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    Physician Shortage

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    Article by by Heidi Chumley, M.D.


    U.S. medical school graduates aren’t enough to fill the physician shortage



    Every year around Match Day, medical and pre-med students alike worry about a rumored “residency cliff.” The theory is that the number of new medical school graduates will soon outstrip the existing inventory of residency positions, and the overflow applicants will be left in professional limbo.


    While that picture seems scary, it’s time for some good news. I’ve believed for years that this concern is more phantom than real, but now there is empirical evidence in the form of a data analysis by a respected source in the New England Journal of Medicine (NEJM).


    Dr. Fitzhugh Mullan, a longtime observer of physician workforce trends, published a report in the NEJM examining recent and projected growth of U.S. medical school enrollment, compared to the rate of increase in residency program positions. Mullan concludes that while the number of graduates has begun catching up with the number of available positions, this gap is narrowing very slowly. In 2024, the number of available residency slots will still exceed the number of U.S. medical school graduates by around 4,500. That means an ample supply of postgraduate training positions for new MDs from not only U.S. schools but deserving international medical graduates as well.

    Put another way, residency positions are gradually becoming more competitive, but this is no reason to abandon a dream of becoming a physician; especially not when we as a nation face a growing shortage of physicians.


    A 2015 study puts this physician shortfall at as many as 90,000 doctors by the year 2025. This number helps put America’s health care problems into perspective. While U.S.-based medical schools are slowly increasing enrollment, they cannot alone make up the gap in the physician workforce. So do we then look to recruit doctors away from Africa, Asia or Latin America, contributing to the “brain drain” from less affluent countries? Thankfully we don’t have to.

    Physician Shortage-temp.jpg

    Many strong candidates are turned away from U.S. medical schools due to a lack of capacity and the resulting arbitrary cut-offs. International medical schools like mine — with a student body made up of mostly of U.S. citizens planning to practice in the U.S. — are doing their part to address the physician shortage by making more room for qualified American applicants. Many of my school’s graduates go on to become primary care physicians or to care for underserved populations — and some do both.


    Detractors of Caribbean medical schools have often exploited pre-med students’ residency anxiety to frighten them away. Mullan’s important report in NEJM should help lay that to rest.


    Heidi Chumley is executive dean and chief academic officer, American University of the Caribbean School of Medicine (AUC).
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    thxleave is offline Elite Member 7200 points
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    Article excludes the amount of DO schools out there. And the amount of residency programs that want fully trained FMGS as cheap labor for 3 years.

    Despite all this reassurance. The Caribbean choice is gone. I graduated from SGU this year. Scored 230's/220's/CS no failures. Didn't fail any of my classes, and graduated within 4 years. I applied to a 100 Psychiatry places to get 12 invites. A DO in my situation would apply to around 20 places and get 12 invites. They probably don't even take the USMLE, but instead take the inferior COMLEX. Trust me... An average on Comlex is 500, and translates to around 210s on Step 1 (which is 50%tile on Comlex to like bottom 10-20%s on Step 1) Also they do rotations at non-greenbook places at a private practice with no real training (they will brag about doing IM rotations or Surgery rotations with no calls or weekends). So at the end of all this situation, I didn't match. The majority of my places I interviewed ended up ranking DO's/US MD's higher. I know of 4 others in my situation from SGU and AUC that didn't match Psychiatry this year with similar amount of interviews. I am also a US Citizen. As of right now, I am living at my parents place, applying to jobs. BTW it's pretty tough to explain why a MD is applying for an entry job. I will be more then excited for a job now that just pays 40k a year. If I leave out my MD, I would have to explain 4 years gap in my resume.

    I don't have a problem with the Top 3 Caribbean school. The island living conditions are a lot better then what some might say. Administration, and setting up my clinical rotations was no hassle. The biggest issue is that DO's are appearing like rabbits, and they won the PR battle. A DO with 200s/210s are preferred over a SGU grad with 220s/230s. Also the DO can probably fail a test or two, and still match. We are discriminated heavily against. Some will say the only reason why we are in the Caribbeans are due to personality flaws. You score bad on the Steps... They assume that you aren't intelligent enough to be a doctor in the first place, and that's why you went to a different country for medical school. You do alright on the Steps... they assume you have personality flaws.

    I am warning people to avoid Caribbeans, not because of the school or even the quality of education. It's the huge discrimination you will receive. Sometimes people will make you feel less then human, and more akin to an animal. In my rotations I notice some malignant places know the situation you are in as a IMG, so they will treat you worse then the DO's/MD's. If the same attending treat your colleagues worse, they will report to school, and pull out of the rotation slots. As an IMG, you keep quiet, because the school is trying to maintain as much rotation slots as they can.

    Of course Heidi Chumley is going to say this on her article. It's because she is the executive dean and chief academic officer of AUC. She has a bias in maintaining the school is not falling.

    For the love of God, don't come to the Caribbean schools. It use to be you score 210's or 220's your chances of matching is solid (no guarantees of course, because nothing in life is guaranteed). Now the chances of matching is reduced, and more people are slipping. In fact I know someone with 210's not matching FM this year, all he had was 3 interviews and he applied to a 100 places, US Citizen from SGU also. No fails BTW.

    Normally I would keep quiet, but I just want to warn people out there. There are already tons of posts, but they are from Canadians that need J1 or people with failures. Well I am a US citizen with no failures, that didn't match with decent scores. Hindsight I shouldn't have done this. I should have done PA school or honestly tried for DO. Around 2012 when I matriculated it use to be SGU = DO. There was some places that preferred us, and main reason for DO was the private match. Now it's automatic DO>>>>>>>Top 3 no matter what. Even a brand new for private like RVU have a better reputation then us.

    There will be some old school IMGs that say it's still viable, but that's before DO's were this prolific. Also, you will hear some stories about some people with low scores matching, but remember... What happens when you don't match? So just a counterpoint to this article.

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    adamcollin is offline Junior Member 513 points
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    don1 is offline Senior Member 543 points
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    That is odd, I have had several friends match this year with low step score from Caribbean schools who graduated a couple years ago. Mind you they likely matched to lower tier family medicine programs.

    That is horrible you did not match despite having strong step scores and going to a well established caribbean medical school but I wonder if there is a red flag to your application or you selected competitive programs. I don't know how competitive psych is, I'm a surgery resident.Why did you not apply to family medicine or Internal medicine? I suppose is it easy for me to say that in hind sight, but as a caribbean graduate you don't know what will happen in the match.

    I suggest working on applying for the match this year and consider family medicine and internal medicine. Also, consider spending some time with a program you are interested in and doing research or something with them.

    Quote Originally Posted by thxleave View Post
    Article excludes the amount of DO schools out there. And the amount of residency programs that want fully trained FMGS as cheap labor for 3 years.

    Despite all this reassurance. The Caribbean choice is gone. I graduated from SGU this year. Scored 230's/220's/CS no failures. Didn't fail any of my classes, and graduated within 4 years. I applied to a 100 Psychiatry places to get 12 invites. A DO in my situation would apply to around 20 places and get 12 invites. They probably don't even take the USMLE, but instead take the inferior COMLEX. Trust me... An average on Comlex is 500, and translates to around 210s on Step 1 (which is 50%tile on Comlex to like bottom 10-20%s on Step 1) Also they do rotations at non-greenbook places at a private practice with no real training (they will brag about doing IM rotations or Surgery rotations with no calls or weekends). So at the end of all this situation, I didn't match. The majority of my places I interviewed ended up ranking DO's/US MD's higher. I know of 4 others in my situation from SGU and AUC that didn't match Psychiatry this year with similar amount of interviews. I am also a US Citizen. As of right now, I am living at my parents place, applying to jobs. BTW it's pretty tough to explain why a MD is applying for an entry job. I will be more then excited for a job now that just pays 40k a year. If I leave out my MD, I would have to explain 4 years gap in my resume.

    I don't have a problem with the Top 3 Caribbean school. The island living conditions are a lot better then what some might say. Administration, and setting up my clinical rotations was no hassle. The biggest issue is that DO's are appearing like rabbits, and they won the PR battle. A DO with 200s/210s are preferred over a SGU grad with 220s/230s. Also the DO can probably fail a test or two, and still match. We are discriminated heavily against. Some will say the only reason why we are in the Caribbeans are due to personality flaws. You score bad on the Steps... They assume that you aren't intelligent enough to be a doctor in the first place, and that's why you went to a different country for medical school. You do alright on the Steps... they assume you have personality flaws.

    I am warning people to avoid Caribbeans, not because of the school or even the quality of education. It's the huge discrimination you will receive. Sometimes people will make you feel less then human, and more akin to an animal. In my rotations I notice some malignant places know the situation you are in as a IMG, so they will treat you worse then the DO's/MD's. If the same attending treat your colleagues worse, they will report to school, and pull out of the rotation slots. As an IMG, you keep quiet, because the school is trying to maintain as much rotation slots as they can.

    Of course Heidi Chumley is going to say this on her article. It's because she is the executive dean and chief academic officer of AUC. She has a bias in maintaining the school is not falling.

    For the love of God, don't come to the Caribbean schools. It use to be you score 210's or 220's your chances of matching is solid (no guarantees of course, because nothing in life is guaranteed). Now the chances of matching is reduced, and more people are slipping. In fact I know someone with 210's not matching FM this year, all he had was 3 interviews and he applied to a 100 places, US Citizen from SGU also. No fails BTW.

    Normally I would keep quiet, but I just want to warn people out there. There are already tons of posts, but they are from Canadians that need J1 or people with failures. Well I am a US citizen with no failures, that didn't match with decent scores. Hindsight I shouldn't have done this. I should have done PA school or honestly tried for DO. Around 2012 when I matriculated it use to be SGU = DO. There was some places that preferred us, and main reason for DO was the private match. Now it's automatic DO>>>>>>>Top 3 no matter what. Even a brand new for private like RVU have a better reputation then us.

    There will be some old school IMGs that say it's still viable, but that's before DO's were this prolific. Also, you will hear some stories about some people with low scores matching, but remember... What happens when you don't match? So just a counterpoint to this article.

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