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Bryan Carmody Profile picture
Bryan Carmody
@jbcarmody
The Sheriff of Sodium | Pediatric nephrologist | Associate professor | APD | Husband | Dad | Virginian | Advocate for medical students and common sense
4 subscribers
Nov 16 • 12 tweets • 3 min read
Aw jeez, not this again.

According to this consultant, hospitals now *lose* an average of $304,312 per physician per year.

🤦🏻

Guess it’s time for another thread on Budgetary Gerrymandering. Image First, stop and think.

If indeed we truly lived in a world in which hospitals LOSE hundreds of thousands of dollars on each doctor they employ, then it begs a simple question.

Why employ doctors?

I mean, why not just fire them all and stop the bleeding?
Oct 8 • 14 tweets • 5 min read
The AAMC shared preliminary data for the 2024-2025 residency application cycle.

For specialties that use ‘big signaling,’ applications per applicant are down ~35-40% from a couple of years ago.

I’ve got a couple of things to say about that… and the AAMC’s spin on it.

(🧵) Headline from MedPage Today - link to full article below First, the data.

Here’s how much the number of applications submitted per applicant in certain specialties has changed from ERAS 2023 to ERAS 2025:

Otolaryngology -42.5%
Dermatology -42%
Orthopedic Surgery -40%
Urology -36%
Anesthesiology -26%
Oct 3 • 11 tweets • 3 min read
This year, OB-GYN applicants used a new system - ResidencyCAS - to apply to residency programs.

ACOG just released preliminary application data - and a couple of figures caught my eye.

(🧵) First:

I thought there might be a few holdout programs, but no. *100%* of OBGYN programs used the new system.

(I don’t think the AAMC’s circle-the-wagons plan is working out so good.)
May 11 • 23 tweets • 6 min read
For the past couple of days, my timeline has been full of headlines about how medical students are avoiding states with more restrictive abortion laws.

The headlines are tantalizing… but are they true?

I’m skeptical.

(🧵) Screenshot of NPR story: “Medical residents are starting to avoid states with abortion bans.” If you’ve somehow missed all of this, here’s a typical article (which happens to be the one I screenshotted above).

npr.org/sections/healt…
Feb 19 • 16 tweets • 6 min read
UPDATE:

Last week, a Nepali doctor filed a class action lawsuit against the National Board of Medical Examiners, alleging discrimination based upon national origin and requesting that invalidated USMLE scores be restored while examinees appeal.

Today, the NBME responded.

(🧵) The court will issue a ruling by February 21 - so the outcome of the suit remains uncertain.

Still, the NBME’s filing provides additional details on the scope of the scandal, how the cheaters were caught, and what’s likely to happen in the future.
Feb 15 • 12 tweets • 4 min read
A brief update on the USMLE cheating scandal:

This week, a Nepali doctor and Match applicant whose Step 1, Step 2 CK, and Step 3 scores were all invalidated has sued the NBME.

The NBME will respond by February 19, and the court will render a decision by February 21.

(🧵) Screenshot from the lawsuit, noting that the plaintiff requests a decision by February 21, 2024, so that she can participate in the 2024 Match. The NBME has asked to have until February 19 to file an opposition brief. The suit alleges that the NBME did not follow its own policies by invalidating scores before the involved examinees had an opportunity to appeal. Screenshot from the lawsuit, describing the USMLE’s procedure for investigating whether a person cheated, and allowing an appeal. The quoted section does not provide for identifying cheaters before the process is completed.
Feb 9 • 19 tweets • 4 min read
It’s always messy when a residency program loses accreditation - but this one seems particularly messy.

An update on the Crozer Chester surgery residency program closure…

(🧵) Some background:

On January 8, the ACGME withdrew the accreditation for the Crozer Chester Medical Center general surgery residency program.

The hospital was told that the program need to shut down by January 12 - just FOUR DAYS later.

beckershospitalreview.com/hospital-physi…
Dec 7, 2023 • 8 tweets • 2 min read
Big changes may be coming for internal medicine residency applicants in the 2024-2025 application cycle…

The @AAIMOnline is recommending:

-⬆️ preference signals from 7 to 15 (3 gold, 12 silver)

-capping interviews at 15

-no interviews before November 1 Increasing the number of signals will likely function as a soft application cap, as we’ve seen in other specialties.

Many IM programs will still evaluate/interview applicants who don’t signal - but many others will receive so many signaled applications that they’ll stop there.
Nov 8, 2023 • 13 tweets • 4 min read
If you want to become a pediatric subspecialist, you’ve gotta do a fellowship.

For most subspecialties, that fellowship lasts 3 years.

But most of that time isn’t spent learning clinical medicine. It’s spent doing research.

Ever wondered why these fellowships last so long?

🧵


Screenshot from NRMP website, listing typical fellowship length for academic general pediatrics (2-3 years), child abuse (3 years), developmental-behavioral pediatrics (3 years), and neonatal-perinatal medicine (3 years).
Screenshot from NRMP website listing typical fellowship length for pediatric cardiology, pediatric critical care, pediatric emergency medicine, pediatric endocrinology, and pediatric gastroenterology. The length is 3 years for each subspecialty except for pediatric EM, which is 2-3 years.
Screenshot from NRMP website showing typical length of fellowship for pediatric hematology-oncology, pediatric hospital medicine, pediatric infectious disease, pediatric nephrology, and pediatric pulmonology. The length of fellowship is 3 years for each subspecialty except for pediatric hospital medicine, which is 2-3 years.
Screenshot from NRMP website, showing typical fellowship length for pediatric rheumatology (3 years) and pediatric transplant hepatology (1 year). The short answer is, “because the American Board of Pediatrics requires it.”

But why?

For instance, in many specialties, a resident can choose between a 2-year clinical or a 3-year academic fellowship. The ABIM accepts either… but the ABP only accepts the latter.
Oct 25, 2023 • 13 tweets • 5 min read
For weeks, I’ve waited patiently for preliminary application data for the 2023-2024 residency application to be released by the AAMC.

And today they dropped.

So you know what that means.

Yup, that’s right.

It’s time to break it down, Winners & Losers style™️.

(🧵) LOSER: Application Fever.

For years, the biggest theme in the ERAS opening data is some variation of “What incredibly large number of applications are being submitted now?”

Applicants are still submitting lots of applications… but many specialties are DOWN from last year.
Graphic showing the mean number of applications per applicant for the 2023-2024 residency application cycle.
Image
Oct 25, 2023 • 13 tweets • 4 min read
Andrew Taylor Still was the father of osteopathic medicine, and the A.T. Still School of Osteopathic Medicine in Arizona has been a leader in DO education.

ATSU-SOMA just announced a major change in their curriculum… one that has big implications for schools elsewhere.

(🧵) Main building on the ATSU-SOMA campus, taken in 2017. Quick background:

ATSU used to have a ‘3+1’ curriculum, where second-year students were assigned to local community health centers to continue their classroom education and begin getting clinical experience. Screenshot of the ATSU-SOMA ‘1+3’ model, from the ATSU-SOMA website (courtesy of the Wayback Machine). “Upon admission to ATSU-SOMA, students are assigned to one of our 16 select community health partner sites around the country. During year two at their assigned CHC partner sites, students engage in patient care with CHC physicians while at the same time continuing their academic education through in-classroom experiences and distance education technologies. Students will continue their small group learning, led by community health center partner physician faculty.”
Aug 22, 2023 • 11 tweets • 5 min read
A Cautionary Tale:

After Match Day, medical students are typically asked by their future residency program to read, sign, and return a document that looks like this.

It’s a contract, right?

(🧵) Page 1 of Exhibit A, the memorandum of appointment to house staff at Barnes-Jewish Hospital. The document goes on for pages and pages - 18 in all - outlining the hospital’s expectations of and obligations to the resident.

I mean, it sure *looks* like a contract…


Page 2 of the Memorandum of Appointment.
Page 3 of the Memorandum of Appointment.
Page 7 of the Memorandum of Appointment.
Page 8 of the Memorandum of Appointment.
Jun 28, 2023 • 5 tweets • 2 min read
How much do hospitals receive from the government to train residents?

It depends. There are multiple funding streams and the formulae are complicated.

But here, a consulting firm did the math...

…and estimated that, in 2019, the average Medicare subsidy was $145,435/resident. Again, this is the overall average… so many hospitals receive less. But some receive more.

More on the complexities of the calculations here:

thesheriffofsodium.com/2022/02/04/how…
May 23, 2023 • 16 tweets • 4 min read
Last week, Tennessee passed legislation to allow international medical graduates to obtain licensure and practice independently *without* completing a U.S. residency program.

This is BIG news.

So you know what that means.

Time to break it down, Winners & Losers™️ style.

(🧵) Screenshot of Tennessee HB ...Screenshot of the second ha... WINNER: Experienced IMGs.

Many residency programs screen applicants with a “year of graduation” filter - so some of the most experienced IMGs are chronically unmatched.

But now, if IMGs are residency trained with 3+ years of experience, repeating residency won’t be necessary.
Mar 17, 2023 • 14 tweets • 4 min read
Well, the envelopes have been opened. Tears (hopefully of joy) have been shed. And just like that, another Match Day is in the books.

And you know what that means.

Time to break it down, Winners & Losers™️ style.

(🧵) LOSER: Emergency Medicine programs.

It’s been discussed all week, but this year, there were more unfilled EM spots than there have been in the previous 15 years combined.

Only 82% of EM positions filled. That’s the lowest of all specialties except radiation oncology (81%). Number of unfilled EM positions from 2008 to 2023. From 2008
Mar 15, 2023 • 22 tweets • 8 min read
In 1998, a small residency program in Colorado lost its accreditation.

It wasn’t the kind of thing that you’d expect to change the course of academic medicine.

And yet, it *almost* did.

Earlier, I explained how the Match started. Now, I’ll tell you how it nearly collapsed.

🧵 The Rocky Mountain Osteopathic Hospital, home of the family When the HealthONE family medicine residency shut down, the residents lost their jobs.

And some of them went to see an attorney named Sherman Marek.

marekweisman.com
Mar 14, 2023 • 4 tweets • 2 min read
For those following along as we continue the countdown to #MatchDay2023, it’s now time for Part 4 in our six-part series.

Yesterday, I described how the NRMP did their best to ignore one doctor’s fight to make the matching algorithm applicant-optimal.

Today, I’ll explain why. Screenshot of the opening slide for The Match, Part 4: Unrav We’ll cover why outside-the-match offers threaten the existence of the match; how the GI fellowship match failed; and why the NRMP fought so hard for their “All In” policy.

It’s all here:

The Match, Part 4: Unraveling and going all in
Mar 13, 2023 • 7 tweets • 2 min read
I wasn’t done with my rant when I ran out of Tweets in my thread.

But I think this is shameful. At least say something like, “In response to student concerns that the existing algorithm advantaged programs [Williams reference], the NRMP Board commissioned a study…”

At least honor the man’s courage and perseverance with a single superscript notation of his work!
Mar 13, 2023 • 26 tweets • 9 min read
As we countdown to Match Day, I want you to meet Dr. Kevin Jon Williams.

For nearly 20 years, he fought for - and eventually won - a student-optimal matching algorithm.

It’s one of the great stories of advocacy in Match history… and the NRMP refuses to acknowledge it.

(a 🧵) Graphic of Dr. Kevin Jon Wi... Lemme explain.

In 1962, mathematicians David Gale and Lloyd Shapley solved the “Stable Marriage Problem.”

By using a deferred acceptance algorithm, you could pair up a set of men and women who each wanted to be married, but had varying preferences among the potential partners. Screenshot of Gale and Shap...
Mar 7, 2023 • 14 tweets • 4 min read
Lemme flesh out the argument here since some respondents and QT’ers seem to be missing the point.

It’s not just “greedy insurance companies are making health care expensive!”

It’s that *we built a system that incentivizes insurers to systematically ⬆️ health care costs.*

(🧵) The issue is the so-called “80/20 rule” of the Affordable Care Act.

The goal was to keep insurance companies from taking excessive profit margins by requiring them to spend at least $0.80 of every premium dollar on paying for health care.

healthcare.gov/health-care-la…
Feb 21, 2023 • 13 tweets • 4 min read
Back to review the ACGME’s proposed pediatric program requirements - this time with a focus on pediatric residents and faculty.

If you missed Part 1, it’s below. Otherwise, well, you know what time it is.

It’s time to break it down, Winners & Losers™️ style.

🧵 WINNER: Patient caps.

The ACGME guidelines stop short of *requiring* patient caps… but the fact that “programs are encouraged” to limit the number of patients a resident can care for at a given time sets the stage for them to make this an accreditation standard in the future. Screenshot from the ACGME’s...