Medical residents are often described as overworked, underpaid, and the backbone of healthcare. It’s true, residents regularly work 60-80 hours per week, earning far below what their hourly rate would be under minimum wage, and struggle to maintain work-life balance. But despite how often we hear these statements, the deeper reality is that the resident workforce problem is more complex than it appears.
One surprising element is the cost of training ONE medical resident. On average, it takes $150,000-$250,000 per year, which includes salary/benefits, teaching faculty, administrative staff, and accreditation requirements (Kalter, 2019). Even more surprising? Teaching hospitals do not pay this cost. Instead, most of the funding comes from the federal government through Medicare GME (Graduate Medical Education). Because Medicare pays the bill, Congress controls how many residents can be trained each year, and this number often fails to keep pace with the growing number of medical school graduates. As a result, newly graduated doctors cannot secure residency positions and are unable to practice medicine at all, leaving hundreds of doctors in limbo every year.
To address this, several solutions have been proposed. One of the most promising ideas is from the American Medical Association (AMA). They are recommending competency-based training, which would allow residents to graduate once they demonstrate mastery rather than after a fixed number of years. This could shorten training time, reduce costs, and get physicians into the workforce faster. However, this would require medical boards to adopt rigorous, standardized competency assessments (Goldhamer et al., 2024). Other reforms include tax credits for private hospitals that choose to self-fund residency positions and encourage health insurance companies to contribute financially to residency training. Both ideas would diversify funding sources and reduce the system’s dependence on Medicare, but this would require Washington to come together and make legislative change (which is highly unlikely, in my opinion).
Political differences shape how reform might come about. Democratic proposals typically focus on increasing federally funded residency slots, raising Medicare caps, and expanding GME funding. Republican proposals, on the other hand, emphasize restructuring the system through deregulation, encouraging private innovation, shortening training through competency-based pathways, and offering tax incentives for hospitals that train their own residents.
The current model does not match the needs of today’s healthcare system. Whether through increased investment, innovative training models, or public-private partnerships, I believe meaningful change will demand collaboration across the isle. Where do you stand? Do you think this is federal government problem, or should it be delegated to the states?
Goldhamer, M. E. J., Pusic, M. V., Co, J. P. T., Kim, M. J., & Weinstein, D. F. (2024). Promotion in place: A model for competency-based advancement in residency training. Academic Medicine, 99(5), 534–540. https://doi.org/10.1097/ACM.0000000000005459
Kalter, L. (2019, July 25). U.S. medical school enrollment rises 30%. Association of American Medical Colleges. https://www.aamc.org/news/us-medical-school-enrollment-rises-30
Another click-bait title! Mercy Makoa!!
ReplyDeleteI thought that Gen Bio or O-Chem was the "weeding" factor but maybe residency and the government funding may be the actual 'weeding' factor in medicine (there's actually a lot to consider lol).
Over the summer, the big talk was the "Big Beautiful Bill Act" that was introduced earlier this year (AMA had a podcast earlier this month about it: https://www.ama-assn.org/member-benefits/events/one-big-beautiful-bill-act-impact-physicians-and-patients). The biggest issue that a bunch of pre-med and medical students were concerned about was the loan cap of $200,000. A friend of mine stated,"Going to medical school will now be for the rich or those who can afford it." Do you think that this bill will help the enrollment rate to decrease and possibly helping the residency slots?
Now looking at a the bigger picture, it may take a lot of money to get through medical school, and now through residency. As MS4 students are looking forward whether or not they match with their desired locations and specialties, they now have to worry about the fundings and living through the residency crisis. I do agree that the current model does not match the needs of today's healthcare system.
I think that is exactly what's going to happen. I think medical school (and most professional schools) were always catered to the rich and/or more well-affluent community members unfortunately. And while med school is expensive and many people do rely on loans to pay for schooling later on, the cost of even applying, interviews, secondaries, and more are also a factor in why many people of diversified backgrounds don't always make it onto their final goal of medical school (or other grad programs) as they would've based on pure merit, etc. It's honestly heartbreaking to see. And it begins, and while yes a bit of a slippery slope argument, it begs the question are we stifling talented and caring individuals from bright futures before they've even had a chance to try.
DeleteDefinitely some strong food for thought in this one, Makoa. It really gets me thinking and very nervous that here is another thing to keep me from my dream? With how our world is going, the rising cost of living, etc., how do you justify years of schooling to be left stagnant post graduation? Even more so for individuals, like those of us in a program like this, with even more hours of school under their belt--at what number of years do you stop trying for that/any residency spot if you keep not making the government's quota number? And if we have such a shortage of providers now, why can't our legislation get it together to start helping match supply with this surplus of demand? I agree with you, I doubt they'll make any real changes, well, to mostly anything, anytime soon.
ReplyDeleteThis was such a thoughtful breakdown of an issue that gets oversimplified far too often, and honestly a refreshing shift away from pure physiology into a broader but equally important topic that directly affects us as future clinicians and MSBS students. I especially appreciate how you highlighted the disconnect between the growing number of medical school graduates and the federally capped number of residency positions — it’s a structural bottleneck that impacts patient care just as much as it affects trainees. The idea of competency-based advancement is compelling, but like you noted, its success would depend heavily on consistent, standardized evaluation across programs, which feels like a major hurdle. What stands out most to me is how deeply political this problem is. Until funding mechanisms and training pathways stop depending on unpredictable federal decisions, the mismatch between physician supply and residency slots will continue. Your post really underscores the urgency for collaborative reform rather than patchwork fixes.
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