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Wednesday, Sept. 4, 2013

For Residents

Survey reveals residents' match motivations

The National Resident Matching Program (NRMP) has released the results of its 2013 applicant survey, which offers insight into the motivations residents consider when ranking programs.

By far, the factor cited most by residents in selecting the programs to which they applied and in ordering their rankings was geographic location, surpassing both quality of the educational curriculum and training and the reputation of the program. Other elements frequently cited by residents included the quality of the faculty, whether the program was at an academic medical center and the quality of the other residents in the program. Fewer residents considered programs' salary histories, board pass rates and previous match violations.

The survey also revealed that U.S. medical school seniors who successfully matched submitted a median of 29 applications, and were offered an average of 15 interviews. The NRMP also offers a breakdown of the data by specialty.

As you move from training to practice, the AMA's popular guide Succeeding from Medical School to Practice can help. The comprehensive, easy-to-navigate resource includes a wealth of valuable information plus streaming video to help medical students, residents, fellows and young physicians confront the nonclinical demands of training and today's practice environment.

States grappling with physician shortages

As the national physician shortage looms, more media attention is being given to how individual states are growing their supply of physicians.

Texas, for instance, recently has rubber-stamped plans to open two new medical schools and is considering legislation that would devote $16 million to expanding residency opportunities for graduating medical students at Texas facilities, according to an article in the New York Times. Without this expansion, there will be more graduating medical students in Texas than first-year residency slots beginning next year.

The funding would mostly benefit hospitals that do not already have programs but would only pay for the first year of training. This leaves some critics wondering who will pay for the other years. Thomas Blackwell, MD, the associate dean of graduate medical education (GME) at the University of Texas Medical Branch in Galveston says the financing would not be enough to encourage his own program to expand.

While the grants would provide up to $65,000 per trainee, it costs $100,000 to $150,000 per year for each physician in training. The challenge will be identifying new hospitals or other providers that would be willing both to offer GME and partner with rural hospitals to help treat Texas' growing underserved populations.

Meanwhile, Wisconsin also is considering how to get more trainees to practice in rural settings. This is particularly important for Wisconsin, where almost 20 percent of the population lives in rural areas.

While Wisconsin's two medical schools are successfully pursuing initiatives to graduate more students committed to rural medicine, the number and type of GME positions in the state don't match up. The Wisconsin Collaborative for Rural GME recently has developed initiatives to address the problem, according to a recent opinion piece by several state leaders in medical education.

The initiative encourages small community organizations to offer training experiences at local hospitals and clinics. However, the authors believe a more aggressive program is required. They propose a workforce commission that would perform data collection, develop recommendations to help the state meet its workforce needs and lay the groundwork required to get physicians in training to take primary care positions in rural Wisconsin.

Washington state's medical educators also are starting to think creatively about how to get their students to come back and practice rural medicine in the state, reports NPR's NW News Network. Pacific Northwest University is offering residents real-world experience at the Community Health of Central Washington clinic.

Unfortunately, the state's rural residency spots are limited, and two-thirds of the graduates of Pacific Northwest University must leave to find residency positions. Leaving for residency often means the physician won't return.

"The best predictor of where somebody will go into practice is where they took their residency, and a good proportion end up practicing within 100 miles of where they finished their residency," said Roger Rosenblatt, MD, a family medicine professor at the University of Washington.

Don Weaver, MD, chief medical officer for the National Association of Community Health Clinics, agrees that positions should be expanded in rural areas, but that's easier said than done. Unless the cap on Medicare-funded residency positions enacted in 1997 is lifted or alternative funding mechanisms are developed, the chances of positions opening in rural Washington—and across the country—remain slim.

On a federal level, the AMA is advocating for Congress to sustain Medicare support and federal funding for GME to protect access to care and address physician shortages in undersupplied specialties and underserved areas. Visit the AMA's grassroots advocacy site, www.SaveGME.org, to be part of the concerted effort to strongly urge Congress to protect federal funding for GME.