Clinical Clerkships

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The Problem & Solution

doctorvisits_graph

The Physician Workforce is Aging: 250,000 Active Physicians Are Over 55

Source: National Ambulatory Medical Care Survey, 1980, 1990, 2000, 2003
Prepared by AAMC Center for Workforce Studies

The Physician Workforce is Aging: 250,000 Active Physicians Are Over 55

Source: U.S. Census

numberofelderly_graph
physicianworkforce_graph

The Physician Workforce is Aging: 250,000 Active Physicians Are Over 55

Source: American Medical Association (AMA) Physician Characteristics and Distribution for 1985 data: AMA Masterfile for 2005 data
Active physicians include residents/fellows
NOTE: 1985 data excludes 24,000 DOs.
Prepared by AAMC Center for Workforce Studies, March 2006

In a 2015 study, the Association of American Medical Colleges (AAMC) reported that although physician supply growth is projected to increase modestly between 2013 and 2025, demand will grow more steeply, and the shortage of physicians will range between 46,000 to 90,000 by 2025.

An independent study conducted by the American Medical Association (AMA) reports that the physician shortage to be as high as 130,000 by 2025.

And past studies jointly conducted by the AMA and the Accreditation Commission for Graduate Medical Education (ACGME) found the physician shortage to be 85,000 to 200,000 by the year 2020.

Although the exact figures between each study is being debated, they all point to one universal theme – there is an impending shortage of physicians in America.

States in different parts of the country are experimenting with the idea of alleviating the workload sending patients to Physician Assistants (PAs) and Nurse Practitioners (NPs).
This can open up access to healthcare in places in need. But is this the best solution? Is the quality of patient care being compromised because of the convenience that PAs and NPs provide us? Is the training that PAs and NPs go through sufficient to see patients on their own? How does this affect insurance reimbursement? Will this open up the floodgates for PAs and NPs to do even procedures that a physician spends years training for?

Longer work hours and declining insurance reimbursement rates are making would-be doctors rethink their career paths. The United States’ uninterrupted population growth trend along with the aging Baby Boomer population will more than double the over-65 population by 2030. This puts a high demand on health care. One in three practicing physicians are over the age of 65 and close to retirement.

All of these factors create the perfect storm and contribute to the dangerous reality that patients will face in the near future.

And because it takes nearly a decade to train a physician, this is an issue that needs to be addressed today.

piechart_2
U.S. Senior
50.9%
Non-U.S. IMG
22.0%
U.S. IMG
14.8%
Osteopathic
7.8%
U.S. Graduate
4.3%
Canadian
0.1%
Fifth Pathway
0.1%

According to the National Resident Matching Program (NMRP), International Medical Graduates (IMGs) represented more than one-third of total applicants during the 2014 residency match.

Source: NRMP Data Warehouse

In response to the shortage of physicians, U.S. medical schools have gradually increased their enrollment rate. Despite the increase and the opening of new medical schools across the country, the demand is simply too high and unmanageable.

For decades, International Medical Graduates (IMGs) have filled vacant residency positions and produced great physicians to serve the community. IMGs account for over one-third of the total residency applicant pool and fill approximately 10,000 residency slots each year. Graduates of Internal Medical Schools come back to the U.S. with the same licensing and privileges as graduates from U.S. medical schools.

In order to be considered competitive residency candidates, IMGs must train in ACGME accredited hospitals that house a residency program. With U.S. residency positions becoming increasingly competitive, many program directors are now requiring U.S. clinical experience as a prerequisite for IMGs.

And each year, international medical students seek U.S. clinical training with the hope of attaining the prerequisite experience required to secure a competitive residency position. Across the country, many hospitals are recognizing the value of bilingual and bi-cultural physicians, and have elected to open their doors to these international medical students in an effort to support their pursuit of a quality U.S. clinical education.

Residency positions are still in short supply. While the Teaching Health Center Graduate Medical Education Payment Program is funding new residency programs, it does not address the shortage of residency positions in an adequate manner. Legislation is currently being worked on to increase the number of Medicare- sponsored residency slots, and bills currently in Congress could increase the number of residency slots for new physicians by 15,000 over a five year period. The healthcare community needs to prepare for this, so that an adequate number of qualified candidates can fill these positions as they become available.

The Clinical Rotation Program

The Clinical Rotation Program is a standardized clinical clerkship program designed exclusively for IMGs, working in unison with the medical school. The program provides IMGs comprehensive clinical experience in primary care and various specialties.

During the clinical rotation, students work directly with physicians, nurses, and other hospital staff. They conduct history taking, physical examinations, case presentations, and laboratory analysis. Students may also attend workshops, conferences and grand rounds. Hands-on experience provides students with the opportunity to apply theoretical knowledge to patients.

Rotations vary from 4 to 12 weeks in length. Clinical clerkships are conducted in the inpatient and outpatient setting, depending on the nature of the clerkship and the availability ofthe attending physician. Students are expected to demonstrate the highest standards of conduct and professionalism during each rotation. 100% attendance is required in every rotation. Violation of hospital rules or a pattern of inappropriate or unprofessional behavior will resultin immediate disciplinary review.

CHHA takes pride in mentoring students for U.S. residency. Students become eligible for the National Resident Matching Program (NRMP) by successfully completing the USMLE Step I, Step II/CK, and Step II/CS. Students that complete their clerkship training through the Clinical Rotation Program will build a strong foundation in clinical medicine and prepare them for success in the annual Residency Match.

Placement Requirements

Identification
  • Curriculum Vitae
  • Letter of Good Standing from medical school
  • Verification of US citizenship, permanent residency, or other visa status
  • Governmentissued I.D. or passport
  • Personal health insurance
Vaccination Requirements
  • Tuberculosis screening
  • Influenza vaccination
  • Varicella vaccination records or proof of immunity
  • Tetanus, Diptheria, and Pertussis
  • Measles, Mumps, and Rubella
  • Hepatitis B Series
  • 10 Panel Urine Drug Test
Professional Liability Insurance
  • $1,000,000 for each occurrence
  • $3,000,000 in annual aggregate
Certifications
  • Basic Life Support Certification (BLS)
  • Infection Control/ Barrier Precaution Training Certificate
  • Health Insurance Portability and Accountability Act (HIPAA) training certificate
  • Background Check – includes sex offender, office ofthe Inspector General (OIG) , and the Excluded Parties List System (EPLS)

Our Office Locations

Hi CHHA, this is Faiza your former student. Hope you’re doing well! Just wanted to share the news that I matched for residency this year! Thank you for all your help and support throughout the process, I really appreciate it!!”

– Faiza

Dr. C., ENT rotation. He is one of the top ENT surgeons in Houston. He is a knowledgeable man and an excellent professor, meaning that, he taught me the most important procedures, examination of the patient, etc. I saw over 20 patients per day and I can tell you that I was exposed to a lot of diseases that other students in my country are not. I saw acromegaly, parotid cancer, Tertiary syphilis symptoms, cholesteatoma, Menieres Disease, SNHL, etc.

Dr. R., Ortophaedics-Trauma. He is an excellent teacher, very challenging in a good way. I did over 5 presentations and completely learned all the anatomy necessary for this rotation. I went to a lot of surgeries, herniated disc surgery (Diskectomy). He gave me a MRI interpretation class.

Dr. P., ophthalmology. The basis of his teaching is the respect. He always told me that I am a medical student, not an employer, and I was there to learn. So I did it, I learn and I appreciate his patience and dedication. He provide me with all the books for my learning. Also I went to the hospital and observed over 7 surgeries.

Dr. S., OBGYN. She is a great professor, an excellent doctor and I can tell that all I know about obstetrics is because of her dedication and teaching. I spent many many hours in Memorial Hermann Hospital ( histerectomy, vaginal deliveries, c-sections, etc) and I saw over 20 patient per day. That’s how we learn.

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