Episode Summary

Pediatric nephrologist, medical educator, and "Sheriff of Sodium" Dr. Bryan Carmody joins Drs. Koka and DiGiorgio to challenge some of the most persistent narratives in American medicine. From the AAMC's physician shortage projections — which Carmody argues serve the interests of medical schools more than patients — to the mechanics of the residency match, application fever, ERAS pricing, and the largely unrealized promise of pass/fail Step 1, Carmody brings his characteristic data-driven skepticism to each topic. The conversation closes on what's arguably the most consequential question: what should residency selection actually be optimizing for, and why are program directors squandering the leverage they have to drive real change in undergraduate medical education?

Chapter Markers

00:00 Introduction

02:02 How Carmody became the Sheriff of Sodium

05:03 Why people keep getting medical education wrong

07:46 The physician shortage: skepticism and incentives

09:03 Rebutting the AAMC's 86,000-doctor shortfall projection

11:17 Supply-induced demand and the limits of training more physicians

17:06 Third-party payment, discretionary care, and the real drivers of access problems

20:27 Who benefits from the physician shortage narrative

26:36 GME funding: $45 billion, hospital incentives, and the case for or against it

30:01 The Match explained: history, origins, and why it exists

35:22 ERAS, NRMP, and the financial architecture of residency applications

40:21 Preference signaling: what it is and why it's quietly capping application volume

44:12 Is the Match a monopoly? The congressional report and the anti-competitive argument

51:18 Step 1 pass/fail: the promise, the timing, and why it stalled

55:43 What actually changed — and what didn't — after 2022

58:00 What program directors should be demanding — and aren't

01:08:12 What we're not doing well in resident selection

01:11:59 Using selection systems to elevate the quality of every applicant, win or lose

01:18:45 The neurosurgery combine

Co-Host Handles

@anish_koka and @drdigiorgio

Show Handle

@drsloungepod

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