to understand that there is no national physician licensing; every state has its own laws, regulations and licensing requirements for physicians. While there is a push for a national physician license, states are highly unlikely to give up this control any time soon, so don't hold your breath for it. You can find the specific requirements for licensure in each state by searching for their Board of Medicine websites (I believe every state has one now).

[jsr]

11. There is a summary at

http://www.fsmb.org/usmle_eliinitial.html

IMG refers to foreign-trained doctors
USMLE is the licensing exam required of all MDs
COMLEX is the licensing exam required of all DOs (DOs only need the COMLEX for their medical license, but many also take the USMLE for residency purposes)

[riderinthestorm]

5. Several factors are contributing but the lack of residency spots is the biggest problem

The shortage is a result of several factors. A large number of medical professionals are reaching retirement age, as is a large group of patients: Nearly 15 million will become eligible for Medicare in the coming years, the Association of American Medical Colleges reports.

On top of that, there is a lack of residency spots available for students graduating from medical school. In 2011, more than 7,000 were left with degrees that said "M.D." but no place to continue their education, according to the National Residency Matching Program.

Many residency spots are funded by Medicare, and there's a cap on the number a hospital can claim each year. That number, about 100,000, has remained steady since 1997. While the Affordable Care Act will redistribute some unused residency slots and increase funding for the National Health Service Corps, more needs to be done, advocates say.

"There will be real physician shortages if we don't do more to lift the residency cap," said Dr. Atul Grover, the Association of American Medical Colleges' chief advocacy officer, in a statement. "People on both sides of the aisle have realized the need to train more doctors."

http://www.cnn.com/2012/06/29/health/doctor-shortage-affordable-care-act/index.html



This article is pretty good and its fairly short (since you're short on time - heh).

[Nuclear Unicorn]

6. Why is there a cap at all?

If someone demonstrates competency they should be allowed to practice.

[riderinthestorm]

8. My family members who are in medicine tell me its about the money

Restricting the number of doctors keeps their wages higher (so they can actually afford to pay off their exorbitant student loans).

In 1997, lawmakers placed a cap on the number of medical residencies—hospital training required for all doctors—in order to contain costs under Medicare, which pays for most of these training slots.

In reality its probably both of these things.

Removing the cap is overdue especially because the ACA is going to mean a lot more Americans will have a shot at getting health care. We'll need all the doctors we can get.

[uponit7771]

10. This is exactly what I hear, there's no need to "cap" the amount of docs who go into residency given

...the need and cost of the doctors that are already there.

[Nuclear Unicorn]

12. I think its a vicious cycle.

Docotrs restrict competition to keep wages high to pay of high student loan costs. Student loans cost so much because they know the doctors will be making large salaries in the future.

[jsr]

7. Those 7,000 MDs are not American

The vast majority of graduating medical students in the U.S. (i.e. MD or DO degree holders) match a residency spot every year.

[riderinthestorm]

9. I hadn't heard that. Do you have a link?

I'm not disputing it. Its quite possible but I'd be interested in seeing the data.

Regardless, its true we have a doctor shortage that's only going to get worse (especially with GPs) when the ACA is fully operational and many millions of Americans can finally access health care.

[jsr]

13. Here is a summary:

Last edited Wed Aug 29, 2012, 11:48 AM - Edit history (1)

http://www.nrmp.org/data/chartingoutcomes2011.pdf
There were 16,559 U.S. Seniors in the 2011 Main Residency Match.
Overall, 91.4 percent U.S. seniors matched to their preferred specialty, ranging from a high of 96.9 percent (Family Medicine) to a low of 44.0 percent (Plastic Surgery).

So, about 1,400 seniors did not match their first choice. That doesn't mean they're unemployed. If a med student doesn't match their 1st/2nd/3rd/etc choice, they can always 'scramble' and get a spot somewhere (typically in a less competitive specialty and/or location). Also, "U.S. Seniors" here refer to graduating MDs. Although many DOs participate in the NRMP match and are counted under "independent applicants", there is a separate residency match for DOs which occurs before the NRMP match, and their combined match rates are also very high.

The bottom line: It's pretty hard to not match a residency spot if you're a U.S. MD or DO degree holder.

[econoclast]

14. Understood...BUT....

So each year there is a Residency spot for each graduate. But the point is that if the number of those Residencies is capped, and the med schools KNOW that and only admit as many new students as will eventually have a Residency....then we have artificially capped the number of Doctors. If more Residencies were available then more People would be admitted to med school. Recall the premise of the report is that med schools turn away qualified applicants because of too few Residencies. So the fact that every graduate gets a Residency just demonstrates that the number of graduates is being managed to meet the artificially small number of Residencies. No?

From where does the CAP originate? Congress? HHS? Medicaid /medicare bureaucracy ?

[jsr]

17. John Kasich

It was Kasich who authored the Balanced Budget Act of 1997 which contained the cap, as part of his failed attempt to balance the budget.

Yes, residency is the choke point in medical training. No residency means no medical license, i.e. your medical degree is pretty much worthless.

In response to the physician 'shortage', U.S. med schools have been increasing enrollments, but because of the residency cap, people are predicting an OVERSUPPLY by 2016 or so, when the number of MD/DO graduates exceeds the number of available residencies and some U.S. med students will fail to match.

Yes, it's totally screwed up.

[hunter]

16. We can solve this problem real fast...

Pay people to go to medical school and pay for more primary care residency slots.

Now we are importing doctors trained by other nations, including our own students who often pay dearly to attend foreign medical schools.

The USA is now outsourcing medical education just like we've outsourced other jobs.

This "doctors are paid too much" corporate shill inspired whining, especially for primary care physicians, is the same bullshit you hear about other highly skilled U.S. workers. Our for-profit and much of our thoroughly corrupt "non-profit" healthcare industry wants to import cheap foreign medical labor they can push around and abuse the same way U.S. business abuses other recent immigrant labor.

Your hospitals, for-profit clinics, and health insurance companies would be importing doctors and medical staff from third world nations and paying them in room and board if they thought they could get away with it. They already are getting away with too much.

[jsr]

18. Agreed

The primary care folks should be paid more. In terms of public health, primary care saves more lives and gives you the best bang for the buck in the long run.

[4th law of robotics]

26. Or perhaps offer loan forgiveness

for doctors who go in to under-staffed medical fields.

I don't know the actual numbers but if we have a glut in neuro-surgeons they can pay back their full medical loans. If we have a crippling deficit of general practioners they can have their loans wiped after 5+ years of practicing.

Something like that.

And maybe the same for nurses.

[nadinbrzezinski]

20. GPs is where we do have a shortage

the other problem we have is that the AMA lobbied for those caps.

[hunter]

22. Check out my post above and the wikipedia AMA link below...

http://en.wikipedia.org/wiki/American_Medical_Association

There were 215,854 members as of December 2010, of which 47,227 (21.9%) were medical students and 31,049 (14.4%) were residents or fellows. The total was a decrease from the 2009 membership of 228,150.

A 2011 article asserted that "somewhere in the neighborhood of 15% of practicing US doctors now belong to the AMA." Membership total as of Dec 31, 2011 (including residents and students) was 217,490 of approximately 954,000 practicing physicians.

The AMA is fading as a political force. It stopped representing doctors and sold out, mostly to the pharmaceutical industry.

The group's leadership didn't see it coming -- the modern corporate rule that every worker is a replaceable cog in the profit machine, even doctors...

[nadinbrzezinski]

23. Yup, exactly.

but they were the ones who lobbied for those caps.

[greymattermom]

24. one thing you won't hear much talk about

Is that half or more of medical students are women, and twice as many women practice part time as men.

http://www.ama-assn.org/amednews/2012/03/26/bil10326.htm

[hunter]

27. "Part-time" for doctors is often forty hours a week or more.

Women with families are more likely to insist on reasonable hours.

"Full time" doctors tend to work sixty hours a week or more. That's the expectation of modern hospitals, clinics, and group practices. Those doctors who don't regularly pull sixty to eighty hour work weeks are called "part time."