the medical draft

Friday, March 10, 2017

The sun sets on the first day of this year’s NFL free agency as rejoicing, and perhaps mourning, breaks out through the country with each team’s fans praying that this…might…be …the…year!  Hope springs eternal for the next season after seminal events in each sport. Whether it is the NCAA signing period bringing high school stars to campus, or the trade deadline in the NBA and NHL where a final push to the playoffs might be a reality. But there is another draft that is happening now that will likely have a much more tangible effect on people’s lives…literally.

The 2017 National Residency Matching Program (NRMP) releases its results beginning March 13 and the lives of thousands of medical students and millions of patients will be forever changed. In the fall of 2016, at the beginning of their fourth and final year of medical school, more than 40,000 soon to be doctors begin the application process for residency training slots and the start of graduate education. Almost 5,000 teaching hospitals offer more than 30,000 training opportunities in every specialty of medicine, from surgery to ophthalmology, psychiatry to family practice, pathology to whatever other type of medicine you can imagine.

The process is relatively simple. The medical students apply to a residency program (usually more than a few), visit and interview at a couple and then on February 22 send their wish list to the “Match”. Residency program directors, and their staff, sift through the applications, medical school grades and interview performance to decide where they rank the soon to be doctors o their draft board and submit their list as well. NRMP computers do the rest, and next week marriages are announced. There will be some rejoicing, some sadness and some mourning. A few students won’t be matched, but like the NFL, there is a supplemental draft since some programs also don’t fill their positions.

But why should the rest of the world care; it’s not like fans fill a stadium every Sunday and have fantasy resident teams based on how well a new doctor cared for a patient in congestive hear failure or assisted on an operation. Aside from the direct care that the residents provide at a teaching hospital, the results of the Match might alter the landscape of a community for a generation to come. Training can last 3 to 7 years or more and during that time, these new doctors start families, put down roots and often tend to stay in the area where they did their training.

The young fourth year medical student that interviewed at your local hospital might be the surgeon who is emergently operating on you in ten years. She might be coaching your basketball team or he might be running for school board. These are the new young professionals who become the fabric not only of the medical community but also of the community as a whole.

Unfortunately, there is a cloud that hangs over this year’s Match. Because foreign medical graduate students also participate in the Match in search of US quality training, there has been concern raised by the NRMP that travel restrictions for some might affect their ability to begin training on the traditional start date in July. From the NRMP press release:

  • …This uncertainty leaves programs the choice of not ranking qualified applicants or risking empty training slots on their program start date. Even if the ban ends after 90 days, there is concern that the consular interviews that are required prior to obtaining visas will be so slow that affected applicants will not be able to start training on time. There also are concerns about whether residents and fellows who are in the U.S. on visas will be able to remain in their training programs. 
  • The consequences of the Executive Order are far reaching for Match applicants, and the upheaval it is causing is extensive. The affected applicants have worked hard for many years to achieve their goal of becoming physicians, and they should not be denied that opportunity because of a blanket policy that does not consider the individual. Similarly, U.S. training programs should be able to select applicants based on their excellent character and qualifications, without regard to nationality. Both applicants and programs benefit from an orderly process for entry into graduate medical education. The Executive Order disrupts that process very considerably.

As NFL free agency winds down and the hype of their draft begins, teams begin reshaping their team to become more competitive in the coming years. The NRMP  allows hospitals and communities to do the same thing when it comes to the quality of medical care available. Perhaps it might be time to appreciate the medical draft that touches health and welfare of thousands of communities in the US. Knowing that your local hospital has filled their training slots in family medicine and surgery should make you feel a little safer for the next thirty years. Wit hall that is at stake, it is surprising that the Match isn’t must watch reality television. I wonder if ESPN might be interested?


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the other draft

Monday, May 12, 2014

For fans of the NFL, the draft has become a Christmas like celebration of hope for the future and dreams of success. Each team has evaluated hundreds of college football players to find those few who might bring success in the years to come. The team hopes to find the player with skill and personality who can add to team value. The player hopes to be drafted by a team that will allow him to have an impact and play almost immediately and will have playoff potential. The fans want a player who will be skilled, loyal to team and bring pride, dignity and a trophy to their city. Through rounds of intervie

While the NFL draft spectacle occurs under the bright lights of the media, a much quieter draft takes place every spring and the results will affect the local quality of life much more than a quarterback or linebacker. This spring, more than 34,000 medical students applied for a residency training slot, their first step to becoming a specialist after getting their MD degree. Half were from US medical schools, half were international graduates and all were looking for one of 27,000 places to get training in specialties ranging from pediatrics to surgery to radiation oncology. Few people outside of the medical community care about the match, but the results will affect their lives and the lives of their families for a generation or more.

The match dance is pretty simple. Medical students decide what kind of doctor they want to become and apply to residency training programs who will screen the applicants to find the ones that are the best fit for their needs and style. Students visit hospitals and go through rounds of interviews and rank the places in order of preference. Residency directors, sift through applications, recommendation letters and decide on their draft list. On one fine spring day, a computer silently matches the student with their new home. The match is binding, just like the NFL; one goes where one is matched. There are also a few free agents who don’t get matched but a few spots may become available closer to July, when the hospital academic year begins.

But why should you care what newly minted MD might show up to be trained at the hospital down the road? It seems that after spending, three to seven years of more in training, most docs tend to settle down near where they trained. That new medical school graduate may be looking after patients in your neighborhood for the next 30 years. Their kids will go to school wit hyour kids. The next soccer or little league coach may be your family doctor; the obstetrician may sing alto in the church choir and in a few cases, they may be your next Governor or Senator.

The statistics are in from the 2014 match and there is some good news for patients. Almost 40% of US medical students opted for training in primary care, either family medicine, internal medicine or pediatrics. The percentage entering radiology was the lowest in 15 years. The shift away from surgery specialties and radiology may signal that people enter medical school to develop relationships with their patients and that leads them to practices where they can again grow with their patients and their families. It also signals an altruistic change. Primary care is not a highly compensated specialty and while physicians are comfortably paid, the average medical student debt at graduation is north of $170,000. The benefits are not always financial when it come to looking after people.

The new crop of doctors will arriving by the end of June. They will begin forming opinions of their hospital, neighborhood and city relatively quickly. They will develop relationships and roots will be established. If the community is lucky, that doctor will decide to stay a lifetime. If not, it’s just like the NFL, there is always a hospital that will enter the free agent market looking to lure another doctor to their town, and the hope will begin again for the next spring draft.

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