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Recent News, U.S. Politics

For Medical Students, a Growing Residency Gap

In a previous blog entry I discussed reasons not to go to law school, namely, the high debt and low employment ratio. It seems that medical students are facing a similar situation, as reported by the Washington Post’s Sarah Kliff.  “But there’s also a downside to heading to medical school these days: Students’ odds of getting in a residency program are rapidly shrinking — and medical students have begun to live in fear of this very scary chart,” writes Kliff. The chart contrasts medical residency applications rising steeply, with a gradually increasing line of open 1st year residency positions.

As Brian Tamanaha, author of Failing Law Schools noted in his CATO speech, the Bureau of Labor Statistics is predicting 22,000 law openings annually–with law schools graduating between 40,000 and 45,000 students.

Med students, like law students, are saddled with a huge amount of college loan debt. According to the Association of American Medical Colleges (AAMC), the class of 2012 had an average debt of $166,750 (pdf). 30% of these graduates were planning to enter a loan forgiveness or repayment program.

For a graduate with $170,000 in federal loans, the income-based repayment would be $410 to $490 a month during the three residency years. If paid $160,000 annually post-residency, the graduate would pay $2,000 to $2,200 per month using income-based repayment. However, unlike law school, doctors are going to be paid much more. You can view the average salaries here.

That is, if they can make it to, and through, residency. “Who is to blame for the gap between medical school graduates and residency slots?” reports Kliff. “As with many things these days, it’s largely Congress. When legislators passed the balanced budget amendment in 1996, it capped the number of residencies that Medicare can fund. Since then, hospitals’ slots have been tethered to 1996 levels.”

“The Affordable Care Act did take some steps to address this: It has put $167 million toward funding about 1,000 new residency slots under a new Primary Care Residency Expansion program (you can read more about that here).”

One solution mentioned by Kliff is more government funding. The other is changing the health care model so that fewer doctors are required. “The trouble here is both solutions face big obstacles,” writes Kliff. “The legislation to lift the residency cap died in committee, likely due to the costs: If you want to pay for more residency slots, more federal dollars have to come from somewhere.”

“As for reducing the need for doctors, that requires rethinking models of care that doctors have used for decades,” writes Kliff. “For at least the foreseeable future then, medical students are likely left with a scary chart, one that makes the big investment in medical school seem a bit less certain as a surefire good deal.”

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