Blog Archive

Tuesday, December 12, 2017



Know Better, Do Better / The Match
 
I am going to begin this blog by starting with the “bottom line”.  DO NOT match non-US citizens into residency slots until all US doctor graduates have matched into a residency.  It is as simple as that.  Get your own “house” in order first, then be generous with your excess.
 We DO have a responsibility as members of the human race to care for the well-being of others, namely, world-wide healthcare.  However, the licensing rules for the practice of Medicine in the US require the completion of a US RESIDENCY.  So first we owe the right to complete their training to our OWN graduated US DOCTORS, before offering residency slots to non-US citizens.  That is the way the “World” works.  Hurdles abound to protect the rights of the citizens of each country.  Their citizens’ right to work is met before hiring foreigners. 
Our country once welcomed non-citizen doctors to fill the gaps in our doctor shortages.  Since the Balanced Budget Act of 1997 ironically created an “imbalance” between the number of medical school graduates and residency slots, that situation has changed.  I would suggest an immediate freeze on matching non-citizens into our inadequate supply of residency slots, until this shortfall has been corrected.
Reporter Tony Dokoupil of CBS News presented a story about  foreign doctor graduates from President Trump’s 7 travel ban countries.  They were applying for residency slots in the US (1).  It turns out more than 1,000 doctors from these 7 countries ALONE were applying through the NRMP for the residency match on March 17, 2017 (does not include applicants from other foreign countries).  There are currently 15,000 doctor graduates from these SAME 7 countries ALREADY WORKING in US residencies today! 
Mr. Dokoupil interviewed the Dean of Southern Illinois University School of Medicine, Dr. Jerry Kruse, about these foreign applicants.  Dr. Kruse was anxious to help these doctors match, in spite of the travel ban, in hopes they would someday practice in the rural underserved areas of Southern Illinois.  Dr. Michael Gannon, president of the AMA, weighed in on this situation as well.  This is the misinformation that galls me!!!!  I “know” of 8,640 doctor graduates, 42% of which are US citizens, who would have loved to work in Southern Illinois.  They were the UNLUCKY doctor graduates who did NOT match into a residency on Match Day, March 18, 2016!!!  They cannot get a license without a US residency.
I am NOT saying “DO NOT MATCH FOREIGN MEDICAL GRADUATES”.  I am saying, “Match US citizen graduates from both US and Foreign Medical schools FIRST, and then match non-citizens second.  So now we KNOW BETTER, let’s do better…

Tuesday, December 5, 2017







Why Are We Not Upset? / DOC SHORTAGE
https://www.youtube.com/watch?v=LoiM4aHIr1o

Initially upon learning about the “why’s” of the residency shortage, I thought the lack of action to correct this travesty was due to the lack of knowledge about its existence.  The doctors I contacted had heard a little about the residency shortage but just assumed the unmatched doctor grads were “weaker candidates” and would just have to reapply again next year.  As discussed in prior blogs, the residency shortage has NOTHING to do with applicant qualifications (since all have met the requirements for applying in the NRMP), and everything to do with the shortage and the compounding effects of re-applications.  Now we know the story.  Why are we not enraged??!!

Perhaps a feeling of powerlessness causes most of us to shrug our shoulders and feel grateful it does not affect us personally.  But what if this circumstance involved one of your children or a relative?  Knowing all the years of study, sacrifice, and money they had endured, only to be denied the right to complete the last requirement for practicing Medicine, might get your interest and action!

Just think of all the rural and underserved areas of our country which would be overjoyed to have one of these fully educated doctors work in their areas.  The healthcare professionals who serve for a week in a third world country know first hand the “preciousness” of a doctor.  Some friends of mine travel annually to Guatemala to perform orthopedic and gynecologic surgeries for the masses.  One team makes an initial visit prior to the team trip just to triage the patients on which they will operate.  That way, there will be no time wasted when they return during the actual team visit, and as many surgeries as possible will be performed.  How can we just “discard” our unmatched doctors with no regard for the “human condition”?  What would Guatemala not do for one of our “cast offs”??!!

Some might say, “Look at all of the lawyers who do not get jobs”.  Although this comparison is quite a “stretch”, at least the lawyers were allowed to complete all their requirements to practice Law.  They probably were aware before Law School that getting a job might be difficult.  I do not think most students beginning Medical School worry about not being able to “complete” the requirements to practice Medicine.  Usually, the hard part is getting “into” medical school.  If there was a “glut” of doctors in the US today, prospective students would enter medical school at their “own risk”, and not be “blindsided” in the end.

I believe the Medical community and all Healthcare Professional should actively promote a solution to this residency shortage.  The “Public” is clueless as to the traditions and requirements of Medicine.  Only those who have taken this path can fully appreciate the devastation that is occurring with the discard of thousands of fully educated doctors.  Yes, I know, you are all “very busy”, and do not have time to take on this cause.  But, you DO have your voices, your email contacts, your “followers”, your legislators, your colleagues, your Medical Societies, and ”theoretically” the AMA, to help promote this agenda FOR YOU.  So talk to them about it and demand a solution!

http://nomatchmds.blogspot.com/

Tuesday, November 28, 2017






Blog Plan / Residency Shortage
https://www.youtube.com/watch?v=NRiGZnNS9Oo

The goal of this blog is to create a “tsunami of outrage” over the betrayal and waste of fully qualified doctor graduates who cannot complete the last step of their medical training.  Due to the bureaucratic mismanagement by the Federal Government, this outrage should lead to ACTION to correct this travesty before the loss of thousands of fully educated doctors.

The actual “loss” of these doctors to the practice of Medicine has been caused by the pyramid effect of too few residency slots available compared to the increased number of graduating medical students.  This “pyramid” should have occurred prior to acceptance into medical school, and not after, as has been caused by the Balanced Budget Act of 1997.

 My plan has been to write a series of blogs to fully explain how the residency shortage began, what has resulted as a consequence of the shortage, the misconceptions about the unmatched doctors’ qualifications, the multi-state approaches to correcting the shortage, and the lack of National leadership in correcting this travesty.

I decided to post blogs 3 to 4 times per week to get the whole story out before readers lost interest.  That has been accomplished.  If you have missed any prior blogs, I would encourage you to go back to the beginning and read/listen to all of the blogs (I can read all of them in less than 1 hour, and the videos are 3-4 minutes each and would take an hour+).  My plan going forward is to post a blog one time per week on Tuesdays.  However, I would also post again on Thursdays if any important developments occur or if I received any personal stories to share.  I would encourage anyone with a personal story to share to write to me.  I will keep your identifying information private.  If you subscribe to the blog, you will receive email notification of any new posts.

 The success of a blog depends upon its readership.  So my next area of focus is going to be blog promotion.  I am still writing letters/emails, sending out press releases to the media, connecting on Twitter, and “Like/Share” on Facebook.  Please help me by sharing this blog with your colleagues and contacts.  I am very receptive to suggestions you may have for me which you can communicate by email (Leslapol727@gmail.com)

 Although I do not relish being called Saturday Night Live’s version of “Debbie Downer”, history will probably repeat itself this week on Friday March 17th, Match Day 2017.  I wish I could say that all of the doctor applicants will match, but they will not.  Since there have been more than 8,000 unmatched doctors for each year over the last 5 years, I  imagine that this year will be the same….Add another 8,000+ unmatched doctors to this story!!!
http://nomatchmds.blogspot.com/
 

Tuesday, November 21, 2017







This Is a Shout Out! / #Save GME


I want to hear your stories…I want the Nation to really know and feel “your pain”. That is how we relate.  We imagine ourselves in someone else’s shoes, and then the problem seems real.
 
If you are willing to share your story, I will gladly protect your identity.  I realize how devastating this travesty has been.  I know how you must cringe every time a friend or relative asks you where you are in your training.  The answer for an unmatched doctor is “no where”.  That answer is a real conversation stopper in any social setting.  Do you quickly answer, “I did not match into a residency because there are currently too many med school grads for the number of available residencies”?  And those around you are thinking, “Yeh, right.  You must not have been a very good student.”  This situation has nothing to do with how good a student you were.  It has everything to do with a bureaucratic “slip up”.  The slip up occurred when the Federal Government decided to save money by reducing the number of residency slots, but forgot it still needed enough residency slots to accommodate the number of graduating med students.  This situation has NOTHING to do with how “smart” the unmatched doctors are.

Please tell us about your path to becoming a doctor, its challenges, sacrifices, and “costs”.  I will edit your story to fit into a blog (I have been told that blogs have to be short to keep the reader’s attention).  I will not reveal your identity, since I know how mortifying this tragedy has been.  My email is:  leslapol727@gmail.com
http://nomatchmds.blogspot.com/

 

Tuesday, November 14, 2017


Answers from the NRMP / Does a Residency Shortage Really Exist?
 
 

At the annual Florida Medical Association meeting in August of 2017, a proposal was made by a delegate to create a new “Assistant Physician” license for the State of Florida, like the one passed in Missouri.  This would enable unmatched doctors to actually work in Medicine until the number of residency slots increased.  They could eventually obtain a residency leading to licensure while maintaining and improving their medical skills.  This proposal was voted down by the members.  One reason given repeatedly was that a residency shortage does not really exist.  How can this be, given the match results of a 9,000+ slot annual deficit?

Once and for all I want to answer the question “Does a residency shortage actually exist or not?”  To me, the answer is obvious, “yes”, because each year 8,000-9,000 doctors do not match into a residency.  Why then is there such disagreement on the answer to this question?

In order to get a legitimate answer to this question, Mona Signer, the CEO of the National Residency Matching Program (NRMP) was contacted.  Let me begin with some of the numbers that Ms. Signer provided:

  • “The NRMP Main Residency Match encompasses 42,000 applicants and 32,000 positions”
  • “more than 99% of the positions are filled”
  • “Post-SOAP (Supplemental Offer and Acceptance Program) only 203 positions remain unfilled, and many were in preliminary surgery”
  • When asked why the preliminary surgery positions go unfilled:  “Many are dead-end positions that do not lead to further training.”
So according to a legitimate source, the CEO of the NRMP, about 10,000 applicants to the Residency Match per do not match into a residency slot.  So yes, a residency shortage actually exists!

Not so fast my friend!  Here are the issues which distort the factual answer to whether a residency shortage really exists.  Some people say that a residency shortage does not exist because there is not and WILL NOT be a doctor shortage in the next decade.  If there is not an impending doctor shortage, why worry about 10,000 unmatched doctors each year?  Other people contend that the majority of unmatched doctors are graduates of International Medical Schools (IMGs).  So why worry about them?  Here are some statistics which deal with these issues:

            ·        The American Association of Medical Colleges (AAMC) projects a doctor shortage of
                   up to 105,000 doctors over the next decade

·        In the 2017 Match, 45% of unmatched doctors were IMGs

·        27.6% of unmatched doctors in 2017 are US citizens

·        14,000+ US citizens, IMGs, did not match over the last 5 years

To me the factual answer to whether a residency shortage really exists does not depend upon whether you believe in the use of less costly healthcare providers for the future of Healthcare in the US.  It does not matter where a doctor went to medical school, as long as they have met all the criteria for application through the NRMP.  It DOES matter to me if the applicants are US citizens.  These are the doctors who are required to complete a US residency to practice in the US.  They are the citizens whose tax dollars are funding US residencies through Medicare and Medicaid.  They are the students who followed the “rules” of the Social Contract to practice Medicine in the US and are entitled to complete the last requirement.

 The social and political aspects of Medicine in the US have nothing to do with whether a residency shortage exists.  IT DOES!

 

Tuesday, November 7, 2017


Are Medical School Loans like “Predatory Loans”?
 
 
 
https://www.youtube.com/watch?v=ILEb7N7flMw
 
Some times the only way to get peoples’ attention is to go after their money…Yes, YOUR money.  Just imagine if all of the Nation’s student loan debt went into default.  In 2017 the total US student loan debt reached $1.45 Trillion.  That total exceeds total US credit debt by $425 Billion.  Just imagine if all 50,000 unmatched doctor graduates over the last 5 years declared bankruptcy and their student loans went into default.  The average medical school debt is $183,000, but some of the unmatched doctors I have heard from have debts of $350,000, $400,000, and more.  That is a lot of student debt coming out of our tax dollars in the event of default.

Because our Nation has broken its “Social Contract” with unmatched doctor graduates, they cannot obtain the work necessary to repay millions of dollars in student loans.  They cannot obtain a license to practice Medicine in the US without a required US medical residency.  This residency shortage began when the Balanced Budget Act of 1997 capped the number of funded residency slots.  Now the number of fully qualified medical graduates exceeds the number of residency slots available.  Without a residency these unmatched doctors cannot practice Medicine.

Currently, I am asking a lawyer in my city to consider the feasibility of a class action lawsuit against the Federal Government on behalf of the unmatched doctor graduates.  Although I am not a lawyer, here is how my thinking goes.

The US division of Medical Education has created a list of requirements for medical licensure in the US.  At the same time, another division of the US government, Health/Medicare, has cut the spending necessary to complete the final step required to obtain a medical license, namely, completion of a US medical residency.  Two US departments are working in opposition to one another.  This is to the detriment of its citizens, who have followed a prescribed regimen of study, only to reach a dead end when it comes to completing the last requirement for licensure.  Would this be considered “Bait and Switch”?  You get the idea…

Recently, an L.A. Times editorial talked about predatory loans.  It defined “predatory lending” as loans “with no way to repay their original loans other than to obtain further ones”.  The Consumer Financial Protection Bureau will require payday and auto title lenders “to do the sort of thing banks and credit unions already do:  Before extending a loan, they’ll have to determine whether the borrower can repay it”.  The last sentence of the editorial says, “the issue here isn’t access to credit.  It’s protection from predatory lending”.

If a medical graduate cannot repay student debt because of a government whose right hand does not know what the left hand is doing, I would accuse the US Government of “predatory lending”!

 

Tuesday, October 31, 2017


Dirty Little Secret / Residency Match

 
 
 

Assuming that over the last 5 years alone over 50,000 doctors have not matched into a residency, why are we not hearing more about the Residency Shortage?  Why are we not outraged?  Surely, the 50,000 unmatched doctors should be incredulous about their futures, despondent, mortified, frustrated, and ultimately furious with a system which has betrayed them! Why are we not hearing from them or about them?  My answers include:  the unmatched doctor is embarrassed by “their own” failure to match- a “dirty little secret”, the lack of a support group or committee to join, the isolation each unmatched doctor experiences while their peers are rejoicing in a “match”, and the other unmatched doctors are “scattered” across the US. There is a sense of futility unmatched doctors have when they try to figure out a plan, a solution, or “someone” to contact to correct this injustice.  Think about it.  Who would you contact under the circumstances:  your legislator, your dean, the Federal Government?  There is no “one person” who can right this wrong.

Recently, my son met a new doctor graduate at a happy hour he was hosting in his Chicago condo.  The doctor had failed to match into a residency this past March and was very sad and reluctant to discuss it.  My son told her about my blog and website, and encouraged her to look at them.  The topic was so painful that she just wanted to drop the subject.  My heart cringed ONCE AGAIN when I heard this sad story.  My first thought was, if only she would listen to my blogs she would realize the fault for not matching was not hers, but a system which had failed her.  That also, the sheer numbers of applicants and the use of computerized screening had probably eliminated her application from consideration, that any redeeming parts of her application had probably gone UN-READ, and that unfortunately that scenario was bound to repeat itself in subsequent match attempts.  I hoped that with this knowledge her sadness and embarrassment would change to one of anger and determination to let her voice be heard on this travesty.

Leading up to the next residency Match Day 2018 I am going to be focusing on getting those 50,000 unmatched doctors to unify and speak out.  No one will care about the solution to the Residency Shortage as much or as fervently as those affected by it.  Ironically, in the next decade we will all be affected by it to some degree with the impending doctor shortage.  Yet, until the unsuspecting public is directly impacted by this shortage, there will be little public outcry.  That is why the unmatched doctors, their friends, family and colleagues need to get over their “uncomfortable” dirty little secrets, and convert their embarrassment to action!  Let’s get the word out there regarding the residency shortage and our Nation’s failure to uphold its side of our “Social Contract

www.NoMatchMDs.blogspot.com