Blog Archive

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…

www.NoMatchMDs.blogspot.com

Tuesday, December 26, 2017

 

 
 
 
 
Move Unmatched Dr. Grads to the “Top of the List” /
Residency Shortage
https://www.youtube.com/watch?v=yfYsiJJNHCs

As I watched an episode of “Designated Survivor” a thought came to my head.  Move unmatched doctor graduates to the “Top of the List”.  “President Kirkman” was conducting a town hall meeting with constituents and was asked by a laid off factory worker what the “President” was going to do to help him.  The answer was “…I am going to create a public works program….and anyone in the last 4 years who has lost a job, their names are going to be put at the top of the list for these jobs”. 

 These unmatched doctors are the victims of a system which “shot itself in the foot”.  It allowed too many medical school grads, but reduced the number of residency slots needed to complete the last required step of training for a license.  I have read the sagas of unmatched doctors saying, “If only I had gotten a higher Step II score, maybe I would have matched”.  It is heartbreaking to hear the self recrimination of these unmatched doctors, when they are not the ones at fault.  And to add “insult to injury”, the match process continues to “selectively ignore” the same applicants’ repeated attempts to match, by using computer generated numeric cut points to “reduce” the deluge of applications each residency program is now receiving.

These unmatched doctor grads should be moved to the “top of the list” for residencies, to prevent their permanent loss to Medicine.  It seemed so “obvious in the “Designated Survivor” episode.  That’s what is FAIR.  How can we do that?  Here are some ideas I have brainstormed:

  • Utilize each and every accredited residency slot (some are left unfilled)
  • Create “emergency resident slots” to already accredited programs (@ least 1 slot for each existing program)
  • Create “Transitional Year Programs” with each medical school to place unmatched doctors
  • Move unmatched doctors to the “top of the list” in the next year’s match.  Each residency selects 1 unmatched doctor from the previous 5 years unmatched applicants
  • Place US citizens first, before any non-citizen applicants
  • Offer incentive money with state funds to private hospital corporations to add residencies, as in Florida with HCA Hospitals
  • Create positions at VA Hospitals for unmatched doctors to work under supervision of current VA staff doctors
  • Activate/Re-Activate a “House Physician” license (as in Florida) for unmatched doctors to work under supervision of hospital staff physicians
  • Expand House Physician license to County Health Clinics and VA system
  • Expand NRMP to 3rd tier match to “place” remaining unmatched doctors
  • Provide malpractice umbrella coverage to allow unmatched doctors to work under licensed physicians within their office
We have to quit “blaming” the unmatched doctors for their “failings”.  They have passed ALL the CRITERIA necessary to apply through the NRMP.  They deserve a Match!
http://nomatchmds.blogspot.com/

Tuesday, December 19, 2017



A Win-Win for Doctors and Vets / #Save GME
https://www.youtube.com/watch?v=VZvNDuP1xlY

Most of the solutions I have described to eliminate the Residency Shortage will take time to enact.  They involve legislative changes at both the National and State levels (I have already talked about how long and hard those changes can be).  I have also described what has been passed in several States.  What most concerns me are the unmatched doctor grads TODAY.  What can we do to “preserve” them before they are forced to leave Medicine permanently?

Perhaps you recall a “mini uproar” that came out in the Washington Post in May 2016.  The article titled, “VA:  Let nurses Treat Vets”, related how “The Department of Veterans Affairs would dramatically expand the authority of nurses to treat patients…”(1)  This plan was intended to reduce long waits for medical appointments and “to ensure the VA has the authority to address staffing shortages in the future”, according to VA Undersecretary for Health Dr. David Shulkin.

 I wrote to Dr. Shulkin at that time to propose a “win-win” for both doctors and vets.  I suggested hiring the unmatched doctor grads through the VA to see patients under the supervision of the current VA medical staff (much as with the supervision provided in a residency program).  The unmatched doctors would be given meaningful work as well as further medical experience and training.  The Vets would receive timely care with reduced appointment wait times due to the increased staffing.  The doctors would apply again for residency as the number of residency slots increased.  The supply of doctors would increase to alleviate doctor staffing shortages for the VA in the future as well.

Ironically, these doctors would be “distributed” all across the US, as are the Veteran Hospitals.  This would be a quick fix to two currently existing problems, the Residency Shortage and the long appointment wait times for Vets.

I received a response from Dr. Shulkin stating that the VA does NOT have its own residency programs (although residency programs actually DO staff VA hospitals).  I responded again to Dr. Shulkin that I was aware of that fact, but was instead suggesting a temporary use of these unmatched doctors until the deficit was eliminated.  Dr. Shulkin replied, “Oh, now I understand”, but nothing more was said.  I suppose this is where the politics come in to play.  I am assuming the “greater plan” was to reduce healthcare costs for Vets by allowing nurses to provide more cost effective care (I discussed the pros/cons of nurse vs. doctor provided care in a prior blog). 

So this is one proposal I am suggesting to “preserve” the unmatched doctors in a timely fashion before it is too late, and their educations would have been for naught.  The VA could more easily create a system much like Missouri did (Assistant Physician license), because the VA system is Federally operated.  It would require only “one” new license which would apply nationwide.  The usual hurdles of individual state licensure for these “unlicensed” doctors would not be an issue.  It would save the costly and tedious process of changing each state’s licensure laws to accommodate this National “emergency”.  These doctors could work to provide quality, yet supervised care to our veterans, while under the supervision of current VA doctors.

(1)
https://www.washingtonpost.com/news/powerpost/wp/2016/05/27/to-cut-wait-times-va-wants-nurses-to-act-like-doctors-doctors-say-veterans-will-be-harmed/?utm_term=.52493662cce7

http://nomatchmds.blogspot.com/

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/