The United States is known throughout the world as a land of opportunity. American children have always been asked the generic question: “What do you want to be when you grow up?” They give an array of answers. “Firefighter!” “Singer!” and of course, “When I grow up I want to be a doctor.”
It has generally been the case that going to medical school ensured your career in any specialty. The difficulties were the MCAT, medical school classes, and the USMLE, which are brutally difficult, requiring strenuous studying and dedication. However, the bumpy road to becoming a doctor is now lined with even more obstacles for medical students and graduates. Currently, there is an influx of students entering medical school, yet post-graduation, they are not attaining residency positions. Many experts call this the “Residency Bottleneck”. It means that while more doctors are graduating (an additional 7,000 graduates every year over the next decade), and medical schools are expanding, medical residency positions are not. This year, nearly 17,500 U.S. medical graduates applied for residency; a whopping 1,100 did not match according to the National Resident Matching Program (NRMP). What’s more, those numbers do not account for the thousands of international and foreign medical graduates who face even more difficulty as they compete with U.S. graduates.
The Affordable Care Act will insure thousands of people who previously were not covered. This would require an influx of 10,000 doctors a year in primary care alone. However, if the demand for new residency positions is not met, patients will be left scrambling in the emergency room, potentially not even seeing a doctor. This dilemma thwarts preventative care measures which are emphasized by health professionals today. Unless measures are taken to address the residency bottleneck the U.S. will face a shortage of 90,000 doctors in 10 years. The Association of American Medical Colleges (AAMC) provides further data on this staggering shortage.
Medical groups, lawmakers, and prospective health professionals are alarmed at these numbers. Groups such as the American Medical Association, the Association of American Medical Colleges and the American Osteopathic Association are lobbying for bills introduced in the House and Senate which are aimed at adding 3,000 residency slots every year from 2015 to 2019. These same groups have attempted to lobby another plan to increase Medicare funding towards residencies which would create 15,000 positions over five years.
Rather than waiting for Congress to intervene, Dr. Michael Everest and his team at Residents Medical Group (RMG) have expanded residency positions by starting ACGME-accredited training programs in community-based hospitals. In most cases, the institution is in a rural disparaged area, with a low ratio of doctors to patients.
The problem is that residency positions are expensive to fill, with the AAMC predicting $9 billion to address the disparity over the years. But what cannot be denied is the overarching effects of leaving medical graduates out in the cold. Not only will their debt pile up, but the public will be at a disadvantage without the presence of qualified, enthusiastic, young health professionals.
One team, Residents Medical Group, has taken a proactive, ground-up route in addressing this problematic bottleneck. Rather than waiting for Congress to intervene, Dr. Michael Everest and his team at RMG have expanded residency positions by starting ACGME-accredited training programs in community-based hospitals. In most cases, the institution is in a rural disparaged area, with a low ratio of doctors to patients. The organization aids these hospitals in all steps of accreditation, including completing the Complex Program Information Form, outlining goals, objectives, core curriculum, rotations, and arranging affiliations with appropriate accredited medical universities. In addition, RMG maintains the Residency Training Program for two years.
RMG’s services offer a two-fold solution to the daunting problem that the residency bottleneck poses. Firstly, institutions previously lacking these vital conditions benefit from ACGME-accreditation through increased revenues and exposure to grants and funding, as well as physician retention and recruitment – a major concern for many hospitals. Secondly, the community benefits from an ACGME-accredited facility through quality healthcare. Subsequently, facilitating a residency training program gives the opportunity for fresh young healthcare professionals to exercise their highly skilled and needed profession.
Until Congress comes to a consensus about the allocation of funds towards residency programs, the bottleneck will continue, and the doctor shortage in the U.S. will not be addressed. Without change, there will be literally thousands of doctors not being able to practice medicine. The question therefore is, will future generations be saying, “When I grow up, I don’t want to be a doctor.”