It’s like a very strange game of musical chairs. By the end of the 2013 “Match Week,” where medical students are matched with residencies across the country, 528 graduating students did not have a slot. Without this crucial match, their career in medicine is effectively frozen. At a time when Americans are concerned with the needs of our aging population, increased insurance access and doctors leaving the profession, it makes little sense to leave eligible potential physicians orbiting outside the health care system.
A residency is advanced medical training in a hospital or clinic that adds hands-on skills to the knowledge they gained in medical school. They rotate throughout different specialties during the first year and then focus more intensively on their chosen specialty. But if you can’t get a residency, why not just start practicing once you became an M.D.? Well, according to current laws governing physicians, you must complete three to six years of residency training to obtain a license to practice. So, no license means…no practicing medicine.
It’s a strange situation because medical schools across the country have increased their enrollment capacity and enrollment is up. But this will not add to the number of doctors available to deliver care if residencies remain frozen. Congress capped the number of Medicare supported residency training positions through the Balanced Budget Act of 1997 and teaching hospitals already absorb a large portion of residency costs. That means that competition for the limited number of residencies is fierce, with 2013 being the most competitive yet at 40,000 applicants, and the unmatched continue to roll into the next year’s pool.
Students may not be aware of this situation when they enroll in medical school, and the gap between the number of residency slots and the number of applicants continues to widen—it’s known colloquially as “the jaws of death” by med students. This is added stress as they shoulder the cost of traveling to multiple interviews during their last year of medical school. After the interview period is over, students submit a “rank-order list” to a centralized matching service called the National Resident Matching Program. There’s even a “scramble” opportunity after Match Day to secure a residency that wasn’t listed, but most of those opportunities are gone within a week.
Virginia Department of Health Professions Director Dianne Reynolds-Cane says that in Virginia, the median age of a physician is 51. “Nearly 20 percent of physicians expect to retire within the next five years,” she says. This means that we’ll lose more doctors than we create in that time period.
To avoid a doctor shortage, we’ll have to maximize the residents we do have, once they become practicing physicians. This might mean more hours on the job—but the trend is toward physicians working less hours. “In my opinion our greatest recruitment challenge lies in the increased number of physicians we need for the future to achieve even the same number of full-time equivalents we have in practice today,” says Faye Petro Gargiulo, vice president of physician development for Riverside Health System.
The situation appears dire—so what’s being done about it? The Association of American Medical Colleges and other organizations are lobbying Congress and has committed to increasing the number of medical school spots by 30 percent by 2017. A bill was re-introduced in the U.S. House of Representatives in March 2013 to increase the number of residences by 15,000 over the next five years. But the bill is still in committee, possibly due to the hefty $1 billion dollar-a-year price tag.
There are record high medical school admissions, but no additional doctors are being produced to treat our parents, neighbors or friends. The frozen bottleneck must be opened to provide the necessary clinicians to care for the aging U.S. population, before health care hits an iceberg.
