Health Care

April 5, 2013

More medical school grads vying for limited number of residency programs

Kelly Lambright considers herself blessed.

Kelly Lambright considers herself blessed.

She was matched with Via Christi’s family medicine residency after receiving her medical degree from the Medical University of South Carolina in Charleston.

“I’m really thankful for the ability to be where I am right now and have a residency in family medicine,” said Lambright, a second-year resident. “I think going out from residency, I could do almost anything. The possibilities regarding future career opportunities and the type of medicine I’ll be practicing are plentiful.”

Via Christi said it has the second-largest family medicine residency program in the country.

In 2013, the program had 572 applications for interviews. It ended up matching 18 students from 12 schools and 12 states.

“Matching” is the term used to describe the pairing of residency programs with medical students. The students apply to medical or hospital programs in which they are interested, and officials at that program interview the students. They then make offers to the students for residencies.

Educators and hospital program officials think residencies will become more competitive soon with more medical students vying for a limited number of federally subsidized positions.

According to the National Resident Matching Program, 97 percent of U.S. seniors matched in 2013, compared with 98.5 percent in 2012, when 262 had no position. Almost 1,000 more U.S. seniors were competing in 2013 than in 2012.

The organization plans to release a full report on this year’s matches in May.

In Wichita, there are more than 200 residents in anesthesiology, family medicine, internal medicine, pediatrics, OB/GYN, orthopedic surgery, psychiatry, general surgery and radiology.

Medical schools are turning out more students with degrees to help with the predicted doctor shortage, but to finish training, doctors must complete residencies “under the care of supervising faculty to finish or polish” them to practice independently, said physician Garold Minns, dean at the University of Kansas School of Medicine-Wichita.

Two years ago, KU’s Wichita medical school expanded its class size by 36 students to help address the predicted shortage of physicians, Minns said. But residencies are what will determine the number of physicians who practice.

“Until residency numbers can expand, we probably aren’t going to be very successful in increasing our workforce,” Minns said.

Congressional action

The Association of American Medical Colleges projects a nationwide shortage of 90,000 physicians by 2020. It’s pushing for Congress to lift the cap on residency training programs, adopted as part of the Balanced Budget Act of 1997.

Last month, two bills were introduced to address the shortage. The House’s Training Tomorrow’s Doctors Today Act and the Senate’s Resident Physician Shortage Reduction Act of 2013 would phase in 15,000 residency positions over five years.

But Minns said he isn’t optimistic about additional funding.

“Many of us feel like this is certainly something Congress needs to be clearly aware of,” Minns said. “It seems like with most things right now, there’s just not enough money to take care of all the needs. The federal government is under pretty tight constraint.”

For 2012, Wesley received about $2.9 million in Graduate Medical Education payments. Via Christi officials say their annual subsidy for Graduate Medical Education is about $3 million.

The Wichita Center for Graduate Medical Education, a consortium of the KU medical school, Via Christi and Wesley, has information on its website that shows salaries for residents range from about $48,000 to $58,000 annually, depending on the residents’ year.

Mark Stovak, director of Via Christi’s Family Medicine Residency Program, says the bills now in Congress don’t focus on the right area.

“The bill recently introduced in the Senate increases more residency spots, not for primary care but for specialty,” Stovak said. “That increases the number of physicians, but the wrong type. We don’t need 15 more nephrologists in Wichita. We need 15 more family physicians to meet the demand.”

Primary care

To compound the issue, more medical students are going into higher-paying fields such as radiology and anesthesiology instead of primary care, according to the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, an offshoot of the American Academy of Family Physicians.

The center estimates the number of graduates practicing primary care, which includes fields such as family medicine and pediatrics, fell 15 percent between 2002 and 2006.

Wichita has some of the oldest family medicine residencies in the country, said Ruth Weber, associate program director for Wesley’s family practice residency.

Wesley’s family practice program accepts nine students each year, and most of its residents stay in Kansas, Weber said. About one-third of Wesley’s family medicine residents go to rural areas, about one-third go to urban areas and one-third become hospitalists.

She said the young doctors are tracking more to higher-paying fields for a number of reasons, including paying off student loans and having a more stable lifestyle.

“(Family practitioners) are the people getting phone calls in the middle of the night,” she said.

Patient access

Physicians say the shortage and other factors, such as the changing population, could affect patient access in the coming years.

“It’s a perfect storm almost,” said Stephen Nesbit, chief medical officer of Via Christi Hospitals Wichita. “We have an aging population. I think 10,000 enroll in Medicare every day. And folks are living longer.”

On top of the baby boomers experiencing more health issues as they age, more Americans are expected to get health insurance in the next year because of federal mandates that are part of the Affordable Care Act.

Typically, people with insurance seek more health care, Minns said.

Making the match

Among those who will provide the additional health care in Kansas are medical students who are now in residency programs.

March 15 was National Match Day, when medical students learned what residency programs had accepted them.

At KU’s Wichita medical school, 56 fourth-year students matched with residency programs across the country. KU officials said 58 percent of them will go into primary care, which includes family medicine, pediatrics and internal medicine.

The school would not release the number of students who didn’t get a match. It also would also not release the number of fourth-year students in the class, saying it wasn’t a reliable number and “changes from week to week.”

For students who finish medical school and can’t get into a residency program, options are limited.

It varies from program to program, but the family medicine program at Via Christi won’t grant interviews for residents unless they have graduated from medical school within one year of the application, Stovak said.

“If they don’t get into a program, they just have to keep trying,” he said.

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