(CMA Alert, March 23, 2015 issue)
(CMA Alert, April 6, 2015 issue)
Match Day keeps some ACIP updates HPV new doctors in California, vaccine recommendations sends others out-of-state Friday, March 21, on National Match Day, California’s graduating medical students learned whether they can begin practicing medicine here – or if they must leave the state to begin their careers. The National Resident Matching Program matches graduating medical students with residency programs using a mathematical algorithm that pairs the rank-ordered preferences of applicants and program directors to produce a “best fit” for filling available training positions. However, this year, more than 41,000 medical school seniors and graduates applied for only 30,000 available residency positions. “Match Day is a pivotal point in a medical student’s career,” said California Medical Association (CMA) President, Luther Cobb, MD. “Many students graduating from California medical schools want to continue their education and training by attending residency programs here. Unfortunately, because of funding restraints, there aren’t enough openings to accept them all.” Beth Griffiths, fourth-year medical student at UC San Diego School of Medicine, is one of the lucky ones. Griffiths matched her first choice – UC San Francisco – for an internal medicine residency, primarily focused on training primary care physicians. She hopes to practice primary care for adults in Northern California, focusing on caring for Spanish-speaking patients. “Unfortunately,” she says,” there is a tremendous shortage of physicians who are fluent in Spanish.” Griffiths is thrilled to stay in California to practice medicine. “I like the commitment to serving the underserved that is part of so many of our training programs,” she says. “I also hope to stay active in issues of public policy, which are so relevant to the practice of medicine and improvement of public health.” But although Griffiths will remain in California, many medical students will not. The federal government, through the Medicare program, has been the major funding source for residency programs. Regrettably, this funding has been frozen since 1997, despite California’s population growing over 10% in the same time. In addition, many residency program leaders say that funding received from Medicare and Medicaid does not fully cover the cost of even the current residency training slots, so sponsoring institutions such as teaching hospitals must absorb residual costs. That’s why CMA is sponsoring SB 22, authored by California State Senator Richard Roth (D-Riverside). The bill would establish a Graduate Medical Education Trust Fund that can receive contributions from private sources in order to provide grants to residency programs in areas with the greatest need. 38 | THE BULLETIN | MARCH / APRIL 2015
During its February 2015 meeting, the Advisory Committee on Immunization Practices (ACIP) recommended the 9-valent human papillomavirus (HPV) vaccine (9vHPV; Gardasil 9, Merck) as one of three HPV vaccines that can be used for routine vaccination, according to a report published in the March 26 issue of Morbidity and Mortality Weekly Report. The U.S. Food and Drug Administration approved 9vHPV in December 2014. Based on a review of clinical trials, the committee determined the new vaccine was more cost-effective and had 97% efficacy compared with the current 4-valent HPV vaccine. With the addition of five strains, the new vaccine protects against 14% more HPV cancers for women and 5% more for men. The committee stressed that they did not express a preference of one vaccine over another. Nearly two-thirds (64%) of invasive HPV-associated cancers are caused by HPV types 16 or 18, and about 10% are caused by types 31, 33, 45, 52 and 58. HPV types 6 and 11 cause anogenital warts. Similar to quadrivalent HPV vaccine (4vHPV), 9vHPV protects against HPV 6, 11, 16 and 18; 9vHPV also protects against types 31, 33, 45, 52 and 58. Specific ACIP recommendations are as follows: • For routine vaccination of females, 9vHPV, 4vHPV, or bivalent HPV vaccine can be administered. • For routine vaccination of males, 9vHPV, or 4vHPV can be administered. • Routine HPV vaccination should begin at 11 or 12 years old, but the series may be started as early as 9 years old. • Females ages 13 through 26 and males ages 13 through 21 who have not been vaccinated previously or who have not completed the 3-dose series should also be vaccinated. • Males ages 22 through 26 may also be vaccinated. • Men who have sex with men and immunocompromised persons through age 26, including those with HIV infection, should also be vaccinated with either 9vHPV or 4vHPV if they were not previously vaccinated. The evidence underlying these recommendations included findings of a randomized trial enrolling approximately 14,000 females ages 16 through 26. This showed noninferior immunogenicity for the HPV types shared by 4vHPV and 9vHPV and high efficacy for the five additional types. Other trials in clinical development compared antibody responses across age groups and females and males.