Monday, December 07, 2009

The New American Medical School Challenge

Nature abhors a vacuum.

And no where is this more clear than residency slots in Internal Medicine.

Today, I learned some interesting statistics that should alert medical students applying to residency programs across the country.
  1. Surprisingly, applicants to our categorical residency program is up 15% this year.

  2. The number of foreign medical graduate students to this year's applicant pool has increased 50% over last year.
In short, the medical marketplace for doctors is becoming a global one, and the need to support current salary levels is likely to erode in the not-so-distant future.



Anonymous said...

dr wes
could you expand on the post you made? i cannot follow the logic you used to reach your conclusions.

DrWes said...

anony 01:20 pm-

The data I report are from one institution, ours, that was shared with me today before I sat and interviewed a few of the applicants.

The thoughts here are mine, and should not be construed as representing perspectives or numbers as reported by the AAMC.


Anonymous said...

'need to support current salary levels'--whose salary levels are you referring to? the number of graduates are the same, no? how would the composition of trainees affect salary levels?

DrWes said...


While the number of residency spots is fixed now, with the potential new influx of 30+ million new patients to our health care system, the need for primary care specialists will grow. The capitation models being proposed ("Accountable Care Organizations," "medical homes," bundled payments, etc.) for physician reimbursement are likely to become the norm.

Although I do not want to sound a doomsday alarm, as doctors increasingly become employees to hospital systems and primary care continues on its path to commoditization, the ability for young doctors to bargain for higher salaries will be difficult because the supply of foreign medical graduates willing to work for relatively lower salaries and fill the gaps seems virtually limitless.

Keith said...


So you finally agree with me!?

Having seen what outsourced labor from India has done to salaries in IT, it is not a too large a leap to see the same happening to the medical profession, with plenty of willing Indians and Pakastanis willing to work for a fraction of what doctors here make. If medicine becomes institutionalized and run by administrators hiring docs to work for salary, it will only be a matter of time before they start whittling down the salaries of specialists. The only hope is to do what some specialties manage to do, which is limit the number of residency slots so to create a constant shortage of their particular specialty (see dermatology and orthopedics). We are probably training too many cardiologists presently, given what seems to be less need for angiography and stenting, which may be why the goverment feels it can pick on cardiology services. It is called the law of supply and demand and the medical profession will not remain immune to this phenomena. But the good news is that it may decrease our health care costs in the long run. The question you have posed in the past is will it cause a decrease in quality? That remains to be seen.