Medical Workforce

In the 2009 Residency Match, there are 25,185 positions offered. There are 36,972 applicants registered, and of those, 16,008 are U.S. allopathic medical school seniors and 20,964 are independent applicants (former graduates, osteopathic applicants, and international medical students). How do we interpret these numbers? On the one hand, we have enough positions for all U.S. medical school graduates, and indeed, we have room for more. With the greater need for physicians, some medical schools are expanding their class sizes, and hopefully there will be residency positions for all these graduates.

On the other hand, we don't have enough positions for all the applicants. If we expanded residency training, the applicant supply would meet those slots, mostly with international medical graduates (IMGs). Indeed, these graduates often go into the fields that need more doctors such as primary care. But whether or not we should be training so many IMGs might be controversial; this often puts a brain drain on the countries supplying those residents. That is, other countries are training medical students that ultimately leave to the U.S. and may not return to their home country. This is a detriment to those countries, and we should not try to exacerbate that problem.

The reality of this situation is that residency positions are unlikely to expand. The funding for resident training comes from Medicare, and in an era with overwhelming healthcare costs and an uncontrollable federal debt, we are unlikely to fund more training spots. But that leaves us with this question: without training many more residents, should we be expanding medical school classes? And what should our attitude be towards independent applicants and international graduates?