Long Island Business News
Med School Grads Face Residency Shortages
By Claude Solnik
July 1, 2013
Featuring:Dr. Andrew Yacht, Chief Academic Officer, Hofstra North Shore-LIJ School of Medicine
Rising medical school enrollment and waning federal aid have created a shortage of residency positions for graduates, leaving some with mountains of debt and no shot at an internship.
Historically, nearly all graduates from U.S. medical schools have landed residencies, formally known as graduate medical education and a requirement for a medical license.
The glut of graduates follows a 2006 decision by theAssociation of American Medical Colleges to end a moratorium on approving new schools.
Since then, the number of U.S. medical schools has increased from 125 to 141, including 12 granted preliminary or provisional accreditation. Seven more schools are in the works.
Almost 26,000 students are currently enrolled, a jump of 30 percent since the decision to expand.
The number of residencies has remained flat at about 100,000, however, with 25,000 positions opening each year. As a result, more than 525 U.S. medical school graduates, including some seeking residencies in general surgery and emergency medicine, were turned away this year.
“That’s incredibly unusual,” said Dr. Frederick Schiavone, vice dean for graduate medical education at Stony Brook University School of Medicine. “For the first time in the history of the United States, residents are not getting jobs after they complete medical school. That happens in other countries. It never happened in the United States.”
While there are no signs of flagging enrollment at medical schools, there are clear signals that federal support for residency programs may have peaked.
Congress did not approve proposals last year that would have added 15,000 positions to the program, which already costs taxpayers $9.5 billion annually. Two pending bills are also considered long shots.
Additionally, the Obama administration is seeking cuts in federal support for graduate medical education of $11 billion over a decade.
“The government is hard pressed to put more money into the system, to open up more residencies,” said Dr. Andrew Yacht, chief academic officer at the Hofstra North Shore-LIJ School of Medicine. “I’m not sure hospitals want to be in the business of training, unless they’re reimbursed. It costs a lot of money.”
A further burden on residency funding: Thousands of medical students who studied abroad, about half of them U.S. citizens, who seek post-graduate work in America.
In many cases, foreign graduates have more advanced degrees and greater clinical exposure and experience, according to Yacht, suggesting residency programs will face tough choices.
“The large cohort of international medical school graduates who seek U.S. training positions every year will be in even greater jeopardy,” wrote John K. Iglehart in a New England Journal of Medicine article titled “The Residency Mismatch.”
Even those educated in the United States will feel the heat of competition as graduating classes continue to grow.
“The competitiveness will increase,” said Wolfgang Gilliar, dean of NYIT’s College of Osteopathic Medicine. “Therefore, students will have to adjust their first or second choice and may have to consider residencies and specialties they might not have otherwise.”
To increase the odds of getting graduates into the residencies they want, local medical schools have begun offering training and mentoring to help students pass medical board tests on the first attempt, and with higher scores.
“We believe that’s an important part of our mission,” Stony Brook’s Schiavone said. “We’re on a road for great preparation to give them the most tools they can have to be competitive.”
But with medical school debt hovering near $170,000 – the median for graduates in 2012 – some would-be physicians may simply elect a different career path.
“I’m not saying that will happen for everybody,” Yacht said. “But for those who know exactly what they want to do, if they feel like they’ll make this huge investment and not get their choice, some really talented people may not go into the field at all.”