[asdfj999]

ACGME reducing supply hasn't been true for at least 10 years. Medical schools and residency positions are exploding and quality of training is decreasing. Medical schools are now finding it hard just to place their students into adequate clinical rotations because hospitals are saturated with learners. Despite that, we even have to bring in more than 5,000 international physicians every year just to fill the available residency positions because there literally aren't enough American graduates. Meanwhile, reimbursements keep getting cut and physician liability increases.

[spacemadness]

You’re confusing me here. The hospitals are overloaded with learners but there aren’t enough graduates?

[asdfj999]

Both can be true at the same time. Just some rough numbers.

There are approximately 30,000 American medical graduates each year. There are about 40,000 residency spots per incoming class each year. Both of these numbers continue to go up at least several hundred per year, it's just that always residency spots > American graduates. That answers the "not enough graduates" question.

Each year, that 10,000 resident surplus is filled with approximately 4,000 US citizens who went to international schools and 6,000 non-US citizens who went to international schools.

Now for hospitals being saturated with learners. There are at least 162,000 residents and fellows and 60,000 medical students (3rd and 4th year students) in total in the hospitals, not counting students in other disciplines such as nursing, physician assistant, etc. That means there are at least 222,000 residents/fellows/medical students in the hospitals. I am saying that to accommodate 222,000 learners getting enough exposure to all the nuances of medicine is extremely difficult and, as medical schools continue to grow, many schools are finding it hard to place students into environments with adequate opportunities to learn.

I'm a doctor. When I was in medical school, I literally had to call and send applications begging other physicians to take me as a student, otherwise the school threatens to dismiss you for not meeting graduation requirements. Many students don't have that problem, however many do and the number is increasing. It is just very hard to scale massively complex infrastructure while maintaining quality.