Hitting a Nerve

More medical students but not more residency slots


 

"Waiter!"

The stereotype of a waiter/waitress as a struggling actor or college student is pretty old. But what if someday it becomes struggling doctors?

I’m not sure that’s too far fetched, either. Medical schools across the country are opening new campuses and expanding, hoping to generate the number of physicians that predictions say will be needed to treat the aging American population (which, I guess, includes me).

But training is another story. The 2% sequestration cuts we’ve had for almost a year include funding for residencies. For neurology, there’s been an additional 5% cut for the National Institute of Neurological Disorders and Stroke. And, of course, more cuts are predicted to come. The long-dead stereotype of the wealthy doctor who works 30 hours a week and spends the rest of his time at the golf course or house in the Caribbean is still so ingrained into the American consciousness that politicians on both sides love to promote it.

The result of these cuts is that while more people may come out of medical school, there will be no residency slots for them. Training program sizes are currently frozen or shrinking. The open slots for any field will go to the top of the class, leaving a large number of new doctors $200,000 in debt and ... waiting tables.

Even when I was in school (the Miocene era) there were a few people who did the "scramble" after match day, frantically trying to find a program with open slots. In my class of 120, I think there were 5. But imagine if the scramble involves a third of a class or more. Realistically, unless things change, there just won’t be enough slots for most of them.

Medical school doesn’t prepare you to practice real medicine. While you may be a doctor, you still don’t have the knowledge or experience from residency. Trying to practice straight out of school is likely going to get someone killed. And I can’t imagine a malpractice company willing to insure you.

Some will take on further debt and go to law school. Others will find work with insurance companies, denying MRIs. Some may even head overseas to countries with less-rigorous licensing requirements. And some of you may meet in a restaurant, hoping for the big call to say there’s a residency opening.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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