Family Medicine has some of the most absurd requirements I have seen, especially for IMG's. Can't be out of postgrad for more than 2 years, must have 3-6 months of USCE, etc.. Meanwhile IM's requirements for IMG's is being ECFMG certified and having a pulse.
Are you serious?? Sounds like they want only AMGs for FM. But the pay in FM, Pediatrics, IM and Psych are the lowest paid salaries and these programs are aware of that. Why would anyone want to apply? There needs to be an incentive, which is why most AMGs don't bother applying for these programs but instead for others despite their low scores and limited knowledge compared to their IMG counterparts. So now you are left with openings or gaps. How can any of these programs consider being so picky when IMGs are applying for them? At least they are being filled, so they should be grateful. After all that how hospitals get funding, when a program is run well!
@@karensmithfam3187 absolutely correct. primary care sees the widest range of pathologies, has the most bs to filter through and gets paid the least by far. even if they dont pay the same, at least bring it closer.
pediatrics: the obvious problem is pay. A lot more DO's are coming out of obscenely priced private schools. People are thinking about how they'e going to pay off that debt.
21:25 okay wait this is actually genius-Sonny is Step 1 because he was initially the most prominent son but got killed off first. Michael is Step 2 CK because although initially in the background, he stepped up to help/lead the family when needed. And Fredo is Step 3 because he’s just the random after thought for everyone involved.
Thank you thank you. I could have used your description when I tried to explain it originally here: Mailbag: Questions about the USMLE th-cam.com/video/co05HNjJUPQ/w-d-xo.html
Are there some ways to find out the matching statistics of specific residency programs? For example, I’d be interested to find the matching statistics of UCSD Internal Medicine residency program for 2023 and 2024.
I am curious which company is allowing that. I just found out there is some group out there called Sarthi that does this. Who regulates them and why are they not charged criminally for stealing??!!
This was my first time viewing a video from your channel and I thought it was great! Good breakdowns of facts with opinion as well. I'll be watching future videos as well!
Thank you for watching! And if you’re interested in this kind of stuff, you may want to explore the old videos as well. I’ve tried to be somewhat selective in what I choose to talk about (and the depth with which I talk about it) so that the content will be worth someone’s time even if they stumble on the video later. Some things are still pretty topical… but others are evergreen.
I actually spoke to Everest (the man in the bribe trial) in 2022 when I was applying for anaesthesia. He essentially wanted 250k and would get me matched at a program. I ran for the hills, and thankfully, this cycle, I am matched.
New IMG rules make sense for places with actual shortages, but its painfully obvious to see they're going to be leveraged to bring in cheaper labor and depress salaries
hospitals wont hire them bc insurance wont pay out to non-board certified doctors. It looks bad on paper but i dont think anything is gonna change tbh.
It's also being used by red states that have strict anti abortion laws that are at risk of losing American MDs moving to other states. Red states have the ultimate trump card and can just open the flood gates to IMGs
They are already doing that, but replacing with NPs. They have actual MDs teaching them the trade without them going through the emotional pain, time consumption, financial stress or more importantly education. Instead there is a lack of respect for medical doctors and it's easier to exploit them instead of valuing their skills. To me this type of practice or replacement of actual MDs will affect patient care and I hope it is serious enough for greedy and cheap hospitals to see that!
I'm curious about fellowship matches as well, particularly for internal medicine - though there are many unmatched IM residents, many who go into IM purely do it to move on to fellowships. I suspect the most competitive fellowship subspecialties have similar match rates to the most competitive non-IM residencies, but I haven't seen the data
Here’s the graphic I made for the fellowship match this year. Match rates for applicants are essentially the inverse of program fill rates. x.com/jbcarmody/status/1729933555810132429?s=46&t=bmm1gv3HxWdNazimqL_3_w
Can you please please make a video on filters set by programs? Should we cross all the filters set by them or should we nly cross 2 out of 3 something like that?
Dr. Carmody, thank you for this insightful video. I'm curious if you have any insight as to whether or not a malpractice insurance carrier would be willing to underwrite an IMG who has not completed any form of US residency training. As a physician myself who does a lot of medico-legal consulting, I'm curious as to this. Thanks!
Hello Sheriff, does AAMC or NRMP provide any data breakdown for residency applicants/matches who have dual degrees? Particularly MD/PhD, but other relevant degree combos like MPH would be quite interesting to see if available. Thanks!
If I were to become an MD, I would definitely go for Emergency Medicine. I love being a Trauma ER Nurse and love my ED docs.....There's no other place I'd rather be...Second would be Ortho or Oncology....
Thanks for the content and information, very helpful. I actually did my Master's thesis on the healthcare worker shortage, and specifically physicians versus mid-levels in filling the gaps. I definitely believe we are going to have a physician shortage of some nature in the united states, the question really is how much will it be filled by mid-levels, and what effect will that have on the quality of healthcare for the average patient in the future. All I'll say is, after doing a lot of research, I will only be seen by MDs and DOs
I’m gonna post a video on the physician shortage soon. It’s been near the top of my priority list for a while… but never at the very top to get it done. But I’ll be eager to hear what you think when I do.
I am 100% with you! I refuse my family members and myself to be seen by PAs and NPs. They don't have the same training or knowledge. I don't understand how they are given salaries like MDs when they don't go through the same training, financial stress, the length of time in 1 exam and the number of those exams taken, or the stress of not knowing your future based on the number of attempts, the amount of money in applications for residency, the rejections and despite all this they are using MDs to train them like doctors. Doesn't seem fair, seems like cheap practice by hospitals and I am sure hospitals have to answer to someone for this (maybe a state rep)! Nurses are actually in shortage, but most of them want to be like doctors without the proper training. I think hospitals need to consider hiring them as nurses so that gap is closed. Or these nurses should be sent to rural areas to cover the shortage of physicians.
Next year will be interesting because medical school has been free tuition was in bronx, the poorest area of New York city. Maybe more medical school students will be chosen primary care specialty, emergency medicine, etc.
It's a nice thought and I wish I could agree, but that really depends on people thinking very short term. The long term financial incentives haven't changed at all. I expect modest increases in primary care fields, if any.
WHAT?! Did I hear you correctly?! People are SELLING residency positions?!?! Are you kidding? And who the **** has an extra 120-200k??? Especially IMGs since our currency is usually worth less than the American dollar. Oh my God
Some Indian billionare paid 9 milion USD so that Rihanna can sing at his son's wedding. There are many rich people outside of the US with some ambitious kids...
I wonder if those states where these loopholes exist are going to exploit IMGs and pay them much lower than the market rate therefore deflating the rates in those states. If IMGs were able to practice in any state and bypass residency then that’s an entirely different story
This news of course is bad for the future of American medicine. Yes graduates are responding to market forces appropriately. They are now funneling into specialty care which in turn exacerbates the siloed fragmented care model here that explains why we spend 5000 more per capita with vastly inferior outcomes in developed countries.
Another great episode! Thank you. As a long time IMG grad who's down with training, this is the first time I've heard about residency spots for 6 digits sum of money! That's just crazy.
I am actually going to be distributing this video around to all IMGs so that they are aware of this. Because many are aware, but the ones who are desperate sometimes are blinded and need to be reminded.
The most basic definition of economics: How people (& companies) react to financial incentives & disincentives. The problem is the 3rd party payor model drives these incentives & distorts what specialties/subspecialties patients value.
With all of the problems with the matching process applicants should be thankful they don't have the problems of dental and veterinary graduates. Most dental graduates have to pay for their residencies( in addition to having the highest tuition rates in health care). Veterinary graduates are often forced to sign predatory contracts with animals hospitals where they can be sued for hundreds of thousands of dollars.
I think it will occur… eventually. My expectation is that the biggest, most research driven programs will continue to defend the necessity of three-year fellowships with all of the usual tropes (“I never knew I wanted to become a funded investigator until someone MADE me do research!”, “I’m no longer involved in research but my previous mandatory research experience is SO VALUABLE to my current role!”), but the most important/unspoken thing is they benefit from fellowship doing research, so it’s easy to see a system of three-year fellowships, postdoc after postdoc, fourth-year fellows, etc. as an untarnished good. However, in many subspecialties, fellowship programs go unfilled - and these programs have a strong incentive to broaden the pipeline. Historically, the voices of these programs don’t carry as much weight at the ABP as the big name programs do… but the fact that the ABP now allows 2- or 3-year pediatric hospital medicine fellowships opened the door just a crack. Eventually I think logic will prevail.
How competitive is pathology residency? Is it really difficult to get residency. I knw some ppl matched pathology on there 4 cycles...is it impossible in upcoming residency matches
I think AI-assisted charting and scribing will make family med more desirable in the future. Right now, I couldn’t choose it based purely on the obscene amount of administrative time.
Great video as always. Is there an existing medical body that you feel should be on the hot seat to push for changes to address the big picture problems? Obviously the AAMC will do whatever they can to print money from ERAS and other services. The leadership of competitive specialties have no obvious incentive to shake up their situation. Should it be groups like specialty boards like the AAFP or AAP pushing to make their services compensated better and their specialties more desirable as a result? Some specific federal or state authority? I feel like as long as med students value "prestige" and compensation (ie indefinitely) then any marginal changes by competition to ERAS, efforts by program directors, or policy changes from medical schools are just band aid solutions. I feel like people will always follow the money, but I'm not even sure what group exists now that is best situated to change where the money is going, if there is one.
Going P/F on step exams is a big mistake and it will hurt graduates of lower tier programs. In the past, step exam scores would get the top graduate of University of Oklahoma higher ranked on a plastic surgery rank list compared to the bottom tier grad at Harvard Med. But now residency programs have lost one of their key distinguishers (test scores) so the bottom of the class Harvard grad with a barely passing Step 1 score will beat out a Univ of Oklahoma grad who has a 99th percentile step score. Medical schools are gradually turning into law schools, where the name of the school trumps just about everything else.
This is an astute comment - many people don’t realize that the pediatric population is actually DOWN from 20 years ago. But the number of pediatric residency positions offered in the Match continues to climb each year (and that trend will likely accelerate with new ACGME program requirements).
@@sheriffofsodium Take the clue from South Korea. They are facing critical shortage of pediatrics in many areas because no one wants pediatric residency. Pediatric residencies are no longer in demand because earning potential is becoming very limited since very few babies are being born.
30 years s/p residency her; you cite interesting theories about why so many unfilled spots but you omitted another potential reason, that being the glaucomflecken videos and how they portray some specialties.
Family Medicine has some of the most absurd requirements I have seen, especially for IMG's. Can't be out of postgrad for more than 2 years, must have 3-6 months of USCE, etc.. Meanwhile IM's requirements for IMG's is being ECFMG certified and having a pulse.
Are you serious?? Sounds like they want only AMGs for FM. But the pay in FM, Pediatrics, IM and Psych are the lowest paid salaries and these programs are aware of that. Why would anyone want to apply? There needs to be an incentive, which is why most AMGs don't bother applying for these programs but instead for others despite their low scores and limited knowledge compared to their IMG counterparts. So now you are left with openings or gaps. How can any of these programs consider being so picky when IMGs are applying for them? At least they are being filled, so they should be grateful. After all that how hospitals get funding, when a program is run well!
@@karensmithfam3187 absolutely correct. primary care sees the widest range of pathologies, has the most bs to filter through and gets paid the least by far. even if they dont pay the same, at least bring it closer.
Yes I agree FM has historically encouraged American grads to
if you don't like it, stay being a "doctor" in whatever shithole country you're from. #MAGA #MURICA
pediatrics: the obvious problem is pay. A lot more DO's are coming out of obscenely priced private schools. People are thinking about how they'e going to pay off that debt.
Locking peds hospitalist behind a fellowship seems ridiculous.
It's a complete fucking racket
More on that story here:
Academic Capitalism: Rethinking the Expansion of Subspecialty Fellowships
th-cam.com/video/uLnZdDXutKE/w-d-xo.html
21:25 okay wait this is actually genius-Sonny is Step 1 because he was initially the most prominent son but got killed off first. Michael is Step 2 CK because although initially in the background, he stepped up to help/lead the family when needed. And Fredo is Step 3 because he’s just the random after thought for everyone involved.
Thank you thank you. I could have used your description when I tried to explain it originally here:
Mailbag: Questions about the USMLE
th-cam.com/video/co05HNjJUPQ/w-d-xo.html
Are there some ways to find out the matching statistics of specific residency programs? For example, I’d be interested to find the matching statistics of UCSD Internal Medicine residency program for 2023 and 2024.
I love Winners and Losers. It's like the NFL draft or the MLB trading deadline.
Selling residency spots is next level crazy lol!! Goes to show how sought after US residency spots are!
I am curious which company is allowing that. I just found out there is some group out there called Sarthi that does this. Who regulates them and why are they not charged criminally for stealing??!!
plus, if the money was what they were after they could have put on all of it in opening a local practice and call it a day
@nn1146 I don't get what you mean by that? People pay upwards of $50K to $100K to get residency. I'm curious who gets that money.
Most dentists have to pay for their residencies.
This was my first time viewing a video from your channel and I thought it was great! Good breakdowns of facts with opinion as well. I'll be watching future videos as well!
Thank you for watching! And if you’re interested in this kind of stuff, you may want to explore the old videos as well. I’ve tried to be somewhat selective in what I choose to talk about (and the depth with which I talk about it) so that the content will be worth someone’s time even if they stumble on the video later. Some things are still pretty topical… but others are evergreen.
I actually spoke to Everest (the man in the bribe trial) in 2022 when I was applying for anaesthesia. He essentially wanted 250k and would get me matched at a program. I ran for the hills, and thankfully, this cycle, I am matched.
So he was never criminally charged? And I'm curious if he's done this in the past, where did the money go?
New IMG rules make sense for places with actual shortages, but its painfully obvious to see they're going to be leveraged to bring in cheaper labor and depress salaries
hospitals wont hire them bc insurance wont pay out to non-board certified doctors. It looks bad on paper but i dont think anything is gonna change tbh.
Yes this is news to me! It's going to be crazy
It's also being used by red states that have strict anti abortion laws that are at risk of losing American MDs moving to other states. Red states have the ultimate trump card and can just open the flood gates to IMGs
They are already doing that, but replacing with NPs. They have actual MDs teaching them the trade without them going through the emotional pain, time consumption, financial stress or more importantly education. Instead there is a lack of respect for medical doctors and it's easier to exploit them instead of valuing their skills. To me this type of practice or replacement of actual MDs will affect patient care and I hope it is serious enough for greedy and cheap hospitals to see that!
0@@karensmithfam3187
I'm curious about fellowship matches as well, particularly for internal medicine - though there are many unmatched IM residents, many who go into IM purely do it to move on to fellowships. I suspect the most competitive fellowship subspecialties have similar match rates to the most competitive non-IM residencies, but I haven't seen the data
Here’s the graphic I made for the fellowship match this year. Match rates for applicants are essentially the inverse of program fill rates.
x.com/jbcarmody/status/1729933555810132429?s=46&t=bmm1gv3HxWdNazimqL_3_w
Can you please please make a video on filters set by programs? Should we cross all the filters set by them or should we nly cross 2 out of 3 something like that?
Dr. Carmody, thank you for this insightful video. I'm curious if you have any insight as to whether or not a malpractice insurance carrier would be willing to underwrite an IMG who has not completed any form of US residency training. As a physician myself who does a lot of medico-legal consulting, I'm curious as to this.
Thanks!
Thank you for this much awaited video! As someone who is aspiring to apply for next year’s match, this is really helpful.
Looking forward to having you in next year’s Winners & Losers!
@@sheriffofsodium Can’t wait!
Never clicked a video that fast
Thank you for watching.
Nice!
Dropping a Flexner reference in a video is a flex in its own right
Hello Sheriff, does AAMC or NRMP provide any data breakdown for residency applicants/matches who have dual degrees? Particularly MD/PhD, but other relevant degree combos like MPH would be quite interesting to see if available. Thanks!
imagine having the 1 unfilled EM slot in 2016
If I were to become an MD, I would definitely go for Emergency Medicine. I love being a Trauma ER Nurse and love my ED docs.....There's no other place I'd rather be...Second would be Ortho or Oncology....
How's their schedule like? What is the pay like?
Thanks for the content and information, very helpful. I actually did my Master's thesis on the healthcare worker shortage, and specifically physicians versus mid-levels in filling the gaps. I definitely believe we are going to have a physician shortage of some nature in the united states, the question really is how much will it be filled by mid-levels, and what effect will that have on the quality of healthcare for the average patient in the future. All I'll say is, after doing a lot of research, I will only be seen by MDs and DOs
I’m gonna post a video on the physician shortage soon. It’s been near the top of my priority list for a while… but never at the very top to get it done. But I’ll be eager to hear what you think when I do.
@@sheriffofsodium can't wait!
I am 100% with you! I refuse my family members and myself to be seen by PAs and NPs. They don't have the same training or knowledge. I don't understand how they are given salaries like MDs when they don't go through the same training, financial stress, the length of time in 1 exam and the number of those exams taken, or the stress of not knowing your future based on the number of attempts, the amount of money in applications for residency, the rejections and despite all this they are using MDs to train them like doctors. Doesn't seem fair, seems like cheap practice by hospitals and I am sure hospitals have to answer to someone for this (maybe a state rep)! Nurses are actually in shortage, but most of them want to be like doctors without the proper training. I think hospitals need to consider hiring them as nurses so that gap is closed. Or these nurses should be sent to rural areas to cover the shortage of physicians.
Next year will be interesting because medical school has been free tuition was in bronx, the poorest area of New York city. Maybe more medical school students will be chosen primary care specialty, emergency medicine, etc.
It's a nice thought and I wish I could agree, but that really depends on people thinking very short term. The long term financial incentives haven't changed at all. I expect modest increases in primary care fields, if any.
It is not happening. They are making more derms
If I can get my hands on Match lists, I’ll break it down.
I wish I could be as naive as your are :)
No chance. Free tuition = much more competitive applicants = gunner MD students = gunning for plastics or neurosurg.
Your predictions always turn out true! wondering if you have one for
next year’s loser speciality we can witness coming true :’)
Congratulations to everyone that matched today, and thank you for this wonderful breakdown!
WHAT?! Did I hear you correctly?! People are SELLING residency positions?!?! Are you kidding? And who the **** has an extra 120-200k??? Especially IMGs since our currency is usually worth less than the American dollar. Oh my God
You heard correctly. Expect to hear more about this story in the future, either here or elsewhere.
@@sheriffofsodium I hope you do make a video about it, you're an excellent story teller and diligent investigator!
Would love to see a video about this as an IMG grad who completed training!!!!
Some Indian billionare paid 9 milion USD so that Rihanna can sing at his son's wedding. There are many rich people outside of the US with some ambitious kids...
I wonder if those states where these loopholes exist are going to exploit IMGs and pay them much lower than the market rate therefore deflating the rates in those states. If IMGs were able to practice in any state and bypass residency then that’s an entirely different story
This news of course is bad for the future of American medicine. Yes graduates are responding to market forces appropriately. They are now funneling into specialty care which in turn exacerbates the siloed fragmented care model here that explains why we spend 5000 more per capita with vastly inferior outcomes in developed countries.
Absolutely love your takes - witty and insightful.
Another great episode! Thank you.
As a long time IMG grad who's down with training, this is the first time I've heard about residency spots for 6 digits sum of money! That's just crazy.
I am actually going to be distributing this video around to all IMGs so that they are aware of this. Because many are aware, but the ones who are desperate sometimes are blinded and need to be reminded.
The most basic definition of economics: How people (& companies) react to financial incentives & disincentives. The problem is the 3rd party payor model drives these incentives & distorts what specialties/subspecialties patients value.
With all of the problems with the matching process applicants should be thankful they don't have the problems of dental and veterinary graduates. Most dental graduates have to pay for their residencies( in addition to having the highest tuition rates in health care). Veterinary graduates are often forced to sign predatory contracts with animals hospitals where they can be sued for hundreds of thousands of dollars.
With Trump administration planning to cut medicaid budjet i would never risk my future by pursuing Paediatric residency 😢
DOs on the up!! 🎉
As a pediatric subspecialist, what do you think it's going to take for pediatrics to stop being delusional about mandatory 3-year fellowships?
I think it will occur… eventually. My expectation is that the biggest, most research driven programs will continue to defend the necessity of three-year fellowships with all of the usual tropes (“I never knew I wanted to become a funded investigator until someone MADE me do research!”, “I’m no longer involved in research but my previous mandatory research experience is SO VALUABLE to my current role!”), but the most important/unspoken thing is they benefit from fellowship doing research, so it’s easy to see a system of three-year fellowships, postdoc after postdoc, fourth-year fellows, etc. as an untarnished good.
However, in many subspecialties, fellowship programs go unfilled - and these programs have a strong incentive to broaden the pipeline. Historically, the voices of these programs don’t carry as much weight at the ABP as the big name programs do… but the fact that the ABP now allows 2- or 3-year pediatric hospital medicine fellowships opened the door just a crack. Eventually I think logic will prevail.
This cycle was a wild ride but glad its over LOL. Congrats to my fellow DO's who matched, WE MADE IT!
I had to jump off "X" to finish/publish my reform & so was looking forward to this video.
Praise be, the Lord of electrolytes has returned
Was eagerly waiting for this video!!
You are doing awesome work. I love your analysis. Thank you for doing it.
There are several factors driving the "physician shortage." I think we do need more slots but that's not the root cause/real answer.
It's systemically intentional
Great video
Another great video- thank you
Come down to the south or the rural community… there’s a shortage
A shortage… or maldistribution?
As always, It's awesome & very informative Sir.
Just one question. Which exma step is Don Vito Corleone representing? 🤣
NRMP THE MATCH
How competitive is pathology residency? Is it really difficult to get residency. I knw some ppl matched pathology on there 4 cycles...is it impossible in upcoming residency matches
What is the pay for pathology? How long is residency? And once you are finished what is it that you do with it?
I was more excited for this video than the Match
That’s a high compliment!
Family Med here. Very sad, but understandable.
I think AI-assisted charting and scribing will make family med more desirable in the future. Right now, I couldn’t choose it based purely on the obscene amount of administrative time.
The legend 🔥🔥🔥
Great video as always. Is there an existing medical body that you feel should be on the hot seat to push for changes to address the big picture problems? Obviously the AAMC will do whatever they can to print money from ERAS and other services. The leadership of competitive specialties have no obvious incentive to shake up their situation. Should it be groups like specialty boards like the AAFP or AAP pushing to make their services compensated better and their specialties more desirable as a result? Some specific federal or state authority?
I feel like as long as med students value "prestige" and compensation (ie indefinitely) then any marginal changes by competition to ERAS, efforts by program directors, or policy changes from medical schools are just band aid solutions. I feel like people will always follow the money, but I'm not even sure what group exists now that is best situated to change where the money is going, if there is one.
Awesome series.
Going P/F on step exams is a big mistake and it will hurt graduates of lower tier programs. In the past, step exam scores would get the top graduate of University of Oklahoma higher ranked on a plastic surgery rank list compared to the bottom tier grad at Harvard Med. But now residency programs have lost one of their key distinguishers (test scores) so the bottom of the class Harvard grad with a barely passing Step 1 score will beat out a Univ of Oklahoma grad who has a 99th percentile step score.
Medical schools are gradually turning into law schools, where the name of the school trumps just about everything else.
Non us IMG here. Soaped but I will continue
Hang in there. Wishing you the best.
@@sheriffofsodium thank you for your video. I see that I need to improve my IV skills. I was one of the the unknown redflags
Been waiting for this to drop
It's hard for me to believe that they didn't?????
med students are too far in debt to be doing peds and family med.
Another sheriff banger
6:15 😂 lol this part killed me
Trying to head ‘em off at the pass
pediatrics is going down because there is less and less babies being born
This is an astute comment - many people don’t realize that the pediatric population is actually DOWN from 20 years ago. But the number of pediatric residency positions offered in the Match continues to climb each year (and that trend will likely accelerate with new ACGME program requirements).
@@sheriffofsodium Take the clue from South Korea. They are facing critical shortage of pediatrics in many areas because no one wants pediatric residency. Pediatric residencies are no longer in demand because earning potential is becoming very limited since very few babies are being born.
@@tindrums With Trump administration planning to cut medicaid budjet i would never risk my future by pursuing Paediatric residency 😢
30 years s/p residency her; you cite interesting theories about why so many unfilled spots but you omitted another potential reason, that being the glaucomflecken videos and how they portray some specialties.
this for profit corps are going to bring childrens to work in hospital soon to make bucks.
I’ve been a match loser for 4 years now. I think its time to quit at this point
I think the fact img are allowed to match US residency is absolutely ridiculous