Where the money goes

The following facilities received state and federal government funds during the 2012 fiscal year for graduate medical education payments and supplemental teaching payments. This money is used to help pay for residency positions throughout the state.

Aiken Regional Medical Center: $1,003,122

AnMed Health: $6,116,856

Greenville Hospital System: $47,830,617

Greer Memorial Hospital: $270,880

Hillcrest Memorial Hospital: $118,647

McLeod Regional Medical Center: $4,417,382

Medical University Hospital: $90,264,726

MUSC College of Medicine: $50,876,279

Oconee Memorial Hospital: $834,016

Palmetto Health Baptist: $2,107,516

Palmetto Health Richland: $35,665,096

Patewood Memorial Hospital: $326,072

Self Regional Healthcare: $4,264,607

Spartanburg Regional Medical Center: $14,586,858

Trident Medical Center: $4,165,558

USC (USC College of Medicine): $5,664,695

Total: $268,512,927

Source: S.C. Department of Health and Human Services

Lash Springs, 27, of Myrtle Beach, will graduate from the Medical University of South Carolina in the spring, which is why he’s so busy these days planning his next move.

Springs and thousands of other fourth-year medical students across the country are knee-deep in the process of interviewing for a residency position.

“I’m scheduled to interview at 13 places right now,” Springs said. “I probably won’t do all of them, but I’m scheduled for 13.”

Residents fall somewhere between medical students and full-fledged practicing physicians. Some medical school graduates will complete their residency training in a primary care field, like internal or family medicine. Others want to specialize in more lucrative areas, like dermatology or oncology, for which there are fewer available positions.

No matter their chosen course of training, residency programs allow recent medical school graduates an opportunity to practice their craft in a real-world setting for several years.

These programs are mandatory. Insurance companies won’t reimburse doctors for their services if they don’t complete the required training. They cannot be licensed to practice, either.

‘That sounds terrifying’

Springs, who wants to practice family medicine, won’t find out where he’ll end up next year until March 21 — Match Day.

It may be a hospital in Colorado or Tennessee or North Carolina, maybe even South Carolina, but Springs doesn’t have too much to worry about. He’ll most likely end up somewhere.

MUSC has a strong record for matching its fourth-year students to residency programs — 100 percent of its 159 graduates were successfully placed last year. But every medical school can’t boast such good results.

At the University of South Carolina School of Medicine, five students out of 85 in the 2013 graduating class were not matched last spring. Across the U.S., an estimated 500 medical students were unmatched, an MUSC administrator told the Board of Trustees at the group’s October meeting.

It’s simple math. There are too few residency positions for the applicant pool.

“If you get to that point where you’ve worked hard for four years and you’ve applied for a spot and you don’t get one — that’s a pretty daunting reality,” Springs said.

He didn’t even mention the student loans. In 2011, tuition cost an average $25,000 for state residents and $48,000 for non-residents each year at public medical schools in the U.S., according to the Association of American Medical Colleges. Over four years, this financial aid, plus the loans often used to cover a student’s cost of living and interest on those loans, add up.

“They probably have accumulated between $350,000 and $400,000 in debt,” said Dr. Mark Lyles, chief strategic officer at MUSC.

For students that don’t match, “That sounds terrifying,” Springs said.

‘A very difficult situation’

Lyles estimates about 22,000 students graduate from medical school in the U.S. each year. He said there are 28,000 residency positions available, and the extra spots are filled by students who have attended international medical schools, many of them U.S. citizens returning home to practice.

But as the number of medical schools across the country increases and the number of medical students in each graduating class increases too, the number of students who are unmatched every year will continue to grow.

“The number of residency spots is absolutely not keeping pace,” said Dr. Chris Pelic, who counsels MUSC medical students during the interview process. “It’s setting it up for a very difficult situation.”

The federal government helps fund residency programs with Medicare dollars, but the federal contribution to these programs hasn’t changed since 1997.

“We’ve seen this coming like a tsunami a little bit,” Pelic said.

Paying for residency

“Over the past 16 years, people have continued to expand residency spots, it’s just maybe not directly in the areas where we have the most pressing medical need,” Lyles said.

South Carolina, for example, needs more primary care doctors — family doctors, internists, pediatricians — particularly in rural parts of the state.

The Medical University Hospital and the MUSC College of Medicine receive more state and federal money than any other institution in South Carolina to fund graduate medical education and to help pay doctors to teach these doctors-in-training — more than $140 million during the 2012 fiscal year.

But most of the money is used to help pay for residents based in Charleston, where there’s no shortage of doctors.

In total, the state and federal governments spent about $268 million in fiscal year 2012 to fund graduate medical education in South Carolina.

Tony Keck, director of the South Carolina Medicaid agency, said that’s more money than most other states.

“The question is, if little old South Carolina is spending more money than almost anyone else, why isn’t South Carolina getting a better production of physicians in primary care, in rural areas, in mental health?” Keck asked. “There’s just, generally, very little, if any, accountability for that money.”

Keck’s agency has organized a series of meetings this fall in Columbia to explore how the state can potentially expand residency programs in areas of critical medical need.

The group, chaired by Francis Marion University President Fred Carter, is expected to publish its report in December.

“We’re still in the early stages of deciding what we might do and how we might do it,” Carter said.

Lyles, who participates in the meetings on behalf of MUSC, said the conversations have been productive. The group is now studying how other states have tackled the issue.

“In South Carolina, I think there’s a focus on how much we’re spending,” Lyles said. “How much are we spending and what are we getting? I think it’s great to periodically examine what you’re getting for what you spend to make sure you’re spending it ideally.”

Keck said some of the group’s recommendations may be implemented as early as next year.

“I think there’s a real opportunity and a real interest among everybody to make a significant portion of that money more accountable for actual production of the types of physicians that we need in the state,” he said.

Next steps

It’s not clear how these recommendations will affect soon-to-be medical-school graduates.

For now, though, Springs is less focused on state-level policy issues than he is on his own career path.

“I’ve done one (interview) and I have another one this week,” he said last week.

In family medicine, students can apply to programs in urban hospitals or rural communities.

Rural residency programs are often popular among students who have attended medical school outside the U.S., because the programs are considered less popular and less competitive.

Springs said the decision should be left with the student.

“It’s ultimately my career. It’s what I choose to do,” Springs said. “I don’t think I should be pushed into that.”

Reach Lauren Sausser at 937-5598.