<p>An interesting perspective pointing out the need for states with low per-capita physician numbers to increase their GME funding. </p>
<p>The</a> Residency Mismatch</p>
<p>…where $$$ will come from?</p>
<p>Interesting but the article didn’t say how much more money was needed. This is, in my opinion, a major failing of ACA. Billions of dollars in setting up insurance exchanges and providing subsidies and nothing for training more doctors.</p>
<p>Well, Philip Longman, demographer and economist, argues that hospitals that don’t produce primary care physicians (like JHU, WUSTL, Mass General plus another 155 hospitals that receive the lion’s share of federal medicare funding) should have their federal support reduced or eliminated, and those funds redirected to hospitals that do train primary care docs.</p>
<p>[When</a> the Best Hospitals Are the Worst - James Hamblin - The Atlantic](<a href=“When the Best Hospitals Are the Worst - The Atlantic”>When the Best Hospitals Are the Worst - The Atlantic)</p>
<p>I also heard of an argument that there are no lack of physicians; the real problem is the distribution of physicians.</p>
<p>I’d argue that if the role of primary care doctors is going to be supplanted by physician’s assistants that triage the patients and then determine whether or what specialist they need to see, then hospitals that produce specialists are what is needed. </p>
<p>The article also didn’t say how many U. S. trained physicians cannot practice due to lack of residency spots. Would limiting the access of foreign trained physicians to those spots free up enough residency positions?</p>
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<p>That’s already happening. US MD and DO students are very heavily favored in the residency match process. </p>
<p>As for the number of unmatched US seniors–the number is quite small, ~3%. 528 US seniors were unmatched after SOAP this spring. </p>
<p><a href=“http://www.nrmp.org/pressreleasepostmatch2013.pdf[/url]”>http://www.nrmp.org/pressreleasepostmatch2013.pdf</a></p>
<p>PAs are very knowledgeable, one appointment that we had few years ago with my D. impressed me much more than the MD that PA was working for. PA was much more aware, listened better, knew axactly what the problem was (very very unusual also, some skin conditioned developed during vacation in Mexico), prescribed the correct medicine and was very young. Unfortunately, I did not see her anymore. I said unfortunately, because I much rather have this PA at my every appointment than her not impressibe boss (MD). BTW, I am talking about family physician office, not dermatologist. You cannot get into dermatologist without waiting for 3 month and it is going to get worse</p>
<p>What happens to the unmatched seniors? Can they become primary care physicians? Can they go into the match in subsequent years? Do they work for industry in pharmaceuticals or medical devices?</p>
<p>^They scramble (according to my D.), not sure if I spelled it correctly.</p>
<p>People who go unmatched get notified on Monday (match day is Friday). They then use SOAP to land a unfilled position in whatever specialty has open spots.</p>
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<p>The short answer is essentially zero today and in the near future. </p>
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<p>The growing US med school grads will supplant foreign medical grads for GME slots. Of course, that may not address the issue of primary care, but US trained physicians will still be able to find a residency.</p>
<p>btw: I concur with tatin in that over time, primary care will be delivered primarily by PAs. (It will be an inevitable result of cost-cutting.)</p>
<p>They can try again later if they don’t get something that year with SOAP ([National</a> Resident Matching Program - Wikipedia, the free encyclopedia](<a href=“National Resident Matching Program - Wikipedia”>National Resident Matching Program - Wikipedia)). If you’re ok with being a FM physician anywhere in the country, your odds of not finding a sop as a US MD are probably way less than even 3%. I imagine most of the unmatched applicants from US schools are people who set their sights too high (e.g. only applying to plastic surgery programs or only applying to top medicine programs), not people who are simply unable to match anywhere.</p>
<p>I’m sure people do jobs in other industries although the only people I know who did that straight after med school did it without even attempting to match. I don’t know them well enough to know whether it was truly “by choice” or maybe they were dissuaded from trying. Judging by the professions though, (one is a USMLE and shelf exam tutor making over $100/hour and the other is going to work for Dr. Oz’s show) I’m guessing they would have matched if they tried.</p>
<p>I believe you have to do 1 year (which is very easy to land) to take Step 3 and get a license to practice however you won’t be able to be board certified in any specialty (including primary care ones) which will obviously hurt your ability to be hired anywhere.</p>
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<p>Others may have specific geographical requirements due to family situations (spouse, kids, etc.) which will not allow them to relocate.</p>
<p>"I imagine most of the unmatched applicants from US schools are people who set their sights too high "
- or simply being stupid when it actually matters the most…like being ranked #1 and go only to 3 interviews for DERM!! This is actual life example, yes, #1 rank and a great everything else DOES NOT guarantee anything if you decided being basically arrogant and stupid and the end…but I believe that she scrambled, where, I do not know…but a good lesson for all here, stay humble, stay on a ground…all the way, nobody is immune to failure</p>
<p>Speaking of Medicare, ;)</p>
<p><a href=“https://www.aamc.org/advocacy/washhigh/highlights2013/350196/072613energyandcommercesubcommitteemovesforwardsgrrepeal.html[/url]”>https://www.aamc.org/advocacy/washhigh/highlights2013/350196/072613energyandcommercesubcommitteemovesforwardsgrrepeal.html</a></p>