EPtalk by Dr. Jayne 12/11/25

The Association of American Medical Colleges has released new data showing that medical school enrollment has hit an all-time high. Total enrollment for 2025 is 100,723 students. It’s also the largest first-year class in history at 23,440 students.

A few stats stood out to me:

• Incoming students range in age from 18 to 60.
• The students logged 16.8 million hours of community service before applying, which averages 717 hours per person.
• The cohort includes 163 military veterans.

Medical training can be a long, winding road, so congratulations to the entering class. For those on a semester schedule, go crush those finals.

I also saw an article about CMS contracting with Clear for identity verification as part of its quest to “kill the clipboard.” Eliminating manual and paper-based processes is a worthy goal, although technology alone never solves the problem. In my experience with process improvement work, the real challenge lies in understanding operations, culture, and history. Those often determine why a workflow looks the way it does.

My mammography center is a perfect example. It finally retired its wonky and duplicative paper questionnaire this year. I briefly celebrated not being handed a clipboard, but then was asked all the same questions verbally, regardless of whether or not the information was already in the chart.

The technician was rushed and misread my chart more than once. That led to a longer discussion than I cared to have while standing in a gown with half my body exposed.

I noted on my Press Ganey survey that these questions should be asked before patients disrobe. Whether anyone reads those comments is another story. Progress in healthcare tends to arrive as two steps forward, one step back.

As we coast toward year’s end, I’m watching healthcare IT projects nearly grind to a halt as team members take time off. Some absences were planned well in advance, especially for parents whose children are out of school, so those projects are only mildly affected. Others are chaotic as people realize, often too late, that their PTO is “use it or lose it.” The result is patchy staffing and sudden bottlenecks across teams.

I have worked under nearly every time-off model imaginable, from “unlimited” time away, subject to manager approval, to miserly accrual programs that make it hard for people to take more than a day or two off early in the year. Some employers allow a modest PTO bank before triggering “use it or lose it” rules. Others shut off rollover entirely. As a manager, I’ve always tried to explain the details to my team, including subtleties for remote employees who live in different states. I encourage people to spread their time off throughout the year unless they have a specific reason to save it.

Not everyone tracks their PTO or understands the fine print, and that can lead to scrambling at the end depending on organizational policies. I’m working on a multi-entity project in which time-off rules vary widely within the same metropolitan area. The most flexible arrangement allows employees four weeks of paid time off per year. Employees are required to take a minimum of two weeks away from the office, but can choose to have the other two paid out as wages. For those who don’t feel they need time away from work, that might be a good option.

A nearby organization uses what I call a “use it or else” policy. Employees cannot bank their PTO and cannot simply forfeit it. They must take all remaining days before December 31, even if doing so leaves co-workers hanging. Leadership announced the change over the summer, but many employees did not grasp the consequences, which is creating December chaos. Managers have been tasked to hold individual conversations to make sure everyone burns through their time. The official explanation is to avoid claims that workers aren’t allowed to use their time off. I’m sure there’s more to the story, but I don’t think the policy is working out as planned.

This year, I’m also seeing more people taking time off in December for health-related visits because they have already met their insurance deductibles. Hip and knee replacements seem to dominate. When I asked an orthopedic friend about it, she said her practice is running at full throttle to accommodate demand. The bigger problem, she said, is physical therapy. Local PT programs cannot keep pace with procedure volume, so her staff spends an extraordinary amount of time coordinating care to ensure patients are seen immediately after surgery. I don’t think that the folks who make healthcare policy and decide on our country’s patchwork of misaligned incentives understand these patient realities.

What is the atmosphere like in your workplace this holiday season? Are you racing to complete projects or taking a leisurely stroll towards the new year? Is it a ghost town due to last-minute PTO use? Leave a comment or email me.

Email Dr. Jayne.