The competition for spots in medical schools may get a little less fierce over the next few years, but the competition for postgraduate residencies may be heating up. The number of federally funded residencies has remained capped since 1997, despite the expected significant increase in the number of first-year medical students by 2017.
These training positions are largely funded by the federal health care program known as Medicare. There are hardly more residency spots being created to meet the demand of new graduates. Medical organizations are pushing House of Representative and Senate leaders to create more spots to offset these challenges, but their efforts may be futile in the short term.
"We don't want to see U.S. medical grads, facing $200,000 in student loans, not be able to actually finish their training, take care of patients and pay off those loans," says Atul Grover, the chief public policy officer for the Association of American Medical Colleges.
In March the organization backed two bills introduced in the House and one in the Senate that outline a plan for adding 3,000 residency slots each year from 2015 through 2019.
At any given time there are about 120,000 medical school graduates in training to one day practice as surgeons, dermatologists, anesthesiologists and other types of doctors. Ideally, an additional 10,000 a year would be needed because of people newly insured through the Affordable Care Act, says Grover.
Even though the bills provide a compromise, they may not enact immediate change.
Health journalist John K. Iglehart wrote in a June article for the New England Journal of Medicine that efforts by the AAMC and its allies to persuade Congress to increase Medicare graduate medical education support – funding an additional 15,000 positions – were thwarted during the debate over the Affordable Care Act, and new efforts are long shots, given the emphasis on constraining government spending.
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Leaders at the American Osteopathic Association are also rallying support.
"Members of Congress might agree that we need new residency spots," says Ray Quintero, director of the department of government relations for the association. But "the cost of residency spots is quite expensive. So there's been an inability to find the funding."
The AOA brought together between 800 and 1,200 medical students, physicians and other medical professionals in March to lobby on Capitol Hill about increasing the number of residency spots. The organization plans another lobbying day in March of 2014.
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The University of Nevada School of Medicine is preparing students to get into residencies when fewer spots are available, says Ann Diggins, the school's director of recruitment and student services.
In the last few years the school has started gathering more data about the profiles of students who match in competitive residencies and using data from the National Resident Matching Program to advise students about the specialties in which they should attempt a match. That data, combined with an analysis of a student's strengths and likes, can give them a better chance at solidifying a residency match.
"Medical students want that information so they can make an informed decision," she says, noting that this kind of information from the program wasn't always available. "Some of this, I think, has driven positive changes in how we advise students."
At the School of Medicine at Oregon Health and Science University, professors are trying a variety of ways to make students more competitive residency candidates. They now receive training in topics such as informatics, which examines how information is delivered. Students are encouraged to think about how tools such as Facebook, Twitter and email factor into corresponding with patients and others in the health care community.
Residency programs have changed and what they're looking to do has changed, says George Mejicano, the school's senior associate dean for education. He says OHSU has also made changes in how it directs students in making their match selections to better increase their odds.
"It's both an advising and a curriculum process," he says.
Prospective students trying to plan their medical careers should spend time with physicians in multiple health care settings to see if being a doctor is really what they want to do, says Margo Vener, a family physician who also teaches medicine at the University of California—San Francisco. She has been advising UCSF students on their career and residency choices since 1999.
"This is an incredibly long and arduous training process," says Vener. And because it's followed by possibly a 30- to 40-year career, "training is the tip of the iceberg."
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