EMERGENCY MAILBAG: The USMLE Cheating Scandal Sheriff of Sodium 2024-02-02 | This week, the USMLE announced that a number of test-takers from Nepal would have their Step scores invalidated due to “a pattern of anomalous test performance” suggesting “prior unauthorized access to secure exam content.”This was big news that flooded my inbox and DMs… and necessitated an *emergency* mailbag. Here, I’ll cover ‘USMLE recalls’; Prometric center test security; how the cheaters got caught (and what will happen to them in the future); and where the USMLE should go from here to improve test security and maintain trust in their scores.*** - Be sure to check out Part 2 and Part 3 here!MORE Emergency Mailbag: The USMLE Cheating Scandal, Part IIyoutu.be/c5sRsi3OyvgMailbag: Wrapping Up the USMLE Cheating Scandalyoutu.be/MR1hzK-hu34-NOTES:1. Here are the official statements from the USMLE and the ECFMG…usmle.org/usmle-program-statement-notification-invalidated-exam-scoresecfmg.org/news/2024/01/31/statement-on-invalidation-of-usmle-examination-scores2. I mentioned a few videos that explain in further detail certain other things about the USMLE…Breaking the magic: how the USMLE three-digit score is calculatedyoutu.be/yCnsEekmh1oMailbag: Questions about the USMLEyoutu.be/co05HNjJUPQA Brief Update on USMLE Score Creepyoutu.be/1gKKAZ5aO8E3. Here are the papers I mentioned…Wood TJ, et al. Identifying the unauthorized use of examination material. Eval Health Prof 2010;33(1):96-108.pubmed.ncbi.nlm.nih.gov/20042416Smith R. Cheating at medical school. BMJ 2000;321:398.pubmed.ncbi.nlm.nih.gov/109380334. Here’s the CNN story on the American Board of Radiology recalls scandal…cnn.com/2012/01/13/health/prescription-for-cheating/index.html#5. Here’s the Medscape article on USMLE recalls…(n.b., the reporter was actually working on this for a couple of weeks BEFORE the USMLE’s announcement!)medscape.com/viewarticle/us-board-discloses-cheating-grads-say-problem-rampant-2024a10002aj?src=mbl_msp_iphone&ref=text&form=fpf6. Here’s a brief news article on AAMC v. Anyanwu… but if you want a really wild ride, look up the actual court filings.https://copyright.byu.edu/student-sued-for-allegedly-wearing-spyglasses-during-mcat_MUSIC:‘Clutch’ - Nicolas Major.
The $100,000 H-1B Visa: Winners & Losers Edition Sheriff of Sodium 2025-09-22 | Last week, President Trump issued a proclamation that will require a $100,000 fee for every new H-1B visa application. When nearly 20% of the physician workforce consists of non-citizen international medical graduates, this policy will have significant effects on medical education and medical practice in the United States.So who wins - and who loses - when the H-1B visa gets a six-figure price tag? It’s time to break it down, Winners & Losers style._NOTES:1. The presidential proclamation is online here:“Restriction on Entry of Certain Nonimmigrant Workers.” September 19, 2025.whitehouse.gov/presidential-actions/2025/09/restriction-on-entry-of-certain-nonimmigrant-workers2. I referenced several previous Sheriff of Sodium videos. Here they are, in order of mention:-Following The Money: A Primer on Resident Physician Compensationyoutu.be/0WhxiuD4Rb8-Match Day 2024: Winners & Losers Editionyoutu.be/agCoT2nvhyE-Tell Me Again About the “Physician Shortage”youtu.be/gIHRbzdT-fA_MUSIC:“Clutch,” by Nicolas Major._COVER:Graphic from ChatGPT.
The Applicant’s Guide to Strategic Preference Signaling Sheriff of Sodium 2025-09-10 | Preference signaling has become one of the most important determinants of success in residency selection. So how do you stack the odds in your favor? What’s the most effective way to allocate program preference signals in the Match? Which programs will review your application without a signal? How do applicants figure out at which programs their application will be competitive? Should applicants identify a geographic preference - or not?It’s time to take a look at preference signaling through the lens of strategy._REFERENCES (in order of mention):Siegel MS. How I do it. October 13, 2024. https://medicine.yale.edu/news-article/how-i-do-it/ The Sheriff of Sodium. Preference Signaling: Winners & Losers Edition. August 19, 2020. thesheriffofsodium.com/2020/08/19/preference-signaling-winners-and-losers-edition Feroe AG, Smartt AA, Pulos N, Aiyer AA, Levine WN, Barlow JD. Preference signaling during the orthopaedic surgery residency application process. J Am Acad Orthop Surg 2023; 31(1): 1-6. journals.lww.com/jaaos/abstract/2023/01010/preference_signaling_during_the_orthopaedic.1.aspx National Resident Matching Program. Charting Outomes: Program Director Survey Results, 2024 Main Residency Match. August 8, 2024. nrmp.org/match-data/2024/08/charting-outcomes-program-director-survey-results-main-residency-match The Sheriff of Sodium. Advice for the Residency Interview. youtu.be/ZbV8Y3D27Tw?si=KW-giAyqcCirYs6P Association of American Medical Colleges. Exploring the relationship between program signaling and geographic preferences with interview invitations across specialties: 2025 analysis. March 5, 2025. aamc.org/media/85596/download Association of American Medical Colleges. Exploring the relationship between geographic preference and interview invitations across specialties. March 5, 2025. aamc.org/data-reports/data/eras-statistics-data Presro. POV your residency interview with an anesthesiologist who did not read your app. youtube.com/shorts/_-aSrAZCFTc?si=kKozZs0Ly7BBYC94 Keneally R. The conundrum of divergent signaling by couples applicants. J Grad Med Educ 2023; 15(4): 439-441. meridian.allenpress.com/jgme/article/15/4/439/494777/The-Conundrum-of-Divergent-Signaling-by-Couples_MUSIC:“Clutch,” by Nicolas Major.
The Research Arms Race in Residency Selection Sheriff of Sodium 2025-08-17 | Medical students today are doing more research than ever before. That’s a great news! Right? Right??? In this video, we’ll explore the research arms race in residency selection, from its origins to its many externalities – and highlight some simple and big-picture fixes that could transform this from a harmful competition into a public good. _ NOTES: You may also like this post from the Sheriff of Sodium website: The Residency Selection Arms Race, Part 3: The Research Arms Race thesheriffofsodium.com/2022/07/19/the-residency-selectionarms-race-part-3-the-research-arms-race _ REFERENCES (in order of presentation): Couch NP. About heparin, or… whatever happened to Jay McLean? J Vasc Surg 1989; 10(1): 1-8. pubmed.ncbi.nlm.nih.gov/2664233 McLean J. The thromboplastic action of cephalin. Am J Physiol 1916; 41: 250-257. journals.physiology.org/doi/abs/10.1152/ajplegacy.1916.41.2.250 McLean J. The discovery of heparin. Circulation 1959; 19(1): 78. ahajournals.org/doi/10.1161/01.cir.19.1.75 Elliott B, Gottschall Z, Suppa E, Carmody JB. Trends in medical student authored publications, 2012-2022. Res J Int Med 2025; e00002. doi.org/10.63495/7106384 National Resident Matching Program. Charting Outcomes in the Match: Characteristics of U.S. MD seniors who matched to their preferred specialty (2024). nrmp.org/match-data/2024/08/charting-outcomes-characteristics-of-u-s-md-seniors-who-matched-to-their-preferred-specialty-2024-main-residency-matchTruel JS, Ferree S, Fathy R, Hossler E, Rosman IS. Demographic differences and the impact of research years for reapplicants to dermatology residency programs: a retrospective cohort study. J Am Acad Dermatol 2024; 91(5): 971-972. pubmed.ncbi.nlm.nih.gov/39009222Pathipati AS, Taleghani N. Research in medical school: a survey evaluating why medical students take research years. Cureus 2016; 8(8):e741. pubmed.ncbi.nlm.nih.gov/27672532 Nguyen M, Chaudhry SI, Asabor E, et al. Variation in research experiences and publications during medical school by sex and race and ethnicity. JAMA Netw Open 2022; 5(10): e2238520. pubmed.ncbi.nlm.nih.gov/36282497 Sun E, Tsou BS, Tian J, Eltemsah L, Srikumaran D, Chow J, Woreta F. Fate of research articles reported by ophthalmology applicants: what happens to ‘submitted’ and ‘in preparation’ articles? J Surg Educ 2023; 80(5): 750-756. sciencedirect.com/science/article/abs/pii/S1931720423000570 Burkhart RJ, Hecht CJ, Karimi AH, Acuna AJ, Kamath AF. What are the trends in research publication misrepresentation among orthopedic residency and fellowship applicants from 1996-2019: A systematic review. Clin Orthop Relat Res 2023; 481: 1292-1303. pubmed.ncbi.nlm.nih.gov/36728037 Altman DG. The scandal of poor medical research. BMJ 1994; 308: 283. bmj.com/content/308/6924/283 Association of American Medical Colleges. Debunking the research arms race: navigating publications in medical school. Webinar from June 18, 2025. vimeo.com/1098326557 - MUSIC: “Clutch,” by Nicolas Major.
Is there a better residency matching algorithm? Sheriff of Sodium 2025-07-24 | For decades, the NRMP and other matching organizations have used deferred acceptance algorithms to pair up residency applicants with residency programs. But what if there was a better way? According to a new paper, there is.Using a mixed integer linear programming (MILP) model and real rank order list data from the SFMatch, the authors re-ran the 2011-2021 ophthalmology matches. The results were striking. Both programs and applicants matched to higher positions on their rank order list, and every single program position got filled.Sounds great, right? But there’s a fatal flaw in this algorithm - one that makes it susceptible to gaming, ruins outcome stability, and altogether renders it unsuitable for use in the real world. If you don’t see it already, then allow me a few minutes to break it down with you.It’s time for a Journal Club.-NOTES:Wu Y, et al. Improving residency matching through computational optimization. JAMA Netw Open 2025: 8;(6):e2517077.jamanetwork.com/journals/jamanetworkopen/fullarticle/2835467Van Gelder RN, et al. Is it time to modernize the residency match process? MedPage Today; 22 Jul 2025.medpagetoday.com/opinion/second-opinions/116622The Match Seriesyoutube.com/playlist?list=PLc36yFQWkuG1sXk62A3zeRWB8aoK5SISP_MUSIC:“Clutch,” by Nicolas Major.
Student Loan Reform: Winners & Losers Edition Sheriff of Sodium 2025-07-16 | On July 4, 2025, the "Big Beautiful Bill" was signed into law by President Trump. Among many other things, it contains sweeping reforms for federal student loans that will significantly change the way that medical training is financed. This has important implications for pre-meds, medical students, physicians, hospitals, and honestly, the future of medicine in general.So you know what that means: it's time to break it down, Winners & Losers style._REFERENCES (in order of mention):-H.R. 1 (119th Congress) - One Big Beautiful Bill Act.congress.gov/bill/119th-congress/house-bill/1/text-Sheriff of Sodium. The vulnerabilities of osteopathic medicine. 22 Nov 2021.thesheriffofsodium.com/2021/11/22/the-vulnerabilities-of-osteopathic-medicine-AAMC Analysis in Brief. An updated look at the economic diversity of U.S. medical students. 2018; 18(5).aamc.org/data-reports/analysis-brief/report/updated-look-economic-diversity-us-medical-students-Association of American Medical Colleges (AAMC). Debt, costs, and loan repayment fact card for the Class of 2024.students-residents.aamc.org/media/12846/download-AAMC Analysis in Brief: Trends in cost and debt at U.S. medical schools using a new measure of medical school cost of attendance.aamc.org/system/files/reports/1/aibvol12_no2.pdf-AAMC: Physician education debt and the cost to attend medical school, 2020 update.aamc.org/data-reports/students-residents/report/physician-education-debt-and-cost-attend-medical-school-Libassi CJ, Grosz M, McGuinness S, Matsudaira J, Darolia R. OCE Working Paper - OCE2024-007. U.S. Department of Education. An overview of graduate borrowing and outcomes. January 2025.web.archive.org/web/20250321010300/sites.ed.gov/ous/files/2025/01/grad_borrowing_report-1.14.pdf__NOTES:If you want to hear about the have's and have not's of tuition free medical school, check out this SoS video:Tuition Free Medical School: Winners & Losers Edition.youtu.be/f-3XNGpHYDs?si=inJ2ZSTZqmwGwe_h_MUSIC:"Clutch," by Nicolas Major.
Surviving in Academic Medicine (Advice for MD-PhDs) Sheriff of Sodium 2025-07-03 | It’s a bold move to ask someone who is NOT a clinician investigator (and barely considered an academic) for advice on how to succeed in academic medicine… but ask and ye shall receive.This is a version of a talk I gave to MD-PhD students in June 2025. In it, I’ll offer my opinion on how to have a job that you love by securing funding, balancing clinical work, avoiding burnout, and keeping your career from turning into the prize counter at Chuck E. Cheese.-SECTIONS:0:42 – Introduction: Abraham Wald and survivorship bias.5:48 – Think hard about your goals.10:44 – Assess your competitive advantage.13:06 – This is your career, not Chuck E. Cheese.18:16 – Loyalty needs limits.19:54 – Develop a healthy relationship with competition.22:45 – Build founder skills.27:42 – Carefully configure clinical time.32:15 – Do what you love.34:58 – Be skeptical._REFERENCES:In order of mention…-Wald A. A method of estimating plane vulnerability based on damage of survivors (1943).https://apps.dtic.mil/sti/tr/pdf/ADA091073.pdf-Simone JV. Understanding academic medical centers: Simone’s maxims. Clin Cancer Res 1999; 5:2281.pubmed.ncbi.nlm.nih.gov/10499593-Lorsch J. Funding trends and factors affecting success rate.loop.nigms.nih.gov/2014/02/funding-trends-and-factors-affecting-success-rate-Kaiser J. Fountain of youth: a congressman’s plan to make NIH grantees younger. Science 6 Oct 2014.science.org/content/article/updated-fountain-youth-congressmans-plan-make-nih-grantees-younger-Association of American Medical Colleges. Congress must support robust federal funding for the NIH. 4 Feb 2025.aamc.org/about-us/aamc-leads/congress-must-support-robust-federal-funding-nih-Mallapaty S. NIH grant rejections have more than doubled amid Trump chaos. Nature 19 May 2025.nature.com/articles/d41586-025-01539-5-Wosen J and Payne D. NIH details how Trump budget would cut support for grants, training and research centers. STAT 6 June 2025.statnews.com/2025/06/06/nih-cuts-newly-released-documents-detail-impact-on-grants-training-research-labs-Gladwell M. Complexity and the ten-thousand-hour rule. The New Yorker 21 Aug 2013.newyorker.com/sports/sporting-scene/complexity-and-the-ten-thousand-hour-rule-Casselman B. The legend of Abraham Wald.ams.org//publicoutreach/feature-column/fc-2016-06_COVER IMAGE:The legendary P-51D Mustang, from the Virginia Beach Military Aviation Museum.militaryaviationmuseum.org_MUSIC: “Clutch,” by Nicolas Major.
PART 2: Yes, Doctors, AI Will Replace You Sheriff of Sodium 2025-05-19 | If you missed Part 1, catch up here:Yes, Doctors: AI Will Replace Youyoutu.be/kALDN4zIBT0-NOTES:Saab K, et al. Advancing Conversational Diagnostic AI with Multimodal Reasoning.gstatic.com/amie/multimodal_amie.pdf-MUSIC:“Clutch,” by Nicolas Major.
Yes, Doctors: AI Will Replace You Sheriff of Sodium 2025-05-12 | Will AI replace doctors? Or simply augment them? There’s a right answer.CHECK OUT PART 2 HERE:PART 2: Yes, Doctors, AI Will Replace Youyoutu.be/Vfe-OthXmKw_NOTES:Andrade NS. How much time do surgeons spend operating? [preprint]medrxiv.org/content/10.1101/2025.02.15.25321677v1.fullHuddleston Jr., T. “Bill Gates: Within 10 years, AI will replace most doctors and teachers- humans won’t be needed for ‘most things.’” CNBC, March 26, 2025.cnbc.com/2025/03/26/bill-gates-on-ai-humans-wont-be-needed-for-most-things.htmlSheriff of Sodium. Tell Me Again About the “Physician Shortage”youtu.be/gIHRbzdT-fA_MUSIC:“Clutch,” by Nicolas Major.
Developing and Advocating for Sustainable Business Models in Academic Medicine Sheriff of Sodium 2025-05-01 | As doctors, we have good jobs. The trick is keeping them that way. And unfortunately, among the biggest threats to long-term happiness in academic medicine are the pressures imposed by the business of medicine. Here, I’ll share a talk I gave to a group of doctors in my specialty about how to advocate to get or keep a SUSTAINABLY good job._NOTES:I gave five discrete pieces of advice…4:38 - Play stupid games, win stupid prizes.7:30 - Look past the smoke and mirrors.12:56 - Show your value.18:30 - It’s not what you say, it’s how you say it.23:16 - Rising tides lift all ships._REFERENCES (in order of mention):MGMA Provider Compensation and Productivity Data Report, May 2024.mgma.com/getkaiasset/252744ee-c63b-4a96-9211-8a5d6b908b39/MGMA-2024-Provider-Compensation-Data-Report.pdfChildren’s Hospital of Los Angeles Annual Report, 2023:chla.org/sites/default/files/2024-02/1117444-Annual-Report-CHLA-FY23-WEB.pdfChildren’s Hospital of Los Angles consolidated financial statement:fdpclearinghouse.org/file/get?id=3829“Texas Children’s to Lay off 1000.” Becker’s Hospital Review, August 6, 2024.beckershospitalreview.com/finance/texas-childrens-to-lay-off-1-000“Texas Children’s Leadership Pay Grew by 125% in Years Before Layoffs.” Houston Chronicle, October 22, 2024.houstonchronicle.com/projects/2024/texas-childrens-hospital-leadership-pay-layoffs“Texas Children’s Hospital Sponsoring Houston Open Positions Company as International Brand.” Houston Business Journal, March 1, 2024.bizjournals.com/houston/news/2024/03/01/texas-childrens-hospital-sponsorship-houston-open.htmlMeritt Hawkins Physician Inpatient/Outpatient Revenue Survey, 2019.amnhealthcare.com/siteassets/candidate-blog/physician/merritthawkins_revenuesurvey_2019.pdf_MUSIC:“Clutch,” by Nicolas Major._ARTWORK:Money tree by Kevyn Adha/Vecteezy.
Executive Order on Medical Accreditation: Winners & Losers Edition Sheriff of Sodium 2025-04-25 | This week, the President issued an executive order threatening to remove the authority of the organizations that accredit medical schools and residency training programs. It’s a move with far-reaching implications, and its intent and impact deserve examination. So you know what that means. Yup, it’s time to break it down, Winners & Losers style._REFERENCES1. Trump DJ. Executive order: reforming accreditation to strengthen higher education. April 23, 2025.whitehouse.gov/presidential-actions/2025/04/reforming-accreditation-to-strengthen-higher-education2. Do No Harm. How accreditors inject identity politics into medical and healthcare education. March 18, 2025.donoharmmedicine.org/wp-content/uploads/2025/03/DNH-Accreditors-Inject-Politics-into-MedEd-DIGITAL.pdf_MUSIC:“Clutch,” by Nicolas Major.
Match Day 2025: Winners & Losers Edition Sheriff of Sodium 2025-03-21 | It’s that time of year again. Today is Match Day 2025.So you know what that means.Yup, that’s right. It’s time to break it down, Winners & Losers style._NOTES:Here are the other Sheriff of Sodium videos I mentioned…1. The ERAS Death Spiral.youtu.be/87ppECqBI1U?si=IEKld835xhSsY-iw2. The Applicant’s Guide to Strategic Preference Signalingyoutu.be/pmRwRDe2gs83. The Match, Part 5: The lawsuityoutu.be/2SsU2Y40XwY_REFERENCES:National Resident Matching Program. Advance data tables. March 21, 2025.Trump D. Executive order. “Protecting the United States from foreign terrorists and other national security and public safety threats.”whitehouse.gov/presidential-actions/2025/01/protecting-the-united-states-from-foreign-terrorists-and-othernational-security-and-public-safety-threatsSavage C. Draft List for New Travel Ban Proposes Trump Target 43 Countries. New York Times, March 13, 2025.nytimes.com/2025/03/14/us/politics/trump-travel-ban.htmlAssociation of American Medical Colleges. Exploring the relationship between program signaling and interview invitations across specialties. December 2, 2024.aamc.org/media/81251/download?attachmentAlbert v. American Society of Health System Pharmacists.fingfx.thomsonreuters.com/gfx/legaldocs/znpnjblbapl/Albert%20v.%20American%20Society%20Of%20Health-%20System%20Pharmacists%20Inc..pdfScarcella M. House panel launches antitrust probe of medical residency system.reuters.com/legal/government/us-house-panel-launches-antitrust-probe-medical-residency-system-2025-03-17Satel S. Medical schools’ botched pass-fail experiment. City Journal, March 5, 2025.city-journal.org/article/united-states-medical-licensing-exam-pass-fail-gradingTallo C, Kiel A. Did Step 1’s pass/fail switch actually increase medical student burnout? KevinMD, November 22, 2024.kevinmd.com/2024/11/did-step-1s-pass-fail-switch-actually-increase-medical-student-burnout.htmlAgolia J, et al. Diminishing objectivity in the residency application process. JAMA 2025.pubmed.ncbi.nlm.nih.gov/39913130Warm E, et al. The shadow economy of effort: unintended consequences of pass/fail grading on medical students’ clinical education and patient care skills. Acad Med, 2025.pubmed.ncbi.nlm.nih.gov/39773910_MUSIC:“Clutch,” by Nicolas Major.
How much money do hospitals get to train residents? Sheriff of Sodium 2025-02-22 | Training resident physicians is good business for hospitals. Residents don’t just contribute to patient care - they often enable generous federal subsidies from Medicare to the hospitals where they work. NOTES:-The DGME and IME payments hospitals receive from CMS are a matter of public record. See:cms.gov/data-research/statistics-trends-and-reports/cost-reports/hospital-2552-2010-form-To learn more about how this stuff works, check out the full video:Following The Money: A Primer on Resident Physician Compensationyoutu.be/0WhxiuD4Rb8
Following The Money: A Primer on Resident Physician Compensation Sheriff of Sodium 2025-02-21 | Why don’t resident physicians earn more? How much does Medicare pay for resident training – and why is that figure so hard to pin down? Would residents make more if there were no Match? Should residents unionize to earn more?It’s time to follow the money – and answer all your questions about resident salaries and compensation._NOTES AND REFERENCES: The Match, Part 1: Why do we have a Match? youtu.be/jRxHn5l6E4A?si=_gXsLGCwZfYZlhI2 Budgetary Gerrymandering. youtu.be/HoVTL1KMifs?si=A1wBMeEp1XEooIsm Resident Unionization, Part 1: Lessons from Hamburger University. youtu.be/2dp2lzMTNIo?si=cCsN6BHIkWwFeMW2 Chandra A, Khullar D, Wilensky GR. The economics of graduate medical education. N Engl J Med 2014; 370(25): 2357-2360. pubmed.ncbi.nlm.nih.gov/24826947 Mayo Foundation v. United States, 562 U.S. 44 (2011). loc.gov/item/usrep562044 CMS Hospital 2552-2010 form: cms.gov/data-research/statistics-trends-and-reports/cost-reports/hospital-2552-2010-form Code of Federal Regulations, Section 413.79 – Direct GME payments. ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-413/subpart-F/section-413.79 National Academies of Science. Graduate Medical Education that Meets the Nation’s Health Needs. ncbi.nlm.nih.gov/books/NBK248024 Council on Graduate Medical Education (COGME), Eighth Report. Patient Care Physician Supply and Requirements: Testing COGME Recommendations. November 1996. hrsa.gov/sites/default/files/hrsa/advisory-committees/graduate-medical-edu/reports/1996.pdf Harvard Crimson. ‘Public and open boss fight’: Mass General Brigham, hospital trainees spar over union drive. March 21, 2023. thecrimson.com/article/2023/3/21/mass-brigham-housestaff-union_MUSIC:“Clutch,” by Nicolas Major.
Tell Me Again About the “Physician Shortage” Sheriff of Sodium 2025-01-14 | Everyone knows there's a doctor shortage, right? Wait times are long. Visits are short. And that's if you can even find a doctor that takes your insurance. Obviously, we need more doctors.Or maybe... just maybe... the problems in our health system are deeper and more complex, and simply training more physicians won't actually fix them. And maybe the people who want you to believe that it will have another agenda.If you think we have a doctor shortage, please give me few minutes to change your mind._SECTIONS:0:17 - PART ONE: TELL ME ABOUT THE PHYSICIAN SHORTAGE10:19 - PART TWO: TELL ME AGAIN ABOUT THE PHYSICIAN SHORTAGE37:20 - TAKEAWAY #1 - TRAINING MORE DOCTORS IS NOT A MAGIC BULLET39:40 - TAKEAWAY #2 – DOCTOR SHORAGES ARE DISTRIBUTIONAL45:25 - TAKEAWAY #3 – MOST CHAMPIONS FOR THE DOCTOR SHORTAGE ARE SELF-SERVING_REFERENCES: 0:56 - Association of American Medical Colleges. The complexities of physician supply and demand: projections from 2021 to 2036. aamc.org/media/75236/download?attachment2:05 - NBC Nightly News, “Primary care doctor shortage worsening across U.S.”nbcnews.com/nightly-news/video/primary-care-doctor-shortage-worsening-across-u-s-1938355899713:00 - Boston Globe. Primary care access is declining in Mass.: ‘We have never, ever seen numbers fall like this.’bostonglobe.com/2024/03/12/metro/primary-care-physicians-crisis-wait-times3:54 - Idaho Statesman. “Health care shortage ‘has plagued Idaho for years.’ Here’s what U of I is doing about it.”idahostatesman.com/news/local/education/article291190645.html5:06 - Milwaukee Magazine. “The nationwide doctor shortage is forcing patients to search for primary care.”milwaukeemag.com/the-nationwide-doctor-shortage-is-forcing-patients-to-search-for-primary-care5:28 - New York Times. “As children’s hospitals close children’s units, where does that leave Lachlan?”nytimes.com/2022/10/11/health/pediatric-closures-hospitals.html6:01 - NPR. “What’s the cure for America’s doctor shortage?”npr.org/2023/03/29/1166873700/whats-the-cure-for-americas-doctor-shortage6:41 - Philadelphia Magazine. “The Waiting Game.”phillymag.com/be-well-philly/2024/04/22/doctors-appointment-scheduling9:00 – Med City News. “With whopping $100M investment, UnitedHealth Group seeks to tackle workforce crisis and lack of diversity”medcitynews.com/2022/06/with-whopping-100m-investment-unitedhealth-group-seeks-to-tackle-workforce-crisis-and-lack-of-diversity16:08 – Desai AS. Zilebesiran, an RNA interference therapeutic agent for hypertension. N Engl J Med 2023; 389: 228-238. nejm.org/doi/full/10.1056/NEJMoa220839120:48 - Boston Globe. Mass General Brigham doctors demonstrate amid push to unionize.bostonglobe.com/2024/11/30/metro/mass-general-brigham-doctors-union27:34 - Urgent Care Association. Urgent Care Industry White Paper. urgentcareassociation.org/wp-content/uploads/2023-Urgent-Care-Industry-White-Paper.pdf29:16 - Idaho Statesman. “Idaho needs doctors. But many don’t want to come here. What that means for patients.” May 15, 2024.idahostatesman.com/living/health-fitness/article285521662.html31:30 - AAMC Analysis in Brief. An updated look at the economic diversity of U.S. medical students. October 2018.aamc.org/media/9596/download34:18 - Kaiser Family Foundation. Medicaid-to-Medicare fee index.kff.org/medicaid/state-indicator/medicaid-to-medicare-fee-index35:29 – Bisgaier J, Rhodes KV. Auditing access to specialty care for children with public insurance. N Engl J Med 2011; 364:2324-2333.nejm.org/doi/full/10.1056/NEJMsa101328539:08 - CMS. National Health Expenditures.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical40:16 - Gudbranson E, Glickman A, Emanuel EJ. Reassessing the data on whether a physician shortage exists. JAMA 2017; 317(19):1945-1946.jamanetwork.com/journals/jama/article-abstract/261320946:07 - The University of Georgia School of Medicine – economic impact report:https://medicine.uga.edu/wp-content/uploads/9.25.24-UGA_Economic-Impact.pdf46:59 – Sheriff of Sodium. What are resident physicians worth?youtu.be/uLvb9vv03xE?si=hI4zihbl4jARYBoR48:57 - Kaiser Family Foundation – Marketplace insurers 7% premium increase:kff.org/affordable-care-act/press-release/marketplace-insurers-are-proposing-a-7-average-premium-hike-for-202553:00 - Kaiser Family Foundation. Hospitals and physicians represent more than half of total health spending. kff.org/private-insurance/slide/hospitals-and-physicians-represent-more-than-half-of-total-health-spending-MUSIC:“Clutch,” by Nicolas Major.
Do hospitals really lose money on doctors? Sheriff of Sodium 2024-11-17 | According to a recent report from a healthcare consulting firm, hospitals lose $304k on every physician they employ. How did they come up with this figure? It’s called budgetary gerrymandering, and I’ve got a slightly longer video on it for anyone interested.
Advice for the Residency Interview Sheriff of Sodium 2024-11-07 | Interview Day is where your rank position is determined - which is why I’m always surprised that so many residency applicants under-prepare for the interview, make avoidable mistakes, or fall into traps. Here’s my advice for how to put your best foot forward._NOTES:NRMP Program Director Survey (2024): nrmp.org/match-data/2024/08/charting-outcomes-program-director-survey-results-main-residency-matchMaxfield CM, et al. Bias in radiology resident selection: do we discriminate against the obese and unattractive? Acad Med 2019; 94(11): 1774-1780.journals.lww.com/academicmedicine/fulltext/2019/11000/bias_in_radiology_resident_selection__do_we.41.aspxKassam AF, et al. Swipe right for surgical residency: exploring the unconscious bias in resident selection. Surgery 2020; 168(4): 724-729. Dr. Glaucomflecken video: How to Ace Your Neurosurgery Residency Interview youtu.be/C5BD9DGXoYk?si=h5KM6bMEkqLAYlNh _ CREDITS:Images: wojak-studio.com Music: “Clutch,” by Nicolas Major.
Charting Outcomes in the Match: Winners & Losers Edition Sheriff of Sodium 2024-09-18 | Every two years, the National Resident Matching Program releases their “Charting Outcomes in the Match” reports. This year, we got three reports, with 799 pages of charts and data showing how applicant qualifications are associated with the likelihood of matching into different specialties for MDs, DOs, and international medical graduates (IMGs).The Charting Outcomes reports are a treasure trove of data that highlight important trends in residency selection; what qualifications program directors really care about; and some just plain fun stuff about biostatistics. So you know what that means.Yup, it’s time to break it down, Winners & Losers style._NOTES:1. Wanna check out the Charting Outcomes reports for yourself? They’re linked here:nrmp.org/about/news/2024/08/the-2024-charting-outcomes-reports-are-now-available2. Along the way, I referenced a few other Sheriff of Sodium videos:-FACT POLICE: Residency applicants and residency positionsyoutu.be/L75fj_5Ar4s-The Applicant’s Guide to Strategic Preference Signalingyoutu.be/pmRwRDe2gs8-ERAS and Financial Conflict of Interest at the AAMCyoutu.be/PRR7PaoF1lY3. Here’s more on Simpson’s Paradox:https://plato.stanford.edu/entries/paradox-simpson/4. Here’s a paper on how anti-drug campaigns had no effect (or might have even increased!) teen drug use:Block LG, et al. Am J Public Health 2002; 92(8): 1346-51.ncbi.nlm.nih.gov/pmc/articles/PMC1447241_MUSIC: “Clutch,” by Nicolas Major.
Board certification for exceptionally qualified IMGs: Winners & Losers Edition Sheriff of Sodium 2024-08-27 | For as long as the American Board of Internal Medicine has existed, completing an accredited U.S. residency program has been a pre-requisite to sitting for the internal medicine board exam. But last week, the ABIM announced a proposal that would allow “exceptionally qualified” international medical graduates who complete a U.S. fellowship program to to sit for both their general and specialty medicine boards - even if they did their residency overseas.This would be a major change to longstanding policies… so you know what that means.That’s right, it’s time to break it down, Winners & Losers style._NOTES:1) The ABIM’s video explaining the pilot is here:youtu.be/p52BVyjVVNw?si=Z8hbjTdXnHeeGhs-2) I also referenced a few old Sheriff of Sodium videos…-The Match, Part 1: Why do we have a Match?(includes discussion on why we have residency training/history of board certifying organizations)youtu.be/jRxHn5l6E4A-Bypassing residency for IMGs in Tennessee: Winners & Losers Editionyoutu.be/VeGqKHYLxYQ-The ABIM Under Fire: How Doctors Can Realistically Fix MOCyoutu.be/aNgf6oYZlcg3) If you want to comment on the ABIM proposal, there is a link here:blog.abim.org/call-for-public-comment-pilot-model-pathway-to-board-eligibility-for-exceptionally-qualified-international-medical-graduates_MUSIC:“Clutch,” by Nicolas Major.
What’s the average USMLE Step 2 CK score? Sheriff of Sodium 2024-08-14 | New USMLE score performance data just dropped… and the mean Step 2 CK score is now 249. NOTES:Here are the most recent USMLE Score Interpretation Guidelines:usmle.org/sites/default/files/2022-05/USMLE%20Step%20Examination%20Score%20Interpretation%20Guidelines_5_24_22_0.pdf
The Man Who Beat the USMLE (in Court) Sheriff of Sodium 2024-08-13 | In 2020, resident sent an email to a state medical board. Attached was a copy of a USMLE score report showing a passing score on Step 3.There was just one problem. The score report was fake.This is the incredible-but-true story of how that resident beat the USMLE in court and received a medical license without ever passing Step 3._NOTES:1. In the United States, there is a public right to observe judicial proceedings. Although courts can seal records for good cause, there's a presumption that what occurs in court should be transparent and open to public inspection. Anyone can inspect public court records on PACER (though registration and a per-page charge are required).pacer.uscourts.gov2. Here's the video that discusses how there's NEVER been a USMLE score recheck that resulted in a score change:Mailbag: Questions about the USMLEyoutu.be/co05HNjJUPQ3. Here's the video with advice on getting kicked out of residency/medical school, in which I made the point "Policies are your best protection":Mailbag: Help! I’m Getting Kicked out of Medical Schoolyoutu.be/scDJECi6bLY_MUSIC:"Clutch," by Nicolas Major.
How many residency positions are preliminary? Sheriff of Sodium 2024-07-20 | How many residency positions are preliminary - and how many are categorical? Can the growth in residency positions overall be explained by a growth in PGY-1 transitional and preliminary medicine/preliminary surgery positions?
The COMLEX Level 2-PE is coming back Sheriff of Sodium 2024-07-17 | Don’t say I didn’t warn you. The NBOME seems intent on bringing back a clinical skills examination as a requirement for licensure - likely for the DO Class of 2028.NBOME Core Competency Capstone for DOs (C3DO):nbome.org/c3doX post: https://x.com/jbcarmody/status/1812856888813306129?s=61&t=26I8DpCR65k8SG5Fx81zVg
Tuition-Free Medical School: Winners & Losers Edition Sheriff of Sodium 2024-07-12 | Earlier this week, Michael Bloomberg donated $1 billion to Johns Hopkins University in order to make the school “tuition free” for (most) students. The announcement generated lots of fawning media coverage and inspired debates and hot takes on social media.So you know what that means.It’s time to break it down, Winners & Losers style._References and call-outs, in chronologic order: 1. New York Times coverage of the Johns Hopkins gift: $1 Billion Bloomberg Gift to Hopkins Makes Tuition Free for Most Medical Students nytimes.com/2024/07/08/us/bloomberg-donation-johns-hopkins- medical.html 2. The New York Times Magazine on how long it would take the average Amazon worker to acquire their founder’s wealth: 9 Ways to Imagine Jeff Bezos’ Wealthnytimes.com/interactive/2022/04/07/magazine/jeff-bezos-net-worth.html 3. ProPublica reporting on billionaires’ effective tax rates: The Secret IRS Files: Trove of Never-Before-Seen Records Reveal How the Wealthiest Avoid Income Tax propublica.org/article/the-secret-irs-files-trove-of-never-before-seen- records-reveal-how-the-wealthiest-avoid-income-tax 4. 55% of medical students say debt has “no influence” on specialty choice: Thomas B. Free medical tuition: will it accomplish its goals? JAMA 2019; 321(2): 143. jamanetwork.com/journals/jama/article-abstract/2718252 5. Systematic review on medical student debt and specialty choice: Pisaniello MS, et al. Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review. BMJ Open 2019; 9:e029980 bmjopen.bmj.com/content/bmjopen/9/7/e029980.full.pdf 6. Here’s the Sheriff of Sodium video that resulted in a takedown request from a medical school featured in the top 10 most expensive medical schools. (Fast forward to around the twelve minute mark for the offensive graphic.) Addressing Osteopathic Medicine’s Vulnerabilities: The View Through an External Lens youtu.be/RC3pFmynxJQ?si=1cyprZONdGfH5FZl 7. Here’s the video on the Flynn effect and merit in medicine: On the Flynn Effect and Merit in Medicine: youtu.be/FHOCuKW8new?si=eb4uaiDO-Z6DHQiA_ MUSIC: “Clutch,” by Nicolas Major.
How many USMLE questions are experimental items? Sheriff of Sodium 2024-07-01 | How many questions on the USMLE are scored - and how many are unscored experimental items? We actually learned the answer to this during the COVID-19 pandemic. Here was my original Tweet when it happened:https://x.com/jbcarmody/status/1268904159522295808?s=46&t=bmm1gv3HxWdNazimqL_3_w
Should USMLE Step 3 be Pass/Fail? Sheriff of Sodium 2024-06-29 | Should USMLE Step 3 become pass/fail? I’m just not sure it matters much when we’re talking about the Fredo of the USMLE Corleone brothers.Here’s the news article on the AMA resolution:ama-assn.org/medical-residents/usmle-step-3/move-usmle-step-3-pass-fail-boost-residents-well-beingThere are some other components that could be useful - such as shortening the length of the exam (from two days to one) and allowing U.S. medical students to take the exam before they begin residency.
Do USMLE cheaters lower my score? Sheriff of Sodium 2024-06-28 | Do people who cheat on the USMLE and achieve very high scores lower the scores for honest examinees? The answer is no (or at least, not as far as we know). The reference group for the USMLE are examinees from U.S. MD-granting medical schools who are taking the test for the first time. So far, the only examinees whose scores have been invalidated for cheating are international medical graduates.
Inside the Sausage Factory: How the USMLE Passing Standard is Set Sheriff of Sodium 2024-06-26 | How is the passing score for the USMLE determined? And why does the minimum passing score keep increasing over time? In this video, I’ll answer both questions - and provide an overview of the Angoff standard setting method; the Angoff modifications used by the National Board of Medical Examiners; the differences between norm-referenced and criterion-referenced exams; and even review some questions from the original NBME exam.NOTES:1. I mentioned a couple of previous Sheriff of Sodium videos…On rising USMLE performance:A Brief Update on USMLE Score Creepyoutu.be/1gKKAZ5aO8E-On the appropriate context for the USMLE Step 1 pass rate:FACT POLICE: The USMLE Step 1 Pass Rateyoutu.be/Ov2tkX-_YGI2. Here is the NBME’s survey on the “ideal” fail rate for the USMLE:Margolis J, Clauser BE, Winward M, Dillon GF. Validity evidence for USMLE examination cut scores: results of a large-scale survey. Acad Med 2010; 85 (10): S93-S97. pubmed.ncbi.nlm.nih.gov/20881714 3. There’s also a vintage post on the USMLE pass rate on the Sheriff of Sodium website:thesheriffofsodium.com/2019/01/20/a-peek-inside-the-usmle-sausage-factory-setting-the-step-1-minimum-passing-score_MUSIC: ‘Clutch,’ by Nicolas Major.
FACT POLICE: The USMLE Step 1 Pass Rate Sheriff of Sodium 2024-05-24 | Have you heard that more students are failing the USMLE Step 1 exam than ever before, or that 25-50% of students are deferring their Step 1 exam because they’re unprepared to pass the test? Me, too!Thing is, there’s a lot of silly, sky-is-falling, and self-interested misinformation out there. So today, I’m back as the FACT POLICE, to explain how we should - and shouldn’t - make sense of changes in the pass rate._NOTES:1. Wanna re-watch the original episode of FACT POLICE? It’s here:FACT POLICE: Residency applicants and residency positionsyoutu.be/L75fj_5Ar4s2. Here’s the X post with the good ol’ days of Step 1 shower studying:https://x.com/seandreyer/status/1514649772384309252?s=61&t=26I8DpCR65k8SG5Fx81zVg3. If somehow you missed my video on the USMLE cheating scandal, it’s here:Mailbag: Wrapping Up the USMLE Cheating Scandalyoutu.be/MR1hzK-hu344. And here’s the paper on the University of Michigan’s 14% deferral rate in 2015-2016:Daniel M, et al. Perspect Med Educ 2019; 8(3): 187.ncbi.nlm.nih.gov/pmc/articles/PMC6565661_MUSIC:“Clutch,” by Nicolas Major.
Improving Surgical Education: How to Build Windmills - and Stop Tilting at Them Sheriff of Sodium 2024-05-19 | This is a talk I got to give at a meeting of a state chapter of the American College of Surgeons.MUSIC:‘Clutch,’ by Nicholas Major.
Mailbag: Away Rotations Sheriff of Sodium 2024-04-24 | Who should do an away rotation - and who should think twice? Where should you do an away rotation? Is it worth doing an away rotation at a program that is unlikely to give you an interview? And how do you excel when you’re on your audition rotation? Once again, it’s time to clear out the old Mailbag and answer your questions._NOTES:1. I mentioned a couple of previous videos in this one. Here are the links if you missed them.Match Day Mailbag: What if I don’t Match?youtu.be/8DkEPdG7pRgThe Applicant’s Guide to Strategic Preference Signalingyoutu.be/pmRwRDe2gs82. Here’s the study I cited:Winterton M, et al. The prevalence and cost of medical student visiting rotations. BMC Med Educ 2016; 16:291.bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0805-z_MUSIC:‘Clutch,’ by Nicolas Major.
Do USMLE scores *really* predict patient care outcomes? Sheriff of Sodium 2024-04-13 | Do patients whose doctors had higher USMLE scores really have better clinical outcomes? A recent paper - written by authors from the National Board of Medical Examiners - claims that they do.Sounds like it’s time for a Sheriff of Sodium Journal Club._NOTES:1. Here’s the paper, which found an association between higher USMLE scores and lower in-hospital mortality and shorter length of stay:Norcini J, et al. The associations between USMLE performance and outcomes of patient care. Acad Med 2024; 99(3): 325-330.pubmed.ncbi.nlm.nih.gov/378162172. Here’s the study on whether darker-skinned soccer players were more likely to receive red cards:Silberzahn R, et al. Many analysts, one dataset: making transparent how variations in analytical choices affect results.osf.io/gvm2z3. Here’s the paper I mentioned that evaluated differences in clinical outcomes between MD and DO physicians:Miyawaki A, et al. Comparison of hospital outcomes for patients treated by allopathic versus osteopathic hospitalists: an observational study. Ann Intern Med 2023; 176(6): 798-806.pubmed.ncbi.nlm.nih.gov/37247417…as well as the accompanying editorial:Wray CM, Carmody JB. Equal and no longer separate: examining quality of care provided osteopathic and allopathic physicians. Ann Intern Med 2023; 176(6): 868-869.pubmed.ncbi.nlm.nih.gov/372474194. More on the Matthew Effect, from Wikipedia:en.wikipedia.org/wiki/Matthew_effect_MUSIC:‘Clutch,’ by Nicolas Major.
Match Day 2024: Winners & Losers Edition Sheriff of Sodium 2024-03-15 | The rank order lists were submitted. The button got pushed. And today, #Match2024 applicants learned their fates. Now it’s time to break it down, Winners & Losers style.-NOTES:1. Most of the data used in the graphics can be found here:NRMP Advance Data Tables for the 2024 Main Residency Match:nrmp.org/wp-content/uploads/2024/03/Advance-Data-Tables-2024.pdf2. The 2023 Medscape Physician Compensation Report:medscape.com/slideshow/2023-compensation-overview-6016341#3. MedPage Today: Leaked AAMC Emails Reveal Concern About ERAS Exodusmedpagetoday.com/special-reports/exclusives/1090674. If you need to catch up, I made several videos on the USMLE cheating scandal…Emergency Mailbag: The USMLE Cheating Scandalyoutu.be/A3_HG5uc47IMore Emergency Mailbag: The USMLE Cheating Scandal (Part II)youtu.be/c5sRsi3OyvgMailbag: Wrapping up the USMLE Cheating Scandal (Part III)youtu.be/MR1hzK-hu345. Here’s the article on states changing their policies on IMG licensure:MedPage Today: More States Cut Training Requirements for Some International Medical Graduatesmedpagetoday.com/special-reports/exclusives/1091686. Here's the WSJ article and legal case I mentioned for the pay-to-play residency scam:Wall Street Journal: NYC Prosecutors Allege Man Tried to Bribe Hospital for Residency Slotswsj.com/articles/BL-HEB-39283CaseText: Chopra v. Physicians Medical Centercasetext.com/case/chopra-v-physicians-med-ctr-llc-57. Sheriff of Sodium post on the day of the USMLE Step 1 pass/fail announcement:thesheriffofsodium.com/2020/02/13/usmlepassfail-a-brave-new-day-MUSIC:"Clutch," by Nicolas Major.
Death of a Program: The ACGME vs. Private Equity Sheriff of Sodium 2024-03-05 | In January, the ACGME notified the Crozer Chester Medical Center that their general surgery residency program had to shut down - in four days. What happened to get there - and what has happened since? This is a story not just about one residency program - but a story about power and greed that highlights a number of things that are wrong about residency training, the American health care system, and maybe even America at large.-NOTES:1) The news articles I mentioned on Crozer’s financial struggles:Unpaid bills: Prospect, Crozer Health struggling to pay vendors for vital hospital serviceswhyy.org/articles/pa-delaware-county-prospect-crozer-health-unpaid-bills Crozer Health lays off 215 people as part of ‘operational restructuring plan’whyy.org/articles/crozer-health-hospitals-layoffs-restructuring Crozer Health, Prospect unable to pay for ambulance repairswhyy.org/articles/pa-delaware-county-crozer-health-prospect-ambulances-need-repair-cant-pay Piles of biohazard bags, delayed medications: inspection reports find ongoing problems at Crozer-Chesterinquirer.com/health/crozer-chester-medical-center-safety-reports-20231120.html 2) For more on ‘withdrawal of accreditation under special circumstances’, see the ACGME Policies and Procedures manual:acgme.org/globalassets/ab_ACGMEPoliciesProcedures.pdf 3) If you missed my video on resident physician financials (which includes discussion of Medicare DGME and IME payments):How Much Are Resident Physicians Worth?youtube.com/watch?v=uLvb9vv03xE&feature=youtu.be 4) For additional information on Prospect Medical Holdings, Leonard Green & Partners, and the private equity playbook, check out Eileen O’Grady’s excellent report here: How Private Equity Raided Safety Net Hospitals and Left Communities Holding the Bagpestakeholder.org/wp-content/uploads/2022/11/Prospect_Primer_Nov-2022.pdf -MUSIC:‘Clutch,’ by Nicolas Major.
Mailbag: Wrapping Up the USMLE Cheating Scandal Sheriff of Sodium 2024-02-23 | Since my last video, there have been important developments and revelations in the USMLE cheating scandal - mainly related to information disclosed in a lawsuit filed by one Nepali doctor against the National Board of Medical Examiners. So once again, it’s time to provide some perspective by clearing out the old Mailbag.I’ll answer some new - and re-answer some old - questions, like:How did the cheaters get caught?Why did the USMLE focus on Nepal?Did these examinees know they were cheating?Was there a test center security breach - or not?How do we know all the cheaters got caught?Should we bring back USMLE Step 2 CS?Should the USMLE only be offered in the United States?Could the cheaters face any legal consequence?What happened in the lawsuit against the NBME?Will the USMLE investigate cheating in other countries?__NOTES:-If you missed Part 1 or Part 2, you can catch up here:Part 1:EMERGENCY MAILBAG: The USMLE Cheating Scandalyoutu.be/A3_HG5uc47I?si=msHsRzEjF06QD4EVPart 2:MORE Emergency Mailbag: The USMLE Cheating Scandal (Part II)-There’s a collection of articles on the USMLE Step 2 CS exam on the Sheriff of Sodium website:thesheriffofsodium.com/usmle-step-2-cs__MUSIC:“Clutch,” by Nicolas Major.
MORE Emergency Mailbag: The USMLE Cheating Scandal, Part II Sheriff of Sodium 2024-02-04 | Yesterday, I put out a video answering questions about the USMLE cheating scandal. And no sooner than I did, my inbox and DMs filled up again with more questions, necessitating a historically unprecedented *second* emergency mailbag.If you missed Part 1, catch up here first:EMERGENCY MAILBAG: The USMLE Cheating Scandalyoutu.be/A3_HG5uc47I…and be sure to also listen to Part 3:Mailbag: Wrapping Up the USMLE Cheating Scandalyoutu.be/MR1hzK-hu34_NOTES:Breaking the magic: how the USMLE three-digit score is calculatedyoutu.be/yCnsEekmh1oWhy does the USMLE use experimental items?thesheriffofsodium.com/2020/06/07/why-does-the-usmle-use-experimental-itemsMUSIC:‘Clutch,’ by Nicolas Major.
The ERAS Death Spiral Sheriff of Sodium 2024-01-30 | For over two decades, the Electronic Residency Application Service has been the AAMC’s cash cow. As “Application Fever” intensified, fees paid by desperate residency applicants trying to get a job subsidized a dramatic expansion of the AAMC’s services. But now, that business model is under threat from new competition and an important change in the residency selection process. This video explains the threats to ERAS - and how they could result in big changes for the AAMC._NOTES:1. Here are the other Sheriff of Sodium videos I referenced in the video:ERAS and Financial Conflict of Interest at the AAMCyoutu.be/PRR7PaoF1lYThe OB/GYN - ERAS Divorce: Winners & Losers Editionyoutu.be/LgP_KtosMMgThe ERAS Preliminary Data Drop: Winners & Losers Editionyoutu.be/nsl1B0DxbbQThe Applicant’s Guide to Strategic Preference Signalingyoutu.be/pmRwRDe2gs82. Here are the AAMC press releases I mentioned:“AAMC Establishes New Fee Structure for 2025 ERAS Residency Application Season”aamc.org/news/press-releases/aamc-establishes-new-fee-structure-2025-eras-residency-application-season“AAMC Fee Assistance Program Expanding With 60% ERAS Application Discount”aamc.org/news/press-releases/aamc-fee-assistance-program-expanding-60-eras-application-discount3. Here’s the paper recommending ‘big signaling’ for internal medicine programs:Catalanotti JS, et al. Rethinking the Internal Medicine Residency Application Process to Prioritize the Public Good: A Consensus Statement of the Alliance for Academic Internal Medicine. Am J Med 2023; online ahead of print.sciencedirect.com/science/article/abs/pii/S0002934323007441_MUSIC:“Clutch,” by Nicolas Major.
ERAS and Financial Conflict of Interest at the AAMC Sheriff of Sodium 2024-01-19 | This is the story of the Electronic Residency Application Service (ERAS), and how it grew from being a neat solution to an important problem to transforming the financial fortunes of the organization that created it. It’s a story about financial conflict of interest and mission creep and coercive monopolies and the fundamental problems of non-profit organizations in the medical education and training space. I think it’s an important story - and I hope that, by the end, it makes you think a little bit, too.NOTES:Applying Smarter: How to Move Beyond Apply Smart and Improve Residency Application for Everyoneyoutu.be/HzEQ5HqHc08Carmody JB. Applying smarter: a critique of the AAMC Apply Smart tools. J Grad Med Educ 2020;12(1): 10-13.meridian.allenpress.com/jgme/article/12/1/10/428755/Applying-Smarter-A-Critique-of-the-AAMC-ApplyJoshi ART, et al. ERAS and the NRMP and their roles in residency recruitment - a primer for surgical program directors. J Surg Educ 2019;76(5): 1163-1166.pubmed.ncbi.nlm.nih.gov/30956085FACT POLICE: Residency applicants and residency positionsyoutu.be/L75fj_5Ar4sForbes - When Margin Becomes the Mission: Healthcare’s (Sometimes) Unholy Pursuit of Profit (Suchin Jain) forbes.com/sites/sachinjain/2022/04/29/when-margin-becomes-the-mission-healthcares-sometimes-unholy-pursuit-of-profit/?sh=1d5c3740524e
Mailbag: Letters of Intent and Post-Interview Communication Sheriff of Sodium 2023-12-31 | Will it improve my chances of matching to tell a program that I’m ranking them #1? What about if I just say I’m ranking their program very highly? Should I tell multiple programs that they’re my #1? What should I do if a program tells me I’m “ranked to match”? These are some of the questions we’ll answer in this edition of the Mailbag, as we explore strategy, game theory, and NRMP regulations. NOTES:0:35 SHOULD I SEND A LETTER OF INTENT? -NRMP Report, 2023See Table 17 for the average number of ranked applicants to fill each position by specialtynrmp.org/wp-content/uploads/2023/05/2023-Main-Match-Results-and-Data-Book-FINAL.pdf -Solis RN, et al. Applicant-to-residency program communication: does it matter? Ann Otol Rhinol Laryngol 2020; 129: 1056-1062.pubmed.ncbi.nlm.nih.gov/32483992 -Han AY, et al. Love letters to residency programs: the value of letters of intent in the general surgery residency application process. J Am Coll Surg 2023; 236: S97-98. 12:27 SHOULD I SEND A LETTER OF INTEREST? 13:48 SHOULD I SEND MULTIPLE LETTERS OF INTENT? -NRMP Match Code of Conduct for Applicantsnrmp.org/wp-content/uploads/2023/08/NRMP-Match-Codes-of-Conduct_Applicants.pdf 23:40 A PROGRAM SAID I’M RANKED TO MATCH – SHOULD I CHANGE MY ROL? -NRMP video on the matching algorithmyoutu.be/kvgfgGmemdA -Sheriff of Sodium videos on the history of the matching algorithmThe Match, Part 2: The battle for the algorithmyoutu.be/_wGHG7QQmkU?si=Q5_I3WfxCqZKw5vA The Match, Part 3: On marriages and matchingyoutu.be/eEdeq3kqfuA?si=LHM0w2YkhVuN015m -NRMP Match Code of Conduct for Programsnrmp.org/wp-content/uploads/2023/08/NRMP-Match-Code-of-Conduct_Programs.pdf __MUSIC:‘Clutch,’ by Nicolas Major.
Mailbag: Questions about the USMLE Sheriff of Sodium 2023-12-20 | Time to answer more of your questions - this time, about the United States Medical Licensing Examination.We’ll cover…1. What to do if you have a problem at a Prometric test center (0:51)-USMLE policy on “unanticipated test conditions” (see page 15)usmle.org/sites/default/files/2023-08/2024bulletin.pdf.pdf2. Should you request a USMLE score recheck? (5:50)-“To date, the score recheck process has not resulted in a score change.”usmle.org/scores-transcripts/score-rechecks3. I failed the USMLE - can I appeal that it was a statistical fluke?-Sheriff of Sodium: A brief update on USMLE score creepyoutu.be/1gKKAZ5aO8E?si=ZAyKlrUN9fWdEBsn-USMLE score interpretation guidelinesusmle.org/sites/default/files/2022-05/USMLE%20Step%20Examination%20Score%20Interpretation%20Guidelines_5_24_22_0.pdf-Rubright JD, et al. Acad Med 2022; 97(8): 1219-1225.pubmed.ncbi.nlm.nih.gov/354429114. Do USMLE Step 3 scores matter for residency selection?-NRMP Program Director Survey (2021)nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-for-WWW.pdf5. Why did the USMLE Step 1 pass rate drop after pass/fail?-USMLE performance data:usmle.org/performance-data—MUSIC: “Clutch,” by Nicolas Major.
FACT POLICE: Residency applicants and residency positions Sheriff of Sodium 2023-12-02 | Are there enough residency positions for all U.S. medical graduates? Is the number of residency positions growing at the same rate as medical school enrollment? The answer to both of these question is “yes” - but if you hang around online, you’ll meet people who will lead you to believe otherwise.In this video, I’ll perform my constabulary duties as the Sheriff of Sodium by fact-checking the actual numbers of residency applicants and residency positions as well as the growth rate of GME.NOTES:Tania Jenkins - Doctors’ Orders: The Making of Status Hierarchies in an Elite Professionhttps://cup.columbia.edu/book/doctors-orders/9780231189354What are Resident Physicians Worth?youtu.be/uLvb9vv03xEMUSIC: “Clutch,” by Nicolas Major.
A Brief Update on USMLE Score Creep Sheriff of Sodium 2023-11-21 | Earlier this fall, the National Board of Medical Examiners released updated USMLE performance data. Naturally, that means it’s time again to talk about USMLE score creep. In this video, I’ll explain what’s driving the slow and steady increase in USMLE performance; examine what it means for current medical students, residency applicants, and program directors; and predict how the format of the USMLE will change in the very near future. _NOTES, BY SECTION: 0:39 – Overview of #scorecreep USMLE Score Interpretation Guidelines (12-Sept-2023)usmle.org/sites/default/files/2022-05/USMLE%20Step%20Examination%20Score%20Interpretation%20Guidelines_5_24_22_0.pdf1:56 – USMLE scores, then and now 4:14 – “It’s because Step 1 is pass/fail!” 5:14 – “Everyone is cheating!” 7:18 – “They keep increasing the passing standard” Sheriff of Sodium: A peek inside the sausage factory – setting the Step 1 minimum passing score (2019)thesheriffofsodium.com/2019/01/20/a-peek-inside-the-usmle-sausage-factory-setting-the-step-1-minimum-passing-score 10:13 – “I’d score 270 if I took Step 2 today” 11:03 – How USMLE scoring works Sheriff of Sodium: Breaking the magic – how the USMLE three-digit score is calculated (2020)youtu.be/yCnsEekmh1o?si=Cn0Ik9AgCBZLcLd8 14:39 – Thought experiment: Roger Bannister 17:04 – “It’s just because test prep is better” 18:21 – Thought experiment: the electric washing machine 19:49 – “This proves nothing because the test is different” 21:44 – “The exam must be getting easier!” Case SM, et al. Acad Med 1996; 71(10 Suppl):S238-30.pubmed.ncbi.nlm.nih.gov/8940926 Step 2 CK Sample Test Questionsusmle.org/prepare-your-exam/step-2-ck-materials/step-2-ck-sample-test-questions 28:00 - “How will programs evaluate applicants when everyone scores a 270?” Mee J, et al. Adv Health Sci Educ 2023; online ahead of print.pubmed.ncbi.nlm.nih.gov/37665413 _MUSIC:“Clutch,” by Nicolas Major.
The Battle for Clinical Training Sites Sheriff of Sodium 2023-11-11 | In October 2023, the A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA) announced a major change to their curriculum. On the surface, this is no big deal. Schools change curricula all the time, right? But the reasons why they made this change tell us something very important about medical education.-NOTES:1. This video is based on this post from the Sheriff of Sodium:“The New Frontier: Fighting for Clinical Training Sites”thesheriffofsodium.com/2023/10/25/the-new-frontier-fighting-for-clinical-training-sites2. If you missed my 2021 talk for the osteopathic medical school deans, it’s here:“Addressing Osteopathic Medicine’s Vulnerabilities: The View through an External Lens”youtu.be/RC3pFmynxJQ3. If you’re interested in the full results of the AAMC survey I mentioned, it’s here:AAMC Medical School Enrollment Survey: 2019 Resultsaamc.org/media/47726/download-MUSIC:“Clutch,” by Nicolas Major.
Touching the Elephant: The Pediatric Subspecialty Shortage Sheriff of Sodium 2023-11-06 | This is a version of a talk I was invited to give to a group of Chief Medical Officers (CMOs) from children’s hospitals around the country, at the recent Children’s Hospital Association meeting in Phoenix, AZ.We hear a lot about doctor shortages - so in this talk, what I wanted to do was apply principles of logic and economics to current data and rhetoric regarding the looming pediatric subspecialty shortage in particular, in the hopes of developing practical solutions and identifying opportunities for advocacy for children’s hospital leaders. _MUSIC:“Clutch,” by Nicolas Major.
The ERAS Preliminary Data Drop: Winners & Losers Edition Sheriff of Sodium 2023-10-30 | The first round of data for the 2023-2024 residency application cycle just dropped. What can these data tell us about what to expect in the 2024 Match - and how residency selection is changing in general?-NOTES:1. This video is based on a post of the same name at The Sheriff of Sodium website. The post includes all of the data graphics and hyperlinks to references.thesheriffofsodium.com/2023/10/28/eras-2024-preliminary-data-drop-winners-losers-edition2. Apologies for my voice - I’ve been a little under the weather. But with a time-sensitive topic, I didn’t want to delay putting this out.3. Apologies also for the loss of audio at 18:05. What I said was something like this:“Winner: Thalamus.A few years ago, I thought Thalamus – a Silicon Valley startup founded by a former resident – was going to be the disruptive innovator that would upend the AAMC’s near monopoly on the residency application market.Their interview scheduling software was better than ERAS’s Interview Explorer – so I figured once they acquired enough market share (or startup capital), Thalamus would pivot into application software and challenge ERAS directly.So I was as surprised as anyone when the AAMC announced a strategic collaboration in which they agreed to provide Thalamus’ interview scheduling software to ERAS users free of charge. It seemed like Darth Vader contracting with the Rebel Alliance to fix the Death Star’s exhaust port.Of course, not long after the AAMC-Thalamus venture was announced, OB-GYN programs announced their plan to leave ERAS for the 2024-2025 application season. So did Thalamus bet on the wrong horse?I don’t think so.”-MUSIC: “Clutch,” by Nicolas Major.
Academic Capitalism: Rethinking the Expansion of Subspecialty Fellowships Sheriff of Sodium 2023-10-01 | This is a video about the steady increase in subspecialty fellowships - and the less-than-completely-honest justifications that are made for them. It’s a video about who really wins - and loses - when we prolong medical training more and more. It’s about how we’ve enabled a kind of academic capitalism that benefits those who have seized control of the means of production at the expense of those who are lower on the pyramid - and what we ought to do about it.-NOTES:1. I promised I’d link to this video on the history of residency training:The Match, Part 1: Why do we have a Match?youtu.be/jRxHn5l6E4A2. Some sections/highlights…0:22 - Introduction - The urgent care fellowship1:31 - The scam of academic capitalism2:34 - Primer on medical training4:10 - Content warning5:26 - Objection: But medicine is getting more specialized!13:19 - Objection: But residency programs offer different experiences!14:48 - Objection: But these fellowships are for future academicians!18:19 - Objection: But these fellowships are optional!22:38: Case study: Hospital Medicine28:38: Alternatives considered for pediatric hospital medicine32:49: Incentives to academic physicians42:05: We must begin to take trade-offs seriously-MUSIC:“Clutch,” by Nicolas Major.
Residency Application Mailbag: The Personal Statement Sheriff of Sodium 2023-08-21 | It’s been a while since my last Mailbag… but recently I received a few questions about residency applications in general and the personal statement in particular, and it felt like a good opportunity to publicly clean out the old inbox.PERSONAL STATEMENT FAQs:1:34 - Should I write a creative personal statement?6:32 - Should I share sensitive personal information in my personal statement?8:42 - Do I have to include a patient encounter in my personal statement?12:15 - Should I discuss my USMLE failure in my personal statement?19:39 - Should I write program-specific personal statements?22:36 - Is it okay to use a two-page personal statement?24:16 - How do I make my personal statement better?-MUSIC:“Clutch,” by Nicolas Major.
The ABIM Under Fire: How Doctors Can Realistically Fix MOC Sheriff of Sodium 2023-08-14 | Over the past few weeks, I’ve followed on social media as sentiment toward the American Board of Internal Medicine’s Maintenance of Certification (MOC) program has evolved from simmering anger into a honest-to-God social movement.Of course, we’ve seen this all before… and previous efforts have stalled out and fallen short of creating transformative change in MOC. So for doctors who really want to change and improve this system, I’ll analyze and grade various strategies that could be used for advocacy efforts._NOTES:Here’s Chadhi Nabhan’s “Healthcare Unfiltered” interview with Dr. Aaron “Papa Heme” Goodman and Dr. Rich Baron of the ABIM:youtu.be/u4QVwGqestg_VIDEO SECTIONS:BACKGROUND (1:46)1) Get involved with the Board (9:47)2) Kick up dust on social media (12:54)3) Go grassroots (15:07)4) Support a competitor (16:39)5) Help a forensic accountant (18:34)6) Call your state legislator (20:30)7) Hire an attorney (21:54)8) Investigate an alternative (24:19)9) Influence the real power centers (29:25)_MUSIC CREDIT:“Clutch,” by Nicolas Major.
