Is everyone deserving?

[WolfpackWife]

So, this is a spin off from a comment in another thread, as well as a discussion on FB. I am curious to know everyone's opinions, and I am not positing this scenario with any specifics because I think each individual case could be different. Admittedly, I am also curious to hear your opinions because there are a lot of spouses here in competitive specialties so I want to know your take. Without offering more detail, in your opinion:

Does every medical school graduate deserve a residency spot? (That does not mean they automatically get one, obviously the match still applies...just that no US medical school grad goes unmatched. This question also is regardless of the fact that there aren't enough residency spots anyways). Why/why not?

[SoonerTexan]

I dunno.

I do think this is interesting:

Way back in the day my FIL was on the admissions committee for DHs med school (this was when DH was in middle school or younger and FIL had been at another institution for 6 years when he applied)

One year the decided to admit a class based on grades/test scores alone with no interviews. He said it was unilaterally the worst class they had ever had and they went back to the normal process the next year. The class struggled through all 4 years and everyone noticed how bad they were on the clerkships. Not 100% related, but interesting


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[corn poffi]

No. Nobody "deserves" or is entitled to anything.

[bokelley]

I don't think anyone deserves a spot. But I am very much against the constant addition of new DO schools without residency spots. I believe this is a giant issue!!

[alotofyarn]

I don't think everybody deserves a spot, but I do think schools should consider finding ways to weed students out before they get to that. I feel like if a med school is willing to give you a diploma, they're saying that they think you should be a practicing physician, and I know that this isn't happening. Does it look worse for a school to have a lower retention rate with high match rates, or a high retention rate with lower match rates?

[Ladybug]

The resident programs benefit from having transitionals because a few people get fired or non-renewed contracts each year.

[oceanchild]

Are there really not enough residency spots for all US grads? I'm deeply skeptical of that.

[WolfpackWife]

ALOY - that was my first impression as well. I was very surprised to learn the lengths that schools (DHs included) will go to to retain students who are failing/flailing. It's my understanding that it is because drop out rates reflect poorly on the school, but doesn't that set the failing student up for...more failure? And I'm not talking about one-off inital struggles...but 2,3,4 years of failing grades, poor evaluations, bombed attempts at Step/COMLEX, and struggles...why isn't there intervention beforehand? It's one thing to help students get their footing and be better students but it's another to prop up students who can't make the grade - literally and figuratively - and then send them out into a match where they don't really have a chance.

That said, I know there are academically unsuccessful students who have the potential to be great clinicians, but are in danger of not getting that chance because on paper they aren't good match candidates. How do you mitigate that?

I am also floored at how some of my husband's classmates were admitted to medical school in the first place - not only because of the struggles (that they openly share on their FB pages) but also in the ways in which they present themselves in general.

[OrionGrad]

My understanding is that it's a financial thing for med schools. If they kick out a MS1 for poor performance, they're missing out on tuition for the next 3 years (because it's very difficult to fill an upper level med school spot). So med schools have a financial incentive to push students through, even if they're not nearly qualified to match for residency.

[WolfpackWife]

Which makes sense, OG! I can see that perspective, and am not surprised by it. Well, to some extent I am. I do think the excessive hand holding over multiple years sets people up for matching failure and being saddled with debt that they can't repay the same way they would have if they matched. To that end - I do think the very real and sometimes very painful transition during first year with all of the adjustments and realizations of how much pressure and competition there is, there should perhaps be some leniency and resources to help students mitigate that.

My question originated because, as a spin off of the "Not a doctor, just an MD" article and a subsequent thread and FB discussion, a few people who were spouses or friends of unmatched medical school grads - for whatever reason they went unmatched - felt that every single medical school graduate should be entitled to a spot - which I guess would mean that there first would have to BE enough spots for all US medical school grads in which case the unmatched students wouldn't be an issue.

I saw the issue two ways: unmatched students who worked their assess off for four years but were just poor test takers and couldn't fully excel because of the pressure or discouragement, but in whom some attendings/residents could see potential or at least added value, versus students who just...inherently couldn't succeed or even maintain average performance, over and over again. Do I think the former should be considered as a whole individual, instead of just how they appear on paper? Probably yes. But the latter I think is more of a case of...they just aren't meant to be a doctor and just because they could meet the minimum requirements to get out of medical school as a graduate, doesn't mean they won't bring down a team or negatively affect a patient as an intern or resident/should be practicing medicine at all.

[Vanquisher]

Are there really not enough residency spots for all US grads? I'm deeply skeptical of that.

Yes, there really aren't enough spots. And, it's getting worse every year.

They don't add residency spots. At all. For years they haven't added residency spots, but have added med school spots. Furthermore, there are greater numbers of foreign grads wanting to match.

The reason they don't add residency spots is money, of course. Right now each residency slot is funded through the federal government to the tune of more than $100,000, at almost $150,000. In order to add more residency slots, a program has to have a verifiable need and ability to train that resident, and they have to remove a slot elsewhere, or that slot goes unfunded. No hospital or school wants to shell out that money if they don't have to.

Does every med school graduate deserve a slot? No. Do most? Yes.

In Missouri, (a law just passed) they allow med school grads to practice as assistant physicians under the supervision of a licensed doc, much like a PA. While this jacks up my intended profession, I see this as a possible partial solution. Allow graduated med students who pass their boards to practice as a PA.

It's gotten bad out there.




Heidi

[oceanchild]

Ok, I'm more than willing to be proven wrong here, but somebody has to explain what I'm missing.

This is all 2014 numbers:
18,078 allo grads (https://www.aamc.org/download/321532...stable27-2.pdf)
4,997 osteo grads (http://www.aacom.org/reports-program...orts/graduates)
=23,075 US grads

26,678 NRMP PGY-1 spots (http://www.nrmp.org/wp-content/uploa...2015_final.pdf)
2,988 AOA spots (https://www.natmatch.com/aoairp/stats/2014prgstats.html)
=29,666 residency spots

I'm not denying that there are issues, particularly with distribution, and I understand that foreign grads are involved too. I'm just not sure where the idea that there are fewer residency spots than US grads is coming from.

[SoonerTexan]

xposted with OceanChild

Hold up...according to this were were more than 10k extra spots if all US grads matched.

http://www.nrmp.org/wp-content/uploa...2014-Final.pdf

I added up the numbers of spots offered and the numbers of matched/unmatched US Seniors on the chart on page 8 of the PDF.

2014 Residency Spots offered: 25356
2014 Matched and Unmatched US Seniors: 16372

This was 2014 match data that only distinguished between US Seniors and Independent applicants, which I would assume means DOs and FMGs. So really there are more than enough spots for the "intended" population, it's just the competition from DOs or FMGs means some US Seniors aren't matching. And if they are the better applicants, well, who am I to say they shouldn't?

I definitely think we need more residency spots, but I also don't think making sure EVERY applicant has a spot is the right strategy either--that demand will never slow down.

[maelissa]

I am also surprised and actually very disappointed/angry/confused why under-performing students and residents continue being pushed to the next level. I know many physicians/future physicians that I wish I could warn people about because they are that incompetent and will likely hurt someone someday.

ALOY - that was my first impression as well. I was very surprised to learn the lengths that schools (DHs included) will go to to retain students who are failing/flailing. It's my understanding that it is because drop out rates reflect poorly on the school, but doesn't that set the failing student up for...more failure? And I'm not talking about one-off inital struggles...but 2,3,4 years of failing grades, poor evaluations, bombed attempts at Step/COMLEX, and struggles...why isn't there intervention beforehand? It's one thing to help students get their footing and be better students but it's another to prop up students who can't make the grade - literally and figuratively - and then send them out into a match where they don't really have a chance.

That said, I know there are academically unsuccessful students who have the potential to be great clinicians, but are in danger of not getting that chance because on paper they aren't good match candidates. How do you mitigate that?

I am also floored at how some of my husband's classmates were admitted to medical school in the first place - not only because of the struggles (that they openly share on their FB pages) but also in the ways in which they present themselves in general.

[SoonerTexan]

Also, say what you want about Texas in other areas, but I think they get tuition right. It is heavily funded by the state and I don't think any school but Baylor (which is private and still not that expensive) is over $20k a year. We averaged about $16-17k. I know they kicked at least one person out in MS1--and it was deserved.