Blog Archive

Thursday, March 2, 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

http://nomatchmds.blogspot.com/
 

Tuesday, February 28, 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

Monday, February 27, 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!