미국의 레지던트 자리 부족

(출처 : http://www.directortom.com/director-tom/2008/10/10/does-your-companys-video-have-a-mismatch-problem.html)

지난 수십년간, 미국내 의사의 공급(의사 수)은 너무 적었다가, 너무 많아졌다가, 

다시 너무 적은 상태로 오락가락 하고있다. 

2006년, 의사 수가 부족할 것이라는 경고가 있었고 

AAMC는 그 후 10년간 의과대학에서 선발하는 학생을 30% 늘릴 것을 권고하였다.

그러나 더 많은 의사를 양성하고자 하는 것에 있어서 또 하나의 장애물이 있다.

레지던트 숫자는 늘어나지 않았기 때문에 

늘어난 의대 졸업생 전부를 수용하지 못하게 된 것이다. 

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For generations, the supply of practicing physicians in the United States has swung from too small to too large and back again. In 2006, alarmed about a growing physician shortage, the Association of American Medical Colleges (AAMC) recommended that medical school enrollments be increased by 30% over the next decade

But there’s another barrier to creating enough practicing physicians: there are insufficient residency posts to accommodate all these medical graduates.

After two decades (1980 to 2000) when the number of U.S. medical school graduates remained steady (about 16,000 annually), a burst of activity has led to the expansion of existing medical schools, the development of new ones, and rapid growth of colleges of osteopathy. 1 In 2002, there were 125 U.S. medical schools; today, there are 141, and about one third of the recent growth in enrollment derives from new schools.

Indeed, federal funding is a key factor limiting the number of GME positions, which, in contrast to medical school seats, has increased remarkably slowly — at an annual rate of 0.9% from 2001 through 2010.2 

Medicare is the primary supporter of GME programs

Efforts by the AAMC and its allies to persuade Congress to increase Medicare GME support — funding an additional 15,000 positions — were thwarted during the debate over the Affordable Care Act (ACA).

For the 2009–2010 academic year, 27 states still had more GME positions than they had undergraduate medical and osteopathic students to fill them

Many of the remaining states are rural, small, or both and have limited GME capacity; 

Among the large states with too few GME training positions, Florida and Texas face major challenges: between them, they have developed four new medical schools in the past decade but have added very few advanced training posts.

On a national level, the American Academy of Family Physicians (AAFP) argues that the administration’s cut to Medicare

GME funding could imperil family- medicine residency programs.

Given enrollment growth, it may soon be impossible for all graduates of U.S. medical and osteopathic colleges to secure GME slots unless there is a sizable increase in the number of training positions. Currently, there are 117,604 residency- training posts accredited by the Accreditation Council for Graduate Medical Education. In the 2013 main residency match, according to the National Resident Matching Program, 25,463 positions were filled with 17,119 graduates of U.S. medical schools, 6307 graduates of international medical schools (2706 U.S. citizens and 3601 non-U.S. citizens), 2019 graduates of colleges of osteopathic medicine, 14 graduates of Canadian schools, and 4 from Fifth Pathway programs.5

The large cohort of international medical-school graduates who seek U.S. training positions every year will be in even greater jeopardy.

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N Engl J Med. 2013 Jun 19. [Epub ahead of print]

The Residency Mismatch.

Iglehart JK.

Source

Mr. Iglehart is a national correspondent for the Journal.

Abstract

For generations, the supply of practicing physicians in the United States has swung from too small to too large and back again. In 2006, alarmed about a growing physician shortage, the Association of American Medical Colleges (AAMC) recommended that medical school enrollments be increased by 30% over the next decade. Now, entering classes are projected to reach 21,434 students by the 2016-2017 academic year, almost a 30% increase over 2002 (see table). Colleges of osteopathic medicine have been growing for the past 20 years, doubling in number from 15 to 30 and increasing enrollments from 6892 students in 1990 to . . .