Monday, April 25, 2011

Gambling with Matches

"Match Day" came and went this year on March 17th; I find it interesting to look at the raw data from the residency match, as it gives one an idea of what the next generation of physicians are thinking about the future, and my chosen specialty in particular. It is also instructive to see what is put out as PR for the match and compare it to the match results themselves:

For Second Year, More U.S. Medical School Seniors Match to Primary Care Residencies
For the second year in a row, more U.S. medical school seniors will train as family medicine residents, according to new data released today by the National Resident Matching Program (NRMP). The number of U.S. seniors matched to family medicine positions rose by 11 percent over 2010. In Match Day ceremonies across the country today, these individuals will be among more than 16,000 U.S. medical school seniors who will learn where they are going to spend the next three to seven years of residency training.

I'd like to focus on three residencies --- Family Medicine, Internal Medicine, and General Surgery. For Family Medicine, 48% of the 2,708 slots this year went to US medical school graduates, compared with 44.8%, 42.2%, 43.9%, and 42.1% in the previous four years. For Internal Medicine, the numbers were somewhat higher, with 57.4% of the 5,121 positions being filled by US graduates, in comparison to 54.5%, 53.5%, 54.8%, and 55.9%. Both are a bit of a bump up, but the 11% rise noted for Family Medicine in the press release is a bit misleading, as the number of slots increased by 100 over 2010 as well.

General surgery numbers were a bit mixed, as there were more slots available this year (1,108 versus 1,077 in 2010), 81% of which were filled by US graduates; in comparison, the percentages were 83.1%, 77.4%, 83.1%, and 78.1% going back to 2007. Pediatrics and OB-GYN numbers are hanging in the low-to-mid 70% range for the same time period.

What does all of this mean? I'm not really sure. Not being a statistician, I can't say for sure but none of these numbers suggest a statistically significant change in the percentage of US medical school graduates going into these residencies, all political and PR posturing aside. One thing that many tend to forget is that subspecialty care will draw off many of these primary care physicians with time --- into cardiology, GI, neonatology, high-risk OB, plastic surgery, cardiothoracic surgery, etc.

If I was a betting man, I would bet that the minor increase in FP and IM numbers this year will not be sustained; there are too many financial forces working against the physicians in those specialties. And general surgery is not terribly different in the long run.

Friday, April 15, 2011

The Aggravated DocSurg Field Guide to the American Surgeon

I’m in Las Vegas. Actually, I was in Las Vegas, but because my swanky hotel didn't provide the basic internet service that your average Travelodge does, I didn't get to post this until now. Not my favorite place, to be honest --- I don’t gamble, smoke, or hang out with hookers. The ads for “Kourtney Kardashian’s birthday party” at Planet Hollywood don’t interest me in the least. I’m quite sure that that mobile billboard advertising for “girls that want to meet” me are a bit less than honest. And I think it is frankly immoral to charge a guy $22 for a martini that isn’t served in a quart-sized glass.

This trip was about business, not pleasure. I was at the Trauma, Critical Care, and Acute Care Surgery meeting held at Caesar’s Palace every spring. Basically, it’s a meeting that talks about all of the things that you don’t want to have happen to you. I have a general rule about medical meetings --- never stay at the hotel hosting the event. The room rates are high, despite the advertisements for “discounted” prices in the meeting brochure, and I like to stretch my legs a bit on the way to and from the lectures. This provides me plenty of time to practice my people watching skills.

This year, the trauma surgeon meeting was held one floor above a meeting for academic internists. Oil and water, so to speak. Being the slacker that I am, I didn’t bring along the meeting brochure with me to tell me where to go. And since Caesar’s wants people to wander and get mired in the casino, there were no signs directing me to the meeting this morning. So with a couple of thousand doctors streaming up the escalators to meeting rooms, how was I to tell where to go?

It’s simple. I know my peeps! I had no more trouble distinguishing the surgeons from the internists than a mother does her twins. And now, thanks to the Aggravated DocSurg Field Guide to the American Surgeon™, you too can know how to spot a surgeon in any environment.

The first clue to differentiating surgeons from internists at a meeting is a careful observation of how they walk --- surgeons are an impatient lot, and don’t tend to stand on escalators, wander, or stroll slowly. We tend to be on time, but just barely, and mostly arrive solo. Clothing is generally a bit rumpled, and at meetings older surgeons tend to adopt the same “uniform” --- khakis, a blue sport coat, and no tie. A quick glance at the wrist generally confirms a cheap watch --- Timex or Casio “nerd watch,” as SWIMBO calls them --- because we are always taking them off to scrub. Lost of loafers --- once again, because they have to be taken off frequently.

The internists were easy for me to pick out. They traveled in packs, ambled peripatetically, and were constantly fiddling with their smartphones. They tended to be rushing, audibly complaining of being late. All of them carried a meeting satchel every day, which the surgeons almost universally leave in their hotel rooms after the first day of the meeting (or never pick up). The shoes ranged from pumps to wingtips (really -- in 2011) to tennis shoes to sandals.

What about in the hospital? I know who everyone is at my place, but if somehow I was dropped into an ICU in Kalamazoo at midnight, and every doc in the place was wearing scrubs, it’s not really that hard. The surgeon in scrubs will unfailingly have messy hair from wearing a scrub cap all day, will be wearing some sort of OR-friendly shoes (Crocs, Danskos, etc.), more often than not is wearing a white coat, will roll his eyes a lot, and will have a feral look about him/her --- this is a deep-seated response to spending years in training where the hours were long and access to the next meal was suspect. If there’s a surgeon nearby, no doubt there’s a bit of food and coffee in the vicinity.

The internist in scrubs looks a bit different --- wearing the same shoes he came to the hospital in, almost never in a white coat, carrying an armful of stuff that generally consists of patient lists, scribbled notes, and a laptop. But the single most distinguishing characteristic that marks the internist who is wearing scrubs is the presence of a stethoscope slung around his neck. This is as pathognomonic as the blue light special at K-mart.

I hope this serves as a good introduction for those intrepid explorers who brave the halls of a hospital or who come across flocks of docs at a meeting place. The next edition of Aggravated DocSurg Field Guide to the American Surgeon™ will explore the finer points of surgeon identification, such as distinguishing residents from attendings, neurosurgeons from cardiothoracic surgeons, and the finer points of separating joint replacement orthopedists from hand surgeons based upon golf club brands.

If you are wondering if this guide is worthwhile, I can say I have already had one successful student -- Jimmy Buffett:
We're stayin' in a Holiday Inn full of surgeons
I guess they meet there once a year
They exchange physician's stories
And get drunk on Tuborg beer
Then they're off to catch a stripper
With their eyes glued to her G
But I don't think that I would ever let 'em cut on me