Blog Archive

Tuesday, June 20, 2017

Creative Solutions, State by State

Creative Solutions, State by State


            State by State licensing to retain these “untrained” doctors is quite a challenge.  It requires the interest and enthusiasm of state medical societies to bring proposed legislation to their state legislatures. They have to proceed through the lengthy legislative process to enact changes to their existing licensing statutes. Imagine this process for each of the 50 states!

 What are the numbers we are talking about for unmatched doctor grads? (LINK)

  • More than 8,640 unmatched doctors on March 18, 2016
  • More than 40,000 unmatched doctors over the last 5 years
Unmatched doctor grads ESTIMATE by State for 2016 ?

  • California:  1,037 unmatched doctors (based on % of National Population)
  • Florida:  536                             
  • New York:  527                     
  • Texas:  734                             
These unmatched doctor graduates are fully qualified and have met all the requirements set by the National Resident Matching Program (NRMP) to participate in the national “Match”.  They have obtained their MD degrees and passed all required exams, such as USMLE parts Step I and Step II.  There are just not enough residency slots available to meet the increased demand. In order to “preserve” these unmatched doctors until the supply of residency slots increases, each State would have to pass new legislation.  Medical licensure is legislated state by state.  This legislation would allow these grads to work “under supervision” in “qualified settings” (Essentially, residency allows work “under supervision” in a qualified program).  If given the opportunity for meaningful work (and service to the community!), these unmatched grads could re-apply for residency as the numbers of residency slots increase.  The result:  preservation of fully qualified doctors while addressing the impending doctor shortage in the next decade.

 Three states have passed this legislation so far, Arkansas, Kansas, and Missouri.  “Arkansas Graduate Registered Physician Act” applies to an “individual who is a resident of Arkansas…”  Kansas passed a special license which applies to graduates of the University of Kansas School of Medicine.  Missouri passed legislation for “Assistant Physician” which is open to US residents.  State by state legislation could generate its own set of problems while trying to ameliorate this crisis situation.  Arkansas and Kansas have “prevented” a huge influx of desperate unmatched doctors flocking into their states by gearing legislation for their own state residents/graduates.  Missouri could be the “recipient” of this influx.  Just think of all the time, effort, and money which this state by state legislation would entail!

 Why haven’t the AMA and ACGME (Accreditation Council for Graduate Medical Education) acted to correct this travesty on a National level??


Tuesday, June 13, 2017

OH! So We Just Need a New Law? / Doc Shortage

OH!  So We Just Need a New Law?/ Doc Shortage

Have you ever wondered about the procedure to create a new State law?  If you’re like me I thought, “Go to my local legislators”.  That’s exactly what I tried to do.  With all the hype of running for political offices, I thought they would be ready and waiting for a meeting with one of their constituents.  Was I wrong!  I have contacted no fewer than 30 public officials and received exactly 2 responses (written by assistants).  You probably won’t get an in person meeting with your legislator, but you might get to speak with an assistant.  And, you won’t get any audience at all if you are not part of the legislator’s electoral district.

 When I finally obtained an appointment with my State Representative, I proceeded to tell the story of the medical residency crisis.  It turns out that Medical Education has its own traditions, and you can’t just go “apply for another job elsewhere”.  So my representative had no clue as to the components of medical training and the process of communicating this dilemma was an uphill challenge.  After countless letters, emails, and phone calls to legislators, members of the State Board of Medicine, the State Executive Director of Medicine, the State Surgeon General, and yes, even the Governor of the State, I was nowhere on my quest to create a new State law for physician licensure!

 My next step was to contact the Florida Medical Association (FMA) where the advice was ambiguous.  It turns out that in the end, the real process begins with your county branch of the State medical association.  However, after numerous phone messages and emails to the Executive Director of our county’s medical association, I could not believe I was getting no answer!  When I finally decided to go in person to the address of record, my GPS lead me to a PO Box at the post office!  What is with this world?!  No one answers anyone!  It turns out, you will only get a “response” if you are a member of the medical association.  My husband had to make the call….

 So after 4 futile months of trying to get a starting point for the creation of a new State law, here is the ANSWER:

  • Contact a Delegate from your county medical association
  • Convince the Delegate of the merits of a new law
  • If they agree, begin the drafting of a proposal to take to the annual meeting of the State medical association.
  • Present the proposal to the State association and make amendments. If the association agrees…
  • The State association sends the proposal via their legislative delegates to the Health Committee of the State Legislature for drafting into a Bill
  • Continue the legislative process with the Bill to pass a new law
So, you think you have the answer now?  Not so fast!  You won’t believe the politics that get involved.  Politics?  Yes, politics.  Life is really a “turf”war!

Tuesday, June 6, 2017

The Solution/ Residency Match


The Solution/ Residency Match



The solution to the National residency shortage is not an easy one.  It involves a combination of 3 separate factors: 

  •  Medicare funding for increased residency slots (National issue)
  •  reduce time required to accredit a new residency program (2-3 years)-ACGME
  •  new State legislation necessary to “license” these new doctor grads until the deficit in residencies is eliminated ( State  level).
The good news is that the first factor is already being addressed. Senator Bill Nelson, FL, has resubmitted House Bill HR 2124 which, if passed by Congress, would increase the number of residency slots by 15,000 over a 5 year period. However, the bill remains yet to be passed, and it would take 5 years to fully implement.

 We have right now more than 40,000 unmatched doctors over the last 5 years alone.  What will “carry” these doctors until the supply meets up with the demand? 

 The licensing dilemma of retaining these “untrained” doctors is what remains. These licenses are written at the State level (The State of Florida is projected to be 7000 doctors short by the year 2025).  If legislation in each of the 50 states were enacted to “carry” these doctors until the number of residencies has increased, it would prevent the devastating loss of more than 8000 fully educated doctors in the US this year alone.   

 There currently exists in Florida the “House Physician” license, Fl. Statutes 458.345, which allows an unlicensed physician to be hired directly by a hospital and work under the supervision of a licensed physician. Since the advent of Physicians Assistants, this license has rarely been used. This idea could be expanded to work under an individual doctor, much like the new Missouri statute-House Bill 1842, under what is called the “Assistant Physician” license. In Missouri these doctors will work under the supervision of another licensed physician and then re-apply for residencies in subsequent years. 

 Most important is to “preserve” these unmatched doctors, until the supply equals the demand for residencies.  Medicare changes and ACGME credentialing are slow moving bureaucracies.  The States will have to move swiftly to enact legislation to enable these unmatched doctors to obtain meaningful work, and also, to prevent their loss to the Nation when we are going to need these doctors more than ever. 

 How to eat an elephant?  One bite at a time!

Tuesday, May 30, 2017

"Breaking the Social Contract" / The Match

“Breaking the Social Contract”/ The Match


Image result for contract images free
I have heard some pretty sad stories from unmatched doctors.  One doctor wrote that he had applied 4 years in a row to the Match with no success.  He was planning to give up, but somehow my website caught his interest.

 Another med student was driving my son in an UBER car in Chicago, and was expressing fear of not matching.  My son warned him, “All I know is you better get a good score on your Step 2 Exam!”

 One unmatched doctor is working in an indigent care clinic in Jupiter, FL and desperate to complete his training with a residency.  Finally, another unmatched doctor is working as a research coordinator, even after completing an unpaid year in a research fellowship after medical school.

 Some doctors who are forced to start repayment of their school loans have no choice but to obtain some kind of work.  But for what else do they qualify?  (I guess they qualify to be an UBER driver)

 Just imagine the desperation these graduate doctors are experiencing, and the sense of betrayal in a system that has broken its “promise”.   Dr. Keith Frederick, a legislator from Missouri, has        coined the term “Social Contract” to describe what has happened in the US.  When a society establishes criteria to obtain a professional license, the candidate can assume that when the requirements are met, the license will be forthcoming.  Our “society” has prevented the completion of the criteria, and thus has broken the “Social Contract”. 

 Once a student has been accepted into medical school, the time for elimination/screening is over.

 The medical graduate should be allowed to complete all the necessary steps to licensure.  What if our country educated thousands of new teachers but failed to provide enough opportunities to complete the final requirement of student teaching?  It just would not make sense!

 What can be done to correct this dire situation?

Tuesday, May 23, 2017

Residency Match: A Case of Supply/Demand

Residency Match:  A Case of Supply/Demand



During the 1990’s at Bayfront Medical Center in St. Petersburg, FL, the OB/GYN Residency would interview about 50 candidates for 4 residency slots.  The program would often reach their 32nd rank to fill its spots, and sometimes would have to “scramble” by phone to fill all their positions.  This occurred when the number of residency slots exceeded the number of applicants (1).  Now that program ranks 50 candidates and fills their slots by their 10th rank.  Medical students afraid of not matching are applying to an average of 47 residency programs each.  You can see why the numbers of applications have sky-rocketed.

 The difficulty for lesser candidates is how to “breach” the hurdle of their “lower” quantitative scores (even though they are fully qualified DOCTORS).  They are no longer medical students and not yet residents. They have no “umbrella” of supervision and malpractice coverage with which to demonstrate positive attributes to a residency program through an Observership. 

 Most residency programs have started using voicemail, rather than answering thousands of phone requests. Desperate candidates are trying to get an appointment to meet in person and state their case. The residency phones go directly to voice mail. Their email requests are dealt with by generating an automatic response that says they are “filled”.  I was told that an unmatched doctor graduate was escorted out of the residency office by SECURITY at a Miami hospital, when he tried to request an audience in person!  He was told, “You should not have come here.  You should have phoned or sent an email!”

  No doctor who has achieved the right to attend and graduate from medical school should be “eliminated” before having the right to complete the last step of training.  None of these unmatched doctors can work without at least 1 year of post-graduate training (unlike a Physician Assistant who can work immediately after graduation).  Clearly, the number of residency slots needs to increase, YESTERDAY!


(1)   page 6,


What happens to unmatched doctor grads?


Tuesday, May 16, 2017

Quantitative vs. Qualitative Residency Match / NRMP

Quantitative vs. Qualitative Residency Match/NRMP



The problem is NOT just that there are not enough residency positions currently available in the US today.  The travesty is that many of those unmatched doctors will not match in the next few years either, and will have to quit Medicine!  Yes Quit!  Just think about the utter waste of time, talent, money, and DOCTORS.

Over 8,640 doctor graduates nationally did not match into a residency on Mar.18th of this year.* One might think that they can just re-apply next year and all will be well.  Unfortunately, a majority of these doctors will probably never match before their credentials have to be renewed, and their training will be for naught.

These doctors will not match in succeeding years due to the compounding affect of prior years’ candidates re-applying the next year, but more importantly due to the unique situation of having their application being “selectively ignored”. 

The number of applications received by each residency has increased exponentially.   Brandon Regional Hospital Internal Medicine Residency Program received over 900 applications for 20 positions before the residency had even begun!  Blake Memorial Hospital in Bradenton received more than 1000 applications for 15 positions and it just began this July!  All Children’s Hospital in St. Petersburg received 1,400 applicants for 12 slots.

 No administrative assistant has the time to read through 1,000 applications looking for “redeeming qualities” of lower scoring but fully qualified candidates.  The programs will have to rely upon a computer screening using common benchmarks, like Step 2 scores, to reduce the number of applications they review.  So the top ranked candidates will be selected quantitatively versus qualitatively, and the lower scoring candidates will continue to be “selectively ignored” repeatedly and fall into a “limbo”.

Tuesday, May 9, 2017

About The Residency Shortage


Imagine there is a projected teacher shortage of 90,000 teachers over the next decade.  Pretend that you wanted to be a teacher and attended a teacher’s college.  You have only 1 requirement left to fulfill, STUDENT TEACHING.  Assume that in spite of the projected teacher shortage, the Education Budget is cut nationally, which results in a limited supply of student teaching positions.  Without student teaching you can’t get your teaching credential.  Imagine that over the last 5 years alone, there were more than 40,000 students unable to find a student teaching assignment. They would have had to give up on a teaching career, find another job, and begin paying their student loans.  How could such a bureaucratic slip-up occur in view of the projected upcoming teacher shortage???

Well, this is exactly what is currently happening in Medical Education!  There is a projected shortage of 90,000 doctors over the next decade.  Over 40,000 doctors in the last 5 years ALONE have been UNABLE to match into a required residency.  They cannot complete the last step required for a Medical License!  They have to leave Medicine. After being accepted into Med School, 4 years of hard work, passing board exams, and graduating with an MD Degree, they now have to look for other work and begin repaying an average of $183,000 in student loans. 

 It is a classic case of bureaucracy, where the right hand does not know what the left hand is doing.  In 1997 the Federal Government’s “Balanced Budget Act” put a freeze on Medicare reimbursement for medical residency training slots.  Yet, with a projected doctor shortage of up to 90,000 physicians in the next decade, the number of medical schools was INCREASED.  What a surprise!  The number of medical schools increased at the same time as the number of required post-graduate training slots was REDUCED!  This catastrophe has left more than 40,000 graduate doctors, over the last 5 years alone, with no where to go!!

 This blog is designed to educate the public about this travesty.  It is a call to action to those who can help rectify this ongoing catastrophe.  The voices who can help include:  State and US Legislators, State and National Medical Societies, US and Foreign medical school deans, Residency Directors, Medical students, Physicians, Public Health Departments, and finally the MEDIA