THAT IS WHAT WALL STREET GLOBAL CORPORATE HEALTH SYSTEMS WILL DO AS THEY PRETEND TO INCLUDE EVERYONE IN THESE HEALTH POLICIES.
'Third, we aim to accelerate the availability of information to guide decision making. The Obama administration has led a major initiative in health information technology (IT), focusing on the adoption of electronic health records (EHRs) and their meaningful use as a central avenue for transforming care. The proportion of U.S. physicians using EHRs increased from 18% to 78% between 2001 and 2013, and 94% of hospitals now report use of certified EHRs'.
As American doctors leave in high numbers and as US citizens are being pushed out of developed nation health care and into a gutted of funding MEDICAID FOR ALL----you see these Affordable Care Act health institutions writing all these policies will say----oh, well we need to use technology to reach those pesky patients with chronic illness, old age, not enough money to pay cash for ever-rising health care. They are building the environment to justify citizens' need to be connected to outsourced and telemedicine-only health care. Why would a developed nation have this kind of doctor's shortage? A few decades of medical school too expensive to access, US doctors being folded into the largest global health tourism hospitals like Hopkins. This is to where most Veteran's Administration doctors were moved.
AS FAR-RIGHT BURWELL AND THE 1% WALL STREET GLOBAL POLS STATE THIS IS ALL ABOUT EFFICIENCY AND EFFECTIVENESS FOR PATIENTS----MEDICAL PROFESSIONAL ARE SAYING THEY NEVER NEEDED ANY OF THIS.
Doctor shortage, increased demand could crash health care system
By Jen Christensen, CNN
Updated 5:37 PM ET, Wed October 2, 2013
Some doctors worry patients who can't get in to see primary care physicians will clog up hospital emergency rooms.Story highlights
- Approximately 48 million people are currently uninsured in the United States
- There is a physician shortage, and experts say more primary care doctors are needed
- When Massachusetts mandated health insurance for residents, wait times increased
- Technology, team care may help in handling the influx of patients, doctor says
Obamacare is expected to increase patient demand for medical services. Combine that with a worsening shortage of doctors, and next year you may have to wait a little longer to get a doctor's appointment. And the crowded emergency room may become even more so.
There are approximately 48 million uninsured people in the United States. When the mandatory insurance rules of Obamacare kick in next year, and a couple dozen states expand who is eligible for Medicaid, you can bet more people are going to want to use their health benefits.
In fact, so many people were anxious to get access to health insurance -- many for the first time -- when the insurance marketplaces opened Tuesday, more than a dozen of the websites experienced technical glitches.
Obamacare open enrollment: Everything you need to know
Dr. Ryan A. Stanton is worried that this coming flood of newly insured patients may crash the U.S. health care system as well. Stanton works at the emergency room at the busy Georgetown Community Hospital right outside of Lexington, Kentucky.
While he sees trauma cases often, a good number of the patients he sees don't involve trauma. They're the uninsured who can't afford to pay for a regular doctor's visit -- so they use the emergency room instead.
"People turn to the ER because they have no other place to go after hours or they don't have access to a level of appropriate primary care," Stanton said. "The ER has become the safety net of our health care system. We can't turn anyone away like a doctor's office could. ... I worry though with (Obamacare) this will significantly increase patient volume."
There is already a national shortage of doctors, according to the Association of American Medical Colleges. We're down about 20,000 now, and the number is expected to get worse as nearly half the nation's physicians are over age 50 -- meaning many are at or near retirement age. And it's not just doctors who are in short supply; we also need more nurses, according to the American Medical Association.
"Keep in mind the Affordable Care Act didn't create this crisis," said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. "We've got an aging population that needs more care and a growing population."
Government shutdown forces clinical trial patients to wait
A study in the Annals of Family Medicine journal projected the country will need 52,000 more primary care physicians by 2025. Most of those extra doctors are needed because of projected population growth. But the problem also begins in training; only one in five graduating medical residents plan to go into primary care, according to the Journal of the American Medical Association.
Stanton said he might have been interested in primary care rather than emergency care, but the lower pay kept him away. Doctors on average graduate with hundreds of thousands of dollars of debt. Specialists make more money.
"Primary care is the backbone of our medical system, but most people I know in medical school can't afford to go that route," Stanton said.
If the popularity of the insurance marketplaces on the first day they opened is any sign, there will be a lot more people in Kentucky fighting to get a doctor's attention. Problems plagued the Kentucky exchange site until midafternoon, but still more than 1,200 people had purchased policies or enrolled in Medicaid by the end of the day, according to a spokeswoman for the Cabinet for Health and Family Services.
"I think of (Obamacare) as giving everyone an ATM card in a town where there are no ATM machines," Stanton said. "The coming storm of patients means when they can't get in to see a primary care physician, even more people will end up with me in the emergency room."
What happened in Massachusetts in 2006 when the state's mandated health insurance rules went into effect illustrates the impending national problem.
When the Massachusetts law kicked in, wait times to get an appointment at primary care physicians' offices increased significantly, and they've remained high ever since, according to an annual survey from the Massachusetts Medical Society. And Massachusetts has the second highest physician-to-population ratio of any state.
When patients couldn't get doctor's appointments they once again turned to emergency rooms. A Harvard study found all 11 of the emergency rooms that researchers studied in Massachusetts became busier after the law went into effect.
The Affordable Care Act does try to address some of the problems. There's an additional $1.5 billion in funding allotted for the National Health Services Corps, which provides support to health care professionals in exchange for their service in areas with a shortage (physician numbers are particularly stretched thin in rural areas).
The law also puts more money toward training in hopes of increasing the primary care workforce. It offers more graduate positions for primary care doctors and more scholarships. It even offers a 10% bonus to primary care doctors who agree to see Medicare patients through 2015. The law's emphasis on coverage for preventive care may also mean fewer people will need to visit doctors for more serious issues down the road.
Blackwelder is optimistic that this problem will be the prompt the system needs to address these long-standing issues with our medical system. He admits, though, that he's a "glass-half-full kind of guy."
He suggests existing technology could help. Not all patients actually need to see him personally; if there is a way to set up an online system so patients could access records, e-mail simple questions or request prescription refills, that would cut down on the amount of time they'd have to spend in his office.
Blackwelder also thinks a team approach would be more productive in health care practices -- something many hospitals are already trying to adopt.
"In Kingsport, Tennessee, where I work, I'm happy to see patients, but we also have a health department or retail clinics that people could go to for their flu shots or other treatments," Blackwelder said. "And if we maintained good communication with those other providers we could also avoid duplication of services and increase our overall effectiveness."
Qualified nurse practitioners might also be able to lighten some of the primary care physicians' load, as would physician assistants if such practices are allowed. But in some states that are already desperate for doctors, such as Mississippi, nurse practitioners must legally practice under the guidance of a physician.
Other solutions could include opening more residency slots for doctors. Blackwelder said he'd also love to see universities discount tuition for students who studied primary care.
"I'd love for them to say to a student, 'I hear you are interested in primary care,' and present them with a bill with only zeros on it," he said. "And then say to people who were going into a specialty, 'Here's your tuition bill,' with a number in front of all those zeros."
People were worried the health care system would be overwhelmed when Medicare and Medicaid started in the 1960s too, Kentucky Gov. Steve Beshear told CNN chief medical correspondent Dr. Sanjay Gupta, but the system adapted.
"I understand there is a sense of worry, and change can be scary, but our present system is broken," Blackwelder said. "We pay twice as much for our health in this country and have worse outcomes than other countries.
"We will have to start coming up with creative solutions to this problem -- ones that won't have to wait for an act from Congress."
The Affordable Care Act consolidation into ACO------Wall Street deems 'efficient' will end forcing all primary care doctors wanting access to hospitals and medical institutions in the daily business of doctoring to be connected with one of these state health systems. So, a doctor in Baltimore wanting to remain out of this primarily Johns Hopkins health system to do his/her own practice will then find it hard/impossible for those patients to enter a hospital----get lab results or specialized treatment. They are literally being forced into these ACO monopolies and this is one reason many doctors are saying NO THANKS. That's OK because the goal is CONCIERGE MEDICINE-----designer medicine for those world rich who can pay global market rate for health care. They rest of Americans can simply be tied to online customer service.
No one has been more committed to all this than Mikulski, Cardin, Cummings, Sarbanes and all Maryland pols working together with Republicans in Congress to make US public health all about naked capitalism and global corporate profits. THE BEST REPUBLICANS YET! Who have the lowest life-expectancy and worse health outcomes? Republican states ----why do Republican voters want that?
Concierge Medicine will get Massive Boost from Obamacare
Posted by Dike Drummond MD
Concierge Medicine will get Massive Boost from ObamacareThe shortage of physicians caused by the implementation of the Affordable Care Act in the next five years will drive a massive increase in the popularity of Concierge Medicine in the US.
As the typical healthcare organization adapts to the coming tidal wave of newly insured patients it will become very difficult for you to see your doctor when you are ill, impossible to see them for routine care and make the typical experience of getting a checkup feel like being dropped into a “patient mill”.
5 years from now, If you want to have a personal physician see you for all your healthcare needs, you will need to pay for the privilege.
One popular way to do this is “concierge medicine” where you pay a monthly or annual premium directly to your doctor and, in return, they become your own personal physician, taking direct responsibility for your healthcare needs. The good news is that concierge medicine is no longer a privilege of the rich. Premiums are becoming much more affordable – as low as $200/year – and if you enjoy seeing “my doctor” and not being rushed, you will feel the additional money for a concierge medicine doctor is well spent.
Concierge medicine popularity will also be driven by the primary care doctors themselves. Those who want to continue to have a personal relationship with their patients will find it very difficult to be satisfied with the typical high volume practice.
Why Concierge Medicine and why now?
The Association of American Medical Colleges estimates that there will be a shortage of 91,500 doctors by 2020 as the Obamacare insurance coverage provisions are implemented and 30 million Americans become eligible for health insurance coverage.
This tidal wave of newly insured patients has to be served somehow and US Medical Schools and Residency Programs cannot supply anywhere near these numbers of new physicians in this short of a time frame. There is no hope whatsoever to cover the shortfall with newly minted US Residency graduates … none.
The Fork in the RoadHow will healthcare markets respond – especially with regards to primary care?
As the shortage of primary care providers worsens it will literally create a fork in the road for patients and doctors, driving the structure of their practices into two completely different tracks.
- Each is a distinct and logical response to the massive patient overload
- The two models produce dramatically different experiences for both the patients and doctors
- And each will expose gaping holes in a physician’s medical education that must be addressed.
Volume Driven: Doctor as apex of a care pyramid
In the more traditional practice structure, the physician will be come the leader of a care team supervising a number of Nurse Practitioners and Physician Assistants who provide the majority of the hands-on care. The skill and experience of the physician will be saved for the more complicated and severe cases seen that day. The majority of the doctor’s activity will be devoted to leading and coordinating the care provided by the pyramid of N.P’s and P.A.’s who are their direct reports.
This model is invisibly driven by a financial reality – the very high overhead of the practice. The only solution for these groups will be to maximize patient volume. All the front line providers will see 20-30 patients a day, most likely with 15 minute time slots for each visit. It will look and feel like a “patient mill” with everyone doing their best to maximize patient satisfaction and outcomes under extreme time pressure.
As a patient in this model you will only see your doctor on rare occasion and only when you are very ill. Your primary relationship with be with a P.A. or N.P. This may come as a bit of a shock if you are used to seeing “my doctor” whenever you are sick or need a routine checkup.
In 5 years we will learn to accept this as the “normal practice of medicine” in America. All corporate forces in healthcare are leading in this direction at the moment and it seems clear that volume driven care will become the new normal for the majority of patients and medical practices.
For the physician, the challenge of this model is the complete absence of functional leadership skills training in most medical school and residency programs. 30-50% of these physician’s time will likely be spend in leadership and management activities for which they are not prepared on graduation. Office team leadership training should be a popular CME topic in the years ahead.
Service Driven: Concierge medicine / direct care model
As the typical patient begins to notice they are only seen by a physician on rare occasion, a certain percentage will become willing to pay for that privilege. I suspect this will quickly grow to a substantial wave of new demand for concierge medicine services especially as premiums continue to fall and more concierge medicine practices are available.
The surplus of patients means a shortage of doctors. As the shortage worsens, a larger and larger segment of our population will become willing to pay to continue to see their doctor as they do today, especially if your alternative is the high volume patient mill practice I described above.
The huge popularity of the concierge medicine model will have another important driving force – the doctors. The office duties of the physician here are exactly the opposite of those in example #1 above. Here the physician is often seeing less than 15 patients a day, providing direct patient care and continuing to have meaningful personal relationships with their patients. And the dramatically lower overhead of the concierge medicine model means they can make the same amount of income as the volume driven doctors without having to see all those patients or supervise a team of mid-level providers.
As a patient, you will continue to see your doctor whenever you are ill or in for routine care. The doctor will most likely be practicing solo in a small office and will have much more time available for your visit.
As a physician, the challenge of this model is the absence of business training – and specifically marketing training – in most medical education programs. The concierge medicine model is inherently entrepreneurial and will always involve a fairly sophisticated marketing program to be successful. For the first time the doctor must enroll their own patients who pay with their own money for this direct relationship. Acquiring these skills is not an insurmountable obstacle and I have yet to meet a newly board certified MD who understands the essentials of marketing.
What’s a patient to do?
If you would like to continue to have direct access to your doctor in the years ahead, I encourage you to investigate concierge medicine services in your area and ask your current doctor if they have considered a concierge medicine practice. If you google “concierge medicine (your city here)”, you will most likely find a practice nearby. They would be happy to meet you and introduce you to the practice at no charge.
What’s a doctor to do?
If you are a primary care physician with 10 or more years of practice ahead of you, I suggest you look at the various concierge medicine business models and get ready to be met by the fork in the road.
Will you choose to lead a team or build your concierge medicine practice? If you are leaning in one direction or the other, I suggest you get started building your missing skill set – be that leadership or marketing. The wave of newly insured patients is coming.
I heard a Baltimore citizen saying her mother had been held at the Sinai Hospital emergency room for most of the day before being seen and as you see here this is becoming the rule. Whether hospitals in Baltimore City Center are using CODE YELLOW meaning emergency rooms are full when they are not----to move patients to other locations the reality is there are fewer and fewer locations in Baltimore. When Hopkins asks why citizens are still coming to Hopkins' emergency rooms when the outsourced EMERGI-CARE-style national chains are available it is because these URGENT-CARE businesses are not structured to take anything other than preventative care emergencies.
I walked into one of these emergency businesses downtown Baltimore just to see how they are handling health problems. I went in stating all the symptoms of heart failure/heart attack coming in off the street. They had me sit in the waiting area for an hour ----the doctor seeing me said this business was not for these kinds of emergencies and recommended I see a primary care doctor. I said I had no primary care doctor and she said---you need to get one and sent me on my way. I was billed $175 for that visit and my insurance did not pay because they did nothing for this health event.
Now, first the staff should have recognized that I was having a medical emergency and called 911. Then the doctor should have as well or at least told me to go to an emergency room for tests. They did neither because their job is to keep citizens from what are now for-profit emergency centers.
There's Mikulski like all Baltimore and Maryland pols-----once these problems make the media they are mad as heck this has been happening in Baltimore for decades.
Baltimore VA hospital faulted for lengthy emergency room stays
Nearly half of patients sampled spent 6-plus hours, and one spent 24 hours, report finds
September 27, 2013|By Scott Dance, The Baltimore Sun
Shortages of beds, doctors and nurses in the Baltimore VA Medical Center's emergency room resulted in nearly half of a sample of patients spending more than 6 hours at the facility, including one who waited more than 24 hours, according to a critical inspection report released this month.
In that case, a 59-year-old woman who reported a racing and pounding heartbeat waited 24 hours, 8 minutes before being admitted to a unit where her heartbeat could be continuously monitored. In another example, a 52-year-old man with schizophrenia who expressed desires to kill himself or others waited 22 hours until he was transferred to a non-VA hospital for treatment.
The Department of Veterans Affairs inspector general's office detailed the shortcomings in a report that criticized the hospital's leadership for lacking policies to provide on-call doctors and nurses to boost staffing when patient volume surged. Backups in treating patients led to some being examined in the emergency department's triage area, without privacy, the report said.
The findings come to light as Baltimore's VA Regional Office that handles benefits claims is scrutinized for being second-slowest in the country at processing disability claims. Earlier this month, Sen. Barbara A. Mikulski demanded that the agency immediately develop an action plan to improve efforts at speeding claim processing.
The inspectors visited the hospital in November 2012. In a response written in July to the report, VA hospital officials pledged changes, some of which it put in place this past spring. Veterans' advocates said they plan to closely monitor conditions at the hospital to ensure that patient care is improved.
"The concern is that they're not able to get up to the ICU or to be in an inpatient unit without the proper staffing levels," said Jacob Gadd, deputy director for health care for the American Legion, which monitors veterans' health care quality across the country. "We're thankful no veterans were harmed because of the staffing levels."
The inspection found that of a sample of 20 patients on high-volume days, nine spent more than six hours in the emergency department, and six spent more than 20 hours, with an average length of stay of 7.9 hours. Veterans Affairs standards require that no more than 10 percent of emergency patients spend longer than six hours in the facility, the report noted.
Inspectors found that patients often complained about the lengthy wait times. While hospital leaders routinely reviewed patient data each day, they did not review data on patients' length of stay, the report said.
The backlogs frustrated staff too, the report said.
"Although we did not find examples of patients suffering adverse events due to staffing shortages, we did find a dedicated staff that felt frustrated by what they perceived as an inability to provide the quality of care their patients deserved due to staffing shortages," the report said.
The inspectors found that the problems stemmed from an inability to boost staffing during busy times and a lack of a policy outlining how the department would handle patients when it lacked the appropriate beds or enough staff to care for them.
In responses to the inspection appended to the report, leaders at the Baltimore hospital concurred with the report and said improvements were underway. The hospital added extra beds in a unit capable of cardiac and other monitoring, changed schedules for doctors and physician assistants to accommodate expected periods of high patient volume, and improved its on-call systems. The number of nurses assigned to the emergency department also was increased, the response said.
Hospital officials said patient waits have already improved in the emergency department. During the first six months of 2013, the average visit time for patients who were not admitted to the hospital was between three and four hours and the proportion of patients staying six hours or longer fell to 12 percent, they said.
They added that their own assessment of data for patients who stayed longer than six hours revealed that, in many cases, a patient's stay was lengthened because of a need to treat for intoxication before a mental health assessment can be performed.
VA officials did not respond Thursday to requests for comment.
The West Baltimore hospital, adjacent to the University of Maryland Medical Center, has about 700 beds and sees about 8,300 patient admissions and 622,000 outpatient visits annually, according to American Hospitals Association data.
The Baltimore VA office in the Fallon Building on Hopkins Plaza, meanwhile, has been under fire for statistics showing it is one of the poorest-performing in the nation at processing veterans' disability claims quickly and accurately. As of May, more than 81 percent of the 16,000 disability claims at the office were more than 125 days old. The national average is about 67 percent.
It took the Baltimore office six months on average to process a fully developed claim; the national average is four months. The error rate here was the highest in the country at 25.8 percent.
Mikulski and other lawmakers, as well as groups like the American Legion and Disabled American Veterans, have since pressed for improvements. The Baltimore office has reduced its error rate to 23.5 percent and lowered its backlog of cases 125 days or more old to 77 percent.
This story has been updated to make clearer the distinction between the hospital that handles health care and the regional office that handles benefits claims.
Below you see what will become the complete dominance of Johns Hopkins on health care in not only Maryland but as this video shows global corporations. Here is U of M Medical Center being clear that this cancer concentration will harm their ability to compete but U of MMS as a state health institution is not expected to exist soon----it will be folded into this global Hopkins system. When I say citizens will be made to travel distances to receive ordinary health care they always simply received at a local hospital---I am showing an example. Across the nation huge cancer centers are being created to compete globally for cancer patients. Someone in Baltimore could have a health plan that will require they travel to this Washington DC global Hopkins hub for cancer treatment or go to a mid-west cancer treatment center for that treatment. If you have a gold or platinum health policy you will go locally for treatment---if you have Silver you will be told to travel somewhere else if you want treatment and if you have Bronze, Medicare/Medicaid you will be told---sorry, preventative care only your policy only allows for testing to say you have cancer not actually GET TREATMENT FOR CANCER.
So, this Hopkins Washington DC location ----I KNOW, WHERE DID HOPKINS---A SMALL PRIVATE COLLEGE GET ALL THESE FUNDS TO GROW GLOBALLY? ASK MARYLAND POLS-----is marketing globally for patients while over 80% of Americans are moved from accessing this ordinary hospital care.
'Other hospitals in the region, including the University of Maryland, argued against the project, saying they already had plans in the works to offer those services to children in the region'.
' owned by Johns Hopkins Medicine. He points to the cement shell rising behind him'.
United Medical Center and University of Maryland Medical Center----BYE BYE PUBLIC HEALTH INSTITUTIONS----UMMS has these several years been structured as a global for-profit medical corporation preparing for this merger.
Sibley constructing its image as oncology destination as it builds new $242M hospital tower (Video)
Jul 1, 2014, 2:53pm EDT Updated Jul 2, 2014, 10:38am EDT
Jerry Price, senior vice president for construction and real estate at Sibley Memorial… more
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Tina Reed Staff Reporter Washington Business Journal
When patients think Sibley Memorial Hospital in the future, officials hope they’ll think oncology.
The hospital is exactly a year into constructing what will be a $242 million inpatient tower — and an entire floor devoted to treating cancer patients has begun to take shape.
“Behind the lobby is going to be a new (38-bay) infusion center that we’re very excited about,” said Jerry Price, senior vice president for construction and real estate for Sibley, owned by Johns Hopkins Medicine. He points to the cement shell rising behind him.
“Coupled with our existing radiation oncology center that was built two years ago, we’re going to have our comprehensive cancer center,” he said. They are putting millions into building a new proton-beam therapy center. In all, medical oncology and radiation oncology will take up about 80,000 square feet of space in the building at a price tag of $30 million.
Why put so much money into cancer?
“It’s really a function of demographics,” Price said. “Cancer is often a disease of age.”
It’s also part of Johns Hopkins strategy to strengthen its position in the D.C. market. The eight-story addition will include the 200 all-private inpatient rooms, an expanded emergency department, surgical facilities and 18 labor and delivery suites. The emergency room is set to open next spring. The new hospital will be occupied by 2016.
Earlier this year, the District gave Sibley the OK to build a pediatric proton-beam therapy gantry in partnership with Children’s National Medical Center. Other hospitals in the region, including the University of Maryland, argued against the project, saying they already had plans in the works to offer those services to children in the region. Regulators said Sibley demonstrated a need for the service. Proton-beam therapy for cancer patients is expected be a game changer for Sibley, generating a large amount of the hospital's income.
"They want to go nose to nose with the Lombardi Center," said Jay Shiver, a health administration professor at George Mason University and a former Sibley executive, referring to MedStar Georgetown Lombardi Comprehensive Cancer Center.
Below you see why we have hospitals understaffed-----all that revenue going to hospitals from Federal, state, or local funding to profits were being used to expand globally----it all went into real estate and development and not into actual health care. This happened because we had no Federal Health and Human Services or Baltimore Public Health ---OR POLS THAT CARED---providing oversight, accountability, or public health planning.
This is for whom all of Baltimore City and Maryland candidates for any political office work-----they could care less about our citizens.
'According to the NRMP, last year 971 graduates of U.S. medical schools were shut out, accounting for 5.9% of U.S. grads. Graduates of international medical schools fared even worse - less than 50% of them obtained a residency.
That means more than 7,000 doctors were left with a diploma that said “M.D.” but no guarantee they would be able to use it'.
March 16th, 2012
07:29 AM ET CNN
Why your waiter has an M.D.
Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about his Match Day and becoming a doctor.
I met Sam* in the OR a few years ago. A polite surgical technician in his early 30s, we’d often chat after work.
Sam obtained his medical degree from a school in Eastern Europe prior to immigrating to the United States. Now he spends his days cleaning surgical instruments and his nights working in a restaurant.
“Someday I’ll be a surgeon, just like you,” he says to me.
How did this happen? Sam had a bad Match Day.
Medical training in the U.S. involves four years of medical school followed by 3 to 6 years of residency training. International graduates must also attend residency in the U.S. if they wish to practice here.
On Match Day, graduating medical students learn which residency program they’ll be joining. Residency determines a physician’s field of medicine. For a young doctor to become a pediatrician, for example, he or she must complete a pediatric residency.
This year Match Day occurs today, March 16.
The National Resident Matching Program (NRMP) couples prospective applicants with residency programs, sort of like a medical version of eHarmony. Each applicant makes a list ranking the residency programs in their order of desirability. The residency programs do the same with the applicants, and the NRMP matches them up.
Not all graduating medical students get matched.
According to the NRMP, last year 971 graduates of U.S. medical schools were shut out, accounting for 5.9% of U.S. grads. Graduates of international medical schools fared even worse - less than 50% of them obtained a residency.
That means more than 7,000 doctors were left with a diploma that said “M.D.” but no guarantee they would be able to use it.
Just like Sam.
So what are all of these doctors doing?
The majority of unmatched grads obtain a temporary one-year residency spot with no guarantee of future training. They then reapply the following year with hopes of landing a permanent, multi-year residency position.
Others wind up performing research in labs prior to re-entering the Match. Still others abandon their dreams of becoming a practicing physician and exit the medical field altogether.
This situation is only going to worsen. Due to the pending doctor shortage, the Association of American Medical Colleges (AAMC) has called for a 30% increase in medical school enrollment, or 5,000 more doctors each year. College universities have responded to this demand, with 18 new medical schools currently in the process of opening.
The increase in the number of medical students would lead to an increase in residency positions as well, right?
Since 2001, the number of first year residency positions has increased by 3,000, compared to a whopping increase of 6,500 applicants. The slow growth in residency positions is likely due to a 15 year freeze in Medicare support. The current federal budget problems make lifting the freeze unlikely in the near future.
So what does this mean?
For an unmatched M.D. like Sam, it doesn’t bode well. After going unmatched his first year, he tried to match again the following year, but failed.
As the years pass, it’s becoming more and more likely that Sam will never be able to use the degree he earned.
I watch Sam meticulously clean and rinse the surgical instruments, his hands moving steadily and purposefully. There is not an ounce of unused motion. The fluidity and grace in his hands remind me of my surgical mentors.
Then the sad realization hits me. It doesn’t matter how much Sam wants it.
He will never be a surgeon.
*Sam’s name and identifying details have been changed to protect his privacy.
Update: The National Resident Matching Program has matched 95% of U.S. medical school seniors this year - the highest rate in 30 years, according to a press release sent out on Friday. The largest residency increases were seen in internal medicine, anesthesiology and emergency medicine. Also, 510 more international students were matched than were matched in 2011.