The Residency Bottleneck

The Residency Bottleneck

In the United States, it has generally been the case that going to medical school ensured your career in any specialty. However, the bumpy road to becoming a doctor is now lined with even more obstacles for medical students and graduates. Currently, there is an influx of students entering medical school, yet post-graduation, they are not attaining residency positions. Many experts call this the “Residency Bottleneck”. It means that while more doctors are graduating (an additional 7,000 graduates every year over the next decade), and medical schools are expanding, medical residency positions are not. Last year, nearly 17,500 U.S. medical graduates applied for residency; a whopping 1,100 did not match according to the National Resident Matching Program (NRMP). What’s more, those numbers do not account for the thousands of international and foreign medical graduates who face even more difficulty as they compete with U.S. graduates.

The Affordable Care Act will insure thousands of people who previously were not covered. This would require an influx of 10,000 doctors a year in primary care alone. However, if the demand for new residency positions is not met, patients will be left scrambling in the emergency room, potentially not even seeing a doctor. This dilemma thwarts preventative care measures which are emphasized by health professionals today. Unless measures are taken to address the residency bottleneck the U.S. will face a shortage of 90,000 doctors in 10 years. The Association of American Medical Colleges (AAMC) provides further data on this staggering shortage. Medical groups, lawmakers, and prospective health professionals are alarmed at these numbers. Groups such as the American Medical Association, the Association of American Medical Colleges and the American Osteopathic Association are lobbying for bills introduced in the House and Senate which are aimed at adding 3,000 residency slots every year from 2015 to 2019. Rather than waiting for Congress to intervene, Dr. Michael Everest and his team at RMG have expanded residency positions by starting ACGME-accredited training programs in community-based hospitals. In most cases, the institution is in a rural disparaged area, with a low ratio of doctors to patients. Residents Medical (RMG), has taken a proactive, ground-up route in addressing this problematic bottleneck. Rather than waiting for Congress to intervene, Dr. Michael Everest and his team at RMG have expanded residency positions by starting ACGME-accredited training programs in community-based hospitals. The organization aids these hospitals in all steps of accreditation, including completing the Complex Program Information Form, outlining goals, objectives, core curriculum, rotations, and arranging affiliations with appropriate accredited medical universities. In addition, RMG maintains the Residency Training Program for two years. The shortage of residency positions also means fierce competition for these slots.

For foreign and international medical graduates, attaining a slot is highly nuanced and difficult. Being from a foreign school makes getting United States clinical experience (USCE) almost impossible without networking or connections. Residents Medical offers USCE through hands-in insured externships, paid-research fellowships, rotations in core electives, as well as one-on-one USMLE instructions by Ivy League medical graduates who have all scored 260 and above. This curriculum is tailored around the individual. Until Congress comes to a consensus about the allocation of funds towards residency programs, the bottleneck will continue, and the doctor shortage in the U.S. will not be addressed. Without change, there will be literally thousands of doctors not being able to practice medicine. The question therefore is, will future generations be saying, “When I grow up, I don’t want to be a doctor”.