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No reason to fear a 'residency cliff'

April 1st, 2015

by Heidi Chumley

Last week, graduating medical students across the country learned what four years of blood, sweat and tears had earned them. Each year on Match Day, fourth-year students learn where they will go for residency--the paid, on-the-job clinical training that follows medical school and allows a student to become a licensed, practicing physician.

According to the National Resident Matching Program (NRMP), this year's Match Day was the largest on record, with an all-time high of 41,334 applicants. With an overall match rate of 93.9 percent, more than half matched to their first choice.

Despite these positive numbers, a pernicious idea has been circulating through the medical education community for the past few years that we are hurtling toward a "residency cliff," an abrupt, severe shortage of residency positions. The fear is that such a shortage would strand entire cohorts of aspiring doctors in professional limbo, possibly as early as 2017.

Having led medical education programs for a decade, I want to reassure aspiring doctors: It's not that bad. It is certainly not a reason to abandon a dream of becoming a doctor, especially not when the country faces a growing shortage of physicians.

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While it is true that the applicant pool is growing faster than the available positions--this year, the NRMP saw 940 more applicants and 541 more positions--the critical point to focus on is the rate of change year over year. Though the number of residencies per graduate may be decreasing, it is not worsening as rapidly as the "cliff" metaphor implies. Overall, the number of U.S. allopathic medical students is growing by about 2 percent. Comparing this to the 1-2 percent growth in first-year residency positions, we can see that there is a squeeze, but by no means an imminent drop-off. Looking at recent years' data, Match Day 2014 left 412 aspiring doctors in the U.S. without a residency, down from 528 the previous year. These fluctuations are natural and should not raise an alarm.

My school, the American University of the Caribbean School of Medicine (AUC), will send this year's graduates to a wide variety of programs. See Brent Balhoff and Brittany Mott's stories for a couple of examples. Though AUC is still tabulating our full Match Day data, you can view last year's results here.

As the U.S. population grows and ages, American medical leaders should focus on ways to fill the increasing physician shortage. A 2015 study projects a shortfall of as many as 90,000 physicians by the year 2025. Schools like AUC are doing their part to address this imbalance by providing a pipeline of mainly primary care physicians to care for underserved U.S. populations.

Furthermore, we join the broader U.S. medical education community in a concerted push for the creation of more residency positions. Medicare funds most of the country's residencies, paying $9.5 billion a year to subsidize 94,000 positions at teaching hospitals. However, these numbers have not grown with the population since 1997, when Congress passed the Balanced Budget Act.

Teaching hospitals, Medicaid and medical schools like AUC fund 10,000 additional residencies, but these private efforts cannot keep up with population growth without federal dollars. A recent study estimated a need for 1,700 new primary care residency positions.

There is still a great need for increased federal funding, as government is by far the most robust and necessary source of residency programs. However, this policy debate must not deter tomorrow's doctors from attending medical school. The residency shortage is a problem, but it's one that many people and organizations are working to solve.

As legislators and medical experts mitigate the residency shortage, it is up to students to step forward and address the physician shortage. In a country in such need of doctors, allowing "residency anxiety" to dissuade aspiring medical students from their course would be the worst response of all.

Heidi Chumley, M.D. is executive dean and chief academic officer of the American University of the Caribbean School of Medicine.

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