Thread: 2016 -- 1:1 ratio of american med grads to residency spots? Citation?

A statistic that has been cited many times on valuemd is that by 2016 there will be a 1:1 ratio of american med school graduates to residency spots. Can someone refer me to the article that mentions the above statistic? Thanks.

this is the post i posted in the future of ross, any thoughts? thread that basically addressed this issues a month ago...

a few articles to peruse:

https://www.aamc.org/newsroom/newsre...ojections.html

https://www.aamc.org/newsroom/newsre...52/120425.html

https://www.aamc.org/newsroom/newsre...36/120316.html

https://www.aamc.org/newsroom/newsre...00/120316.html

https://www.aamc.org/newsroom/newsre...74/111024.html

then from a NEJM article

http://www.nejm.org/doi/full/10.1056...7519#t=article

here is the article...and the words are straight from the mouth of the AAMC CEO...

http://www.nejm.org/doi/pdf/10.1056/NEJMhpr1107519


thought this summed it up nicely

Because of the cap on Medicare's payments, the expanding number of U.S. medical school graduates, and the continuing influx of some 7000 international medical graduates in search of GME posts every year, before long there will be too few positions to train them all. Currently, about 25% of practicing physicians in the United States are graduates of international medical schools. The slow growth in GME positions — an annual rate of 0.9% over the past decade (Nasca T: personal communication) — contrasts with the increases in enrollment that have occurred in 100 of the 125 allopathic medical schools and a doubling of enrollments in osteopathic medical schools. By 2015, combined first-year enrollment in allopathic and osteopathic schools is projected to reach 26,403, an increase of 35% over 2002 numbers. Eight new allopathic schools and nine osteopathic schools or branch campuses have enrolled their first classes or soon will do so (for details, see Table 1 in the Supplementary Appendix, available with the full text of this article at NEJM.org).
In an interview, Dr. ****** Nasca, CEO of the Accreditation Council for Graduate Medical Education, expressed concern over the narrowing gap between the number of entry-level GME posts and the growing number of medical school graduates. Nasca said, “We estimate that we will see domestic production of medical school graduates functionally surpass our current total number of GME postgraduate year-one pipeline positions [posts that lead to initial specialty certification] by 2015 or sooner
Given the current concern over the federal deficit, the likelihood that Congress will remove the cap on Medicare's GME support is nil. Indeed, holding on to existing GME support may be the best outcome medical educators can hope to achieve.
Nasca added, “In the absence of congressional action to lift the cap, or the unlikely prospect of securing other sources of GME support, we face the risk of graduating physicians in the United States who will be unable to obtain the training required to obtain a license to practice independently.”

and aProgDirector on sdn (who IMHO is pretty insightful)
Before we get all "Doom and Gloom" on this thread, let's make sure we are all talking about the same thing.

There are currently ~23,000 residency spots in the match. This ignores spots given outside the match, and spots in the AOA match. It also ignores the 1 year prelim spots that don't lead to final training, but I also ignored the PGY-2 spots. So, for the sake of argument, let's say there are 25K spots.

There are currently 16K allopathic grads each year, before the increase. Medical schools have increased class size from 10-20%, with most in the 10-15% range. Assuming 15%, that's another 2500 students, so we are at 18.5K allo grads.

There are 8-10 new schools opening. Assume 100 students per year (although most of these schools are planned at 60-80). That's 1000 new students, likely less, and it will take many years before these students are in the pipeline -- a few schools are actually up and running, many are still on the drawing board.

That brings the total to 19.5K allopathic students, and 25K spots. That still leaves 5K spots for DO students and IMG/FMG's. I don't see allo grads in unemployment lines -- assuming they apply intelligently. If you're not competitive for ortho but aim your entire application in that direction anyway, and get nothing, that's simply poor planning in my book. Will every DO student have a spot? Probably. Even if you look at the graph in the article, there will be enough spots as long as spots don't decrease, which seems very unlikely.

There is no question that there will be more competition for spots. And, someone will get squeezed out -- but that's likely to be IMG's and not US allo grads. DO's might feel the squeeze also, but that can be "fixed" by decreasing the number of IMG's allowed into spots.

Last, let's not forget that as class sizes are increased, more people can go to US schools. There is a good chance that many of these people were those that were headed to offshore schools. Someone has to be the "last kid picked", and if you're name is next on the list, you don't get a spot. But, once schools increase class size, the students who "just missed out" will get into a US school instead. So, although there may be a decrease in the number of offshore grads who get into residency spots, there also will be a shift of students from offshore to onshore schools.


things COULD change, but for a few years, we are already seeing some of the difficulties and IMHO its going to get worse before it gets better...its not to say people shouldn't come to the caribbean to go to school, but go in with eyes wide open...without the rose colored glasses.

original thread
http://www.valuemd.com/ross-universi...-thoughts.html

if i had to chose who i felt had a more reliable grasp of the situation, i'm picking the CEO of the ACGME, or an active PD, not someone who has no real connection to the issue other than being a med school applicant.

most of the links you posted don't work, and the last two are the same article.

Yes the majority of the links don't work.

A lot of those numbers seem to be based on the assumption that all of the DOs will apply for the allopathic match when that is certainly not the case. In fact it might be a waste of time for a DO to apply for the allopathic match, since they have their own set of residencies and they would have to take the USMLE Steps in addition to their required COMLEX exams. Take a look at the NRMP data and see for yourself that there were only 2360 DOs in 2012 that applied for the allopathic residencies (they had a match rate of 74.7% for PGY-1).

Have you considered the possibility that the ACGME CEO might be saying those things because he wants the number of residencies to increase significantly? His organization is under political pressure to find a way to train more physicians in this country so that the shortage issue could be minimized. In order to do that the ACGME needs more money and the O administration would try to get it for him...on the other hand the Republicans in Congress would want to cut any type of government spending. Any statistical data can be manipulated to present an argument, and that's what I think that Dr. Nasca, the ACGME CEO, is doing.

I'm just trying to present the data fairly. All of the data I use comes from the NRMP and AAMC tables. It is highly unlikely that there will be a pure one to one ratio of residency spots to active applicants from the US by 2015 or even 2016 (the ratio was 1.45:1 in 2012 according to the NRMP). If Rokshana's comments about trusting "the CEO of the ACGME, or an active PD, not someone who has no real connection to the issue other than being a med school applicant" are directed at me, then you should know that I come from a family of physicians, have friends that are MDs/attend US medical schools, and have personally studied the economics of the health care industry in undergraduate and graduate courses.

The main reason for the shortage is the fact that not enough doctors want to work in the midwest/south. The same can be said of every major healthcare occupation, which is why many Pharmacy grads in the Northeast can't find a job in their region yet more and more PharmD programs are being created. If the AMA had it's way, then it wouldn't want to have this many medical students in the US, since it decreases the average income of AMA member physicians in this country. To a US grad they would be better off with more FMGs than other US grads because the FMGs look worse on paper.

I will say that any students who want to go to the Caribbean/Europe/Asia should realize that there aren't many "safe" options and there is some risk in attending even the best foreign programs. I would suggest the following are the only acceptable programs abroad, if you want to work in the US as a MD: RCIS (Ireland), Sackler (Israel), SGU (Grenada), Ross (Dominica), and AUC (St.Maarten). The reason I say this is because they are the only major foreign progams that students can attend by using government loans to finance their education.

AUA is not acceptable, not only do students need to take private loans (or pay in cash) in order to attend the island school but they don't require the MCAT for admission, which is why graduates from that school can get a 260 on their USMLE Step 1 yet their best match would be a mediocre IM residency program in Philadelphia (this is an example that actually occurred in 2012).

Being a FMG is a disadvantage but if one can match into a true residency program, then no one will really care where you went to school once you have worked as a physician for 5-10 years. Yes things are only getting worse for FMGs and yes more people will be rejected than ever before (even from fellowships). Do well on the USMLE exams and make sure all the doctors in your rotations like you. If you can do that while attending one of the schools I listed, then you should be safe to get something in primary care (other than ER) or other non desirable positions (PM&R, Neurology,etc.).

Originally Posted by curioustobemd

AUA is not acceptable, not only do students need to take private loans (or pay in cash) in order to attend the island school but they don't require the MCAT for admission, which is why graduates from that school can get a 260 on their USMLE Step 1 yet their best match would be a mediocre IM residency program in Philadelphia (this is an example that actually occurred in 2012).

Just an FYI on a couple things, while I agree that SGU/Ross/AUC are better options, to say AUA is unacceptable based on the two facts you presented is a little far fetched. AUA now requires the MCAT for all students starting 2013 (although why they didn't before is beyond me), but the fact that it was approved by Califonia despite not mandating the MCAT shows that the factor must not have been that important. The federal loan issue would only come into play if the vast majority of graduates from the Big3 are unable to obtain a residency position, because then people would start to question why they are funding medical school programs that can't produce board certified medical professionals. Also, to state that the best match result for AUA in 2012 was a mediocre IM program is extremely subjective. Last year they had a graduate obtain a neurosurgery residency position at an ivy league school, Residents/Recent Graduates | Neurosurgery Foundation | Brown University | Warren Alpert Medical School | Department of Neurosurgery, I'd also argue that this year they had one match for anesthesiology in Boston (tough location to match for almost any specialty) and emergency medicine at Emory (a well regarded program) that are more impressive than an average IM match in Philly. I wouldn't say AUA is unacceptable, but I would say it is a slightly more challenging route, mainly because of its short history and subsequent lack of alumni throughout the US.

Back to the topic on hand, while I agree with the advice, "Do well on the USMLE exams and make sure all the doctors in your rotations like you," this could work for any foreign school that allows rotations in the US. If a physician who carries enough weight in the department wants you and you want to work there, whether you went to SGU, AUA or Timbuktu med school, he'll find a way to squeeze you in (maybe directly into the program of your choice, maybe a prelim, maybe a less competitive program/specialty at the same place or a buddy's place and then just transfer you in) Personally, I feel that the standards for obtaining a residency in America will be raised for F/IMGs in the following ways; no failures on any USMLE, increased minimum scores on step1 and 2ck, required clinical experience in the US for a set period of time (6+ months, not including observorships/externships/research) and more programs may require citizenship/green-card status.

Even if the number of US students = number of residency positions, the number of filled residency positions will never equal number of US students because everyone wants to go into a specific specialty (or at least avoid a few). As an I/FMG i agree that we may be relegated to only primary care (barring connections) unless the compensation model somehow changes to favor FM/peds/psych/etc.

sorry, seem to have problems with the links not working when i cut and paste...if you go to the link to the original thread, the links work from there...

https://www.aamc.org/newsroom/newsre...ojections.html

https://www.aamc.org/newsroom/newsre...52/120425.html

https://www.aamc.org/newsroom/newsre...36/120316.html

https://www.aamc.org/newsroom/newsre...00/120316.html

https://www.aamc.org/newsroom/newsre...36/120316.html

https://www.aamc.org/newsroom/newsre...74/111024.html

hopefully these work here

Originally Posted by curioustobemd

Yes the majority of the links don't work.

A lot of those numbers seem to be based on the assumption that all of the DOs will apply for the allopathic match when that is certainly not the case. In fact it might be a waste of time for a DO to apply for the allopathic match, since they have their own set of residencies and they would have to take the USMLE Steps in addition to their required COMLEX exams. Take a look at the NRMP data and see for yourself that there were only 2360 DOs in 2012 that applied for the allopathic residencies (they had a match rate of 74.7% for PGY-1).

DOs are increasingly applying to allopathic programs and over the years, the trend for their getting allopathic spots has increased...when i started med school in 2004, the FMG and DO acceptance % was roughly the same...with less numbers of DOs applying...now more DOs (by some numbers 50% of DO students apply to the NRMP match) are applying and the % of them getting spots has gone up to ~75%...while F/IMGs % of acceptance has gone down to <50% (of course the number of FMGs applying has gone up, esp after 2008 so the absolute number is probably about the same or even higher)....and most of those DO students take the USMLE without an issue...remember many of those DO students couldn't get into a US MD school, just like us, and realized that if they wanted an allo residency they were going to have to take both exams...and increasingly more and more allopathic residency programs will accept the COMLEX scores in lieu of USMLE scores...do not think for one minute that the DO students are going away anytime soon as competition for the IMG...they just have the luxury of having their own DO residency spots as a back up...not a luxury the off shore student can count on...

Have you considered the possibility that the ACGME CEO might be saying those things because he wants the number of residencies to increase significantly? His organization is under political pressure to find a way to train more physicians in this country so that the shortage issue could be minimized. In order to do that the ACGME needs more money and the O administration would try to get it for him...on the other hand the Republicans in Congress would want to cut any type of government spending. Any statistical data can be manipulated to present an argument, and that's what I think that Dr. Nasca, the ACGME CEO, is doing.

sure its possible...the AAMC has also recommended that the number of residency spots need to be increased as well....but don't think for one minute that O is the savior for that! he has already tried to cut pediatric teaching funding that would decrease pediatrics residency spots...he is certainly not the champion of healthcare education...

I'm just trying to present the data fairly. All of the data I use comes from the NRMP and AAMC tables. It is highly unlikely that there will be a pure one to one ratio of residency spots to active applicants from the US by 2015 or even 2016 (the ratio was 1.45:1 in 2012 according to the NRMP). If Rokshana's comments about trusting "the CEO of the ACGME, or an active PD, not someone who has no real connection to the issue other than being a med school applicant" are directed at me, then you should know that I come from a family of physicians, have friends that are MDs/attend US medical schools, and have personally studied the economics of the health care industry in undergraduate and graduate courses.

you are trying to be optimistic ...its understandable...but it is already difficult to get spots and more and more people are finding that, despite having no red flags, that they are getting fewer invites, and some are not matching...and no matter how many doctors in your family (i am the 4th generation of physicians)or how many friends you have in med school or residency or what not, you still will not know what the day to day struggles are of trying to get that residency until you are personally involved in the process or are in those upper echelons of medical policy making...so again the CEOs of the AAMC and ACGME are going to have a *bit* more credibility...

The main reason for the shortage is the fact that not enough doctors want to work in the midwest/south. The same can be said of every major healthcare occupation, which is why many Pharmacy grads in the Northeast can't find a job in their region yet more and more PharmD programs are being created. If the AMA had it's way, then it wouldn't want to have this many medical students in the US, since it decreases the average income of AMA member physicians in this country. To a US grad they would be better off with more FMGs than other US grads because the FMGs look worse on paper.

true enough that to some extent its a distribution problem, both geographic and specialty wise...and until someone makes counseling patients and talking to them as lucrative in reimbursement as doing a procedure , its not going to change much...

Being a FMG is a disadvantage but if one can match into a true residency program, then no one will really care where you went to school once you have worked as a physician for 5-10 years. Yes things are only getting worse for FMGs and yes more people will be rejected than ever before (even from fellowships). Do well on the USMLE exams and make sure all the doctors in your rotations like you. If you can do that while attending one of the schools I listed, then you should be safe to get something in primary care (other than ER) or other non desirable positions (PM&R, Neurology,etc.).

what is a "false" residency program? and what on earth makes you think PM&R and Neuro "undesirable"? And EM is not considered a primary care specialty (though they are a de facto primary care for the indigent)...primary care is FM, IM, Peds, Ob/gyn, and in some instances, GS.

In fact it might be a waste of time for a DO to apply for the allopathic match, since they have their own set of residencies and they would have to take the USMLE Steps in addition to their required COMLEX exams.

It's generally worked out pretty well for my DO friends who applied to MD programs (general surgery, pathology, neurology, etc.) -- but probably even better for some of them who applied to DO programs (neurosurgery, ENT/HNS, etc.). It's certainly not a waste of time for those who want a specialty that is unavailable through DO programs, at any rate.

If Rokshana's comments about trusting "the CEO of the ACGME, or an active PD, not someone who has no real connection to the issue other than being a med school applicant" are directed at me, then you should know that I come from a family of physicians, have friends that are MDs/attend US medical schools, and have personally studied the economics of the health care industry in undergraduate and graduate courses.

I don't know who rok was talking about, but ACGME CEO and PD trumps "family of physicians," "doctor and med student friends," and "personal study." No offense intended, I'm just saying.

I would suggest the following are the only acceptable programs abroad, if you want to work in the US as a MD: RCIS (Ireland), Sackler (Israel), SGU (Grenada), Ross (Dominica), and AUC (St.Maarten). The reason I say this is because they are the only major foreign progams that students can attend by using government loans to finance their education.

Hmmmm. Pretty short list, there. Jagiellonian is excellent, well-connected with US programs, and has US federal loans. Trinity-Dublin is certainly better than a poke in the eye with a sharp stick (and probably better than RCSI, in my opinion). I can think of several other EU programs that are certainly worthy of consideration for someone who is looking overseas for medical education, although that very act if becoming pretty fraught with uncertainty. The list of schools is definitely shrinking, though, that much is for sure. (I would not be starting at my school right now, that much is for certain.)

AUA is not acceptable, not only do students need to take private loans (or pay in cash) in order to attend the island school but they don't require the MCAT for admission, which is why graduates from that school can get a 260 on their USMLE Step 1 yet their best match would be a mediocre IM residency program in Philadelphia (this is an example that actually occurred in 2012).

I'm not waving the pompons for AUA, but you can't only cherry-pick students who under-match (is that a word?), though, can you? I mean, it's pretty convenient to make that statement and simply ignore their recent NSx-Brown, GS-Einstein, and Gas-BU matches. Someone with a 260 who is an arrogant or socially-stunted individual - not saying that this person is, I don't have any idea - isn't likely to match well no matter what. S/he could interview like a stump. S/he could have made poor application choices. S/he could have very bad personal hygiene. S/he could be awesome and have had bad luck on the Match. S/he could have had a strong personal reason for choosing Philadelphia over more prestigious programs elsewhere. S/he could be a rabid Phillies fan. Point being, I think that we don't really know.

Do well on the USMLE exams and make sure all the doctors in your rotations like you. If you can do that while attending one of the schools I listed, then you should be safe to get something in primary care (other than ER) or other non desirable positions (PM&R, Neurology,etc.).

You can never be sure that everyone likes you. You can do your best, but there are still some pretty mean people out there in white coats. You can only control what you put out there... the way that you treat others, the effort that you put in, etc. If you do that, you are probably going to be OK.

I definitely agree with rok on that last statement. Just because you don't happen to want to be a neurologist or physiatrist, doesn't mean that the entire field is undesirable. (You might have meant "less popular" in your comment, but that's not the same thing.)

Originally Posted by rokshana

...primary care is IM, Peds, Ob/gyn, and in some instances, GS.

And, lest we forget, Family Medicine.

i did!!

All I was trying to say was that individuals should figure things out for yourself instead of trusting a CEO. I used data from the AAMC enrollment PDF and the NRMP residency PDF, not my personal opinion to present my argument. I may not appreciate all the rigors you went through, but that doesn't mean I can't do the math. If the other person, Devildoc from Bulgaria, thinks a CEO is more reliable than the AAMC or NRMP, then they can think that, but they are taking the easy unreliable route. Numbers don't lie as frequently as people do.
Even if the number of DOs applying for allopathic programs doubled in four years, something that is almost impossible in such a short time span, there would still be plenty of spots available for FMGs (though the match rate would be something like 20% for them).
Also every time those organizations mention a class size in a statement for 2015/2016 they refer to the first year students not the seniors/graduating class. So really we are talking about the class of 2019/2020, which is about 12 years after Rokshana graduated and I don't know when Devildoc graduated.
Also doesn't it make perfect sense that the organization that is trying to get money paints a grim picture so that it has a better argument to get that money?
Also when I say undesirable I mean that the US MDs don't want to apply to that field as much, I'm not calling it that because I think it's undesirable. I know that right now the most popular trend for US MDs is Emergency medicine, and thank you for correcting me earlier on the primary care mishap.
Regardless believe what you want to believe, I'm done with this argument.