From the land of choice, there may be less, for doctors at least

by reestheskin on 14/12/2015

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From the land of choice, they may be less (NEJM). The issue: with expansion of med schools, there might not be enough residency slots ( a problem we are sort of seeing in the UK).

Potential effects on U.S. graduates have many members of the educational community worried, and this concern has been passed on to medical students through authoritative warnings that they may have trouble securing residency positions and that their choice of specialties will be severely curtailed. Congress’s unwillingness to legislate more Medicare GME funding is often cited as the reason for the perceived squeeze. The positions actually available and the trends reviewed here do not bear out this interpretation. The primary goal of public GME support, it should be noted, is to produce trained physicians to meet the country’s health care needs and not to fulfill the personal preferences of individual graduates for the specialties of their choice. Although the GME gap will narrow slowly, it appears likely that there will be ample positions for all U.S. graduates over the next decade. It would seem difficult to argue that Congress should fund more GME positions in order to create a larger margin for U.S. graduates. Disquiet among medical educators is understandable, but we believe that anxiety among students should not be amplified by well-meaning student advisors or national organizations.

I do not know enough of the economics of all of this, but I am puzzled as to why so much subsidy of ‘training’ is required. I find it hard to imagine that there are easy alternatives to what many junior docs do — even when you factor in the part of their jobs when they are learning or been explicitly surplus to service. I just wonder if this is rigging of the market by the medical certification lobby and, in the UK at least, the NHS monopoly of training and certification. Back of the envelope calculations would made me suspect that our (dermatology) trainees are grossly underpaid (compare what they deliver in the NHS, with their superior skills, to what some medics attract in the badlands of some private highstreet  dermatology).