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Residency Shortage: The Biggest Medical Problem You've Never Heard Of

You've read up on the Affordable Care Act, tort reform, and a bunch of other medical issues - but here's the most important issue in medicine that you're not hearing about.

In a stunning announcement that I just picked up, Raymond and Ruth Perelman have just donated $225 million to the University of Pennsylvania School of Medicine, garnering naming rights. But, more importantly, they plan for most of it to fund the students—reducing the tuition that is so exorbitantly high (for all med schools, not just Penn) as a barrier for attendance so they get the very best here in Philly @ Penn Med.

My first reaction—WOW!  After I calmed down from seeing the largest single gift to a U.S. university ever, my second reaction was one of applause. Some donors completely not from the medical realm (Mr. Perelman made much of his fortune in mining perlite) have chosen to look into our issues. That's admirable, and I'm so happy for my friends at Penn Med who get to enjoy this ease on their burden.

But if you read around about this news bit (I won't go at length here) you get the sense Mr. Perelman prides himself on understanding the concerns and issues of medical education and helping it meet what the new legislation from Washington will be calling for—in simplest demands: more doctors.

What I feel Mr. Perelman misses is the problem that we as medical students are facing but that I have never seen reported outside of a medical education publication—the residency shortage. When we graduate from medical school, we move into internships and residencies in a desired specialty (cardiology, family practice, general surgery, etc.) We apply for these just like you would apply to anything academic—you've got scores, letters of recommendation, interviews, etc.

If we don't complete residency, we don't get certified by state medical boards, don't do a whole lot of other things and ultimately what's important to everyone: we don't practice.

My best current example is looking at medical school as a sink. The faucet the yearly admissions process to medical school. The drain is residency. You want that water getting down the drain—otherwise, you've got trouble my friends. It does no good to turn the faucet on more (increase class size, open new schools, etc.) if you don't make the residency slots more numerous. This leads to an overflow—of students and people with letters after their name who can't do anything.

The money for residency slots comes from The Health & Human Services Department—primarily from Medicare. So with the recent budget muck going on in DC, it hasn't been easy to ask them to fund new residencies which come in at about $35,000/yr per medical resident across the country (it's essentially our salary while we're training).

So in as short as I could possibly make it while being fair to the issue—that is the biggest medical problem you've never heard of. Let your congressional representatives and senators hear from you! Otherwise all that stuff you hear on the news—"Obamacare," Affordable Care Organizations, Tort Reform—mean nothing. We—doctors—need to be trained and certified to help you, and with more and more medical grads coming every year, we're finding it hard to do.

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Katie Patkins May 19, 2011 at 01:53 AM
I totally agree. However with the continued closure of hospitals and, in particular, obstetrical units is being felt by those of us who wish to specialize in OB. It really is a shame.
Ines Stelzer May 19, 2011 at 04:04 AM
I think doctors and nurses are like angels. I have the utmost respect so please don't take my point the wrong way. Although we as a country pay more for healthcare than most of not all other countries, yet we rank 17th when it comes to quality of care. Being one of the richest countries in the world, it hard to understand how a country like Mexico can offer universal healthcare but we can't. I'm not saying mexico has the best healthcare but it beats a blank. Hawaii - has had universal healthcare for over 40 years. It works for them. I think one of the reasons healthcare is available to everyone in other countries is because their doctors are not paid as well as they are in the US who have the highest paid doctors in the world. If doctors in other countries can live very comfortably with their salary isn't that the pay off knowing that everyone in that country has the right to healthcare and treatment? After all, you did become doctors to help the sick, not just for the money right? I'm not saying taking a cut once you've established yourself will fix the problem, waste and fraud also have to be addressed. Obama's plan to forgive medical students loans in exchange for working a determined amount of time in their field would address the problem of repaying student loans, having more people enter the medical field, not sure what happened -- whether it became part of the healthcare plan that was passed.
Cindy Talon-Kayne April 19, 2012 at 01:59 AM
Can we come up with a less expensive model for training general practitioners? Some of the finest doctors in the world come from India and they are training general practitioners after their one year Compulsory Rotatory Residential Internship in the community setting with some of the training of chronic disease management being accomplished online. This model is being offered through the Christian Medical College, considered one of the best medical schools in all of India.
Anonymous September 01, 2012 at 04:16 AM
U.S. does not have the highest paid doctors, first off. Secondly, the cost of attending medical school in America is a huge burden. In 2011, the average graduate of a US medical school was $206,000 in debt. With current government subsidized insurance rate of 6.8%, most medical graduates end up paying back over $400,000 in loans. Another point, once a person graduates a medical school, they are a "Doctor" rather that be M.D. or D.O. However, this person cannot practice medicine until they complete a residency, which is 3-7 years depending on specialty. During this time, the resident will work about 80-100 hours a week, making about $40,000 a year. By the time physicians start making decent money, they are well into their 30s, $300,000 in debt, and making an average of about $185,000. So after about 15 years of education after high school, tell me again who is making too much money? Maybe it's the CEO of the health insurance company pulling down several MILLION.

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