Academia provides such a unique opportunity to see the behind the scenes view of education. I recently returned from the Society of Teachers of Family Medicine meeting in Nashville, Tennessee and I was struck by many different factors. First, I was amazed by the lack of diversity among the attendees and presenters. Out of nearly a 1,000 people, I doubt if there were more than 25 African Americans or Hispanics. Where are the minority faculty educating the next generation of future Family Physicians?
Second, I was astonished at the data surrounding the lack of residency positions that are available to our medical student classes in the United States. Residency is the training programs offered to medical school graduates in their perspective fields. This is primarily the graduate’s “job” for the next three to nine years depending on their specialty. Many of you probably don’t ever pay much attention to the news outlets in mid-March surrounding “Match Day.”
However, Match Day is an anxiety-producing experience for the majority of medical students. Students across the country, roughly at about the same time, learn where they will be working for the next several years. And uncertainty will be at an all-time high in 2014.
The Match process began in 1952 and in that year only 6,000 US medical seniors were applying to 10,400 available internship positions. Twenty years later the positions available had nearly doubled. By 1975, those internships had phased out and traditional, present day post-graduate year positions (PGY-1) had been established. Just as the number of jobs available to graduates had increased, so had the number of applicants. In 2013, having an all-time high of 40,335 registered applicants. However, there were only 29,171 positions available for the 34,335 active applicants out of that pool of candidates.
So why do you care, why is this important to this particular audience, and how does this relate to health care disparities? So glad you asked.
Bottom line: we have more medical students than we have jobs available for them! Essentially, we will have students graduating from medical school with excesses of a $150,000 of debt and no potential residency employment. Many of these “unmatched” graduates will eventually have to take research positions in labs, teach science in local schools, or take other career paths making less than what they would make as a resident physician.
If you are like me, you’re wondering how could this happen in a country such as ours? How did we get here? The first issue came many years ago when the physician shortage was predicted due to the growing baby boomers. Medical schools responded and started accepting more students and even new schools sprung up across the nation. In addition, in 2013 we had a 50 percent increase (5,095) of US citizen International Medical Graduates in the pool of applicants. These students are they who for some reason may not have been accepted to allopathic (MD) or osteopathic (DO) schools in the US and opted to attend medical school elsewhere. There are also a growing number of foreign born graduates applying to the Match as well.
US medical school students have to apply to many more programs to increase the likelihood of finding a spot. Whereas in the past, students typically applied to five to seven programs, now they are applying to 10 or more programs. These interviews also add to the tsunami-sized debt already incurred.
A popular sign in many buildings is “In the event of an emergency, break the glass.” Therefore, I am declaring this residency shortfall as “time to break the glass.” Historically, whenever there is a shortage of anything: jobs, food, or money, under-represented minorities always get the short end of the stick. How will students afford these increased demands? In addition, residency directors are now placing substantial weight on test scores and not just on letters of recommendation and performance in clerkships. Per the data, minority students tend to do better clinically and their true ability may not be adequately represented by test scores alone. Consequently, these students may be disproportionately affected.
I fear the number of minorities completing residency will be less and less if solutions are not designed to address this problem. This could then result in greater disparities because minorities are more likely to work in an underserved area. Although the Affordable Care Act has a small provision to increase primary care, it is still not adequate enough to erase the position shortfalls. Hopefully, this will motivate our communities to be steadfast regarding STEM education. The pipeline to medical school has to be strengthened and students from under-represented groups will have to be well prepared to compete at a much higher level than in years past if they want a seat at the table.
In the event of an emergency, break the glass. The emergency is here.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
