Blog Archive

Tuesday, March 13, 2018

Match Day 2018 Protest / Residency Shortage

The last blog gave an overview of the Indivisible Guide for public action.  I described how it could be utilized to bring the residency shortage to the Nation’s attention.  To many of you the idea of demonstrating or picketing might seem ludicrous.  Granted I would have felt the same way before I became aware of the residency shortage.  Yet, the direness of the circumstances of unmatched doctors calls for drastic measures.

 Normally, I am very much an optimist.  However, in this particular situation I have realized the futility of successive re-applications for residency slots.  I have “laid out” the reasons for this futility in many of my prior blogs.  The Nation is short 10,000 residency slots each year.  The demand for a residency given the current supply creates such a skewed application process.  The system will repeatedly favor the highest scoring candidates.  The result is that many fully qualified doctors graduates have to give up on a career in Medicine.

 So here are the specifics of what I plan to arrange for “peaceful activism” in Tampa on Friday, March 16, 2018, Resident Match Day.  I hope you will take these ideas and plans and use them at a Match Day celebration where you live.  You have 180 medical schools from which to choose…

  • Explore city permits for protests in my area (none needed if on public sidewalks and not obstructing traffic)
  • Contact family, friends and supporters to form a group of activists to “picket” at the USF Match Day party in Tampa, FL on March 16, 2018
  • Prepare public relation materials to hand out:  brochures and business cards (download these at my website:
  • Order 25 t-shirts with the NoMatchMD logo on them (doctors wear white coats)
  • Create protest posters to carry at the demonstration –
-“What About the Docs Who Don’t Match?”

-“Doctor Blindside”

-“Save Our Doctors!”

-“Discarded Doctors!”

-“Residency Shortage = Doctor Shortage”

-“Create More Residency Slots”

·        Reach out to media contacts, especially those who have written about the residency shortage.  Send them protest specifics and include reference links to this issue and a quote to use for a story.

I am going to make PR materials available for you to download on my website, (logo, brochure, business card, poster and sticker template).  Please use them to make your participation more probable.

I hope this will help you too, to get out of your comfort zone and help in the quest to correct the residency shortage.

Tuesday, March 6, 2018

Indivisible Guide for Action / Residency Shortage

After the last presidential election, a group of congressional staffers outlined successful strategies for making contact with members of Congress.  This information came about as a result of the outcome of the presidential election, as a way to keep congressional representatives aware of the feelings of their constituents.  This group of staffers has adopted the name, “Indivisible”, to represent this cause, and to encourage similar groups to form across the country.  It is an insider’s guide to make contact with your legislators.
I want to utilize these “insider tactics” to bring the Residency Shortage to the Nation’s attention.  I am going to suggest that those who would like to find a timely end to the residency shortage, adopt a similar strategy.  Contact your own members of Congress using the Indivisible strategies.  It is only through action that we can hope to eliminate the travesty of the residency shortage.  As I have said, there is no ONE person who has the power to correct this situation. (That is, unless there is a presidential order…) I will describe some of the key points derived from the “Indivisible Guide” to create action, and then propose a more detailed plan to implement these ideas on the upcoming Match Day, March 16, 2018.

To begin, members of Congress are concerned with “reelection, reelection, reelection. So they want their constituents to think well of them, and they want good, local press”.(1) The guide describes four local advocacy tactics:

·        town hall meetings
       ·         other local public events
       ·         district office visits
       ·         coordinated calls

 For the residency shortage, all four tactics could be utilized to make contact with legislators.  But for Match Day 2018 on March 16th, I am going to focus on “local public events”, i.e. Match Day results gatherings across the US.  In my area, that translates to the University of South Florida(USF) Match results party.  It was held last year at Ulele Restaurant in Tampa, Florida.  These events occur across the US on Match Day, when doctor graduates get the results of their residency match.  It is quite a celebration when each graduate finds out where they will be living and working for the next few years in their residency.  The idea is to utilize media attention which will be present to highlight this joyful event, but also to bring attention to the plight of the unmatched doctors.  There is no ill will or rancor involved, just an opportunity to provide another side to this story.

A small group of people to “attend” and distribute information at a Match Day results event is all it would take.  There are about 180 DO and MD medical schools in the US.  Just imagine if the residency shortage story line was generated and picked up by the Media at each one of these locations!  Email your contacts and post a message on your Facebook page to generate a grass roots group to attend the Match Day party near your local medical school.  Record everything at those events and share these clips on Social Media, as well as with local and national media.  Optimize your visibility by staying together as a group, wear similar clothing or message shirts, and carry signs.  Identify and try to speak with reporters on the scene.

One key item described in the Indivisible Guide is that Members of Congress, and probably the Media as well, WANT “concrete asks that entail a verifiable action- vote for a bill, make a public statement, etc.  Perhaps one example of a “concrete ask” could be “Create an emergency placement for unmatched doctors while increasing the number of residency slots”.  You could tailor your “concrete ask” to something pertinent to your State like, “Grant immediate Physician Assistant licensure to unmatched doctors until the residency deficit is eliminated”, or ”Add 2 additional residency slots/year to every existing residency until the deficit is eliminated”.

At the onset of the I stated that my goal was to educate the public about the residency shortage.  With this knowledge a solution to this travesty could be found.  As I have read, a good salesman is really an educator who provides information, which leads the customer to want what the salesman is selling.  Then when we know better, we do better.  This has been my continual focus, to educate the public.  That is why I am proposing “we” use every tool at our disposal to get this message out, even if it means “peaceful activism”.

 To help with this instruction I have created a website, a blog, a Facebook page, and a twitter account.  I have also created a brochure, a poster, stickers, and business cards.  I am happy to make all of these WORD documents available for your use and reproduction in your own area.  You can distribute the brochures at your Match Day event, use the poster as a sign, wear the stickers, and hand out the business cards.  All you need is a small group of supporters to join with you on March 16, Match day 2018.  Please let us all know of your plans, to give inspiration to others who are waivering.  You can write a “comment” to my blog and I can share it with other readers.  The Guide also stresses the need for a “group”, rather than 1 or 2 people.  So get your friends and colleagues to join you in this important cause.

In the next blog I will be more specific about my plans to “demonstrate” for a solution to the residency shortage on Match Day 2018, March 16th.  Please let me know of your plans, so I can encourage others to follow your example.

 I will re-publish this blog several times leading up to Match Day, hoping to enlist more “activists” to our cause.  I have already had offers from my own family members to fly to Tampa for Match day 2018, to help form a group at USF Match Day.


Tuesday, February 27, 2018

Residency Shortage = Doctor Shortage

Many people cannot relate to the current situation with the residency shortage.  My local congressman asked why the unmatched doctors could not just go and apply elsewhere for a job.  The rigid system in place for educating a doctor is very unforgiving.  Without a US residency, a doctor cannot obtain a medical license in the US, period.  One thing we can all relate to however, is the results of a doctor shortage.  That is when it will really mean something to which everyone can relate.

Updating a previous blog about the “Ramifications of a Doctor Shortage”, I wanted to talk more specifically about what this doctor shortage could entail.  The AAMC (Association of American Medical Colleges) now predicts that, “By 2030 the US population under age 18 is projected to grow by only 5%, while the population aged 65 and over is projected to grow by 55%.  Because seniors have a much higher per capita consumption of health care, the demand for physicians- especially specialty physicians- is projected to increase.”(1)  Additionally, on a scale of 1-5, the US currently has a per capita number of doctors of 2.6 compared to Austria at 5.0 (2)  Sweden, Switzerland, and Germany all have about 4 doctors per capita (2).  The US even falls behind the number of doctors per capita of a 3.4 average for other developed countries.  So the US already lags behind per capita in current number of physicians, and this scenario is predicted to get even worse up to the year 2030.  The US is predicted to have a 105,000 doctor shortage. 

Let’s talk about one of the most critical areas of the projected shortage.  “A shortfall of between 33,500 and 61,800 non-primary care physicians is projected by the AAMC (includes surgical and other specialists).”  Think about the average person’s use of doctors.  For females between 0-21, we would assume girls initially go to a primary care doctor and then change to an OB-GYN doctor in the teen years.  Perhaps they would go to the doctor once/year, and sometimes even less.  As I watched my own Mother as she aged she utilized the following physicians:  Primary Care, OB-GYN, orthopedist, Otolaryngologist, Cardiologist, Dermatologist, Audiologist, Ophthalmologist, Gastroenterologist, and Pulmonologist.  I am counting at least 10 specialists, and some on a frequent basis each year.  Going to a doctor has become part of the weekly ritual for many seniors.  Just imagine the difficulty that will be forthcoming in the next decade in receiving quality care from medical specialists.  Personally, I have called the office of a gastroenterologist each day for 3 days, have never talked to a human, left messages, and still have not received a call back.  The office message says to expect delays due to the high volume of calls (and I live in a city, not a rural area). 

 Now back to the current travesty of the residency shortage.  We can see how the non-medical person can relate to the upcoming doctor shortage.  But this doctor shortage directly correlates with the current medical residency shortage.  We as a Nation have been “discarding” fully educated and qualified doctors at the rate of 10,000 unmatched doctors per year.  The AAMC keeps writing about the need to increase the number of residency slots to prevent the loss of thousands of doctors, but to no avail.  No “one” person seems to be taking this impending crisis seriously.  It takes a minimum of 7, and up to 10 or more years, to educate and train a doctor, especially a surgeon or medical specialist.  By the time the doctor shortage is fully realized, the “solution” will take that amount of time and more to catch up with the deficit.  We need to act now to correct the residency shortage to prevent an impending doctor shortage in the future!

Tuesday, February 20, 2018

The Difficulty of Re-Applying to a Residency

As a fairly optimistic person, I would usually err on the side of optimism by encouraging a doctor who did not match into a residency the first time, to re-apply again next year.  However, with all that I have deduced over the last 2 years of research about the residency shortage, I would worry about setting up an unmatched doctor for failure.  Not matching the first time is devastating.  I actually fear the outcomes for these doctors with subsequent failures to match.  I have heard from several doctors who have failed to match after 3 or 4 re-applications.  One doctor actually sounded suicidal…This is what caused me to try to figure out what was happening and why.

I mentioned in my BIO that I have been on the sidelines of Medical Education for 50 years.  Based on my exposure to at least 7 different residency programs, there appears to be one Program Manager or Administrative Assistant assigned to the task of managing residency applications at each program.  With the current situation of the residency shortage, the fear of not matching has caused graduate doctors to apply to an average of 47 applications each.  The application process has been deluged with almost 2 million applications per year (42,000 applicants X 47 applications = 1.974 million applications).  Depending upon the specialty, that amounts to hundreds and thousands of applications to each residency program, and in turn, to 1 solitary program manager!  That is a lot of applications to read!  The applications are lengthy as well.  They include a personal statement and often 3 letters of recommendation, a dean’s letter, and other credentials.  As I have mentioned in a prior blog, several residencies in my area have received:
  • 1,000 applications for 15 positions
  • 900                           20   
  • 1400                         12    "
Based upon these numbers, I came to the conclusion that a computer-generated screening device had to be used to “whittle-down” the number of applications that actually had to be read.  I then realized that due to the “quantitative” screening (e.g. a STEP II score) performed by a computer, the same applicants would be repeatedly passed over, even though the applicants may have had additional years of training, research, etc. This is why my normally optimistic outlook was fearful of offering false hope to the doctors who had not matched the first time. 

Part of me worried that readers would say, “How do YOU know that is really happening?  You don’t work there…”  Another part of me realized no one would readily admit that this process was occurring.  They would want to say, “We read all applications we receive, and give fair consideration to each.”

So I contacted a residency Program Manager I know personally, and interviewed her about their application procedures as well as her other job responsibilities, knowing the full scope of her job would help to generalize the process somewhat to the other residencies across the US. She told me her program receives 500-600 applications, and that she reads each personal statement.  This is her first level of screening.  She admitted that if their numbers of applications were greater, she would resort to a screening of some kind.  She indicated that although there is an email network of program managers and that they communicate with one another, that probably no one would admit to using a computer screening to reduce the applications read for their programs.

The crush of applicants has deluged the programs with phone messages, emails, and cold- call visits.  It is useless to try to make contact with a residency to “state your case” or get a foot in the door.  The program manager said she answers as many emails and phone calls as she can, and lets the others go unanswered.  Any impromptu visits by applicants are not given an appointment.  So your hands are tied.  Your only chance is if your application made the “cut” in the computer screening of programs with huge numbers of applications.  This is why my normally optimistic self has become a realist…

 There are at least 13 other roles the program manager fulfills.  I will name just a few, which in themselves are quite detailed:
  • keep track of 27 milestones accomplished for each resident (16 of them), twice/yr.
  • organize a week-long orientation program for new residents
  • maintain independent contractor contracts for each faculty member
  • keep the “on call” schedules (365 days/year)
  • process physician payments based on clinic, surgery, on-call, supervision, etc.
  • maintain ACGME requirements and credentials
  • reimburse and make travel arrangements for faculty
  • set up online recommendations system for each monthly rotation for each resident
  • read apps, set interviews, arrange visits, answer emails and phone messages
  • etc., etc.
At this point you are probably thinking this is too much information.  I thought that providing this amount of detail would lend credibility to the plight of the unmatched doctor and their chances of successfully matching with successive re-applications.  I have tried to expose the “dirty little secrets” of what is going on during the residency shortage.  There are 42,000 applicants for 32,000 positions each year.  This has to be corrected!  It is complete insanity to discard fully educated and qualified doctors, especially in view of the projected doctor shortage!


Tuesday, January 30, 2018

A Laissez-faire Attitude Toward the Residency Shortage

I want to discuss commonly held beliefs in Medicine which I believe help to create a laissez-faire approach to the solution of the Residency Shortage.  One belief deals with the assumption that highly ranked medical schools/residencies can “infuse” their graduates with a special knowledge not found elsewhere.  The other belief deals with the impression that foreign medical graduates are lesser doctors than US graduates.  International Medical Graduates (IMGs) are the group most affected by the residency shortage.  In 2017 69% of unmatched graduates were IMGs. I believe that these two assumptions promote the lackadaisical approach to a timely solution to the Residency Shortage.  If the unmatched doctors were Harvard graduates, the US would be in an uproar about the utter waste of human time, talent, money, and more doctors

 Consider this.  Assume that the US has a total of 1000 medical school openings each year, but that the schools receive a total of 5000 fully qualified applicants. 4000 applicants will be rejected.  Are we to assume that these 4000 applicants were not smart enough to gain acceptance into a US medical school?  No, there were only 1000 openings, and these positions were filled with the top candidates.  The 4000 disappointed applicants were not unqualified.  There just were not enough openings. In a similar example, the NRMP has 42,000 applicants for 32,000 residency positions each year.  10,000 graduates will not match, yet they met all of the requirements set forth by the NRMP (National Resident Matching Program).  They were fully qualified, but there were just not enough residency slots to meet the demand.

 Let us talk about highly ranked medical schools first.  According to Pauline W. Chen MD, “The notion that a medical school’s quality can be ranked and then passed on directly to their graduates has become an integral part of American culture…But most of these popular rankings reflect a school’s highly specialized research funding and capabilities, not the general quality of its medical school graduates.”(1) Dr. Fitzhugh Mullan was the lead author of a research study and paper conducted at George Washington University School of Medicine.  It included more than 60,000 graduates of America’s 141 medical schools from 1999 to 2001.  He said, “The absolute irreducible mission of medical schools is the education and graduation of doctors to care for the country as a whole.”(1) He continued with, ”The opportunity to learn from and be mentored by faculty members involved with the latest research can be stimulating for medical students, but the pressure to bring grant money into an institution can draw even the most enthusiastic educator away from students and back to the laboratory bench”(1)  According to Dr. Chen, “But educators like Dr. Mullan counter that traditional selection criteria based on cognitive exams and premedical course grades do not necessarily translate into clinical ability.”(1)   Dr. Mullan concludes with, “doctors who have done very well on everything from kindergarten to residency training in terms of getting into prestige places are assumed to have sharp intellects, but none of that correlates in any scientific way with their performance as physicians.”(1)  In essence, residency programs are selecting their residents based upon the same “cognitive exams” and highly ranked research hospital programs described by Dr. Mullan.  This is due to the inordinate number of applicants caused by the residency shortage, and the need to screen the number of applications which have to actually be “read”. 

Next let us consider the belief that IMGs are less qualified doctors, or they would have been accepted into a US medical school.  “During the 1950s, the need for a formal program of evaluation intensified due to explosive growth in the demand for health care services, an increase in economic opportunities for trained medical personnel, and a greater dependence on residents to provide medical care, which created a large number of available positions in U.S. GME (Graduate Medical Education) programs.” (2) The ECFMG (Educational Council for Foreign Medical Graduates) was created to monitor IMG credentials, and certify that IMGs have met medical education and examination requirements.  So when we as a Nation needed additional doctors and residents to provide medical care in the 1950s, we accepted IMGs into our residencies. But now that there is a residency shortage, not so much… “IMGs make up roughly 25% of physicians in training and practice in the United States.”(2)  Granted, they have not attended “highly ranked” medical schools according to “ American culture”.  BUT, they have passed all the criteria and requirements set forth by the NRMP for participation in the Match.  The IMGs have passed the same criterion tasks required of all residency programs, as their US counterparts, and passed the scrutiny of an almost 60 year old organization, the ECFMG.

In the US it is our own inflated self-regard which makes us ambivalent to the plight of the unmatched doctor.  The US is not the only producer of excellence in Medicine.  Let’s put aside our national biases towards medical education. Let’s save the fully qualified doctors who would like to complete the final step in their quest for licensure, especially in lieu of the projected doctor shortage over the next decade.

Tuesday, January 23, 2018

Put Up or Shut Up / Residency Shortage
A proposal to create a new medical license was made at the annual Florida Medical Association (FMA) meeting in August 2017.  In order to make a proposal at the FMA a strict procedure must be followed.  A delegate from a county medical association must obtain approval from their local medical society to bring a proposal to the state medical association.  Following strict written guidelines, the delegate is allowed 3.5 minutes to verbally present this proposal to the delegates.  The proposal presented at this year’s meeting had to do with the creation of a license called “Assistant Physician”, similar to the license passed in Missouri.  This license would allow graduate unmatched US doctors, who met all the requirements for application to the National Residency Matching Program (NRMP) for residency, to work under the supervision of a licensed physician.  This would permit meaningful work in Healthcare until the unmatched doctor could obtain a medical residency, in lieu of the current residency deficit.
This committee voted that the proposal “not be adopted”.  One of the objections discussed in a prior blog had to do with the belief that a residency shortage did not really exist.  I have since received written correspondence from the CEO of the NRMP stating that there have been 42,000 applications for 32,000 positions.  99% of the positions were filled, leaving 203 unfilled slots mostly in 1-year preliminary surgery, where “Many are dead-end positions that do not lead to further training”.  So there definitely is a residency shortage of about 10,000 slots per year.

The second objection raised against this proposal was from the medical student delegates.  They voted “no” because they felt money should be spent on Graduate Medical Education (GME) for creating more residency slots in Florida, and not money spent on creating a new license.  They felt the Assistant Physician license “would have legislative implications as the FMA’s job is to maintain that the physician stays as the leader of the health care team.  This could be a risk to the public if lesser trained providers are allowed to practice Medicine with MD/DO after their name.”(1)

The objection based upon how best to spend money to fix the residency shortage does not correlate with me.  Residency slots are subsidized by Medicare and Medicaid funding primarily.  States like Florida have created incentive money to hospitals for the creation of new residency slots.  The costs for enacting the AP license in Missouri were fairly minimal and involved primarily administrative costs, as delineated in their proposals.  Had these unmatched doctors been allowed to complete residencies, their applications would have been for traditional medical licenses, instead of the AP license.  So that expense would have occurred anyway.  The administrative costs associated with supervisory physicians would be additional, but fairly nominal in view of the benefits to the unmatched doctors and the underserved patients receiving care.  In summary, the worry about how to best spend money deals essentially with two different levels of government, the Federal level for Medicare/Medicaid, and the State level for licensure costs.  The two do not impact one another.  So money to create licenses would not reduce or impact the creation of new residency slots.

How will any of those medical student delegates feel if they happen to be some of the unfortunate doctors who do not match into a residency after graduation?  They might not be so cavalier with their objections.  What have these students and the FMA actually DONE to remediate this crisis of the residency shortage?  A doctor in my community said that the FMA was a “Go along to get along” organization.  He implied that nothing much gets done of significance.  For that matter, the AMA has not effectively dealt with this issue either, from my stand point.  So my answer is “Put up or shut up”.  If this situation had occurred to any of the FMA or AMA delegates, we would be hearing a different story!

(1)  FMA House of Delegates 2017; Consent Calendar Reference Committee III; Legislation; Aaron Sudbury, MD, Chair.

Tuesday, January 16, 2018

Challenge to YOU!  / Residency Shortage


The last 2 blogs explained the process of “peaceful activism” to bring the cause of the residency shortage to the forefront of the Nation’s attention.

As I have explained in my biography of the NoMatchMDs blog, I do not personally work in the field of Medicine.  Yet, I felt that the travesty of the residency shortage warranted my activism, in lieu of the 50 years I have observed Medical Education.  I cannot solve this problem on my own.

I continue to educate the readers of the blog about the intricacies of the residency shortage dilemma.  I have delineated the politics of Medicine which are preventing a timely solution to the shortage.  I have described how a huge majority of the public and medical professionals are unaware of the current scenario.

Perhaps you are interested in this blog because you or someone you know is personally affected by the residency shortage.  I would encourage you and your supporters to become involved in this cause.  If not YOU, then WHO?  Before I became aware of this crisis, I had never even read a blog.  I had never created a logo, a website, never had a Facebook page or used Twitter, never had spoken to a Congressman, never written to an elected official, or fought for any cause.  There comes a time when we each need to speak up and DO something!  I have had to get out of my own comfort zone to learn and use these new skills.  I will be part of a panel at a World Affairs Conference in St. Petersburg, Florida in February, speaking before several thousand people.  I have never done this before either…So I am challenging each of you to step up and help with this cause.  Go back and re-listen to the two previous blogs.  Form your own “protest” group and show up at a Match Day 2018 “reveal” party.  If mine is the only “voice” talking about the residency shortage, the solution will be long in coming…