Today’s New York Times carries an article about the expansion of the US medical education system, with an additional two dozen schools opening or expected to open over the next several years. While this increase in the number of medical school slots is needed, the article fails to address the other, likely more important, component that limits the number of US physicians; that is the number of US residency positions.
Once a student graduates from a medical school he is a doctor, however he is not able to enter practice as a physician. To practice, graduates must apply to and be accepted into a residency program that will train them for an additional three years in whatever subspecialty they have chosen. Currently there are 22,427 PGY-1 spots, 23,343 US applicants, and 46,309 foreign med grad applicants. This means that any increase in medical school enrollment will create increased competitiveness for residency spots, but no actual increase in the annual production of practicing physicians
These new schools claim that they will be more focused on educating primary care physicians, and while they may do quite a bit to encourage their students to seek primary care residencies, the type of doctor a student becomes is not determined by their medical school training, it is determined by their residency. If the US wished to shift the proportion of physicians entering primary care, they would need to expand the number of training spots for family practice, OB/GYN, internal medicine, and general surgery, however even then, the graduates of those programs would be free to enter fellowship training to become subspecialists.
The article goes on to make a few other comments about expanding care with nurse practicioners and physicians assistants and while these providers are a useful tool, they are not a replacement for doctors and should not be treated as such. Hopefully the AMA and other policy makers will soon address the real rate limiter in medical education and expand residency training positions so that we can finally see an increase in the number of practicing doctors. Until then, we’re only putting a band aid on a much larger problem.
[...] it was a 10% increase over the previous class size. As my esteemed co-author already pointed out in a previous post, this increase in graduating medical students has not been met by a coinciding increase in [...]
By: One week until Rank Order Lists are due: Most competitive match ever? « 4 Years + on February 17, 2010
at 20:38