U R lucky, Be grateful

[fatlittlepig]

remember this: There are many people who would give anything to be in your shoes: students who didn’t get into medical school, and many physicians who don’t match. Lest you think these are marginal physicians, something tells me they are not. From Nytimes article:

https://www.google.com/amp/s/www.nyt...ctors.amp.html

Last year, the Association of American Medical Colleges released a study that found that the country would face a shortage of 54,100 to 139,000 physicians by 2033, a prospect made all the more alarming as hospitals confront the possibility of fighting future crises similar to the Covid-19 pandemic. Yet each year thousands of graduates emerge from medical schools with a virtually useless M.D. or D.O.; without residency experience, they do not qualify for licensure in any state.

Residency directors say that although they are committed to diversity and consider many factors beyond test scores, they sometimes use filters in sifting through applications because they receive thousands of applications for just a handful of spots. “Nobody has the time or desire to read this many applications,” wrote Dr. Suzanne Karan, an anesthesiologist at the University of Rochester, in a 2019 blog post. “It makes my job a lot easier when I can filter your applications by M.D./D.O./foreign graduate.”

[Turf Doc]

I agree with the post title and first paragraph.

Nevertheless, I think it's pretty misleading for the article to pretend that Caribbean grads are just "american doctors" and shouldn't have known what they were getting into. They were playing russian roulette and i feel very bad for them but that's the price when you take the easy route into med school. If US MDs were going unmatched that would be a totally different story imo. But no one can prevent predatory for-profit offshore schools from taking advantage of ignorant and hopeful premeds who, for a variety of reasons, maybe should not have been allowed on this path in the first place... and you can't force residencies to rank people who frankly have far more red flags than your average US MD or DO.

[wa2106]

Gotta agree with Turf Doc on this one. I read that article this morning and hoped it would be better but just rehashing of known issues with twist of diversity to get past NY times editorial process.

Why would they choose someone who took 7 years off in medical school as example?

Med schools should have to forgive tuition for students who don't match after 3 tries. That would fix problem. For-profit schools would be shown for what they are.

[Panscan]

I think we should find an alternate pathway for unmatched docs. It makes no sense to me how a PA/NP with an online degree can change specialties in a week but untrained physicians couldn't serve in at least a similar role. If you took a fresh PA out of PA school and a fresh untrained doc I'm not sure how the doctor would look unfavorable in that situation. I'm sure a lot of these people would take that option rather than remaining untrained.

The Carribean stuff is tough. Its essentially lighting money on fire for the vast majority, but its tough to be paternal and say don't do that, especially when a few succeed and do complete it and match.

[Panscan]

I also don't really think a 12 yr predicted shortage in physicians is significant as I assume telehealth and our whole healthcare system will probably look significantly different in 12 years and are likely beyond the scope of our predictions right now. There are a ton of efficiencies we can improve upon between now and then to provide more care without significantly increasing the boots on the ground

[ENT Doc]

I think we should find an alternate pathway for unmatched docs. It makes no sense to me how a PA/NP with an online degree can change specialties in a week but untrained physicians couldn't serve in at least a similar role. If you took a fresh PA out of PA school and a fresh untrained doc I'm not sure how the doctor would look unfavorable in that situation. I'm sure a lot of these people would take that option rather than remaining untrained.

The Carribean stuff is tough. Its essentially lighting money on fire for the vast majority, but its tough to be paternal and say don't do that, especially when a few succeed and do complete it and match.

I like this. I think they have far greater potential to take care of patients than many of the NPs and PAs being churned out.

[ENT Doc]

It’s a tragic situation that these Caribbean med school students are sold a fake bill of goods. But these problems have been going on for years. I find it hard to believe that students doing even the most basic investigation of these schools can’t find this issue brought up. I hope they aren’t getting federal aid somehow. The lack of exploration of this topic is not surprising given the undertones of the piece.

The AAMC should also be ashamed of itself. Who thought that pushing for an increase in med school spots without a known, controlled, commensurate increase in residency slots was a good idea? Thanks for the bottleneck, idiots.

All of this is based on study projections (which they have been doing for years) that fail to account for the basic fact that when a demand/supply mismatch occurs in the market the market responds in ways that are impossible to predict. Forgetting about this, however, their IHS researchers even admit that if NP/PA volume remains high we won’t have any primary care mismatch - we’ll actually have an oversupply of physicians. In all scenarios they project an oversupply of hospitalists. Do we not think they would fill in gaps elsewhere? On the surgical front, while no scenario predicts an oversupply the paradigm has been towards less surgery for things that are not elective. People want less risk, less invasive techniques, and the market supplies those solutions. Think we’ll need as many liver transplant surgeons or hepatologists due to the creation of the wildly successful HCV drugs? As many head and neck oncologists (or rad onc/onc docs) with the creation of HPV vaccines? Technology (used as a general term for medical advancements) tends to create less surgery. Think researchers aren’t working on ways to reduce expensive trips to the OR, or ways to halt atherosclerosis, reduce obesity, better address diabetes, or melt away that new cancer? Some of these efforts will fail. But some clearly won’t. The AAMC modeling doesn’t take this into account, and it can’t. I also don’t think it takes into account the shifts towards HDHP and the decreased utilization that stems from this cost shifting. And let’s say we actually are in a “doomsday scenario” where we have a demand/supply mismatch. Guess what happens? People don’t not get seen - they wait. Solutions to address population health (more effective than seeing a doctor) and get the needy people in more quickly will help to address the waiting scenario. God forbid someone should have to wait 3 weeks instead of 2 to see me because they’ve had “sinus” for 10 years.

And lastly, if I haven’t ruffled feathers already allow me to do so. The undertones in the NYT article are that if only we didn’t screen these worthwhile candidates and used diversity metrics these poor Caribbean students wouldn’t sit in the doldrums of perpetual unmatched status. This implicitly states that we need less Asians in the traditional pipelines (due to historical over representation). This is as gross as it is stupid, since it doesn’t relieve a bottleneck and makes another group wait based on the color of their skin. I will be the first to admit that we don’t have the best handle on what inputs determine quality physicians. I think standardized testing has a role, but I’ll admit it is too heavily relied upon. However, the more squishy, “holistic” metrics are extraordinarily subjective and less easily measured in a uniform manner. Finding the right balance is something we should always strive for. But pardon me if I’ll remain skeptical of “holistic” assessments when we’ve seen them used in college admissions as a means to achieve a desired outcome while overtly being racially discriminatory.

[MPMD]

this is a complex and thorny issue.

what scares me is that new medical schools continue to open up.

i really think there are significant ethical questions when you are opening a for profit medical school and not disclosing this information to students.

anyone who talks about residency application review should be very circumspect until they have done it a lot. holistic review is very difficult. each school presents applicants in a unique way some of which are fairly obscurantist. and don't misunderstand me to think that Ivy League U ruthlessly ranks and Carrib School doesn't, it's much more complex than that.

i also think the workforce issues are pretty challenging to describe and address. doctor workforces in the USA are a massive glut in some areas and critically low in others. when my wife as getting out of residency in 2015 there were no private anesthesia groups in Chicago that were even interviewing let alone hiring. this is not a problem that will be solved just by opening the tap and graduating more people with MD/DO.

[Lordosis]

It’s a tragic situation that these Caribbean med school students are sold a fake bill of goods. But these problems have been going on for years. I find it hard to believe that students doing even the most basic investigation of these schools can’t find this issue brought up. I hope they aren’t getting federal aid somehow. The lack of exploration of this topic is not surprising given the undertones of the piece.

The AAMC should also be ashamed of itself. Who thought that pushing for an increase in med school spots without a known, controlled, commensurate increase in residency slots was a good idea? Thanks for the bottleneck, idiots.

All of this is based on study projections (which they have been doing for years) that fail to account for the basic fact that when a demand/supply mismatch occurs in the market the market responds in ways that are impossible to predict. Forgetting about this, however, their IHS researchers even admit that if NP/PA volume remains high we won’t have any primary care mismatch - we’ll actually have an oversupply of physicians. In all scenarios they project an oversupply of hospitalists. Do we not think they would fill in gaps elsewhere? On the surgical front, while no scenario predicts an oversupply the paradigm has been towards less surgery for things that are not elective. People want less risk, less invasive techniques, and the market supplies those solutions. Think we’ll need as many liver transplant surgeons or hepatologists due to the creation of the wildly successful HCV drugs? As many head and neck oncologists (or rad onc/onc docs) with the creation of HPV vaccines? Technology (used as a general term for medical advancements) tends to create less surgery. Think researchers aren’t working on ways to reduce expensive trips to the OR, or ways to halt atherosclerosis, reduce obesity, better address diabetes, or melt away that new cancer? Some of these efforts will fail. But some clearly won’t. The AAMC modeling doesn’t take this into account, and it can’t. I also don’t think it takes into account the shifts towards HDHP and the decreased utilization that stems from this cost shifting. And let’s say we actually are in a “doomsday scenario” where we have a demand/supply mismatch. Guess what happens? People don’t not get seen - they wait. Solutions to address population health (more effective than seeing a doctor) and get the needy people in more quickly will help to address the waiting scenario. God forbid someone should have to wait 3 weeks instead of 2 to see me because they’ve had “sinus” for 10 years.

And lastly, if I haven’t ruffled feathers already allow me to do so. The undertones in the NYT article are that if only we didn’t screen these worthwhile candidates and used diversity metrics these poor Caribbean students wouldn’t sit in the doldrums of perpetual unmatched status. This implicitly states that we need less Asians in the traditional pipelines (due to historical over representation). This is as gross as it is stupid, since it doesn’t relieve a bottleneck and makes another group wait based on the color of their skin. I will be the first to admit that we don’t have the best handle on what inputs determine quality physicians. I think standardized testing has a role, but I’ll admit it is too heavily relied upon. However, the more squishy, “holistic” metrics are extraordinarily subjective and less easily measured in a uniform manner. Finding the right balance is something we should always strive for. But pardon me if I’ll remain skeptical of “holistic” assessments when we’ve seen them used in college admissions as a means to achieve a desired outcome while overtly being racially discriminatory.

You can get in chronic sinus patients in 2 weeks!? That is amazing.

I have no first hand knowledge but I imagine that the first 2 years are very similar to US medical school. But their rotations are a mess. They are just released and hope to find spots to get all the requirements. Similar to some DO schools. They charge a fortune and it is obvious they do not spend the money on securing an education for their students.

If we are worried about shortages in particular specialities it is easy to fix that. Just increase residency spots for the areas of need. Recruitment night help a little but it is the residency spots that are the choke point.

[Nysoz]

I have no first hand knowledge but I imagine that the first 2 years are very similar to US medical school. But their rotations are a mess. They are just released and hope to find spots to get all the requirements. Similar to some DO schools. They charge a fortune and it is obvious they do not spend the money on securing an education for their students.

If we are worried about shortages in particular specialities it is easy to fix that. Just increase residency spots for the areas of need. Recruitment night help a little but it is the residency spots that are the choke point.

From what I read from student experiences on Reddit, they learn the same material but level of support is essentially nonexistent. Also less leeway if failing any tests/sections. Combine that with living in third world conditions (students there live in similar conditions as the locals, not the island resorts we picture unless the students/parents are rich) it makes it hard to thrive.

I agree that residency spots are the rate limiting step of the entire process. Not sure if you meant it this way, but your idea made me think of my proposed solution. Create residency spots in areas of need like rural areas and such. Combine that with some sort of contractual obligation to stay in the area for x years. They can still travel to a bigger hospital for exposure to other pathology as part of their rotations. Then after x years maybe they grow their roots and stay. If they choose this route the big urban trauma center may not want to hire them after their required stint but it’s better than being unmatched with heavy debt and no prospects. Also likely better than independent NPs/PAs.

[Tim]

For profit DO schools and Caribbean medical schools have been and will be an issue. The drastic difference between the acceptance rates of different programs are not due to "filters". This is not a new problem, just an article that seems to imply that qualifications and achievement do not matter.
90% match rate vs 60% match rate.

40% of the graduates need an alternative career path. I put that on the private med schools. It is unreasonable to think residencies will create a mission to find the diamond in the rough. Smart thing would be to screen out the 40% before they get the student loans. But that would cut into the number of paying customers not getting value for their efforts and money. Honestly, to an extent they are admitting MS students that they have indicators that failure is likely. Failing licensing exams is not a good indicator.

I personally know a friend that did a masters in something and the Caribbean training route and matched. The 60% success rate seems appropriate, unfortunate but appropriate.


https://mk0nrmp3oyqui6wqfm.kinstacdn...ata_2020-1.pdf

[CordMcNally]

I agree that residency spots are the rate limiting step of the entire process. Not sure if you meant it this way, but your idea made me think of my proposed solution. Create residency spots in areas of need like rural areas and such. Combine that with some sort of contractual obligation to stay in the area for x years. They can still travel to a bigger hospital for exposure to other pathology as part of their rotations. Then after x years maybe they grow their roots and stay. If they choose this route the big urban trauma center may not want to hire them after their required stint but it’s better than being unmatched with heavy debt and no prospects. Also likely better than independent NPs/PAs.

It isn’t quite that easy. You’re going to train inferior physicians. EM has been opening residencies left and right in hospitals that have no business with a residency. If we continue down this path of not placing emphasis on good training then the mid levels are really going to take advantage of that.

[Panscan]

More residency spots doesn’t mean people will go rural or to in need areas. They have to be incentivized, ie with money or loan forgiveness. Until that happens the vast majority of people will be simply uninterested . Brute force numbers approach is the worst way to address the issue IMO which I think will look significantly difference in 10 years namely due to telehealth.

If you can get labs, a scan and be seen by a specialist via telehealth I would say that can address a huge majority of issues. Let’s face it physical exam is unnecessary for a large amount of medical issues. There is also some degree of harm involved, ie for every “splenomegaly “ that is palpated and we do a study that shows it’s normal(the majority in my experience), there are costs and radiation doses associated. There’s a NNT just like everything else.

[Panscan]

For profit DO schools and Caribbean medical schools have been and will be an issue. The drastic difference between the acceptance rates of different programs are not due to "filters". This is not a new problem, just an article that seems to imply that qualifications and achievement do not matter.
90% match rate vs 60% match rate.

40% of the graduates need an alternative career path. I put that on the private med schools. It is unreasonable to think residencies will create a mission to find the diamond in the rough. Smart thing would be to screen out the 40% before they get the student loans. But that would cut into the number of paying customers not getting value for their efforts and money. Honestly, to an extent they are admitting MS students that they have indicators that failure is likely. Failing licensing exams is not a good indicator.

I personally know a friend that did a masters in something and the Caribbean training route and matched. The 60% success rate seems appropriate, unfortunate but appropriate.


https://mk0nrmp3oyqui6wqfm.kinstacdn...ata_2020-1.pdf

The effective match rate would be way lower if you also included the numerous people the Caribbean schools weed out in first couple years before they ever get to rotation and matching stage. Would likely be 30% or less. Essentially looking at things from an intention to treat angle.

[Lordosis]

Some of the fault is on the students. When you have a bad marginal gpa and or MCAT and you cannot get into a US medical school they should know that they are taking a huge risk.

It is taking out a half million dollar loan with a 50% chance of having a job at the end. (I am not sure if those numbers are accurate but I cannot be far off). People think that it cannot happen to them and they will have the job.