5 ms·

There has been angst about medical school admissions for decades. Med school admission really is the hurdle to get over in the US. There are more residency spot

There has been angst about medical school admissions for decades. Med school admission really is the hurdle to get over in the US. There are more residency spots than US MD graduates to fill them. By a wide margin. There's a strong medical education research unit in the UK (Edinburgh?); I remember one of their reports on a series of med student interviews making the observation that it was unnerving how the top performing medical students weren't the most compassionate, they were the most ruthless. I'm taking my boards soon and I have to say, the ability to commit to the task, regardless of the emotions of your self, patients, peers, support staff, and family can definitely be an asset at times. Do I hope to take a kinder view when I start working in a few months? I'm not sure kinder would be the word. Supportive of a somewhat different set of ambitions, perhaps. Unfortunately, that ability to deny the emotions of both self and other in pursuit of good clinical care is difficult to separate from 1) the punishment of self-loathing, and 2) the behavior of someone who has been rewarded too long for blind obedience.

maxerickson 9y ago
In recent years residency slots have become the bottleneck.
- killjoywashere 9y ago
  There are ~30,000 PGY-1 spots and only about 18,000 allopathic medical school graduates. (1) All the native allopaths and all the osteopaths together can't fill all the residency spots. We inhale foreign medical graduates. (1) Pages v and 14: http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Results-and-Data-2017.pdf http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Re...
  - javiramos 9y ago
    Wow surprised to see that almost half of all PGY-1 residents are foreign-trained.
    - wighty 9y ago
      That's not true, see the reply above yours for a better explanation.
    - icantdrive55 9y ago
      Doesn't surprise me in the least. They are taking the leftovers. Modern psychiatry is almost a laughable speciality. Even the best psychiatrists dole out dubious drugs; hoping the dosage is low enough to not cause serious side effects--while praying the Placebo Effect will kick in. Now the worst Psychiatrists actually believe these Pharmaceutical Reps. You spend $400k on getting through Med school--in the US. You're a serious, precise, ethical person. Why would you go into a part of medicine that's still so much of an Art? You graduate, you pass your boards, you're the king. You want to help those really at need. You find out quickly that those people have no money. You end up in the rich section of town. You kiss the right MFCC's egos. (The're on a more dubious situation than you. What they do is even more dubious. Talk therapy, and then the CBT. Then it's looking to slide into a dubious 591C3 somewhere, or invented.) If they like you, they will send you patients. O.k.--you realize those that need the most help don't have the funds. You hang your shingle in a fancy zip code. You listen to bored housewives, and hand out speed to their kids. "Exactly how am I going to make my "nut"? Oh, drag my patients in for refills, and regurgitate common sence? It no wonder the average American Scientist(yes--if you finished meds cool on the US, or equivalent country I consider you a Scientist) doesn't want to be a Psychiatryist. Especially at this point in history.
  - riahi 9y ago
    This is a bit more nuanced than this. There's 31,757 positions offered. However, if you are applying into a specialty, you apply simultaneously for a PGY1 and PGY2 position, so those people are being double counted. As a result, you need to subtract 2,677 advanced positions from the 31k positions, yielding 29,080 PGY1 + PGY2. There are 18,539 US MD applicants, but with the merger of the ACGME and COCA, DO applicants must be counted, adding 3,590 to the US graduate pile. That gives 22,129 US graduates competing for 29,080 spots. Yeah we take a lot of "foreigners" but a lot of them are actually American citizens who went to school in other countries and many of whom have US medical education debt, 5,069 in fact (look on page 1, "IMGs"). If you add in the IMGs, that's 27198 US graduates and US citizens applying for 29,080 spots. Only space for about 2000 Foreign Medical Grads. [1] - There are 5346 osteopathic graduates per year. http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Pages/osteopathic-medical-schools.aspx http://www.osteopathic.org/inside-aoa/about/aoa-annual-stati...
    - whitenoice 9y ago
      When it comes to the admission process aren't all IMG's considered the same irrespective of citizenship. So 5069 (citizens) + (x non-citizens) compete for the remaining seats (6951). Isn't that correct?
      - riahi 9y ago
        IMGs (Citizens) and FMGs (foreign nationals who went) are considered slightly differently. IMGs have the advantage of speaking English and have no potential visa issues. This distinction will matter more and more as the race for residency spots tightens and the US becomes more insular, because a lot of IMGs have US educational debt. It also matters where the person went to medical school, e.g. US citizen who went to Israeli medical school vs someone who went to the Caribbean vs an Indian national vs an Iranian national who now will have visa issues with trump. Visa issues are huge, because no one wants to match someone who can't show up for work 2 months later. These subtle distinctions are not easily sussed out by NRMP data, but the trend is that in the current era, IMGs have a slight advantage.
    - Para2016 9y ago
  - deleted 9y ago
    [deleted]
  - pak 9y ago
    So what good does increasing US medical school graduation rates do? OK, it would displace some IMGs/FMGs from residency positions, but it doesn't ultimately create more doctors. You can't be licensed to practice independently in the US unless you enter a residency, take the USMLE Step 3 after intern year, and typically you also take a specialty board exam at the end of residency. See this to understand why the bottleneck is residency positions, not how many US medical students there are: https://www.nytimes.com/2014/07/20/opinion/sunday/bottlenecks-in-training-doctors.html https://www.nytimes.com/2014/07/20/opinion/sunday/bottleneck...
- Balgair 9y ago
  The times are a' changin' Dr. Emory Brown's work out if U Mass in anesthesia is a data point for this. He claims to have a working general anesthesia machine. From the talks and data of his I have seen, it really does work. Yes, it's not good for a pediatric car accident victims, but for tonsillectomies or proctology exams, you know 'routine' general anesthesia, the thing works great. He says that he uses it in his own surgery suite with better 'results' than a human can obtain. Yeah, it's 10 years out, maybe 20. But this trend of replacing doctors with robots (and getting better outcomes) is not going away. So, that there is a current bottleneck may be true, but in the near future, we just won't need doctors for a lot of areas of medicine.
  - aconcong 9y ago
    Not if you understand what makes up anaesthesia. Control of consciousness is only one part of the intervention. Much of it is physical intervention with intravenous cannulation, intubation, extubation, ventilation management, and management of cardiovascular dynamics. Closed loop systems for sedation/unconsciousness may make inroads in the next 10 years but general anaesthesia will require physically capable robots. Doing this everyday and knowing technology and robots the capabilities are a long way away.

maxerickson 9y ago

In recent years residency slots have become the bottleneck.

killjoywashere 9y ago
There are ~30,000 PGY-1 spots and only about 18,000 allopathic medical school graduates. (1) All the native allopaths and all the osteopaths together can't fill all the residency spots. We inhale foreign medical graduates. (1) Pages v and 14: http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Results-and-Data-2017.pdf http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Re...
- javiramos 9y ago
  Wow surprised to see that almost half of all PGY-1 residents are foreign-trained.
  - wighty 9y ago
    That's not true, see the reply above yours for a better explanation.
  - icantdrive55 9y ago
    Doesn't surprise me in the least. They are taking the leftovers. Modern psychiatry is almost a laughable speciality. Even the best psychiatrists dole out dubious drugs; hoping the dosage is low enough to not cause serious side effects--while praying the Placebo Effect will kick in. Now the worst Psychiatrists actually believe these Pharmaceutical Reps. You spend $400k on getting through Med school--in the US. You're a serious, precise, ethical person. Why would you go into a part of medicine that's still so much of an Art? You graduate, you pass your boards, you're the king. You want to help those really at need. You find out quickly that those people have no money. You end up in the rich section of town. You kiss the right MFCC's egos. (The're on a more dubious situation than you. What they do is even more dubious. Talk therapy, and then the CBT. Then it's looking to slide into a dubious 591C3 somewhere, or invented.) If they like you, they will send you patients. O.k.--you realize those that need the most help don't have the funds. You hang your shingle in a fancy zip code. You listen to bored housewives, and hand out speed to their kids. "Exactly how am I going to make my "nut"? Oh, drag my patients in for refills, and regurgitate common sence? It no wonder the average American Scientist(yes--if you finished meds cool on the US, or equivalent country I consider you a Scientist) doesn't want to be a Psychiatryist. Especially at this point in history.
- riahi 9y ago
  This is a bit more nuanced than this. There's 31,757 positions offered. However, if you are applying into a specialty, you apply simultaneously for a PGY1 and PGY2 position, so those people are being double counted. As a result, you need to subtract 2,677 advanced positions from the 31k positions, yielding 29,080 PGY1 + PGY2. There are 18,539 US MD applicants, but with the merger of the ACGME and COCA, DO applicants must be counted, adding 3,590 to the US graduate pile. That gives 22,129 US graduates competing for 29,080 spots. Yeah we take a lot of "foreigners" but a lot of them are actually American citizens who went to school in other countries and many of whom have US medical education debt, 5,069 in fact (look on page 1, "IMGs"). If you add in the IMGs, that's 27198 US graduates and US citizens applying for 29,080 spots. Only space for about 2000 Foreign Medical Grads. [1] - There are 5346 osteopathic graduates per year. http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Pages/osteopathic-medical-schools.aspx http://www.osteopathic.org/inside-aoa/about/aoa-annual-stati...
  - whitenoice 9y ago
    When it comes to the admission process aren't all IMG's considered the same irrespective of citizenship. So 5069 (citizens) + (x non-citizens) compete for the remaining seats (6951). Isn't that correct?
    - riahi 9y ago
      IMGs (Citizens) and FMGs (foreign nationals who went) are considered slightly differently. IMGs have the advantage of speaking English and have no potential visa issues. This distinction will matter more and more as the race for residency spots tightens and the US becomes more insular, because a lot of IMGs have US educational debt. It also matters where the person went to medical school, e.g. US citizen who went to Israeli medical school vs someone who went to the Caribbean vs an Indian national vs an Iranian national who now will have visa issues with trump. Visa issues are huge, because no one wants to match someone who can't show up for work 2 months later. These subtle distinctions are not easily sussed out by NRMP data, but the trend is that in the current era, IMGs have a slight advantage.
  - Para2016 9y ago
- deleted 9y ago
  [deleted]
- pak 9y ago
  So what good does increasing US medical school graduation rates do? OK, it would displace some IMGs/FMGs from residency positions, but it doesn't ultimately create more doctors. You can't be licensed to practice independently in the US unless you enter a residency, take the USMLE Step 3 after intern year, and typically you also take a specialty board exam at the end of residency. See this to understand why the bottleneck is residency positions, not how many US medical students there are: https://www.nytimes.com/2014/07/20/opinion/sunday/bottlenecks-in-training-doctors.html https://www.nytimes.com/2014/07/20/opinion/sunday/bottleneck...
Balgair 9y ago
The times are a' changin' Dr. Emory Brown's work out if U Mass in anesthesia is a data point for this. He claims to have a working general anesthesia machine. From the talks and data of his I have seen, it really does work. Yes, it's not good for a pediatric car accident victims, but for tonsillectomies or proctology exams, you know 'routine' general anesthesia, the thing works great. He says that he uses it in his own surgery suite with better 'results' than a human can obtain. Yeah, it's 10 years out, maybe 20. But this trend of replacing doctors with robots (and getting better outcomes) is not going away. So, that there is a current bottleneck may be true, but in the near future, we just won't need doctors for a lot of areas of medicine.
- aconcong 9y ago
  Not if you understand what makes up anaesthesia. Control of consciousness is only one part of the intervention. Much of it is physical intervention with intravenous cannulation, intubation, extubation, ventilation management, and management of cardiovascular dynamics. Closed loop systems for sedation/unconsciousness may make inroads in the next 10 years but general anaesthesia will require physically capable robots. Doing this everyday and knowing technology and robots the capabilities are a long way away.