Blog Archive

Tuesday, October 17, 2017

Uncle Sam Wants You! / Residency Shortage





Uncle Sam Wants You! / Residency Shortage


The only way the residency shortage will resolve in a timely fashion depends on YOU!  I mean this literally.  There is a no “One” person who can effect this change before countless fully qualified doctors are “lost”.  It will take a groundswell of voices to bring this travesty to the forefront of our Nation.  We need YOUR VOICE.

 

The solution to the residency shortage will not be linear.  As you have read, some states are creating legislation to “preserve” their unmatched doctors until the number of residency slots catch up.  Some states are increasing their budgets to teaching hospitals to underwrite the addition of residency slots and the beginning of new residency programs.  Some states are allowing other health care professionals to perform services once performed only by doctors.  Some states are still “wallowing” in bureaucratic doldrums.  The solutions are a “little bit of this and a little bit of that”.

 In the meantime, thousands of unmatched doctors are dealing individually with an unimaginable “betrayal” and all that it encompasses (school loans, no career path, and despondency).  They “did” what we told them to do, and we “broke the contract”.  Ultimately, “we” will pay the price for this travesty.  Right when the baby boomers tap into healthcare the most, there will be a doctor shortage.  Forget about “preventative care”.  We will be lucky to get “reactive care” for our healthcare challenges.

 When the Balanced Budget Act of 1997 reduced the reimbursement for residencies, yet increased the number of medical schools, the resulting impact has been devastating.  “We” knew this Act was not perfect at the outset, and changes would have to be made.  Little did we know the “individual” repercussions that would ensue. 

 These unmatched doctors have worked so hard, for so many years, and at such great expense, not to be able to complete the final step in their training.  The “right hand” of Congress definitely did not know what the “left hand” was doing.  We have got to make this RIGHT! 

 
 Only your voices and those of your contacts can effect the “tsunami” needed to bring this solution to the forefront.  Please write, tweet, share, and “demand” a solution now!

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Tuesday, October 10, 2017

Second-Half Summary/ Residency Shortage








Second- half Summary/Residency Shortage


Here is the second half of the “story”:

 
  • What is the AMA doing?
  • The Nation has broken the “Social Contract”
  • 25% international medical graduates do not match, yet ECFMG has been monitoring and making recommendations to them for 60 years!
  • We want to think US Medical Schools are “better”, yet individual learning and passing of the “Criterion Task” have leveled the field.  Only fully qualified applicants are eligible to participate in the NRMP in the first place!
  • ACGME is not in favor of Missouri’s plan for Assistant Physician License, yet has not taken the lead in finding a solution
  • AMA and ACGME, two of the most influential agencies in Medical Education, are not leading in timely fashion to prevent an utter waste of human talent
  • The impending doctor shortage will be more than 90,000 doctors short in the next decade
  • Some question the legitimacy of the “Doc Shortage”.  Either the demographics are correct, or they are not!  Baby Boomers are ageing and will require even more medical care.  Is this really politics trying to use lesser trained medical professionals to provide patient care at lower costs, using physician assistants and nurse practitioners?
  • Are P.A.s and N.P.s as qualified as MDs?
  • A number of states are approaching this problem but tend to favor their own residents
  • Need a “tsunami” of outrage to solve this
  • Need action by each person concerned about this solution

Tuesday, October 3, 2017

Solve DOC Schortage State by State







Solve DOC Shortage State by State

https://www.youtube.com/watch?v=YSaPTPzTRyY

 

Until the residency deficit has been resolved, I suggest that each state “preserve” its own doctors.  Currently, the “best numerical candidates” prevail in the residency match (see previous blogs).  That would have to change. 

The tradition of Medical Education is to “reward” the “best” students.  The students with the best GPA, the best test scores, get into the most competitive schools and residencies.  It’s hard to change that mindset.  Every institution wants to attract “the best”.  Any graduate doctor who has passed the requirements of “The Match” already is “the best”.

 I recall the tuition for medical school in South Carolina 5-10 years ago.  Tuition for in-state residents was approximately $50,000/year, and out-of-state $80,000/year.  I remember thinking that if accepted to a South Carolina medical school, a student could get their education, but South Carolina would not be underwriting any part of that cost.  South Carolina would not share in the expense of a doctor’s education, only to have the graduate leave upon graduation.

 Here are the dollars that Florida has allocated to increase the numbers of residencies in the state:

  • 2013, $80 Million for recurring State and Federal funding for Graduate Medical Education (residencies)
  • 2015, additional $100 Million appropriated by Florida Legislators for “Graduate Medical Education Startup Bonus Program”
  • Program “Gives hospitals a one-time $100,000 Bonus for every new residency slot in shortage specialties” (1)
  • The first year 66 new residency positions in seven shortage specialties qualified for the bonus” (1)
  • Florida faces a shortage of 7,000 physician specialists by 2025
As described in a prior blog, Arkansas and Kansas are garnering doctors for their own states.  Their residency solutions apply only to their citizens.  Until the residency deficit is eliminated, I believe that Florida should do the same.  Florida tax dollars are providing the monetary incentives to increase the number of residencies in Florida.  So Florida residents and its unmatched doctors should benefit.  Residency selection in Florida residencies should be skewed toward residents of Florida, not using the traditional numerical ”cutpoints”.  Florida is addressing the residency shortage by allocating tax dollars to increase the number of residencies.  The State of Florida and its doctor grads should benefit from these tax dollars.  These are the doctors who plan to live, work, and stay in Florida.

(1)http://wusfnews.wusf.usf.edu/post/florida-increases-medical-residency-slots-still-faces-doctor-shortages#stream/0

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Tuesday, September 26, 2017

Slam Dunk? / Politics / Residency








Slam Dunk?/ Politics/Residency
https://www.youtube.com/watch?v=DZt3xeV_n00&t=2s

   Too many medical students, yet not enough residency slots.  Impending doctor shortage, yet “discarding” fully educated doctor grads.  Why isn’t the solution to this dilemma a “slam dunk”?  Because nothing is ever that simple.  There are the “politics” involved that complicate the solution to this deficit. 

                                                            (Bloom's Taxonomy) 

    Is there really going to be a physician shortage, or are the VA, The Affordable Care Act, and some states planning to utilize less expensive physician assistants and nurse practitioners to administer healthcare?   Josanne Page of the Cleveland Clinic said, “P.A.s generally make about half a physician salary or less, depending on specialty (an ER doctor makes an average $270,000, an emergency-room P.A. $112,000).” (1)

 “ And several states, such as Arizona, Maine, Maryland, Nevada, Vermont, and Washington have liberalized laws to enable nurse practitioners and PAs to perform some treatment normally done by doctors.” (2)  The Affordable Care Act has allowed millions more insured patients, with a shortfall of sufficient doctors to treat them.  Compared to other countries, the US has 2.5 practicing physicians per 1,000 people vs. 3.2 physicians per 1,000 for an average of 34 other countries. (3)

 Is a PA or NP qualified to see patients as effectively as a doctor?  A PA curriculum typically requires 1 year of classroom learning and 1 year clinical work.  A NP requires a 1-3 year program post graduate after obtaining a nursing degree.  Doctor training requires a minimum of 7 years after college.  The 3 doctors in my family had 7 years, 10 years, and 11 years of post college training.  The further depths of knowledge and medical experience afford a doctor a level of synthesis not attainable with lesser years of study. 

 A dermatologist I know recommended that a patient obtain a consult regarding a skin ailment, sometimes associated with pancreatic cancer( The patient returned to thank the doctor for the early diagnosis of pancreatic cancer which might have been missed under normal circumstances.)  Would a PA have known that correlation? 

  An OB/GYN doctor told a patient to obtain further diagnostics for continued lactation after cessation of breast feeding.  There is an association with pituitary tumors with uncharacteristic lactation.  The patient did end up having a pituitary tumor.  Would this have been noticed by a PA?  Often, a doctor never enters the room when a PA is seeing a patient.

     Ironically, PAs who by “definition” are “supervised” by a doctor, are allowed to work immediately after graduation.  A doctor with 4 years of medical school cannot work at all, until obtaining a license upon completion of a residency.  They can’t even work as a PA due to the stringent PA licensure rules!
 
(1) http://www.nytimes.com/2014/08/03/education/edlife/the-physician-assistant-will-see-you.html?_r=0

(2) http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/08/11/to-address-doctor-shortages-some-states-focus-on-residencies

 
(3)http://www.epi.umn.edu/mch/wp-content/uploads/2013/09/ACA-Overview.pdf

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Tuesday, September 19, 2017

Doctor Shortage / Waste





Doctor Shortage/Waste
https://www.youtube.com/watch?v=DZt3xeV_n00&t=2s

Image result for people queue images free 

 

   Let’s talk about the upcoming doctor shortage.  Here are some statistics and projections:

  • 27.6% of the current physician workforce are age 60+ years old and likely to retire in the next 10 years (1)
  • 32.6% of practicing physicians are women
  • 46.1% of residents are women
  • “Historically women have worked fewer hours than men-a trend that continues today” (2)
  • 24% of current US physician workforce are IMG (International Medical Graduates)
  • 25.9% of US “ resident” workforce are IMG
  • “By year 2025 the United States will face a shortage of between 61,700-94,700 physicians”. (3)
  • “Thousands of baby boomers are turning 65….seniors are the population with the greatest healthcare needs”. (4)
  • “The Association of American Medical Colleges (AAMC) projects there will be a shortage of between 12,500-31,100 primary care physicians in the next 10 years…equally troubling is the shortage of between 28,200-63.700 specialists.”(4)
  • More than 40,000 fully qualified doctors have not matched into a residency over the last 5 years and cannot practice Medicine without residency training.
  • 8,640 doctors did not match on March 17, 2016, what are they doing now?
  • “With medical school and residency combined, it takes a minimum of seven years to train a doctor.” (4)
What are we thinking?!!!  In view of the upcoming doctor shortages over the next decade, we are simply “discarding” our fully educated doctors!  This just does not make sense!

 

(1)   page 12

(2)   page 13

(3)

(4 )page 1

(3)   page 2

Tuesday, September 12, 2017

ACGME (Accreditation Council for Graduate Medical Education)/ IMG





ACGME (Accreditation Council for Graduate Medical Education)/ IMG
https://www.youtube.com/watch?v=hL3mwmLdMZE

Image result for maze images free     The ACGME, via CEO Thomas Nasca MD, does not support the legislation enacted in Missouri.  It deals with using unmatched doctors in underserved rural areas, supervised by a licensed physician within a 50 mile radius.  The doctors could work and reapply for a residency, while performing meaningful and necessary work until the number of residencies catches up with the deficit.  Dr. Nasca bases this belief on patient safety and quality concerns.(1)  He further states that once an unmatched doctor has gone through 2 application cycles, he/she will probably never get trained.  They will remain untrained for the duration of their career.  Dr. Nasca also infers that unmatched international medical graduates are not as smart as US grads, or they would have been accepted into a US medical school.  It sounds like Dr. Nasca is not too worried about unmatched IMGs (International Medical Graduates)!

 I can certainly see the points Dr. Nasca makes about patient safety and quality.  Yet, residency also deals with training “new doctors” under a supervisory set of physicians, albeit closer in proximity.

 However, I have a different opinion about the qualifications of the IMGs.  Two of my own children have graduated from medical schools, one a US grad and one an IMG.  As an educator and mother, I would categorize the child who went to a US medical school as “system smart”, and the one who went to an IMG as “intellectually smart”.

  The US grad decided to go to medical school 2 years after graduating from college in “Broadcast Journalism”, with an “A” average.  The IMG attended the same, very competitive university (97% of incoming freshman have an academic scholarship), intending to go to medical school from the beginning, and majored in “Cell Science/Microbiology”, obtaining a “B” average.  The US grad attended a local less competitive university for pre-med classes and got an “A” average.  The IMG grad took pre-med classes, along with a competitive pre-med science major, while at the highly competitive university, getting a “B” average.

 The US grad was accepted “Early Decision” into a medical school with 1 application.  The IMG med student was only accepted into an international med school.  Two graduates, fairly comparable intellectually, one worked “smarter” in applying for medical school, while the other majored in a subject intended to “help” in Medicine.  It pays to know the system before you begin!

 Yes, this story deals with only 2 medical students. There is a whole “continuum” of ability and IQ in MDs, some are “book smart” and some are “system smart”.  Probably all applicants wished to have gone to a US medical school.  They would not have had to deal with this residency deficit, waited heavily against IMGs.  In spite of all these points, all doctors applying through NRMP have PASSED ALL THE REQUIREMENTS!  Why shouldn’t they be allowed to complete the last step of their training!

 As CEO and spokesperson for the ACGME, I believe Dr. Nasca has a responsibility to suggest a workable solution to this residency dilemma.  Not only is a solution warranted, but leadership in this role of CEO for such a vital organization in medical education is warranted!  If such leadership had taken charge of this travesty, we would not be talking about each state enacting its own legislation.  We would not be dealing with the utter waste of human time, talent, and money.  The AMA has “adopted” a similar stance, based on Dr. Nasca’s recommendation.  So 2 of the most powerful agencies dealing with healthcare in the US are leaving it up to others to fix this bureaucratic nightmare!

Tuesday, September 5, 2017

A Tale of 3 Medical Students




A Tale of 3 Medical Students 
https://www.youtube.com/watch?v=6s1_3ZTanUg

Here’s how medical school works…The first 2 years of medical school cover the acquisition of medical knowledge.  This occurs through lectures, reading, study, and testing.  The acquisition of this knowledge occurs through individual interaction and involvement with the subject matter.  The last 2 years of medical school include monthly clinical rotations at hospitals and clinics in the subspecialty areas of Medicine.  The student treats patients under the supervision of residents, faculty, and attending physicians.  Supervised clinical practice uses the knowledge acquired from the first 2 years of school on real patients for the last 2 years.  Here are examples of how 3 real medical students approached their learning.

 “John” attended the University of Illinois Medical School in the early 1970s, earning the honorary designation of “James Scholar”.  This honor entitled him to the exclusive use of a study carrel at the medical school, and the privilege of designing his own course of study, as long as he passed all requirements and exams.  John’s method of study involved reading each medical text book cover to cover, not attending class, and graduating in 3 years.

 “Mary” attended a US medical school in the South.  Her method of study for the first 2 years was as follows.  She listened to her online class lectures at an accelerated rate of speed on her computer.  She varied her locations between her apartment, Starbucks, and Panera Bread Company.  Her clinical rotations were taken at a variety of hospitals and clinics in the greater metro area around her medical school.

 “Joe” attended An international medical school.  He attended class lectures, read, studied, and took exams.  His clinical rotations took place in the New York City metropolitan area for the last 2 years of medical school.

 These 3 students each had a different approach to the didactic portion of their medical knowledge.  The clinical rotations were a fairly uniform experience, all taken in the US.  They all graduated from accredited medical schools with an MD degree.  They all passed USMLE parts I and II.  They all applied for residency through NRMP.  Haven’t they all fulfilled their side of the “Social Contract”?  Don’t they all deserve the opportunity to complete the final step in their training? 

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