1- MUSC students match in sweet residencies. How many derm spots can there be? sidenote - quick google search says 270. Also, there seemed to be a high proportion of students matching into optho (avg salary - $300,000), but I couldn't find the national stats so I didn't put those in there. Storm Eye (the optho institute here) is highly reputed, so that probably has something to do with it.
So this is good for us MUSC students (count it). We have a good chance of matching into a competitive residency, and this reinforces what we all know - that everyone is going into specialties looking to get money, get paid. ENT and Derm docs get paid an average of $300,000. Radiation Oncologists get an average of $500,000. Wow, no wonder rad onc is so popular lately - especially among research oriented med students..
2- Medicine has a problem. Too many people go into specialties, and not enough people are becoming generalists. The evidence is right here. At MUSC, an average to above average medical school - less than the average number of students go into primary care-type residencies and far more than the average match into competitive specialties.
This puts a huge problem in medicine front and center - the lack of generalists. A problem that starts in med school because it mostly has to do with the match. Internal med/peds people can go on to specialize, but I imagine those people already have their mind made up to go into a subspecialty before they start. If we look at med students - how can we re-incentivize the system so that more students will go into primary care-type fields?
Here's one half-baked idea: guarantee a certain subset of students admission into med school but legally bind them to commit to family med/internal/peds from the beginning. This would guarantee med schools to have a minimum percentage of their classes to go into these specialties. Perhaps you could recruit a different subset of students into these spots, ones more interested in longitudinal patient care, with good people skills rather than focusing on finding the highest IQ's. Quick google search reveals that this idea already exists at Texas Tech and Mercer. Pretty sweet.
I wonder if there are hidden curriculum factors driving students towards some of these more competitive residencies. I'll have to think about that.
see you on the other side,
from ken
enjoy sidenote in 140 characters or less @kensidenotelife.
Definitely a huge problem in medicine. I'm not a big fan of 'locking in' students into primary care fields. I feel like medicine is such a huge field, that students should have the opportunity to discover their passions over the course of their training. I couldn't imagine choosing a specialty right now before even taking a single med school course.
ReplyDeleteInstead, I think incentives on the back end are more valuable. Compensating primary care physicians better, valuing preventative care, etc. Primary care fields already have a lot of things going for them. Generally more stable hours and lifestyle, less years of training, longitudinal relationships, etc. Sidenote: Hypothetically, if all those residencies were compensated equally, what do you think the breakdown would look like? I would expect a lot of highly intelligent, top of the class students to consider primary care residencies for the reasons listed above, which would hopefully increase the # of PCPs and the quality of PCPs. Obviously not all specialties would be compensated equally, but they can certainly be compensated more fairly.
The backend idea makes sense, but there would have to be more incentives or a change in priorities. Somehow getting people to change priorities seems somehow more realistic.
DeleteAlso on the locking people in idea - it wouldn't be for everyone but just because you don't know what you want to do, doesn't mean there aren't people who do. for them maybe it makes sense to graduate earlier, spend less time finding themselves - so to say, not to mention save $50,000+.
yeah, I really like the idea of more loan repayment options through programs like the health service corps or state run programs. I don't think most students are capable of making the choice of what field they want to go into at the start of med school.
ReplyDeleteUNC is starting a new rural medicine program where they provide an undefined amount of scholarship money to those who sign a contract saying they will do primary care in a rural setting. I thought about doing the program, but wasn't ready to commit to it this early in med school.
Yeah, I wish I had some stats on how those programs are working. UMASS has a similar program where they subsidize your tuition quite a bit if you commit to primary care in Massachusetts, but I'm not sure how popular/successful it is. Regardless,
DeleteDefinitely need new incentives for primary care, which also requires a new system for paying physicians, charging patients, etc.
I guess my other concern about the 'locking people in' is whether it would further the divide between specialists and generalists (like the divide between DO/MD). Also, I understand what you mean about having more options and allowing people who definitely want to do primary care to enter primary care and graduate early, but I guess I have the same concerns about that type of program that I would have about combined BA/MD programs where 18 year olds apply to medical school.
I just tried this thought experiment - if I had to 'lock myself in' to a certain specialty but I could cut off a yr off my training, would I do it? At first I said yes, except then I realized in real life I did the opposite of that. Loosely 'locked myself in' to research/academia, except I added 3-4 yrs on to my training...
DeleteAnyways, I need to do some research on the BA/MD programs and come back to this. I feel like the idea of 'locking in' is counterintuitive to most of my other ideas but I still feel like it could make sense. I kind of applied the logic that some people do better with more commitment/focus rather than more freedom.