At a time when one in three Americans report difficulty paying medical bills, up to $750 billion is being spent on care that does not help patients become healthier. Although physicians are routinely required to manage expensive resources, traditional medical training offers few opportunities to learn how to deliver the highest quality care at the lowest possible cost. While the gap is glaring the problem is not new.
In 1975, the department of medicine at Charlotte Memorial Hospital initiated a system to monitor medical costs generated by house officers. In the Journal of Medical Education leaders of the Charlotte initiative described how simply being aware of how clinical decisions impact the costs of care could decrease inpatient length of stay by 21%. Over the last four decades there have been dozens of similar efforts to educate medical students and residents about opportunities to improve the value of care. Some interventions were simple like the one in Charlotte, and simply revealed the cost of routine tests to their trainees. Others provided more sophisticated didactics, interrogated medical records to give trainee-specific feedback on utilization, or creatively leveraged the hospital computer order-entry systems.
Recently, I was having a discussion with a colleague about being a doctor. She confided in me that if someone asked her about becoming a doctor, she would tell him or her to become a nurse practitioner. After reading the emotional open letter to our policymakers in Washington DC, it may sound like a reasonable suggestion. After all, why go into this much debt and spend so much time in training if your prospects are not much better? More recently, the New York Times article points out job prospects for radiology trainees are thinning, meaning the well known “ROAD” (Radiology, Ophthalmology, Anesthesiology, and Dermatology) to success may soon become a road to nowhere if there are no jobs.
There in lies the question, why become a doctor? If the answer is to make money or to have an easy life, then you probably need to look for a new profession. With healthcare payment reform, doctors can expect lower salaries as bundled payment and cost cutting measures are instituted. Moreover, the demand for healthcare will go up as more patients have insurance, leading to higher patient volumes and the expectation to see more patients with the same amount of time.
After the mayhem and jubilation of celebrating a successful match at the Pritzker School of Medicine with our students, I went onto Twitter to follow the #match2013 hashtag to understand what the reactions were. Most were positive, but one headline caught my attention ‘In Record-Setting ‘Match Day,’ 1,100 Medical Students Don’t Find Residencies.”
It is true this was the largest match because it was “All-in” – programs either were in the match for all their positions (including international medical graduates or IMGs) or they were not. Obviously, many programs put more positions up for grabs in the Match. After I reposted this article to Twitter, there were many theories and questions about who these unmatched students were and why – some of which I have tried to answer to the best of my ability below. I welcome your input as well.
Who are these unmatched students? Why didn’t they match?
-Are these IMGs? This number is US Senior medical students who have been admitted and graduated from US medical schools but now have no place to go to practice medicine.
-Does this include those that entered the “scramble” now called SOAP. Technically, those that entered SOAP and were successful would have been counted as “matched” on Friday. Last year, 815 Us seniors went unmatched after the SOAP.