Expatriate Owl

A politically-incorrect perspective that does not necessarily tow the party line, on various matters including but not limited to taxation, academia, government and religion.

Friday, April 03, 2015

Mixing and Matching the MDs

I've been considering the implications behind this one since my wife mentioned it.

The annual ritual of Match Day is anticipated with excitement and fear by 4th year medical students throughout America.  Medical school is only the beginning of a physician's training; there almost always is an internship and/or residency to be served.  How the newly-minted physician is matched to his or her post-graduate training program has a major impact on various life decisions, including but not limited to the nature of the physician's practice, the finances, and, quite often, geographical location.

If the 4th year medical student has a significant other, then the situation is complicated all the more; this I know firsthand, and, without getting too deeply into the specifics, will state that the geographical and financial issues of my then-fiancee's career impacted my own.  Our courtship and marriage continues to be a very viable item after thirty years, but not everyone is so lucky; the marriage between one of my law school classmates and one of my wife's med school classmates did not survive the medical residency period.

So looking at the numbers for this year's Match Day, we had 30,212  physicians competing for 41,334 residencies, a match rate of 73%.  Yes, it is true that some additional residencies will materialize, so the unsuccessful contenders are not yet totally out of luck (and some will go for a PhD or find some other gainful activity).  But let us look at what the numbers tell -- and do not tell.

Behind the official Match Day numbers are physicians who are saddled with debt for their educations.  Those physicians who matched will have some stream of income and will be able to at least make a small dent in their educational debts.  Those who did not match and who are unsuccessful in finding gainful employment, however, will find themselves in some very trying circumstances financially.

The foregoing verbiage is applicable today, was applicable when my wife did her residency match, and was applicable even a generation before, when my uncle did his residency match which sent him out of town.  Today, however, there is a new spin on the Match Day numbers, a spin that Uncle Leonard knows not from his own direct experience, but from the experience of his granddaughter, who this year was fortunate enough to get matched with the residency program that was her number two choice.

Not reflected in the numbers is the fact that the cost of a medical school education -- like any other collegiate educational program in America -- has been rising at a far, far faster rate than the consumer price index.  Not reflected in the numbers is the fact that more and more foreign-educated physicians are entering the game in America.

Not reflected in the numbers is the fact that hospitals and other health care facilities are under pressure to reduce their costs, and so, functions formerly performed by physicians are now being done by others, most notably Physician Assistants and Nurse Practitioners.  To be sure, there is much to be said for a competent PA or NP; my wife speaks quite highly of those in her own department at the hospital where she works.  But in too many instances, the PAs and NPs are being given too long a leash, and are making decisions without the benefit of a full medical perspective.

And, of course, there is the misnamed Affordable Care Act, which has created a demand for healthcare without actually increasing the supply.  If not before, then by the time a student has sat in the classroom for his or her Economics 101 course, then he or she should fully appreciate that as demand increases relative to supply, price increases.

I shall leave it to the economists and statisticians to give detailed analyses of the match numbers.  All I ask of you now, dear reader, is to remember that the Match Day statistics you read are all part of the big ObamaCare train wreck, and must accordingly be viewed in that context.

The Passover holiday will soon be upon us; wishing all a happy and meaningful one.

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