The draft

Tuesday, June 9, 2009

June is draft month. Pro baseball, basketball and hockey leagues divvy up the unproven talent of high school and college kids and bestow upon them the future of their team. Fans live and die by the choices, deciding whether the draft picks will allow them to cheer on to victory or wallow in the agony of defeat.

June is also the month when residents graduate from medical training and enter their first practice. Their patients and communities also have a vested interest in their choices and hope that the newly minted specialists will choose to locate to their town or city. The odds are against most places; there aren’t that many docs to go around.

It takes a fair amount of effort to become a doctor. The usual timetable includes four years as an undergraduate student, four years in medical school and then 3-7 years or more in post graduate or residency training to get enough training to practice medicine independently. A family practice specialist has 11 years invested before seeing the first patient, a cardiovascular surgeon (one that does heart surgery) or a neurosurgeon might have 15 years in the books.

Since there are about 100,000 residents in training every year in the US, only 25,000 graduate into the real world. That may or may not be enough to replace those physicians who retire or leave practice for other reasons. And it certainly isn’t enough to start caring for the aging population that is the United States. The problem stems from a decision decades ago to not increase the number of medical schools and to hold firm the number of spaces available to train residents.

This issue is not news but once it was uncovered, it took years to devise a solution. Three new medical schools received preliminary accreditation in 2008 in El Paso, Miami and Orlando and existing medical schools have started to ramp up their enrollment so that there will be about 20,000 medical students being trained by 2012. Not all of these students may have a place to get their residency training.

Teaching hospitals use Medicare dollars to provide a place for residency to learn their skills, but hospitals and Medicare are under financial fire for lack of funding. The decision to keep or cut programs for doctors in training will likely be made based on how much it costs as opposed to how well they teach.

Every year, the talent pool in professional sports gets deeper. The quality of the athlete increases and the ability to perform continues to amaze. The same can be said for the new doctors. Their depth of knowledge and the ability to use technology allows diagnosis and treatment that were unthinkable a decade ago. But as the country ages, will there be skilled available or will June mimic the pro draft. Cities and towns may live and die by the choice of where a physician decides to practice, and whether that choice will allow them to cheer on to victory or wallow in the agony of defeat.

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