Chronic shortage of training sites worries medical schools

The Association of American Medical Colleges (AAMC) says many of its members are worried about a shortage of training sites for students and residents.

The AAMC’s 2016 Medical School Enrollment Survey found that 80% of schools were concerned about the number of available clinical training sites. There were also issues with the numbers of primary care and specialty preceptors.

The graphic below shows that these problems are not new, but in general seem to be worsening. [Click on the figure to enlarge it.]

The situation is exacerbated by increasing competition for clinical sites from osteopathic schools, offshore medical schools, and nurse practitioner and physician assistant schools.

Most of the offshore schools pay hospitals for training their students, but 64% of AAMC schools pay nothing for clinical rotations. I blogged about this in 2012.

Twenty-two new MD and 13 new DO medical schools have opened since 2002, and nearly all other medical schools have expanded their class sizes because of what many predict is an impending shortage of physicians.

In the 2017 match, 43,157 applicants applied for 27,860 PGY-1 positions. In 2016, there were 21,030 first-year students enrolled in MD schools and 7369 first-year DO students which equals 28,399 combined. This means that by 2020, the supply of US graduates will exceed the number of currently available positions.

This is worrying US medical schools who so far have not been significantly affected by the problem of graduates not being able to find residency positions.

In 2014, I wrote about the false assumption that new surgery residency programs will simply materialize to accommodate the growing numbers of applicants. I felt there were not large numbers of community hospital surgeons who were dying to have residents around. I still believe this is true.

I said, “I find it hard to believe that a hospital that has previously not had a residency program and has private practice surgeons who do nothing but operate can turn itself into a setting where surgical education is important.

“Who is going to let the residents operate? Who will give didactic lectures? Who will write the research papers that are required by the RRC to prove that the faculty engages in scholarly activity?”

Established surgery programs are expanding their resident rosters while some educators continue to publish research saying residents are not doing enough surgery to be able to operate independently after graduating from training. Where are the additional cases going to come from?

The AAMC says it has a five-year plan to optimize graduate medical education in the US with “three strategic areas of this initiative: investing in future physicians; optimizing the environment for learning, care, and discovery; and preparing the physician and physician-scientist for the 21st century.”

It all sounds lovely, but somewhat vague. Crunch time is coming soon.

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