Medical students found out where they’ll go to spend the next part of their training on ‘Match Day.’ But questions about physician supply loom.

By Rose Hoban

They squealed, they cried, they jumped up and down, they pounded their fists into the table – they’re young doctors who had just received their ‘match.’

‘Match’ is the process by which doctors graduating from medical school get matched with the residency programs at hospitals, clinics and health practices where they’ll spend a significant amount of time, from three up to seven years. Residencies are where M.D.s become ‘doctors.’

Match is a uniquely American institution, according to Atul Grover, chief public policy officer at the Association of American Medical Colleges. Similar to computer dating services, medical students apply for residencies at the hospitals and clinics of their choice; at the same time, hospitals and clinics are choosing the perfect residents for their programs.

North Carolina has four medical schools and all of the students finishing this spring received their matches last week.

“Graduating students have to apply for more and more residencies,” Grover said. “Most grads are applying to 30 or 40 residencies. International medical students apply to about double that amount. If we didn’t have the computerized system, it would be unmanageable and unfair.

With the passage of the Affordable Care Act, more primary care doctors will be needed to care for upwards of 30 million new patients who will have insurance for the first time.

Medical School	Family Medicine	Pediatrics	OB/GYN	Internal Medicine	Total Students (all specialties)
Duke	2	11	4	19	165
ECU	16	18	4	15	72
Wake Forest	9	11	0	17	113

Many observers have been focusing on the number of doctors coming out of medical programs and steering towards residencies in primary care specialties: pediatrics, family medicine, obstetrics and gynecology, and internal medicine.

North Carolina has a 21.68 primary care physicians per 10,000 people, with a higher ratio of primary care doctors in urban counties than in rural ones. Supply of primary care doctors has been climbing steadily since 2005, according to the Sheps Center for Health Services Research at UNC Chapel Hill.

But the country doesn’t only need primary care doctors, said Grover.

“The other problem with the expansion of insurance is that you’ll accelerate the need for primary care physicians to be the first contact for those patients. They will see people, screen them and they’ll pick up a lot of other stuff, things like things like diabetes and cardiac disease and cancer” Grover said. “Someone needs to see those people as well. That will accelerate the demand for primary care as well as other subspecialties.”

Grover pointed out that most people use primary care doctors for most of their lives, until they get older, and sicker.

“As you get to 60, 70, 80-years-old, complex problems make up for the majority of visits,” Grover said. “Oncologists, nephrologists, endocrinologists… anyone who takes care of older adults, you’ll see a huge need for more of those clinicians.”

In recent years, medical schools have been beefing up their admissions, including schools in North Carolina.

Grover said that in a few years, medical school graduations will go from about 16,000 nationwide to close to 20,000 total.

“And schools of osteopathy are really taking off,” he said. “They were at about 3,000 students a year, and they’re going to 6,000.”

Campbell University in Buies Creek is launching a school of osteopathic medicine that school officials expect will welcome its first students in August, 2013.

And while Grover said all those new doctors are a good thing, there’s another concern over the availability of residency slots for all those new doctors.

“Nationally, we only have about 26,000 first year residency slots,” he said.

Having residents costs most hospitals money, in an environment where hospital economics is changing.

“The challenge for us is that hospitals do research, that loses money. Hospitals do education, that loses money,” Grover said.

“In the past clinical care paid more, so hospitals could make up some of those losses. But now Medicare and Medicaid are paying less, and there’s increased pressure from private insurers… it’s an increasing challenge.”

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