New DO schools, new residency programs/spots?

[DrMetal]

Riddle me this:

We seem to be creating new medical schools (mostly DO). I swear I hear about a new 'inaugural' class every 1-2 years.

Are we also creating more DO residencies, or increasing the # of spots at programs? (I don't hear about that as much, definitely not on the allopathic side).

If not, what happens in 5-10 years with the surplus of DOs???

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[GoSpursGo]

DO residencies are no longer a "thing"--the ACGME, AOA and ACOM all merged back in 2020, and all the former DO residencies can now take MDs or DOs. The former DO residencies are probably a little more friendly to DO grads... whatever.

In any event, there won't be a surplus of US-trained DOs. Rather, the squeeze is going to get even tighter on IMGs. But as it is, there are plenty of unfilled spots in FM, peds, and some IM.

 

[DrMetal]

DO residencies are no longer a "thing"--the ACGME, AOA and ACOM all merged back in 2020

I must've missed that. I blame my "long-COVID" foggy brain. Lakers were also winning a lot in 2020 (won the title eventually), so my mind was elsewhere occupied.

Noted, glad to here it, they should be merged.

But still, the total # of spots (MD+DO) hasn't changed much this decade, right?

Yes, unfilled spots in Peds, FM, IM, and now EM. But if your average DO student isn't interested in any of these, what does she end up doing? Just sucks it up and begrudgingly takes one of these unfilled spots? Are we not then destined to create a bunch of disgruntled PCMs?

 

[GoSpursGo]

Yes, unfilled spots in Peds, FM, IM, and now EM. But if your average DO student isn't interested in any of these, what does she end up doing? Just sucks it up and begrudgingly takes one of these unfilled spots?

Yes.

Frankly, anyone who matriculates at a newer DO school needs to be aware that they are more likely than not to match in a primary care specialty. It's possible they'll kick butt and get lucky with research and get something better, but most people going into those schools will match primary care. If they don't like that outcome where they still get paid >$200k to do a job, then they shouldn't matriculate. Whether they wind up disgruntled is more or less up to them. But it's not like there is any other field where you can start at the bottom and be 100% certain that you'll land your "dream job," so IMO this fail scenario is still pretty good.

Granted, EM is its own dumpster fire that I don't fully understand. It does seem like anyone considering that field needs to be aware of the job market problem. But if they don't want to deal with that headache they should be able to target one of those other fields.

Even people who go to MD schools are not guaranteed to match a competitive specialty just because it's what they have their heart set on. Anyone who applies to something competitive should understand they are taking a risk.

 

[DrMetal]

Yes.

Frankly, anyone who matriculates at a newer DO school needs to be aware that they are more likely than not to match in a primary care specialty. It's possible they'll kick butt and get lucky with research and get something better, but most people going into those schools will match primary care. If they don't like that outcome where they still get paid >$200k to do a job, then they shouldn't matriculate. Whether they wind up disgruntled is more or less up to them. But it's not like there is any other field where you can start at the bottom and be 100% certain that you'll land your "dream job," so IMO this fail scenario is still pretty good.

Granted, EM is its own dumpster fire that I don't fully understand. It does seem like anyone considering that field needs to be aware of the job market problem. But if they don't want to deal with that headache they should be able to target one of those other fields.

Even people who go to MD schools are not guaranteed to match a competitive specialty just because it's what they have their heart set on. Anyone who applies to something competitive should understand they are taking a risk.

Ok. So with all that said, we know # of graduating medical students (MD and DO) >> # of residency spots. Why then are some many primary care residencies going unfilled? It must be the case that some are just refusing to do it, even if it is their last resort.

So then, is there a pool for "lost souls" out there? MD/DO graduates with no residency training, just hanging out in limbo? I know that pool has always existed, but is growing?

EM is a dumpster fire because it was a mis-constructed specialty, destined to fail from the beginning. You can't make a specialty out of an acuity level. Equally absurd was the attempts to create a 'primary care' or 'urgent care' specialty.

 

[GoSpursGo]

So with all that said, we know # of graduating medical students (MD and DO) >> # of residency spots.

Idk where you got that idea. In 2024 there were ~20k graduating USMDs and ~8k graduating USDOs. There were ~38.5k PGY-1 positions. If someone goes unmatched it is because they applied for something that they were not competitive for, but there will still be spots that they can fall back on in the SOAP.

 

[DrMetal]

Idk where you got that idea. In 2024 there were ~20k graduating USMDs and ~8k graduating USDOs. There were ~38.5k PGY-1 positions. If someone goes unmatched it is because they applied for something that they were not competitive for, but there will still be spots that they can fall back on in the SOAP.

Interesting, no idea, my numbers are way off. I always thought (was told) our residency # was the bottle neck.

Ok, so where are all the physicians at? So many mid-levels everywhere.

 

[LucidSplash]

Interesting, no idea, my numbers are way off. I always thought (was told) our residency # was the bottle neck.

Ok, so where are all the physicians at? So many mid-levels everywhere.

Physicians have been systemically socially devalued by corporate medicine and VC, and trust has been pretty badly undermined as well by the politically charged response to Covid. Many of the corporate entities intentionally replacing as many as possible with PA and NPs. Proliferation of 100% acceptance rate online only NP schools flooding the market with NPs who will accept less money than a physician. Especially flagrant in EM. Also happening in primary care. And the reason you refer someone to GI or another specialty and they are likely to be seen by a non-physician even for the initial consult.

Many physicians in such fields looking for exit strategies. Some doing locums or telehealth. Some who are able to FIRE are doing so. Physicians increasingly concentrated in metropolitan centers and avoiding rural areas. Many of the jobs out there are for corporate or VC-backed institutions which do not value physician-level education. So catch 22 where docs don’t want to work there, places hire more NPs to cover, so even fewer docs want to work there etc.

 

[HemeOncHopeful19]

Interesting, no idea, my numbers are way off. I always thought (was told) our residency # was the bottle neck.

Ok, so where are all the physicians at? So many mid-levels everywhere.

There’s a big difference in what people perpetuate about residency bottleneck (and the “doctor shortage”) and reality.

If you google the NRMP match data there’s a nice table in t he first 10 pages or so that lists how many residency spots each year dating back decades… but tldr: there has been much more expansion than you think and we are training more docs per capita than we did in the 90s (really makes you wonder about the “shortage”)

 

[Goro]

Riddle me this:

We seem to be creating new medical schools (mostly DO). I swear I hear about a new 'inaugural' class every 1-2 years.

Are we also creating more DO residencies, or increasing the # of spots at programs? (I don't hear about that as much, definitely not on the allopathic side).

If not, what happens in 5-10 years with the surplus of DOs???

Sone DO schools (including mine) are indeed creating new residency programs.

New MD and New DO programs are opening at roughly the same rate! For example Belmont, AZ SU, and Creighton-AZ.

 

[DrMetal]

(really makes you wonder about the “shortage”)

You're probably right. A perceived shortage, so they can justify hiring lesser qualified individuals (NPs, PAs), and justify other cost-cutting measures.

 

[Obnoxious Dad]

There’s a big difference in what people perpetuate about residency bottleneck (and the “doctor shortage”) and reality.

If you google the NRMP match data there’s a nice table in t he first 10 pages or so that lists how many residency spots each year dating back decades… but tldr: there has been much more expansion than you think and we are training more docs per capita than we did in the 90s (really makes you wonder about the “shortage”)

If you want another great resource about residency slots look at the ACGME Data Resource Book

ACGME Data Resource Book

www.acgme.org

I haven't looked at the NRMP data recently, but I would doubt that the NRMP publication addresses the military, urology and ophthalmology residency slots. The ACGME book is comprehensive.

This piece is 10 years old but it's an interesting look at the economics of residency training:

Does It Cost More to Train Residents or to Replace Them?: A Look at the Costs and Benefits of Operating Graduate Medical Education Programs

The authors used literature, interviews, and administrative data to explore how the financial impact of operating residency training programs might differ by specialty.The policy issue underlying this study is whether Medicare support for graduate medical ...

www.ncbi.nlm.nih.gov

 

[cj_cregg]

We need more docs per capita than we did in the 90s because boomer docs are retiring and boomer patients are aging/requiring more care than they did when they were younger. As a PCP in a rural area, we could probably double the amount of PCPs in my county and still have more than enough volume to go around. It took me 6 months to get in with a PCP myself when I moved out here even in my own health system. Now, is there an argument to be made that some of the shortage is more of a distribution issue - absolutely. But I think we also just need more doctors in the coming few decades due to demographic changes.

 

[HemeOncHopeful19]

We need more docs per capita than we did in the 90s because boomer docs are retiring and boomer patients are aging/requiring more care than they did when they were younger. As a PCP in a rural area, we could probably double the amount of PCPs in my county and still have more than enough volume to go around. It took me 6 months to get in with a PCP myself when I moved out here even in my own health system. Now, is there an argument to be made that some of the shortage is more of a distribution issue - absolutely. But I think we also just need more doctors in the coming few decades due to demographic changes.

Well as I said it’s a good thing we ARE training more docs per capita in the 90s then.

I would bet that there has always been difficulty finding a PCP in your rural area dating back to the 90s.

It doesn’t help that nowadays the documentation/EMR burden/reimbursement is so bad that people will burn out if they actually have to see patients full time 5 days a week…

 

[cj_cregg]

Well as I said it’s a good thing we ARE training more docs per capita in the 90s then.

I would bet that there has always been difficulty finding a PCP in your rural area dating back to the 90s.

It doesn’t help that nowadays the documentation/EMR burden/reimbursement is so bad that people will burn out if they actually have to see patients full time 5 days a week…

I don't think we actually disagree about anything here. Yes, that was my point, we are training more doctors per capita because we need to be. But it is still true that there are significant shortages in high need specialties/areas. It is multifactorial and people leaving clinical work due to administrative burden is part of it as well.

 

[comp1]

The outlook for medicine, as always, remains good. Concur that you're likely to match in a primary care field if you go to a newer med school, but you definitely could still match in other specialties. As others have said, IMGs will be the ones squeezed out first even if residency slots don't match med school slots, which is likely depending on the federal budget. NPs and PAs are not the end of the world. There is more than enough work for everybody and you will live very, very comfortably as a physician, very likely more comfortably than physicians several generations back.

 

[LucidSplash]

The outlook for medicine, as always, remains good. Concur that you're likely to match in a primary care field if you go to a newer med school, but you definitely could still match in other specialties. As others have said, IMGs will be the ones squeezed out first even if residency slots don't match med school slots, which is likely depending on the federal budget. NPs and PAs are not the end of the world. There is more than enough work for everybody and you will live very, very comfortably as a physician, very likely more comfortably than physicians several generations back.

I’m not sure this is actually true for the intermediate future for those in fields like EM and primary care given the cost of medical school and declining reimbursement and inflation. There is downward pressure on reimbursement in such fields due in part due to non-physicians getting FPA in some states, especially if working in a rural or inner city area with a patient panel with poor payer mix.

 

[rokshana]

Ok. So with all that said, we know # of graduating medical students (MD and DO) >> # of residency spots. Why then are some many primary care residencies going unfilled? It must be the case that some are just refusing to do it, even if it is their last resort.

So then, is there a pool for "lost souls" out there? MD/DO graduates with no residency training, just hanging out in limbo? I know that pool has always existed, but is growing?

EM is a dumpster fire because it was an mis-constructed specialty, destined to fail from the beginning. You can't make a specialty out of an acuity level. Equally absurd was the attempts to create a 'primary care' or 'urgent care' specialty.

Actually that’s not true… there are 110% residency spots to us md/do grads, so there are still more residency spots than graduates… but of course some people apply to things that are over competitive and are not Uber competitive applicants ( or are and it’s just a numbers thing for that speciality). And of course, some spots go to IMGs or old U.S. grads.

 

[j4pac]

I must've missed that. I blame my "long-COVID" foggy brain. Lakers were also winning a lot in 2020 (won the title eventually), so my mind was elsewhere occupied.

Noted, glad to here it, they should be merged.

But still, the total # of spots (MD+DO) hasn't changed much this decade, right?

Yes, unfilled spots in Peds, FM, IM, and now EM. But if your average DO student isn't interested in any of these, what does she end up doing? Just sucks it up and begrudgingly takes one of these unfilled spots? Are we not then destined to create a bunch of disgruntled PCMs?

According to NRMP, this was the most successful year for DOs since the merger. Step away from the ledge. No…not every DO is going to get competitive residencies. Not every MD can either. The stats show that DOs have been pushing out IMGs. Thats really who should be concerned right now.