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Comment by naveen99 | Hacker News Reader

In the us, there are almost 3 residency spots for every 2 us medical students.

Right, but then half of all med students apply only to derm residency or other lucrative and competitive field with nice hours, leaving us in the situation we are in now where 18% of all emergency med department residencies went unmatched: https://www.aliem.com/mismatch-unfilled-emergency-medicine-r...

There was rampant expansion of emergency medicine residency spots in the prior years without an associated increase in demand for new EM docs. People noticed the market there and chose to go elsewhere. Also, the unfilled positions are also the low quality ones where your education would be questionable (linked article mentions corporate owned which imo is a red flag).

Emergency med has decent flexibility in terms of hours. The problem was Covid and remote work reduced infections and accidents and heart attacks, and they lost turf to physician assistants manning urgent care centers.

Not during residency, and I have not idea what the second part has to do with the match going underfilled. Are you saying med students saw this phenomena and decided emergency med was best left to PAs, and did not apply to match?

What I heard was emergency departments suffered brutally during covid, and that has had a chilling effect on anyone wanting to go into it. The med students matching now were all rotating through departments during covid.

yes, there are periodic oversupply and undersupply of various medical specialties (just like oil, labor, money, real estate agents), and medical students do react and choose accordingly. ER was hot for a while, and radiology was not so hot for a few years after 2008. Now surprisingly radiology has held up despite AI fears, because of baby boomers starting to get cancer, and ER is down, because private equity went nuts investing in urgent care centers before covid.

Source?

https://www.nrmp.org/about/news/2023/05/nrmp-releases-the-20...

This is overall not per speciality and doesn’t include overall people who did not apply, the article even says itself it’s a all time match high.

Look no further: https://www.nrmp.org/wp-content/uploads/2023/03/Match-Rates-...

The person i was responding to said that residency spots are the bottle neck, and not medical school spots. While residency spots have not kept pace with population growth also, the medical student spots are a much worse bottle neck. Specialties have their own periodic undersupply and oversupply, but that was not the topic of discussion in the post i was responding to.

Now, I don't know how you would ever include people who don't apply. I mean there are 5 million americans of age every year, so i guess that's a denominator.

what's a all time match high ? The number of spots and students ? Yeah, so ? The concern was that the number isn't high enough, and where the bottleneck is.

The real answer to why doctors in america earn so much, is that everyone in america earns so much. If you compare doctor to median salaries in the us, vs. doctor to median salaries in europe, maybe its not so different ?

> the medical student spots are a much worse bottle neck.

No, they are absolutely not. About 5% of medical school graduates do not placed into a residency program. There's a slew of Caribean medical schools that take only US based students. They have about a 20% non-placement rate.

Med schools have a lot more flexibility in slots. Once established, it's far easier to increase class size by 10% than it to get 10% more residency slots.

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