A pernicious idea is circulating through the medical education community that we are hurtling towards a “residency cliff,” an abrupt and unsolvable shortage of residency positions for graduating medical students. Residency is the paid, on-the-job clinical training that follows medical school and allows a student to become a licensed, practicing physician. The fear is that entire cohorts of aspiring doctors will be stranded in professional limbo, possibly as early as 2017.

From my vantage point of a decade leading medical education programs, I want to make sure aspiring students know: It’s not that bad. It is certainly not a reason to abandon a dream of being a doctor, especially not when we as a nation face a growing shortage of physicians.

The critical point to focus on is the rate of change. While the number of residencies per each medical school graduate may be decreasing, it is not worsening as rapidly as the “cliff” metaphor implies. The number of U.S. allopathic medical students is growing by about 2 percent, whereas the number of first-year residency positions is growing by 1-2 percent.[1] There is a squeeze, but not an imminent drop-off. Match Day 2014 left 412 US M.D.s without a residency, down from 528 the previous year – these are natural fluctuations.

As the U.S. population grows and ages, the more important issue facing American medical leaders is the increasing physician shortage. A 2015 study projects that the U.S. faces a physician shortage of as many as 90,000 physicians by the year 2025. Schools like mine, the American University of the Caribbean School of Medicine, are doing their part to address this imbalance by providing a pipeline of mainly primary care physicians to care for the underserved U.S. population.

Furthermore, we are taking action, along with the broader U.S. medical education community, to push for the creation of more residency positions.Medicare rightly funds most of the country’s residencies, paying $9.5 billion a year to subsidize 94,000 positions at teaching hospitals. Congress established these numbers in 1997 with the Balanced Budget Act. Around 10,000 additional residencies are supported by sources including teaching hospitals, Medicaid and medical schools like ours. However, these efforts cannot keep up with population growth without federal dollars. A recent study estimated a need for about 1,700 new primary care residency positions.

There is still a great need for increased federal funding, as government is by far the most robust and necessary source of residency programs. However, tomorrow’s doctors need not shy away from attending medical school because of this policy debate. The residency shortage is a problem that many people and organizations are highly invested in solving.

As legislators and medical experts address these issues, aspiring medical students must not allow their “residency anxiety” to alter their course. In a country in such need of doctors, that would be the worst response of all.


About the author:
Heidi Chumley, MD is Executive Dean and Chief Academic Officer of the American University of the Caribbean School of Medicine. Dr Chumley joined AUC in 2013 following an eight-year career at the University of Kansas School of Medicine and has been recognized with national awards for teaching, leadership, and scholarship.


[1] National Resident Matching Program, Results and Data: 2014 Main Residency Match. National Resident Matching Program, Washington, DC. 2014