Healthcare leaders across the U.S. are calling it “The Fauci Effect” -- the increase in people applying for medical schools -- and as reported, we are seeing it right here in Nevada. The phenomenon, of course, gets its name from Dr. Anthony Fauci, the country’s most respected infection disease expert.
But industry experts said the Silver State doesn't offer enough residency opportunities for graduates to stay local, which is culminating in an ongoing doctor shortage in the state.
Lauren Hollifield, a class of 2021 M.D. candidate at UNLV School of Medicine, said many future doctors, particularly those with specialties, will often move to Utah or California, because that's where more opportunities are.
"My family is here, I want them to have good healthcare, and in order to have good healthcare, we have to train the resident physicians,” said Hollifield.
Hollifield, a fourth-year medical student and Clark County native, will be graduating in about three months. Now, she's in the thick of applying for her post-graduate medical residency.
"Residency is a period of time -- anywhere from three to seven years -- where you really hone in on the skills of whatever specialty that you chose,” said Hollifield.
But she said Nevada doesn't offer enough residency programs and positions, making it tough to stay in her home state. Some programs around the country accept up to 28 residents per class, according to Hollifield, whereas most programs in Nevada accept between five and 15. This, she said, is forcing many future doctors to move out of state.
"If we continue to increase the amount of medical schools, than you would subsequently need to increase the number of residency positions, it would only make sense that after people graduate medical school they'd have to go to residency,” said Hollfield. “So hopefully the government will give more funding to residency programs."
Touro University CEO Shelley Berkley said Nevada’s doctor shortage is in large part due to the residency shortage.
"The national statistic is that 70% of doctors end up practicing where they do their residency,” said Berkley.
A 2020 report by the University of Nevada and the American Association of Medical Colleges shows Nevada ranks 48th in the country for primary care physicians per 100,000 people.
This shortage, Hollifield said, could inadvertently be impacting Nevada’s COVID-19 death toll.
"I think there's a link between having chronic diseases, and not having them well-controlled, and having poor outcomes with coronavirus,” said Hollifield.
Berkley said the positions are scarce because it's very costly to create these programs, and that's why she said the hospitals have a challenge in creating them by themselves.
Nevada's legislative session starts soon on February 1, and Berkley said she's hoping the governor and legislators will consider funding for graduate medical education (GME), though she worries that, in a pandemic year, it will be unlikely.
Some medical residents, or doctors in training, at UW Hospital who are exposed to COVID-19 patients said they haven’t been able to get vaccinated, even as some staff doctors with less exposure have received shots.
Providers such as physician assistants and nurse practitioners who haven’t been immunized have refused to see infected patients, while unvaccinated residents can’t refuse, the residents said.
“We are asked to bear an outsized amount of the risk while being afforded less protection than other people,” said a surgical resident who asked to remain anonymous for fear of workplace retaliation. “To us as residents this is a part of a pattern in which we are consistently deprioritized in terms of our safety.”
UW Health spokesman Tom Russell said “it’s not our practice” for staff doctors to get shots before residents with more exposure or to let other providers refuse care if unvaccinated.
Spokesman Andrew Hellpap said in a statement that the organization “has vaccinated thousands of faculty and staff involved in direct patient care, including several hundred residents and fellows.”
He said the system plans to start immunizing more residents soon. “Given we have built capacity to administer about 600 vaccine doses per day, our limiting factor in how quickly we can move through our population is the supply of COVID-19 vaccine,” Hellpap said.
Priority is given based on “estimated frequency, duration and intensity of exposure” to patients with known or suspected COVID-19 and guided by “an equity framework that examines risk of exposure, along with age” and social vulnerability, he said.
UW Health last week got 3,900 doses of Pfizer’s COVID-19 vaccine and said it was first inoculating doctors, nurses, respiratory therapists and others in intensive care, emergency medicine and other settings that make them most exposed to COVID-19 patients. Hellpap declined to say if UW Health got more vaccine this week or when it will, but nationally most if not all health care workers are expected to be offered immunization by next month.
Federal officials have designated health care workers and nursing home residents as the top priority groups.
Three UW Hospital surgical residents — doctors who care for patients during additional training required after medical school — interviewed by a Wisconsin State Journal reporter said they represented concerns of dozens of colleagues. Each requested anonymity, citing concerns about retaliation.
The residents said staff doctors have been vaccinated before residents, who spend more time in the emergency room or intensive care treating infected or potentially infected patients and sometimes perform high-risk procedures.
Physician assistants and nurse practitioners who haven’t been vaccinated can opt out of seeing COVID-19 patients, which the residents said was fine, but they can’t.
On a hospital unit with a COVID-19 outbreak, many staff including nurses were vaccinated but residents were not, the residents said.
The residents said they were told they weren’t given higher priority because of a clerical error in which their time in the emergency room wasn’t taken into account, but that an administrator said the error couldn’t be fixed.
Residents in internal medicine, family medicine and critical care have rightly been immunized before surgical residents, but the surgical residents should get priority before staff doctors who have less exposure to COVID-19 patients, the residents said.
“Enough is enough,” one of the residents said.
“We all feel like we’re put at the bottom,” another said.
Residents in some parts of the country have moved to form unions to counter what they see as a decades-old culture of working overtime for relatively little pay. In 2003, the national organization that oversees residency programs said residents could work no more than 80 hours a week.
Front-line doctors at Stanford Medical Center protested Friday over the university's vaccine distribution plan, which they claim doesn't prioritize staff that works directly with COVID-19 patients.
Protesters chanted "We are not disposable," and held signs that said, "Front line workers need protection," "Vaccinate health care heroes" and "Residents can die too" as they demonstrated at the Palo Alto, California, hospital.
According to a medicine chief resident who spoke during the protest, only seven of the resident health staff, "including none of what we would consider the front-line residents," were slated to get vaccinated in the first wave of thousands of doses the hospital received.
"We are furious and angry with you," another chief resident said during the protest. "We cannot be first in the room and back of the line."
There are over 1,300 residents and fellows.
Organizers said they were representing other front-line health care workers, including nurses and respiratory therapists, who they claim also weren't prioritized in the first wave of vaccine distribution.
Stanford Health Care President and CEO David Entwhistle addressed the protesters on Friday, saying, "We'll correct it. We know that it's wrong," according to the San Francisco Chronicle
Stanford Health Care announced Wednesday that Stanford Medicine expected to receive its first shipment of 3,900 COVID-19 vaccines on Friday, with as many or more doses to follow weekly.
"In accordance with federal recommendations, the first Stanford health care workers to be vaccinated will be those who provide direct care and service to patients, those who are at the highest risk of being exposed to COVID-19 and those who have an elevated risk of complications from the disease," the press release said.
But the protesters allege that an error in an algorithm used to equitably distribute the vaccine pushed residents down the list given factors like their young age, but was not corrected.
Officials said they expected all Stanford Medicine health care workers will be vaccinated within two or three months.
Dr. Niraj L. Sehgal, chief medical officer of Stanford Health Care, addressed concerns over the vaccine distribution plan in an email sent to Stanford residents Thursday and obtained by San Francisco ABC station KGO.
"Despite our best intentions to thoughtfully map out a principled vaccine plan to include our residents, fellows, and faculty, it's clear there were several unintended missteps," the email said. "Please know the perceived lack of priority for residents and fellows was not the intent at all."
In a statement to the Chronicle, a Stanford Health Care spokesperson said there were "flaws" in the vaccine plan, and there should be an update later on Friday. Stanford Health Care did not immediately respond to ABC News' request for comment.
Several Stanford Medical Center departments showed their support for the residents following Friday's protest.
"Stanford EM stands by our residents as the most front line of all providers against the COVID pandemic," Stanford Emergency Medicine tweeted. "They must be protected and we will do whatever is necessary to ensure this happens."
"We stand with our housestaff. We support them. We will work for them. Our program will work for them," Stanford Internal Medicine Chiefs tweeted.
The Department of Urology said it found the algorithm "appalling," and that faculty have volunteered that their spots in the line go to "trainees on the front lines to make this right."
The protest comes as California is experiencing a surge in COVID-19 cases that has strained hospitals across the state. Over the past two weeks, the seven-day average cases increased 117% and hospitalizations increased 70%, officials said Friday. Intensive care unit capacity is down to 2.1% statewide.
Owais Durrani does not have a job, a predicament that would have been almost unthinkable for a doctor with his skills a year ago.
At University of Texas Health Science Center at San Antonio, where he is training in emergency medicine, Durrani has treated hundreds of covid-19 patients. He has dosed them with steroids, given them oxygen and carefully turned them onto their bellies to relieve respiratory distress.
“We have been seeing really, really sick people,” he said. He had firsthand experience with the novel coronavirus, too — he caught it in March and recovered after a few feverish days.
Despite all that, the 29-year-old doctor cannot find a company in his hometown of Houston ready to hire him when he graduates next year. Durrani has searched since the summer, “getting on calls with recruiters and hospitals and whatnot,” he said. “And I haven’t locked anything down.”
Like him, many in this class of emergency medicine physicians — young doctors, called residents, who are training in this specialty — are struggling to find full-time employment, even while they work on the front lines treating covid-19 patients.
The dearth of jobs is the result of a domino effect: Many people stayed away from hospital emergency rooms this past year, wary of contracting the virus. As patient numbers dropped, emergency departments brought in less money. As a result, cash-strapped employers stopped recruiting new doctors.
“We’re putting our own lives at risk, our family’s lives at risk,” said emergency medicine physician R.J. Sontag, the president of the Emergency Medicine Residents’ Association. “We’re in, frankly, a financially precarious position with a ton of debt and limited income. And the fact of the matter is that employers just aren’t hiring.”
The pandemic exposed many perplexing vulnerabilities in the American medical system — as varied as critical staffing shortages of nurses and inadequate stocks of protective equipment. This is another one. Fewer places can afford newly minted emergency medicine doctors during a crisis in which it would seem they should be in high demand.
“Calling it a paradox is exactly right,” said Janis Orlowski, the chief health-care officer at the Association of American Medical Colleges. “There’s a need for more physicians. And yet we find ourselves in this situation.”
New contracts have vanished with the “significant shortfall” in hospital and physician practice dollars, she said. The result is that after four years of medical school and up to four years of residency, some new doctors have no place to go.
“It’s by far the tightest job market in emergency medicine that I’ve ever seen,” said Mark Reiter, the chief executive of the consulting group Emergency Excellence and director of the emergency medicine residency program at the University of Tennessee Health Science Center in Nashville. By his conservative estimate, at least a quarter of residents are having trouble finding work.
About 2,500 new emergency medicine doctors enter the workforce each year, Sontag said. They do so heavily in debt, he said, with half of them owing more than $200,000 in school loans, and one-fourth owing over $300,000.
Many of the newest crop have had contracts altered, if not rescinded. “I have a good friend who signed a contract, bought a home, moved his wife across the country,” Sontag said, “and then he lost his contract after he’d already moved.”
The Emergency Medicine Residents’ Association does not have a tally of how many members are without jobs. But a survey from the American College of Emergency Physicians found that 20 percent of emergency medicine group practices laid off doctors this year, almost one-third furloughed them and more than half cut hours or wages.
“What we’re watching now is frightening for the residents,” said Mark Rosenberg, the American College of Emergency Physicians’ president.
Sontag, who attended the UT Health San Antonio residency program, said that only one of 12 final-year residents there has secured a job. In a typical year, all of them would have contracts by now.
It wasn’t unusual for Angela Cai, a physician in her final year of residency at SUNY Downstate’s Kings County Hospital in Brooklyn, to treat patients with strokes. But one man stood out — because he had waited nearly a day last April to call an ambulance.
“If people come in with strokes very early, ideally within three hours, there are some treatments you can offer to reverse the symptoms,” she said. “But that was totally out of the question for him. He wasn’t able to walk.”
She asked the man why he had delayed. “He said he was watching everything on the news and he was afraid,” she said.
That fear of catching the coronavirus fueled a sharp drop in visits to emergency departments. They plummeted by 40 percent in March and April, as reported by the Centers for Disease Control and Prevention’s surveillance program, and children were kept away at even greater levels.
Although emergency departments in coronavirus hot zones are gateways to a flood of covid-19 patients, those zones have been distributed unevenly in time and space. Even in virus hotspots, Reiter pointed out, the pandemic can congest emergency rooms — some patients with covid-19 are kept in emergency department beds, which reduces capacity and causes waiting room delays.
The number of emergency department patients overall is 15 percent below last year’s levels, Reiter said.
“In the thick of it, I definitely wasn’t thinking about my job,” Cai said. “I didn’t really make the connection between how this unprecedented drop in [emergency department] volume would affect my job market.” Cai is still finalizing her plans for what she will do after graduation.
A ‘golden ticket’ no longer
Before the coronavirus, new emergency medicine doctors could expect to receive multiple offers in the last year of their residency programs.
“The residents had their pick of where they wanted to go,” Rosenberg said. If a particular hospital didn’t need more emergency staff, it was often the case another one nearby did.
Hospitals, outside of academic centers, rarely hire emergency doctors outright. Most medical centers instead have contracts with physician provider groups. Those can be small, doctor-run companies, or large corporations, backed by private-equity firms, that employ thousands of doctors who work at hundreds of hospitals.
More than half of the emergency doctors in the United States are employed by investment-firm-owned companies, Reiter said, and those companies have generally been “more aggressive” when cutting back doctors’ hours amid the pandemic.
In the past, recruiters representing employers flocked to residency programs, offering salary advances or to pay moving expenses.
“Residency-trained emergency medicine doctors, for a couple of decades, have had the golden ticket,” said Michael Belkin, a vice president at the physician-recruiting firm Merritt Hawkins. “They could call their shots; they could demand high dollars.”
Since 2008, the number of emergency doctors in the United States has grown from 40,000 to almost 50,000; there are fewer of these specialists per person, though, particularly at rural hospitals. In that same period, the number of doctors enrolled in emergency residency programs grew from about 4,500 to nearly 8,000.
That growth has also increased the competition for jobs, Reiter said.
One doctor in a Midwestern city, a recent graduate of an emergency residency program who spoke on the condition of anonymity to avoid potential career harm, described a fraught path to employment: Last fall, several clinician groups offered the doctor a job. The physician decided to join a small, doctor-run firm.
In the late spring, the emergency department where the doctor was completing a residency began to cut back shifts as non-covid-19 patients stopped coming. The doctor received a call from the new employer, expecting to hear the company was reducing hours, too.
Instead, the firm withdrew the job offer, exercising a 90-day termination clause in the contract. The doctor asked the other groups, whose offers the physician had declined in the fall, for work. None hired the doctor, who has more than $300,000 of student debt.
The doctor found a temporary position at a hospital where, during the first wave of the pandemic, few people visited the emergency department. Now, though, that city is experiencing a surge in patients from the pandemic.
“The acuity of illness has gone up quite a bit in the past few months, particularly with respiratory complaints related to the coronavirus,” the doctor said. “Our census within the hospitals has skyrocketed to pretty much 100 percent capacity.” Amid this rise, the original firm agreed to hire the doctor to begin early this year.
Some residents have opted to apply for emergency medicine fellowships, which provide additional expertise in toxicology, ultrasounds, wilderness medicine or other subjects at academic centers.
“All fellowships have become more competitive this year,” Sontag said. Opting for a fellowship also has financial consequences; the pay in a fellowship is closer to a resident’s salary — an average of about $59,000 — than it is to a full-time attending physician’s salary, an amount in the six figures.
A rough road to recovery
U.S. hospitals — many of them operating on thin margins before the pandemic — lost $50 billion per month in the period from March through June, not including government relief money, according to an estimate by the American Hospital Association. A drop in emergency patients was not the only factor. Scheduled and elective surgeries, previously consistent revenue streams, were canceled. Health-care providers also had to spend money on protective gear and ventilators.
“Cash conservation is probably key for most of these places,” said Kayla Cline, an expert in hospital finances at Texas A&M University.
Congress offered $175 billion of financial relief to the health-care system as part of the massive coronavirus aid packages passed earlier last year. But “often the money didn’t trickle down as it was intended” to practice groups that employ physicians, Sontag said. At least $1.5 billion of interest-free loans went to hospitals and staffing companies owned by well-funded investment firms, according to a Bloomberg News analysis.
One consequence of the pandemic, though, may work to the advantage of new doctors seeking jobs: Some emergency medicine doctors are retiring sooner than they otherwise might have.
The crisis has made a difficult job more challenging. “There’s a lot of depression, PTSD, suicide and the like,” Rosenberg said. “And a couple of things that people like to do after a long shift — maybe go out for a beer, hug a friend, cry on a shoulder — we can’t do any of them now.”
Doctors who work in emergency departments are more susceptible to burnout than average physicians. “There’s only so much trauma and so much — I don’t know how else to say it, but — patient loss that one can handle,” Belkin said.
Orlowski said that when elective surgeries were allowed to resume over the summer, with the drop in coronavirus cases, doctors told her “things were just going gangbusters.” She predicted that patients will similarly return to emergency departments as vaccines against the novel coronavirus become more widely available.
But the job market’s recovery could be slow.
“It’s going to take hospitals two, three, four years to get beyond the financial problems that will occur from this year,” Orlowski said. Until that happens, she said, she expects employers to be more conservative in hiring.
Ben Guarino is a reporter for The Washington Post’s Science section. He joined The Post in 2016. //twitter.com/@bbguari" class="" style="color: rgb(25, 85, 165);">Follow
ZAGREB, September 1, 2019 - The School of Medicine in the biggest Croatian Adriatic city of Split is celebrating the 40th anniversary of the beginning of its work this autumn.
The organisers of a celebration, which was held on Saturday, underscore that in the last 40 years many positive things happened.
Currently the School of Medicine in Split has four teaching programs: Medicine, Dental Medicine, Pharmacy (in collaboration with the Faculty of Chemical Technology) and Medical Studies in English.
The Medicine program annually enrols 90 students, Dental Medicine and Pharmacy enrol 30 each, and Medical Studies in English 60, according to the information available on the school's website.