5 ms·

I have not read the PDF report, but I agree with the title that the residency matching system in the US needs to be fixed. My wife is a current resident in the

I have not read the PDF report, but I agree with the title that the residency matching system in the US needs to be fixed. My wife is a current resident in the US and she graduated from a medical school in SE Asia. She spent tens of thousands of dollars on exams, observerships (yeah, one has to pay to observe at the hospitals and there are only a handful of them that accept observers; there are a few clinics that take money for observerships), unpaid volunteering, unpaid research, and travels. All of that to make her resume stronger so that she can have a better chance at *residency lottery*. Worse, the residency spots are sometimes decided by internal contacts/introductions--just like a regular job. If one's year of graduation is higher than 5, it becomes much harder to get a residency match. Every year, we are leaving behind some perfectly qualified medical doctor candidates in the convoluted, costly and unnecessarily-restrictive system. No wonder doctors in the US expect to make way above what doctors in other developed countries make because of the artificially tough road they have to traverse to become professional doctors in the US. This, in turn, affects (increases) the health care cost that we have to pay when we go see doctors. In summary, it should not be that difficult to become a general (internal medicine) doctor in the US. Actually, I'd go as far as to say that it should not be that difficult to become a doctor of any specialty except a handful like (neuro/orthopedic/opthalmic/cardiac/general) surgeons. A lot of other developed countries (or countries like India, which produces very capable medical doctors) do away with residency bullshit. There must be something that the US can do to make hopeful residents' lives easier.

fallingknife 5y ago
It also selects for being good at jumping through the arbitrary hoops of school / bureaucracy over intelligence. The results of this are apparent to anyone who has had to deal with the medical system in the US.
- MattGaiser 5y ago
  That probably correlates with intelligence. It is a waste of intelligence, but it certainly requires it.
  - fallingknife 5y ago
    Maybe, but the smartest people I know all rabidly hate bureaucracy and credentialism. And if you're smart, why not go into finance / tech instead? No education requirements past college, and you can start earning good money immediately out of school. You even get a decent work life balance in the case of tech.
    - rscho 5y ago
      Because, as difficult to believe as it may be to some people, some people are not all about money since the beginning. Some remain idealistic well into their thirties and earn a medical degree. Once you've got it though... that's when it starts to be difficult to stay idealistic and optimistic.
      - lotsofpulp 5y ago
        They probably should significantly be about the money considering they will likely be entering their 30s with a few hundred thousand dollars of debt. Staring down the barrel of spending your 20s doing arduous, stressful work while your friends have fun, passing prime relationship building years, entering into final childbearing years...not much room for idealism once reality hits.
        nicoburns 5y ago
        No, we probably ought to have a system where they don't need to be.
    - MattGaiser 5y ago
      > No education requirements past college No formal ones. But you better keep up. I know a few med people and a big one for them is risk aversion. Medicine never has a recession. There will never be a glut of doctors. You don’t need to job hunt every 2 years.
    - gnarcoregrizz 5y ago
      > No education requirements past college leetcode. gotta keep up even if you're 15 years deep in the tech industry
sarpeedo 5y ago
From the perspective of a US MD Medical Student. While the match system is certainly imperfect the numbers and points the report makes are either misleading or downright wrong. First, the match rates they reference are pre-soap numbers. In reality, the majority (~99%) of US trained medical students do match somewhere. Second, there are more positions (~38,000) than there are MD graduates (~32,000). Most of these positions are in primary care (Pediatrics, Internal Medicine, Family Medicine) (~17000). Third, most of the unmatched physicians in this country are either US citizens who had to train internationally or foreign citizens who are attempting to gain US certifications. Lastly, NRMP is actually extremely transparent with match data; this reference backs up my claims: https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2021/05/MRM-Results_and-Data_2021.pdf https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/... From my perspective the issues with the match system are below: 1. Application Fever. The average applicant applies to 50-80 programs (depending on specialty) to guarantee matching. 2. Useful work hours. Many residents work 60-80 hours a week with much of this work being scut work rather than useful learning. 3. Low salary and benefits relative to training. Residency salaries are between 50k-70k annual which can be extremely difficult for families living in NYC or SF. 4. Inability to quit or switch programs. Many residents also don't have too much choice in residency location. In Washington State for example the residency positions available are extremely limited.
- rscho 5y ago
  As a foreign medical grad, I agree 100%. Many people who are not med grads unfortunately do have completely skewed views of both our education and practice and are often thoroughly convinced to know everything about us. Strong opinions strongly held.
  - ebiester 5y ago
    Many people who receive health care in the US have strong opinions that it is broken. That is, it is expensive compared to other industrialized countries. It requires sick people to own their health journey in a way other countries would find absurd. The experience of being at a doctor for anything but a basic malady is immensely frustrating. So, there's a definite problem compared to other industrialized countries. And it seems like the supply is artificially constricted which exacerbates the problem. From there, it's speculation. But which part of the above is missing evidence?
throwthere 5y ago
Isn't this more a problem with the residency programs' (right or wrong) perception of your wife's qualifications?
- programmertote 5y ago
  Partly true. It's because my wife is an international medical graduate (IMG), so she had to do a lot more work than local (US) grads to show that she is qualified. Having said that, the local grads don't have it easier if you read the comments in this post. I have a few US friends who were pre-meds and are now professional doctors. I know that they had to put a lot of effort to signal to the programs (e.g., research publications, volunteering at big-name clinics/hospitals, etc.) that they are worthy of the residency training (at competitive programs of course).
bobowzki 5y ago
While I agree with you in principle, I'd like to point out that it's a falasy to believe one specialty is more difficult than another (I'm and anesthesiologist).
- programmertote 5y ago
  What I meant was that for specialties that require more hands-on, emergency (life or death situation) practice such as cardiac/neuro/ortho surgeons (including anesthesiologists because they are part of the surgical teams), we should not allow anyone to easily get licenses (I will not be the judge of whether the current amount of training required for these specialists is enough or not to folks with better knowledge). Most of all, I believe that we can train capable internal medicine/primary care doctors in just 5-6 years instead of 8+3 years that is required now.
  - rscho 5y ago
    'Hands-off' specialists (oncology, immunology etc.) need as much training and practice as a surgeon does. Internal medicine especially so, since they're the hospital's backbone. You break them, you break everyone else. The difference is in the education period: if you're in a 'hands-on' specialty, your level will be very dependent on the quality of your program. For more theoretical specialties, you are the main determinant of your final level. Anesthesiologist here, FWIW.

fallingknife 5y ago

It also selects for being good at jumping through the arbitrary hoops of school / bureaucracy over intelligence. The results of this are apparent to anyone who has had to deal with the medical system in the US.

MattGaiser 5y ago
That probably correlates with intelligence. It is a waste of intelligence, but it certainly requires it.
- fallingknife 5y ago
  Maybe, but the smartest people I know all rabidly hate bureaucracy and credentialism. And if you're smart, why not go into finance / tech instead? No education requirements past college, and you can start earning good money immediately out of school. You even get a decent work life balance in the case of tech.
  - rscho 5y ago
    Because, as difficult to believe as it may be to some people, some people are not all about money since the beginning. Some remain idealistic well into their thirties and earn a medical degree. Once you've got it though... that's when it starts to be difficult to stay idealistic and optimistic.
    - lotsofpulp 5y ago
      They probably should significantly be about the money considering they will likely be entering their 30s with a few hundred thousand dollars of debt. Staring down the barrel of spending your 20s doing arduous, stressful work while your friends have fun, passing prime relationship building years, entering into final childbearing years...not much room for idealism once reality hits.
      - nicoburns 5y ago
        No, we probably ought to have a system where they don't need to be.
  - MattGaiser 5y ago
    > No education requirements past college No formal ones. But you better keep up. I know a few med people and a big one for them is risk aversion. Medicine never has a recession. There will never be a glut of doctors. You don’t need to job hunt every 2 years.
  - gnarcoregrizz 5y ago
    > No education requirements past college leetcode. gotta keep up even if you're 15 years deep in the tech industry

sarpeedo 5y ago

From the perspective of a US MD Medical Student. While the match system is certainly imperfect the numbers and points the report makes are either misleading or downright wrong. First, the match rates they reference are pre-soap numbers. In reality, the majority (~99%) of US trained medical students do match somewhere. Second, there are more positions (~38,000) than there are MD graduates (~32,000). Most of these positions are in primary care (Pediatrics, Internal Medicine, Family Medicine) (~17000). Third, most of the unmatched physicians in this country are either US citizens who had to train internationally or foreign citizens who are attempting to gain US certifications. Lastly, NRMP is actually extremely transparent with match data; this reference backs up my claims: https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2021/05/MRM-Results_and-Data_2021.pdf https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/... From my perspective the issues with the match system are below: 1. Application Fever. The average applicant applies to 50-80 programs (depending on specialty) to guarantee matching. 2. Useful work hours. Many residents work 60-80 hours a week with much of this work being scut work rather than useful learning. 3. Low salary and benefits relative to training. Residency salaries are between 50k-70k annual which can be extremely difficult for families living in NYC or SF. 4. Inability to quit or switch programs. Many residents also don't have too much choice in residency location. In Washington State for example the residency positions available are extremely limited.

rscho 5y ago
As a foreign medical grad, I agree 100%. Many people who are not med grads unfortunately do have completely skewed views of both our education and practice and are often thoroughly convinced to know everything about us. Strong opinions strongly held.
- ebiester 5y ago
  Many people who receive health care in the US have strong opinions that it is broken. That is, it is expensive compared to other industrialized countries. It requires sick people to own their health journey in a way other countries would find absurd. The experience of being at a doctor for anything but a basic malady is immensely frustrating. So, there's a definite problem compared to other industrialized countries. And it seems like the supply is artificially constricted which exacerbates the problem. From there, it's speculation. But which part of the above is missing evidence?

throwthere 5y ago

Isn't this more a problem with the residency programs' (right or wrong) perception of your wife's qualifications?

programmertote 5y ago
Partly true. It's because my wife is an international medical graduate (IMG), so she had to do a lot more work than local (US) grads to show that she is qualified. Having said that, the local grads don't have it easier if you read the comments in this post. I have a few US friends who were pre-meds and are now professional doctors. I know that they had to put a lot of effort to signal to the programs (e.g., research publications, volunteering at big-name clinics/hospitals, etc.) that they are worthy of the residency training (at competitive programs of course).

bobowzki 5y ago

While I agree with you in principle, I'd like to point out that it's a falasy to believe one specialty is more difficult than another (I'm and anesthesiologist).

programmertote 5y ago
What I meant was that for specialties that require more hands-on, emergency (life or death situation) practice such as cardiac/neuro/ortho surgeons (including anesthesiologists because they are part of the surgical teams), we should not allow anyone to easily get licenses (I will not be the judge of whether the current amount of training required for these specialists is enough or not to folks with better knowledge). Most of all, I believe that we can train capable internal medicine/primary care doctors in just 5-6 years instead of 8+3 years that is required now.
- rscho 5y ago
  'Hands-off' specialists (oncology, immunology etc.) need as much training and practice as a surgeon does. Internal medicine especially so, since they're the hospital's backbone. You break them, you break everyone else. The difference is in the education period: if you're in a 'hands-on' specialty, your level will be very dependent on the quality of your program. For more theoretical specialties, you are the main determinant of your final level. Anesthesiologist here, FWIW.