Hundreds of thousands of dollars in debt and no residency: That's the situation 412 medical school graduates have to deal with this year in the United States.
A residency — paid, on-the-job training — is an essential step in becoming a practicing doctor. In some cases, students' failure to obtain a residency has nothing to do with their performance, but rather with the supply and demand of the system that allocates them, the National Resident Match Program.
It also has to do with simple math. The program's annual report, released in May, shows 26,678 positions. For the second year in a row, the number of graduates exceeded the number of residencies available.
Medicare funds those residencies, costing $10 billion a year. Congress set this allocation in 1997, and it has remained unchanged since then — but not for lack of trying. In 2013, lawmakers introduced two bills, the Resident Physician Shortage Reduction Act and the Training Tomorrow's Doctors Today Act. Neither bill passed the House of Representatives.
Janis Orlowski, the senior director in health care affairs for the Association of American Medical Colleges, said Congress needs to increase funding to prevent a catastrophic shortage of doctors.
"We've gotten to a choke point where there are more students graduating than are getting a residency," Orlowski said.
This residency shortage comes at a time when demand for doctors is increasing, she said. An aging population, an increase in the pool of insured people because of the Affordable Care Act and the fact that almost a third of all physicians are expected to retire in the next decade all contribute to the rising need for new doctors. Her organization, interpreting U.S. Census data, predicts a shortage of 130,000 physicians by 2025.
Orlowski said that when she was in medical school during the 1980s, the country faced a similar physician shortage, which led to federal investment in building and expanding medical schools.
This time, medical schools have increased class sizes in response to the shortage, a move that is a good start, she said. But without an increase in the number of residency positions, the number of doctors cannot increase — no matter how many people graduate from medical school.
Students select and rank desired residencies through the National Resident Match Program, which uses an algorithm to meet the needs of both the students and hospitals. For the unlucky ones who don't get a match, it's often just a matter of too many applicants for certain specialties.
This year — match day was March 31 — the number of unmatched graduates decreased to 412 from last year's 528, a change Orlowski attributes in part to students' increased willingness to apply for primary care positions.
"Some primary care residencies did not fill in the past, and they did now, which is good," Orlowski said. "Rather than everyone wanting to be a dermatologist — a very lucrative but hard-to-fill spot — people selected wisely, especially in competitive areas."
James E. Wilberger, a neurosurgeon and vice president for graduate medical education at Allegheny Health System, said that unless something is done, the residency shortage will continue to get worse.
"Right now the number is small, but the trend is disturbing," he said.