Reducing the number of high pay residency slots has merit

I believe that Nilesh Kalyanaraman’s idea of reducing the number of high-pay residency slots has merit.

Of course, this would have to be based on an accurate, bonafide need for the particular specialty service, and would require, at the very least, a biannually updated data base for medical schools to plan with. I believe that some states already make available disease prevalence data —broken down by regions or, in some instances, even by counties. Certainly, if motivated for doing so, such disease prevalence data banks could be generated.

The point is that, currently, many of the high-pay, procedure-oriented specialties are becoming over-crowded—when measured against bonafide, valid statistical needs for their services—where need is defined as the number of cases definitely requiring their particular area of expertise or technique, for achieving a significantly better outcome than could have been achieved by primary care alone.

Yet the evidence suggests today that the ratio of primary care specialty physicians to non—primary care specialty physicians is heavily weighted toward non—primary care specialists. This is an irrational and expensive direction, given the quality and economic issues the system is currently struggling with. Currently it would appear that supply of many of the high-profile, high-pay specialties is now exceeding bonafide needs for their services. If so, this creates the ideal conditions for producing an increase in unnecessary procedures and surgeries, and, for the same reasons, creates a temptation for sub specialist physicians—trained for very focused areas of medical practice—to begin dabbling in areas of medicine unfamiliar to them, in order to remain sufficiently busy.

Until our medical schools meet their responsibility for valid demographic, need-studies, based on disease prevalence statistics—and adjust their specialty residency programs sizes accordingly—tremendous sums of healthcare dollars will be spent needlessly in this manner. Remember the interview with the candid young medical student of the nineties and his admission of planning to enter a specialty with a procedure associated with it, “because that’s where the money is.”

Alan Cato is the author of The Medical Profession Is Dead and the Doctor Is “Critically Ill!”

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