Lawyers aside, few professions can win accolades from mothers than that of the doctor. The earning potential is high, as is the prestige. Who else, after all, can show up at dinner and claim to have spent her day saving lives?
That’s the upside, at least. 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.
Some medical students refer to it, per Kaiser Health News's Ankita Rao, as the “jaws of death.” What it shows are the number of medical student graduates going up and up — as the number of residencies stays relatively stagnant.
Who is to blame for the gap between medical school graduates and residency slots? 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). While those new slots do expand the overall pool of residencies, when you put them in the context of a 15,000 residency slot gap, some describe the program as a “drop in the bucket.”
In the health policy world, there tend to be two schools of thought about how to address this problem. One, perhaps the most intuitive, is to fund more residency slots. This is what legislation from Rep. Allyson Schwartz (D-Penn.) and Rep. Aaron Schock (R-Ill.) would have done. The Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act would have eliminated the cap on residency funding altogether.
Another way to close the gap: Bring down the the number of medical school graduates, and look for other health-care workers who can provide many of the most basic services. This is an idea that was advanced by Linda Green, a mathematician at Columbia University who recently published a Health Affairs study on the topic.
In that paper, she argued that, with a few small changes, the health-care system simply would not need as many doctors as it does right now. She finds that if doctors diverted at least 20 percent of their current workload to other health-care providers, people like nurse practitioners and physician assistants, we would be on track to have our health-care needs met.
The trouble here is both solutions face big obstacles. 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. Changes like that do not happen overnight.
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.