Match Day: Challenges in Graduate Medical Education

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article.

This Friday, more than 18,000 fourth-year medical students in the 141 U.S. schools of medicine will hear where they’ll spend the next 3-5 years of their lives in their residency program. It’s National Resident Matching Day, or “Match Day”—the last step in their rigorous journey to being able to practice medicine.

Match Day is a celebration in most medical schools: each student is recognized and their residency assignment announced to the cheers and high fives of their peers. Each came to med school with notable academic credentials: An average GPA of 3.63 from their baccalaureate program and a MCAT score of 31.4—both increasing annually for more than a decade. Each endured intense classroom coursework in anatomy, physiology, biochemistry, pharmacology, pathology and introductory clinical training in various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and surgery. They’ll embark on their residency alongside 9,000 others who graduated from non-U.S. medical schools, knowing medical education in the U.S. is world’s best: 32 of the top 50 in U.S. News and World Report, 19 of the Top 50 in QS World University Rankings, and 28 of the Top 50 in Shanghai Rankings of World Universities. And most will have debt: 84% will graduate with an average $176,208 note payable.

They’ll join 120,208 residents in 9,528 U.S. programs focused around 27 medical, surgical or hospital-based specialties. Most will specialize: Between 1996 and 2011, the numbers of primary care residents increased 8.4%, specialty residencies increased 10.3%, and 61.1% in sub-specialization. And, as they progress through their residency, their performance will be scrutinized by program directors and faculty who score their capabilities on six dimensions: Interpersonal and communication skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and systems-based practice. If successful, they’ll complete their training and be licensed to practice their trade in a state of their choosing.

Most will be employed by a hospital or medical group: Only 2% consider hanging a shingle in a small/start-up practice an option. Most will practice in a suburban or urban area: Only 3% would consider practicing in a community of fewer than 25,000. And most will have multiple job offers: Merritt Hawkins estimates 63% of finishing residents had more than 50 to consider.

Medical residency training is an integral part of the training necessary for a skilled, competent healthcare workforce. It’s the transition from textbook to doing. Under the oversight of the Accreditation Council for Graduate Medical Education, the residency experience is constantly changing to adapt to the realities of the new normal—team-based experiences, technology-enabled health, care coordination, performance-based incentives and more. Objectively, the relevance and results from the U.S. medical education system—from medical schools to residency to lifelong learning—are the world’s standard. But challenges remain…

How should medical education broaden its application of psycho-social needs, values and preferences in diagnosing and treating individuals? The system’s still prone to think of patients as ill-equipped to self-navigate and ill-informed about treatment options or alternative paths of care. As the transition from volume to value takes hold among payers, methods for increasing consumer adherence and outcomes related to an individual’s behaviors and choices needs attention in medical education.

How should medical education evaluate and increase its emphasis on lifelong learning by physicians? How should licensing be adapted to the realities of increased transparency around physician conflicts of interest and unnecessary care? How should the profession address the practical application of its ethical standards?

How should hospitals and health systems position themselves as attractive employers for physicians? How should medical educators teach clinicians how to operate in an employment model? How can medical debt be addressed in the context of a contractual obligation between employer and clinician? And how should lenders to hospitals and health systems, and payers with whom they contract, assess the differential capabilities, competencies and results of the health system’s approach to its employed physicians?

And how should clinicians be better informed about the complexity and relevant trends in the U.S. system of care—costs, technologies, incentives, insurance, drug discovery, regulation, and more.

Match Day is a big deal to graduating medical students, their families and friends. It’s also a big deal to this country. We have the world’s best-trained physicians, but we can do better. And it involves not just medical educators: it requires thoughtful input from business leaders, health system executives and policy makers.

Paul

Next Monday, March 23, marks the 5th anniversary of the passage of the Affordable Care Act. Pulse Weekly will focus on the status of its implementation, possible changes ahead, and its results to date.

Sources: (Also see FACT FILE for the most recent data about medical residency programs from ACGME data)
Merritt Hawkins 2015 Survey of Final Year ResidentsAmerican Council for Graduate Medical Education, “Data Resource Book for Academic Year 2013-2014,” www.acgme.org; Barbara O. Wynn, Robert Smalley, Kristina M. Cordasco, “Does it Cost More to Train Residents or Replace Them?,” RAND Corporation, September 2013, “Best Global Universities for Clinical Medicine,” U.S. News & World Report; QS Top Universities, “QS World University Rankings by Subject 2014 – Medicine,”Academic Ranking of World Universities; Gemma Flores-Mateo, Joseph M. Argimon, “Evidence based practice in postgraduate healthcare education: A systematic review,” BMC Health Services Research, 7:119, July 26, 2007; Liselotte N. Dyrbye, Matthew R. Thomas, Neena Natt, Charles H. Rohren, “Prolonged Delays for Research Training in Medical School are Associated with Poorer Subsequent Clinical Knowledge,” Journal of General Internal Medicine 22(8): 1101-6, ,May 11, 2007; “Advisory Board Panel on Medical Education (APME),” Association of American Medical Colleges

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

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