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Old 10-09-2013
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Listening The Impact of Obamacare on Residency Spots and Future Practice?

What is your take on this guys?
The impact of Obamacare on doctors and residents?
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As no one answered .... i would like to share some my viewpoints after reading a little ...a lot more is still to be understood to have completely the full picture of it .....also your input is highly appreciated
  • More people getting insured ( 50 million to be newly insured)
  • The increase in primary care doctors demand
  • The expansion of medical schools.
  • There will be an increase in no medical students,
  • Hence there will be an increase in residency programs to allow more students to become doctors ( which are a constant since 1997 under a law called balance budget act)
  • more demand for primary care to increase = internal medicine , family physician
  • no of patients per day to increase
  • less time per patient for doctors = endangering patient-doctor relationship
  • The OB/GYN ….With the law upheld, will see fewer patients who lose their insurance, don’t get birth control, and then come to them with unplanned pregnancies. OCP will be covered under obamacare
  • The surgeons and cardiologists tend to be against Obamacare but the primary care and family doctors tend to be for it.
  • less impact on residents than on physicians = With increased economic pressures on hospitals and limitations on resident physician work hours, attending physician workload to likely increase
  • private practicing physician will get a serious hit ( on expenses = new electronic material to placed and train the corresponding , more paper work = more staff , in the end low percentage of reimbursement’s as compared to a hospital , poor payment schedule)
  • all specialist hit because of early check ups = disease picked up early and treated early by a primary care

    Over all
  • At the clinics the nice thing is if everyone has insurance they might go see a doctor regularly for check up before they come into the hospital. So they might know about problems like high blood pressure well in advance , hence less cost as disease caught early = less cost to manage and treat
  • patients would take advantage of the opportunity to get regular checkups.
  • mostly residents shouldn’t care where the money comes from. They’re going to practice medicine exactly the same way( for what they was hired !)
  • decrease in no of unrelated test to be done = due to bundled payments ( payment given as a whole for an episode of disease i.e. trauma ( single payment for the whole episode = ER physician + primary care + surgeon + therapist + pharmacist ) …so in the end price controlled at all points
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Old 10-10-2013
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From what I've read, this seems to be pretty accurate for now. Still, we really don't know how this will impact the nation for patients as well as physicians. The workload undoubtedly will increase. Also, I'm not fully sure about patients benefiting if the deductibles of insurance plans are so high. They will likely abstain from going to see the doctor despite paying a a monthly premium for insurance due to high copays and insane deductibles.

We will see.
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Originally Posted by tootsie View Post
From what I've read, this seems to be pretty accurate for now. Still, we really don't know how this will impact the nation for patients as well as physicians. The workload undoubtedly will increase. Also, I'm not fully sure about patients benefiting if the deductibles of insurance plans are so high. They will likely abstain from going to see the doctor despite paying a a monthly premium for insurance due to high copays and insane deductibles.

We will see.
yeah you are definitely right here ....

also now under the law previously patients who were denied insurance on the basis of pre existing diseases , won't be now ...so a influx of patients in more than likely to be seen ....also under the new law i read there is an yearly free check up for all the people under the insurance regardless of the deductibles and high co pays ..
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Funny you mention that there will be free checkups per year because I was thinking that a potential solution would be to offer something like that or 2-3 office visits when sick per year. I also read somewhere that the field for physicians will not be as attractive with decreased medicaid reimbursements. Insurance companies pretty much follow what medicaid does and if medicaid pay doctors less, it'll be like having physicians become workers like the department of motor vehicles.

Thanks for bringing this up. I hope to hear more input from others as well. But as of now, the future of the medical career will be less attractive to incoming students- further affecting the already shortage.
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Could anyone explain how this might impact IMGs applying to residency?
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Originally Posted by tootsie View Post
Funny you mention that there will be free checkups per year because I was thinking that a potential solution would be to offer something like that or 2-3 office visits when sick per year. I also read somewhere that the field for physicians will not be as attractive with decreased medicaid reimbursements. Insurance companies pretty much follow what medicaid does and if medicaid pay doctors less, it'll be like having physicians become workers like the department of motor vehicles.

Thanks for bringing this up. I hope to hear more input from others as well. But as of now, the future of the medical career will be less attractive to incoming students- further affecting the already shortage.

you are right though a lot of it is still set to be unfolded ....also in a recent survey conducted by the Medical Group Management Association (MGMA), a trade group representing multi-physician medical practices. The results are in, and they’re unambiguous:

  • A majority (55.5 percent) of practices believe the exchanges will have an unfavorable, or very unfavorable, impact on their practice.
  • Fewer than three in 10 practices (29.2 percent) definitely plan to “participate with any new health insurance product(s) sold” on an exchange, with a majority (56.4 percent) still uncertain.
  • Of those not participating in the exchanges, the top concern, listed by 64 percent of practices, was “concerns about the administrative and regulatory burdens related to these products.”
  • More than two in three practices said that reimbursement rates for exchange plans are somewhat lower (36.2 percent) or much lower (33.2 percent) than “average payment rates from all commercial payers in your area”—and these lower reimbursement rates likely explain the lack of robust commitment by physician practices in participating in exchange plans.

so it depends on first on the state(around 25 states still are not in it ) , then the ultimately the hospital to accept the new exchange ....and then it will finally lead to affect the physician's financial image

also on the yearly checkup = i think for the people who were initially uninsured who hadn't have gone to doctors for years , even when they have been moderately sick , is a lot ...... i.e. something is better than nothing

also the new health reform Requires all new plan sto cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co‐pay or coinsurance = good for a patient
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Old 10-11-2013
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most of the IMGs are interested to hear an increase in the residency spots ??



I think they will increase though I don't have a reference to prove it but with an increase in patient load they will need more doctors
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Old 11-25-2013
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Quote:
Originally Posted by ehtisham View Post
most of the IMGs are interested to hear an increase in the residency spots ??



I think they will increase though I don't have a reference to prove it but with an increase in patient load they will need more doctors
its up to the US Congress (House and Senate) to increase the spots. Obama cant do anything on his own; he can only encourage them or at the most, have a bill drafted and sent to the Congress so that it can be debated and voted upon. Right now, with the political situation at hand, the US House of Reps, with it being majority Republican, is not going to do anything that will benefit or enhance Obamacare in any way. I wouldnt expect the slots to increase unless the Democrats take over the House...and even then, i dont know. The AMA and the medical industry is a pretty powerful lobby; the availability of spots have been capped since 1997.
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Old 12-13-2013
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I am sure you people would have already heard about the Physician Shortage Act which was passed recently. It has proposed to add 15,000 residency positions over a period of 5 years. which means 3,000 positions per year mostly in primary care specialities. you can google it out
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Old 12-13-2013
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Originally Posted by Matchday15 View Post
I am sure you people would have already heard about the Physician Shortage Act which was passed recently. It has proposed to add 15,000 residency positions over a period of 5 years. which means 3,000 positions per year mostly in primary care specialities. you can google it out
That bill has not been passed yet it hasnt even made it to the floor for a vote
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Old 12-13-2013
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Corrections bill has been introduced

http://beta.congress.gov/bill/113th/house-bill/1180
If you can see the bill has lot of cosponsors. Still its a catch22. Nobody can predict the outcome as of now as the bill has been introduced since 2011 in various forms but never made it to the house.

The AMA is heavily lobbying to get the bill passed.
http://vimeo.com/77727683

We must accept the path of US residency is no more a walk in the park.
1.Step 3 is going for a split. http://www.usmle.org/announcements/d...?ContentId=121

2.Repeat Applicants getting heavily bruised in the current Match

3.ECFMG is rolling out plans to put a full stop to Caribbean schools with new accreditation process debunking FAIMER http://www.ecfmg.org/about/initiativ...quirement.html

4.The rise of AMGs http://www.medicalopedia.org/4423/us...starting-2014/

5. JAMA and NEJM doomsday articles

I even wonder sometimes if ECFMG, or IMG forums or Companies who are trying to sell their fancy products to IMGs will even exist in years to come.

Wish there was a lobby group for IMGs too But looks like nobody cares about us
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Old 12-13-2013
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Corrections bill has been introduced

If you can see the bill has lot of cosponsors. Still its a catch22. Nobody can predict the outcome as of now as the bill has been introduced since 2011 in various forms but never made it to the house.

The AMA is heavily lobbying to get the bill passed.

We must accept the path of US residency is no more a walk in the park.
1.Step 3 is going for a split.

2.Repeat Applicants getting heavily bruised in the current Match

3.ECFMG is rolling out plans to put a full stop to Caribbean schools with new accreditation process debunking FAIMER

4.The rise of AMGs

5. JAMA and NEJM doomsday articles

I even wonder sometimes if ECFMG, or IMG forums or Companies who are trying to sell their fancy products to IMGs will even exist in years to come.

Wish there was a lobby group for IMGs too But looks like nobody cares about us
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Old 12-13-2013
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Quote:
Originally Posted by Matchday15 View Post
Corrections bill has been introduced

If you can see the bill has lot of cosponsors. Still its a catch22. Nobody can predict the outcome as of now as the bill has been introduced since 2011 in various forms but never made it to the house.
Its about funding... new medical schools will pop up cause its private sector funding so more AMGs produced... but when it comes to residency spot that is public money. You need roughly 100k (being conservative) per spot... 3000x100k = 300 million in extra funding per year. Its very difficult...

Obviously, it means more AMG and less IMG every year. But if you are an USIMG... you should be fine for next 5-7yrs... But if you are foreign with VISA requirements very difficult....

You can thank St. george and ross for that... it would have been fine if they didnt try to monopolize new york clinical rotations. Caribbean schools just got too much bad publicity in the media... NY times etc. and all of a sudden a nationwide issue.... (just my my opinion)
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Old 12-13-2013
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Keep ready. There is a storm coming. AMA is doing its best to take out the 1997 Cap.

Future IMGs know this:
*Caribbean schools not an option for the future. USIMGs who are already in may survive the storm. FOR NOW
*Think twice before you plan to come to US if you nonUS IMG.
*USMLE/NBME is going massive transformation to deal with the crisis. The exams are getting harder and there are more casualities.
*2014 Unmatched candidates look for other options. I wish most of you match this year.

US is heading UK route which stopped taking IMGs 10 years ago. I would suggest all my friends to have an exit plan. Better be prepared than be in ignorance.Things will get dirty for sure.

Only hoping situation will change for the best.
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Old 12-14-2013
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Quote:
Originally Posted by Matchday15 View Post
Keep ready. There is a storm coming. AMA is doing its best to take out the 1997 Cap.

Future IMGs know this:
*Caribbean schools not an option for the future. USIMGs who are already in may survive the storm. FOR NOW
*Think twice before you plan to come to US if you nonUS IMG.
*USMLE/NBME is going massive transformation to deal with the crisis. The exams are getting harder and there are more casualities.
*2014 Unmatched candidates look for other options. I wish most of you match this year.

US is heading UK route which stopped taking IMGs 10 years ago. I would suggest all my friends to have an exit plan. Better be prepared than be in ignorance.Things will get dirty for sure.

Only hoping situation will change for the best.
I highly doubt that the door would ever close for the IMG as they make a significant amount of workforce of US health system .... just by talking about the facts i.e. the new health care system , the ever increasing population and economy , and the fact that IMG serve the rural population where most AMGs think twice when applying . They will have to go with the bill one way or the other . It is becoming tough ,a fact ,but to think IMG are done in the upcoming years is just insane !
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Old 12-14-2013
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Default sounds like doomsday for non-US IMGs like myself:(

Quote:
Originally Posted by Matchday15 View Post
Keep ready. There is a storm coming. AMA is doing its best to take out the 1997 Cap.

Future IMGs know this:
*Caribbean schools not an option for the future. USIMGs who are already in may survive the storm. FOR NOW
*Think twice before you plan to come to US if you nonUS IMG.
*USMLE/NBME is going massive transformation to deal with the crisis. The exams are getting harder and there are more casualities.
*2014 Unmatched candidates look for other options. I wish most of you match this year.

US is heading UK route which stopped taking IMGs 10 years ago. I would suggest all my friends to have an exit plan. Better be prepared than be in ignorance.Things will get dirty for sure.

Only hoping situation will change for the best.
sounds scary. it's like doomsday for non-US IMGs like myself...I hope I get matched this year...keeping my fingers crossed I am willing to be in any specialty for as long as I get matched...I love FM coz I am interested in all branches of medicine so I don't really care if I get matched to my 2nd or 3rd option...as long as I get matched this year...every year it's getting tougher and every year my chances are getting slimmer as I pass the 10-year mark of a few remaining programs with YOG cut off of more than 5 years but less than 10 years
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Old 12-14-2013
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npktun I know its good to be optimistic. The points you highlighted held good for UK too. But they finally ended up shutting their doors for IMGs.

I know its sound scary. The resident physician shortage reduction act 2013 is the only hope for the existence of IMGs.
Write letters to your Representatives, the President and US surgeon general and the Committee members. Do everything possible in the scope of an USIMG or NONUSIMG. This is our last chance and we have to make a stand for our future and the future of people of our kind.

OR forget the dream of residency
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Old 12-14-2013
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Quote:
Originally Posted by Matchday15 View Post
npktun I know its good to be optimistic. The points you highlighted held good for UK too. But they finally ended up shutting their doors for IMGs.

I know its sound scary. The resident physician shortage reduction act 2013 is the only hope for the existence of IMGs.
Write letters to your Representatives, the President and US surgeon general and the Committee members.Do everything possible in the scope of an USIMG or NONUSIMG. This is our last chance and we have to make a stand for our future and the future of people of our kind.

OR forget the dream of residency
It is good to be cautious and stay in reality but being paranoid is the worst you can do to yourself ....

Also this graphs alone tells what i was stating earlier ....and you cant compare economy of US and UK let alone their policies !







The Impact of Obamacare on Residency Spots and Future Practice?-graph.jpg
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Old 12-15-2013
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Man , you got this totally wrong. The number of residency seats has nothing to do with the economics. Just because US economy is booming US will not open their doors for IMGs. This is not an IT sector where you can create unlimited number of jobs. There is a FEDERAL CAP. Your graphs may delight engineers and other professionals.

This year the NRMP has said there were 40000 applicants for 29000 match positions. Who are these 11,000 applicants who will go unmatched . Going by the previous trends, the major chunk will come out of the IMG pool irrespective of their performance or personal caliber, and not from the AMG basket. This is a question of demand and supply.

If you still believe the economics will do the magic. Lets talk economics. The US economy is already burdened with financing Affordable Care Act. Adding 15000 residency slots is no joke. It will require additional 8 billion dollars support to GME fund of the medicare. Where will this money come from?

Do you think UK stopped taking IMGs because they could no longer afford to support IMGs? Is that what you are trying to say

Over-Optimism is too bad. It makes a person mask himself with fleece of ignorance. I would rather be paranoid and be prepared for the worst
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Old 12-15-2013
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Quote:
Originally Posted by Matchday15 View Post
Man , you got this totally wrong. The number of residency seats has nothing to do with the economics. Just because US economy is booming US will not open their doors for IMGs. This is not an IT sector where you can create unlimited number of jobs. There is a FEDERAL CAP. Your graphs may delight engineers and other professionals.

This year the NRMP has said there were 40000 applicants for 29000 match positions. Who are these 11,000 applicants who will go unmatched . Going by the previous trends, the major chunk will come out of the IMG pool irrespective of their performance or personal caliber, and not from the AMG basket. This is a question of demand and supply.

If you still believe the economics will do the magic. Lets talk economics. The US economy is already burdened with financing Affordable Care Act. Adding 15000 residency slots is no joke. It will require additional 8 billion dollars support to GME fund of the medicare. Where will this money come from?

Do you think UK stopped taking IMGs because they could no longer afford to support IMGs? Is that what you are trying to say

Over-Optimism is too bad. It makes a person mask himself with fleece of ignorance. I would rather be paranoid and be prepared for the worst
My point was simple to understand . US has enormous population and population growth , increasing economy and the new health care (more workload) . It is a matter of time the physician shortage will swell and the increase of residency spots is inevitable !!!

The main reason UK stopped IMG was saturation and just by looking at their geography it wont take long for you to understand this !!!

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Old 12-15-2013
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You are not getting the point again. Even Countries like China and India have enormous population, increasing economy and a new health care.

The US is looking at a cost cutting measure. They are training more nurse practitioners and paramedics giving them more say in patient decisions. The country is not in a situation to spend 8 billion dollars every year and lift the 1997 cap. They cannot spend more on Medicare. Its a bottle neck. The Government is even making efforts to cut 60% GME funding to deal with the financial pressures.

There are powerful lobbies who are against the Resident Physician Shortage Reduction Act. This law never even made it to the house though it has been introduced every year since 2011. You can google it. The lobbies have historically made sure the number of doctors in US is limited and so that doctors are always in high demand.

Technology is a big game changer. There are new articles which are surfacing up showing how doctors can optimize their current time and handle more patient load with the aid of right technology.

My question on UK was rhetorical since you tried to draw comparison between the economies. I wanted to hear it from you. All I want to say is US will stop taking IMGs once the cap limit is saturated.

This is the reason why simple FLEX exam became 3 step USMLE. This is the reason why USMLE will be a 5 exam marathon run.Its a systematic act of desolation to curb the IMGs.

JAMA and NEJM are not a bunch of fools who hallucinate. You have to make peace with the harsh reality. I know you will with time. I am only saying we have to fight back
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Old 12-16-2013
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Inclined to agree with Matchday15.

I've had great conversations with senior interviewers this interview season and the one thing they all state is that they think the number of IMGs will decrease over the coming years.

In addition, a few have said that politicians involved in this are aware of the IMG-visa issues and the 'tax-payer $$$$$$' that is spent on training IMGs who cannot legally stay and practice in the the U.S. after their training.

As medical training moves forward, while at the same time striving to cut costs and deal with The Affordable Health Care for America Act, the emphasis will be on AMGs in terms of training more primary care physicians for communities, and providing incentives for those wishing to switch. At the same time, IMG numbers are projected to decrease as residency programs will collectively recruit residents with the goal of retaining trainees in the system (most IMGs cannot be retained using current visas).
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Inclined to agree with Matchday15.

I've had great conversations with senior interviewers this interview season and the one thing they all state is that they think the number of IMGs will decrease over the coming years.

In addition, a few have said that politicians involved in this are aware of the IMG-visa issues and the 'tax-payer $$$$$$' that is spent on training IMGs who cannot legally stay and practice in the the U.S. after their training.

As medical training moves forward, while at the same time striving to cut costs and deal with The Affordable Health Care for America Act, the emphasis will be on AMGs in terms of training more primary care physicians for communities, and providing incentives for those wishing to switch. At the same time, IMG numbers are projected to decrease as residency programs will collectively recruit residents with the goal of retaining trainees in the system (most IMGs cannot be retained using current visas).
So based on your say it will be better for programs to train resident on H1b visa instead of J1 visa?
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Old 12-17-2013
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Budget cut means less and less money will go to train IMGs ( US or nonUS) (J1 or H1).
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