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The expected "downsizing" of residency programs does not appear to be happening - yet.
That was one conclusion from an analysis of 1998 figures on approved residency positions under the National Resident Matching Program for 1998 by Sidney Weissman, M.D., director of outpatient/inpatient and emergency psychiatry programs at Loyola University Stritch School of Medicine.
Weissman told Psychiatric News that the total of positions available in all specialties in the United States under the NRMP for 1998 reveals a reduction of just 509 positions from the previous year (24,695 in 1997 versus 24,186 in 1998).
Weissman was chair of the NIMH-funded conference on psychiatric workforce in May 1992 and has maintained a keen interest in workforce issues.
The number of residency slots far exceeds the number of graduates from U.S. allopathic and osteopathic medical schools by 6,386. Further, the number does not include osteopathic residency positions.
"In essence, over 6,000 positions are being offered in the 1998 match that will be filled by international medical graduates," Weissman said.
In psychiatry, positions offered in general programs declined from 1,056 in 1997 to 997 in 1998, a decline of 59 positions.
The numbers do not match predictions of the significant decline expected in the wake of Medicare reform legislation that reduced funding for graduate medical education.
"The reduced funding, it was anticipated, would precipitate a reduction of residency positions," Weissman said. "Unless a significant reduction of positions offered by programs occurs in February 1998, when program ‘match’ lists are completed, the anticipated significant reduction has not occurred."
Weissman said that despite the drop in funding for graduate medical education under the Medicare reform law, "housestaff" at teaching hospitals is still the cheapest available source of labor - cheaper, even, than the nonmedical professionals who were predicted by some to take the place of physicians as residency programs downsized.
"A first-year medical resident working on average 70 hours a week at a cost of $45,000 a year is less than half the cost of two nurse practitioners or physician assistants working the same number of hours at a cost of well over $100,000 a year," Weissman said. "Until alternate sources of funding are available to fund nonresident health care providers in hospitals, we will continue to rely on international medical graduates to provide this care while in residencies."
Yet Weissman cautions that the use of low-cost resident providers, while restraining hospital costs, will only fuel the production of excess physicians in a market where they may not be employable.
"If the number of residency positions does not decrease, [there could be] a major decline in interest in medical careers among U.S. college graduates," Weissman said.
"With hospitals turning out what will be perceived as excess physicians and managed care restricting career options, college graduates will see fewer options in medical careers. This will occur as the nation’s economy continues a record sustained growth and career opportunities may seem more promising in other areas."