Yes! All about the money. They are incredibly expensive and limited by the government. I forgot the exact rule and reason but hospitals can’t just create them.
Residency is funded by Medicare (CMS) and that funding is subject to annual renewals by Congress. The total amount of spending was capped in the early 1990s.
However, in 2022, Congress agreed to fund 1000 additional residency slots, phasing them in over 5 years. ( 200/year starting in 2023.)
If you want more residency spots, write/phone/email your Congressional representative to let them know how you feel.
Medicare Graduate Medical Education Payments: An Overview
Yes, they can, but they must fund 100% of the cost of each residency position they create–that includes salary and benefits to the resident, direct and indirect instructional and program-specific cost, instructional materials (think sim labs for procedures) plus overhead. In 2020, the GAO found the cost of funding a single resident ran between $35,000-226,000/year.
State governments fund about 12% of all residency positions in the US. Some states do a better job of funding residencies than others…
In 2016, CA approved a one-time, $100 million budget allocation to support 78 residencies in family medicine, pediatrics, internal medicine, and obstetrics/gynecology for three years. The program is partially maintained ($2.5 million annually) by fees on hospitals, skilled nursing facilities and long-term care facilities. Another $40 million is supported annually by a permanent cigarette tax approved in a 2016
- Doctors funded by these residency funds are trained at sites in underserved areas, and are 40% more likely to choose to practice as a physician in health professional shortage areas (CA Grants 2022]
In 2017, TX approved a one-time, $53 million expansion in grant programs to sponsor over 160 medical residencies and their mentors.
- Overall, residents in this program are twice as likely to select family practice, and mentors are 40% more likely to teach family practice residents ([Nieman 2004]
In 2021, NM doubled the number of state supported primary care residencies, adding 42 new residency positions in underserved areas of the state.
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For context, there are 40,375 residency slots, according to various sources like https://www.ama-assn.org/medical-students/preparing-residency/over-40000-land-spots-match-day-what-are-year-s-trends .
Wow! You are for sure an expert about the topic!
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[quote=“helpingthekid73, post:19, topic:3673472, full:true”]There is an incredible doctor shortage in the US and it is being filled by newly minted physician extenders who have online degrees.
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If hospitals or physician offices are hiring new NP’s from the “for-profit” online programs that have sprung up over the past few years then shame on them. Easiest way to prevent this from happening is to stop hiring them and inquire about their schooling and training during the interview. Those schools are usually pretty easy to weed out on a resume. Trust me, we are not fans of them either.
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@WayOutWestMom thank you. As noted, adding more residency spots isn’t as easy as it sounds.
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Lest anyone think the residency situation is dire or that there aren’t residency position for IMGs…
In 2024 Match, nearly 39,000 positions were offered. (Does not include residencies that are part of the military Match, nor ophthalmology or urology which hold their own individual specialty matches.)
Of those 39,000 available positions, more than 9000 were filled by non-US IMGs. 217 residency programs did not fill all their allotted positions. Family medicine alone had 1237 unfilled positions after SOAP in 2024.
Data available here: Match Data - Residency Match & SOAP Outcomes | NRMP
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IMGs often come without significant debt, since many come from countries where their 6 yr college/med school programs are basically paid for by their country. They will take any residency slot they can get in the US, and then are happy to practice anywhere they can get hired, since they’re still going to make so much more than they would have, in their home countries.
Seems to me that we should be opening up more med schools, and more seats in med schools we already have. There are so many highly qualified applicants who don’t get into med school - many of them would have made fine doctors. We also should be offering loan forgiveness for practicing in rural and underserved areas. Clearly, what we’re already doing is not working.
And then, there is the ethical issue of taking MDs who were trained in 3rd world nations, at the expense of the 3rd world nation, nations who are in desperate need of doctors, and we take them from where they are most needed. We do the same thing with nurses, who also are trained at public expense in poor 3rd world nations, and then come here to earn much higher salaries than they ever could have dreamed of back home.
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Seems like there is a question of money here, as there is with residencies. Are Medical Schools Overcharging You? | Med School Insiders claims that “It’s estimated that instructional costs range from around $48,000 to $51,000 per student per year and the cost of educational resources ranges from approximately $80,000 to $105,000 per student per year. Combined, this is significantly higher than the tuition that most medical students pay each year.” If true, that means that operating a medical school and charging typical (already high) levels of tuition is only doable for an entity with significant other revenue (endowment income, medical and other services, public university subsidies from states, etc.) to help cover the costs.
When my daughters started at our state med school, the Dean gave an opening address to the students and reminded them that the state was investing $100,000/year in the education of each & every student in the class. The Dean also express his hope that after residency, they would repay their “debt” by returning to the state to practice medicine.
Opening a medical school requires enormous capital. At least $50M-$150M.
To be considered for LCME recognition, new medical schools must show they have the financial resources at hand to pay for the first 5 years of operations–this includes the acquisition & maintenance of the physical classroom site (including lab spaces), appropriate educational resources & technologies (for ex, sim labs, standardized patients, research lab equipment, cadavers, educational software, etc), deans & other administrators’ salaries & benefits, faculty salaries and benefits, support staff salaries and benefits, information technology infrastructure, library and information services (including journal subscriptions which run into tens or even hundreds of thousands of $$/year),
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It is the moral thing to do, for our nation to pay to train our own doctors, rather than siphoning off from the 3rd world their doctors educated at public expense there.
Considering that we pay the pharm companies ten times the price for medications as the rest of the world does (including first world nations), perhaps the way to finance the cost of training more MDs here would be taxing the pharm companies’ massive profits.
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I absolutely agree.
But I think this issue is complex and there needs to be a national policy on funding medical education.
Just like there are no easy answers to the shortage of rural physicians, there are no quick and easy solutions to increasing the domestic supply of physicians.
(One of the more complex issues involved is the national shortage of clinical training sites for medical students.)
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Why is it immoral for 3rd-World doctors to come to the U.S. and try to better their own personal situations? Perhaps it would be more moral for the nations in which they received their own medical educations/training to pay them more to stay at home and practice medicine where they were trained?
For that matter, wouldn’t it be immoral – to apply your reasoning to medical students in the U.S. who receive their medical training at a public university in, say, a more rural State (let’s call them “Red States”) – to take a job in another State (lets call them “Blue States”) where they might have more and better opportunities to make butt-loads of money, compared to the State where they were educated? Why should those medical students be penalized for where they received their medical education? Or would you force medical students who receive their medical training in “Red States” to remain in the State wherein they received their medical training, in a form of involuntary servitude?
Why shouldn’t medical students – foreign or domestic – be allowed to seek out situations that they feel are best for them?
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