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by sarpeedo 1725 days 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/...

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.

2 comments

Doesnt the US artifically restrict the number of medical school class sizes based on availibility of residencies ?
It does. The AMA decides how many residency spots there is.
> It does. The AMA decides how many residency spots there is.

Nope. This is a common misconception.

The AAMC (which is different from the AMA) determines the number of people who can graduate from medical school each year, but as pointed out in the original article, the bottleneck is in the number of residency slots. There are already more medical school graduates than there are slots to receive them; increasing the number of medical school graduates wouldn't result in more practicing physicians.

Then who decides how many residency spots are available?
> Then who decides how many residency spots are available?

Well... Congress, essentially, by determining how much funding Medicare gets, a portion of which is allocated to funding residency programs.

Contrary to popular belief, residency programs are by and large not money-making operations (or even self-sustaining ones). If they were, hospitals would expand them! But because they lose money, the government has to subsidize them in order to encourage hospitals to run them at their current levels.

I've heard this simple explanation many times and it never makes sense. Review the EOB (Explanation of Benefits) after going to a hospital and getting examined by a resident, the bill is ~250$ for the 5min visit. Assume there is some work behind the scenes (writing scripts, reviewing charts) and one might think ~10min. That is effectively a million+ revenue center for the hospital for a resident making sub six figures, even considering 50% or more in charge-offs.

Why would the hospital restrict residency spots because of funding? Residents are wildly profitable, so that wouldnt make sense.

The explanation I'm told makes sense is this: US medical boards are unwilling to train more doctors because that would increase supply and reduce overall MD earnings. So they have a small number of openings each year, and blame the "shortage" on Congress.

> But because they lose money, the government has to subsidize them in order to encourage hospitals to run them at their current levels.

I have no doubts they are capable of losing money, on paper at least, especially when spending more means they can get a subsidy from the government.

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.
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?

He said views are skewed, not lacking evidence. Your polemic perhaps demonstrates this. However, opinions that the system is broken may also be lacking evidence. US healthcare ranks highly for outcomes that typically frighten patients. US healthcare also ranks highly by satisfaction, though it also ranks highly for pessimistic outlook. These kinds of statistics may map to what the doctors in this thread are reporting.

https://en.m.wikipedia.org/wiki/List_of_countries_by_quality...

https://www.beckershospitalreview.com/hospital-management-ad...

That's one of the benefits of having a legalized cartel (the AMA) working for you.