January 08, 2013
Gov. Otter should match UME slots with GME slots
The governor of Idaho wants to add 5 more slots for western state students to attend UWashington at in-state tuition rates. Nothing wrong with that: those students are likely to add to the healthcare workforce in their home states after their training. But not if they can't get into a residency program.
Gov. Otter should set up 5 state-sponsored residency slots in Idaho to match.
December 04, 2012
More residencies, cool it on the medical schools
The Texas Higher Education Coordinating Board has a new report on undergraduate medical education. You can download the giant pdf here but I'm going to read it today so you don't have to.
But just a tip: the first recommendation in the executive summary says:
"Additional medical schools should not be established or opened until the number of first-year physician residency positions exceeds the number of graduating medical student by 10 percent."
I think I'm going to like this report because I told you so.
November 27, 2012
More med schools: Austin, TX
Now if only GME had the same momentum...
November 26, 2012
Put the medical schools where we need doctors
Medically underserved areas will remain underserved until there are doctors who like to live there. People who want to go to medical school there are people who like to live there. Put a medical school there. Voila! You now have doctors there.
The same is true of minority demographics, but the politics are trickier. Race is hard. Place is easy.
November 16, 2012
Who pays for that?
I don't understand anything about how stuff gets paid for. Obviously, hospitals and clinics will want to have good doctors to hire in the future, so they should bear some of the cost of making sure those doctors are trained today. But mostly we seem to do it backward with the students and schools themselves bearing the costs.
November 01, 2012
The residency crisis hits Australia
Australia needs more residencies, too. One way to attract smart, hard-working people to live in the U.S. right now would be to have more residencies and internships available. One way to cause severe brain-drain would be to not.
October 29, 2012
Another residency bill
Because we need more residencies---now!---there's another bill before Congress besides the bipartisan H.R. 6352 (from Allyson Schwartz and Aaron Schock).
Joseph Crowley has introduced H.R. 6562 which removes the cap on residency slots that's been in place since 1997. This raises 3,000 new slots a year for 5 years.
Weigh the cost of training an extra 15,000 residents each year against the cost of having hundreds of thousands of aging patients unable to find good primary medical care: it's a no-brainer.
October 27, 2012
Louisiana update 2
Speaking of needing more residencies, the poor folks at LSU are staring down a funding decrease that will shift a lot of residency training from public to private hospitals. I'm not against the shift though I wonder at the statement that "State officials have touted the decision to shift residencies...to private hospitals as a move that will provide better training." The LA State Medical Society is right to criticize the lack of transparency here.
We need a lot more blueprinting and a lot less wait and see.
ACGME and new residencies
So what could motivate the ACGME to withhold accredidation from a FSU program? It better be a real quality issue. I hope it's not due to interpretation of their new residency evaluation guidelines. Please please please make more residencies. Match day is coming up.
October 22, 2012
Here's more about Louisiana. One odd bit: the operating budget has been reduced 25% which will certainly demand redesign of education programs, which will demand reaccredidation, which will demand resources. It won't be pretty.
October 10, 2012
Another medical school!
Keep 'em coming!
ACA: Louisiana edition
The Affordable Care Act is going to shake us all up. Here's the latest from LSU and it's complicated.
Bottom line: there will be a lot less money for taking care of uninsured people and for administration.
From my understanding, the big plan is to reduce the number of uninsured people drastically and stop paying so much for administration-heavy health care. Will it work?
Work hours rules are contentious
This US News article is a bit mealy-mouthed on the impact of work hours rules for residency. I imagine someone outside and new to the debate (like a journalist) would be surprised at the vehemence on all sides. I remember I was.
There was a time when "car accident while driving home" was the number one killer of residents. The idea that (according to the above article) "Ninety-five percent of neurosurgical residency program directors, and 84 percent of chief residents, reported that a reduced workweek would 'jeopardize patient care'" is a hard trade-off.
September 21, 2012
September 14, 2012
Doctors in debt
We're not going to get more primary care physicians from our medical education system until medical students can graduate without a staggeringly giant pile of debt. Why would you work at a rural outpatient clinic when you could specialize and pay down your $162,000 debt?
August 31, 2012
To be clear: we need a lot more residencies. Now.
Here's a chart I made showing the number of medical school graduates in the U.S. from 2002 to 2011. I grabbed the data from the AAMC.
Where are all these new kids going to go? We need more residencies. Now. Go go H.R. 6352!
More PA's in Idaho
More PA's training in Idaho. I don't know much about the impact of PAs on the health care system but I can't imagine more PAs is a bad thing.
Plans for a new DO school in Alabama
"The Alabama Department of Public Health reports 60 of Alabama's 67 counties do not have enough primary care providers, such as general practitioners, family doctors or pediatricians, and that rural parts of the state are the most medically underserved." A new school here is a good thing.
Put the med schools where the underserved live. Admit them. Train them. They will stay and practice.
D. C. Brater agrees. We need more residencies.
August 16, 2012
Targeting patient populations
I've seen lots of evidence that if you want certain people to have more doctors, accept some of them into medical school.
August 14, 2012
MiChart at UMich starts tomorrow
Tomorrow the University of Michigan Hospitals and Clinics will stop using the electronic health records system that it developed in-house and has been using for over a decade and start using a more standard commercial product (EPIC) which has been tailored to UMich and is called MiChart.
What's going to happen? I imagine tomorrow will not be a great day to end up in the hospital. But the records-sharing features (especially with patients) will definitely be a good thing (until there's a security breach, of course).
Changes afoot in residency training
Here's a good run-down of some of the changes coming in residency training. Match will go better because unfilled slots will be allowed find unmatched students and vice versa; this will be needed since residency slots are becoming scarce (Go go H.R. 6352!).
There are also some fundamental changes in how residents will be assessed though this article doesn't describe them. They are interesting: I'll post about them later.
August 13, 2012
Another piece of the more doctors puzzle
Let's make sure docs from other countries meet our standards.
This article says: "Each year, thousands of [International Medical Graduates] IMGs seek to practice in the U.S. These doctors make up a quarter of the U.S. physician work force and play an important role in helping to fill shortages nationwide, with many practicing in rural and other medically underserved areas."
A quarter? I knew it was a lot but I had no idea.
Update: This article about boat ambulances has a buried lead about medical training in India: "While talking about medical education, the minister said that government was considering increasing medical seats to 150 from 100 in each medical college across the state. Besides, there were plans to implement a unique policy to fill up management quota seats in medical colleges, the minister said." That's a 50% increase! This may be the shape of things to come.
August 12, 2012
More residencies means more doctors
August 10, 2012
We need more residencies
We're going to need more doctors. We added more medical students. We did not add more residencies. This article is a good summary of the problem.
Congress could solve this problem, but they won't. Some creative thinking is in order, and quickly. There are more M4s in the pipeline right now than we've had in a while.
August 09, 2012
Small, regional, targeted
A new med school in Northern Ontario. Keep 'em coming. What's the curriculum going to be like? How will they favor local applicants? We'll see how successful they are at getting more locals to become doctors and practice locally. Fingers crossed.
August 07, 2012
What happens when you neglect your medical education system
August 06, 2012
Pakistan asks: should non-medical PhD's teach basic science?
A dust-up between Pakistani health agencies leaves Pakistan medical schools with only a few, aging basic science teachers. How would barring non-medical basic scientists from teaching in the pre-clinical years in the U.S. impact our medical education?