Category Archives: Medical students
Italo M. Brown, MPH, is a third year medical student at Meharry Medical College. He holds a BS from Morehouse College, and an MPH in epidemiology and social and behavioral sciences from Boston University, School of Public Health. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.
In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a second year medical student. The overwhelming majority of respondents cited their respective STEP 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses are noteworthy, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.
This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will enter the health care system over the next 18 months.
More U.S. medical students “matched” to primary care residency positions this year than in 2012, according to data from the National Resident Matching Program (NRMP). Almost 400 more students chose primary care fields— internal medicine, family medicine, and pediatrics—than last year. NRMP is a private, non-profit organization established in 1952 to provide a mechanism for matching the preferences of applicants for U.S. residency positions with the preferences of residency program directors.
Of the 17, 487 graduating seniors who participated in Match Day 2013, 3,135 matched to internal medicine—a 6.6 percent increase from last year. The number of seniors who matched to pediatrics (1,837) represents a 105 percent increase over last year.
This year’s Main Residency Match was the largest in NRMP history, with more than 40,000 student and independent registrants. NRMP attributes the increase to three new medical schools graduating their first classes, and expanded enrollment in existing medical schools.
Conducted annually by the NRMP, The Match uses a computerized mathematical algorithm to align the preferences of applicants with the preferences of residency program directors in order to fill the training positions available at U.S. teaching hospitals.
A report from the Association of American Medical Colleges (AAMC) documents an overall trend toward increased diversity among students applying to medical school.
AAMC’s Diversity in Medical Education: Facts and Figures 2012 finds that nearly half of the applicants to U.S. medical schools in 2011 were non-White. Whites were the largest group of applicants, followed by Asians. “Compared with 2010, in 2011 the percentage of Hispanic or Latino applicants increased by 5.7 percent and the number of Black or African American applicants grew by 5 percent,” the report says.
But only 2.5 percent of medical school applicants in 2011 were Black men. Twice as many Black women as men applied to medical school that year, creating the biggest gender gap in medical school applicants among all racial or ethnic groups.
“We have a major, major problem in this country,” Marc Nivet, EdD, AAMC’s chief diversity officer, told American Medical News. “There is just simply an enormous amount of indisputable evidence that we’re not intervening as effectively as we’d like as a society to increase the talent pool of African-Americans who are capable of taking advantage of the science curricula available up and down the pipeline.”
New data from the Association of American Medical Colleges (AAMC) finds a 3.1 percent increase in the number of students applying to medical school this year. First-time applicants also increased (3.4 percent), which helped bring first-time enrollment at the nation’s medical schools up to an all-time high.
AAMC’s enrollment and applicant data also finds that this year’s entering class of medical students is more diverse than last year. There was an increase in applications and enrollees in all major racial and ethnic groups, and record high numbers for African American and Latino students.
If this year’s trends continue, medical schools are on track to increase total enrollment 30 percent by 2016, AAMC says.
“Medicine continues to be a very attractive career choice for our nation’s best and brightest,” Darrell G. Kirch, MD, AAMC president and CEO, said in a news release. “Given the urgent need our nation has for more doctors to care for our growing and aging population, we are extremely pleased with the continued growth in size and diversity of this year’s entering class of medical students.”
Every year, fourth-year medical students anxiously await “Match Day,” when they learn where they will complete their residencies. But long before they receive their sealed envelopes, an algorithm is at work matching them with schools based on their own rankings and those of the institutions to which they are applying. This week, two men responsible for that algorithm were recognized with the Nobel Prize in Economic Sciences.
In the 1950s and 60s, Lloyd Shapley, PhD, helped create the main concept of “pairwise matching,” or how individuals can be paired up if they have different views regarding who would be the best match. His model was the basis for the National Resident Matching Program (NRMP).
Alvin Roth, who worked independently of Shapley but had closely studied the algorithm as well as other countries’ medical markets, helped redesign the NRMP in 1995 to take into account married couples searching for residencies in the same region or at the same hospital, and to eliminate the system’s bias for hospitals over students.
The new system is still used today, and helps match more than 20,000 positions a year. The scholars’ work is also used to match students to high schools and to match up kidney donors.
Feeling financial pressure to pay back student loans, medical students are choosing higher-paying specialties over primary care to secure higher incomes, according to a study published in Medical Education. In the 18-year-long study, researchers found that 31 percent of medical students who originally aspired to enter primary care had switched to a higher paying specialty by graduation.
The study, which followed more than 2,500 medical students at New York Medical College and the Brody School of Medicine at East Carolina University, asked students about their debt, income and career choices. Students were asked during their first year of medical school, and again in their fourth, to estimate their debt and anticipated income. They also rated how important income was to them, in terms of living comfortably, providing for their families and having an “adequate financial reward for the years of training required.”
The researchers found that students intending to pursue specialties anticipated higher debt, placed a greater importance value on income, and anticipated higher earnings after graduation than their primary care counterparts. They note that students interested in primary care were not altogether without income concerns, but those who did not switch before graduation may have rationalized their choice “by convincing themselves that income is less important than they originally believed.”
“Although many factors influence career choice, money is a significant concern,” the study says. “Medical students in the USA are graduating with increasing levels of debt and debt load appears to be pushing students toward higher-paying careers… Long-term legislative solutions may have to include more substantial corrections of specialty-specific income expectations and forgiveness of debts for those entering [primary care] careers.”
Many elite medical schools — Columbia, Cornell, Harvard, Johns Hopkins and Yale, among them — have no departments of family medicine to train students who want to specialize in primary care. Students interested in that field are instead trained to take care of seriously ill patients and are sometimes even discouraged by professors if they do not pursue a specialty, NPR reports.
But Mount Sinai School of Medicine in New York is making a “fundamental change” in its mission. Previously ranked among the bottom 20 medical schools in the country when it comes to the number of primary care doctors it graduates, Mount Sinai had neither a department nor any family physicians on staff until this June.
Now, thanks to a partnership with the Institute for Family Health, the school employs primary care doctors from the Institute’s community clinics to teach students during all four years of medical school, offering primary care students a chance to learn the skills they’ll need in practice.
"I want to spend my career keeping people healthy rather than trying to bring them back from a very serious illness," Mount Sinai student Demetri Blanas told NPR. "I think it is what society needs right now, and that is important to me."
Neil Calman, president and CEO of the Institute for Family Health, called the partnership “a natural marriage.”
"I think people are finally realizing that the country will be bankrupt if we continue to admit people and readmit people for conditions that could be prevented with good primary care," he told NPR.
Beyond the Affordable Care Act: Training the Next Generation of Health Care Providers for the Post-Reform Era
As students settle back into school and the nation finishes its Labor Day celebration, the Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Elizabeth Wiley, MD, JD, MPH, the national president of the American Medical Student Association and a recent graduate of George Washington University School of Medicine.
Ensuring the health professions workforce is prepared for the challenges to come demands a multifaceted approach. With the Supreme Court’s decision this summer to uphold the Affordable Care Act (ACA), it is more important than ever that our health professions workforce be prepared for health care reform implementation. The statistics detailing the growing demand for health professionals have been well-documented. The Association of American Medical Colleges (AAMC) estimates that there will be a shortage of 124,000 – 159,000 physicians by 2025. But, for medical education, increasing the number of medical graduates alone is likely to be insufficient. Rather, expansions in production could support a higher functioning workforce if accompanied by additional reforms. Five areas identified by the American Medical Student Association for reform include:
• “Flipping the pyramid” and recalibrating specialty distribution: It is critical that we change the culture of medical education to better value primary care. Under the ACA, there is investment in meaningful opportunities for primary care training through programs like teaching health centers. Changing the specialty-driven culture of many medical schools, however, will also require addressing the primary care-specialty reimbursement rate gap.
The following Q&A was conducted by Michelle Scott, a recent graduate of Rowan University who is an intern at the Robert Wood Johnson Foundation (RWJF), working with The Future of Nursing: Campaign for Action. Scott recently attended a conference to launch the Pennsylvania Action Coalition, and interviewed some students who also participated. Read Scott’s reflections on the conference here.
Question: What do you feel your role as a rising physician will be in the plan to bring nurses and doctors together to work toward improving patient care?
Paul Shay: In health care, there has been a historical hierarchy that places the infallible physician above all other health care providers; however, recent literature has shown that collaborative health care is the best health care. It turns out that doctors aren’t infallible, and every team member, from social worker to nurse to physician, is equally valuable in patient care.
As a rising physician, I would be foolish not to embrace this collaboration in my future practice. I will make a concerted effort to let all of my non-physician colleagues know and feel that they are equal members in our team. Furthermore, it is equally, or arguably more, important that I advocate for other physicians to do the same. And outside of our own practices, we need to support the efforts of nursing organizations such as the Pennsylvania Action Coalition and the Pennsylvania State Nurses Association (PSNA).
Enrollment at U.S. medical schools is growing, according to new data from the Association of American Medical Colleges (AAMC). The annual Medical School Enrollment Survey finds that first-year medical school enrollment is expected to reach 21,376 by 2016, an increase of 29.6 percent since 2002. Combined first-year MD and DO (Doctor of Osteopathic Medicine) enrollment—which has already increased by 28 percent since 2002—is projected to reach 26,709, an increase of 37 percent, by 2016.
Forty-three percent of the schools surveyed say they have plans to target—or have already targeted—specific populations that are underrepresented in medical schools, including minorities and people from disadvantaged backgrounds, rural and underserved communities. Among the tactics the schools are using: scholarships, modified or targeted admissions criteria and outreach efforts, and branch campus locations.
Medical schools are also using other approaches to increase their enrollment and quickly put physicians to work. At least four schools have recently begun offering programs that allow medical students to get degrees in three years, instead of four, American Medical News reports. In addition, a consortium of six schools has applied for a $23 million federal grant from the Center for Medicare and Medicaid Innovation to expand the three-year model to more campuses.