VOLUME 28, ISSUE 2

CHALLENGES FACING OUR YOUNG PHYSICIANS

Russell K. McAllister, MD TSA Editor

Over the years that I have been involved in medical education, I have seen many changes occur. We all recall the struggles we went through as medical students and residents. I wish to shed some light on some of the recent challenges that our younger generation of physician trainees are facing.

Worsening Medical Education Debt

The American Association of Medical Colleges (AAMC) report from October of 2015 shows that 81% of all medical students accumulate education related debt during training.1 The mean debt of those students is $180,723, a figure that has been steadily rising for some time. The former days of low interest loans for medical trainees has long past and many of the loans have 6-8% interest rates. If the resident enters forebearance during residency training, followed by greater than 10 year repayment of their loans, the total amount of the loan can easily approach twice the initial amount borrowed. This debt burden can create significant financial hardships for young doctors entering practice.

More Graduates Than Residency Positions Available

In 1997, the government froze the number of Graduate Medical Education positions funded through Medicare. Any additional residency training positions that have been added had to be funded through other sources. This has led to a very slow rise in the number of residency positions available. Coupled with the sharp rise in the number of medical school graduates that we have witnessed (new medical schools and increased class sizes of existing medical schools), we now see many medical school graduates that have no means to continue their medical education.

The National Residency Matching Program reported 41,334 applicants for 30,212 available positions in the spring of 2015. The number of U.S. seniors who will go unmatched for a residency position is expected to be around 500 this year. As the number of medical schools increase, that number will likely worsen unless a solution to GME funding is found.2 According to the AAMC, the top reasons that senior medical students failed to match to a residency program are3:

  1. Low or failing score on the United States Medical Licensing Exam
  2. Not competitive for their first choice specialty
  3. Did not have appropriate backup plan
  4. Did not follow guidance from faculty adviser/dean’s office
  5. Poor interviewing/interpersonal skills
  6. Did not rank enough programs

According to the AAMC’s survey of 141 U.S. medical schools, 87 percent of deans are concerned about the number of clinical training sites available for graduates, up from 72 percent in 2010.4 Deans today face a daunting task of trying to ensure that all of their students have an opportunity to match into a GME program.

Future

It is difficult to imagine being a newly graduated physician who has not matched into a residency position, yet still facing repayment of hundreds of thousands of dollars in educational debt. Additionally, physicians also face many uncertainties in our future such as loss of autonomy, shrinking health care reimbursement, encroachment of midlevel providers, and disruptive technology that threatens specialties. All of this is occurring as our patient population continues to have increasing acuity of illnesses. We must persevere and provide the best care for our patients as we continue to try and attract the best and brightest into the field of medicine and the specialty of anesthesiology. We must all be aware of the increasing obstacles that our new trainees are facing.

  1. aamc.org
  2. nrmp.org
  3. ama-assn.org/ama/ama-wire/post/arent-medical-students-matching-happens-next
  4. bloomberg.com/news/articles/2015-05-04/med-school-deans-worry-graduates-won-t-get-residencies

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