Blog Archive

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



Tuesday, October 24, 2017




                                      NPR Broadcast / Residency Shortage


 
https://www.youtube.com/watch?v=B7u4oUAAOyg
 
August 3, 2017, someone was listening….Julio Ochoa, editor for Health News Florida, broadcast a story about the residency shortage in Florida on NPR Radio, WUSF.  He started the story by talking with Dr. Michael Smith, a 2014 graduate from a Caribbean medical school, who has applied 3 years in a row for a residency in Medicine.  Each year Dr. Smith applied to hundreds of residencies at a cost of $5,000 per year with no luck.  He will re-apply for a 4th time in 2018.  Dr. Smith has accrued a medical school debt of about $350,000 to date, with the inability to work as a licensed physician to begin repayment.  To work in the US as a licensed physician requires a minimum 1 year post graduate training in a US residency.  In reality, the “real minimum” number of residency years is 3 years, for the ability to become board certified.  Doctors are really considered “employable” when they are board certified.

Mr. Ochoa broadcast this story one day before the beginning of the Florida Medical Association annual meeting.  The timing could not have been better!  Apparently, most of the meeting’s attendees did not hear this story.  A proposal to create the new license described in Mr. Ochoa’s story to preserve the unmatched doctors, failed to gain support from the membership.  They voted “no” on the proposal.  The objections raised dealt with the belief that a residency shortage does not really exist, that the doctor graduates were too selective in their choice for residency specialties and that is why they did not match, and that emphasis should be placed on increasing medical education (number of residency slots) and not on creating “short-term” licensing.  Each of these objections provides fodder for upcoming blogs.  The current situation of the residency shortage continues to wallow in the doldrums due to these very misconceptions.

By the way, that “someone” who was listening to Mr. Ochoa’s broadcast, offered Dr. Smith an immediate spot in a “Transitional Residency Program”.  Hopefully, this is “the foot in the door” that Dr. Smith has long awaited!  Congratulations Dr. Smith on your willingness to speak out about this travesty of the residency shortage.  It was never YOUR fault.  It was our Nation that broke its “Social Contract”!

Please listen to Mr. Ochoa’s story for yourself.  Here is the link where you will find it:

 

Tuesday, October 17, 2017

Uncle Sam Wants You! / Residency Shortage





Uncle Sam Wants You! / Residency Shortage


The only way the residency shortage will resolve in a timely fashion depends on YOU!  I mean this literally.  There is a no “One” person who can effect this change before countless fully qualified doctors are “lost”.  It will take a groundswell of voices to bring this travesty to the forefront of our Nation.  We need YOUR VOICE.

 

The solution to the residency shortage will not be linear.  As you have read, some states are creating legislation to “preserve” their unmatched doctors until the number of residency slots catch up.  Some states are increasing their budgets to teaching hospitals to underwrite the addition of residency slots and the beginning of new residency programs.  Some states are allowing other health care professionals to perform services once performed only by doctors.  Some states are still “wallowing” in bureaucratic doldrums.  The solutions are a “little bit of this and a little bit of that”.

 In the meantime, thousands of unmatched doctors are dealing individually with an unimaginable “betrayal” and all that it encompasses (school loans, no career path, and despondency).  They “did” what we told them to do, and we “broke the contract”.  Ultimately, “we” will pay the price for this travesty.  Right when the baby boomers tap into healthcare the most, there will be a doctor shortage.  Forget about “preventative care”.  We will be lucky to get “reactive care” for our healthcare challenges.

 When the Balanced Budget Act of 1997 reduced the reimbursement for residencies, yet increased the number of medical schools, the resulting impact has been devastating.  “We” knew this Act was not perfect at the outset, and changes would have to be made.  Little did we know the “individual” repercussions that would ensue. 

 These unmatched doctors have worked so hard, for so many years, and at such great expense, not to be able to complete the final step in their training.  The “right hand” of Congress definitely did not know what the “left hand” was doing.  We have got to make this RIGHT! 

 
 Only your voices and those of your contacts can effect the “tsunami” needed to bring this solution to the forefront.  Please write, tweet, share, and “demand” a solution now!

http://nomatchmds.blogspot.com/

Tuesday, October 10, 2017

Second-Half Summary/ Residency Shortage








Second- half Summary/Residency Shortage


Here is the second half of the “story”:

 
  • What is the AMA doing?
  • The Nation has broken the “Social Contract”
  • 25% international medical graduates do not match, yet ECFMG has been monitoring and making recommendations to them for 60 years!
  • We want to think US Medical Schools are “better”, yet individual learning and passing of the “Criterion Task” have leveled the field.  Only fully qualified applicants are eligible to participate in the NRMP in the first place!
  • ACGME is not in favor of Missouri’s plan for Assistant Physician License, yet has not taken the lead in finding a solution
  • AMA and ACGME, two of the most influential agencies in Medical Education, are not leading in timely fashion to prevent an utter waste of human talent
  • The impending doctor shortage will be more than 90,000 doctors short in the next decade
  • Some question the legitimacy of the “Doc Shortage”.  Either the demographics are correct, or they are not!  Baby Boomers are ageing and will require even more medical care.  Is this really politics trying to use lesser trained medical professionals to provide patient care at lower costs, using physician assistants and nurse practitioners?
  • Are P.A.s and N.P.s as qualified as MDs?
  • A number of states are approaching this problem but tend to favor their own residents
  • Need a “tsunami” of outrage to solve this
  • Need action by each person concerned about this solution

Tuesday, October 3, 2017

Solve DOC Schortage State by State







Solve DOC Shortage State by State

https://www.youtube.com/watch?v=YSaPTPzTRyY

 

Until the residency deficit has been resolved, I suggest that each state “preserve” its own doctors.  Currently, the “best numerical candidates” prevail in the residency match (see previous blogs).  That would have to change. 

The tradition of Medical Education is to “reward” the “best” students.  The students with the best GPA, the best test scores, get into the most competitive schools and residencies.  It’s hard to change that mindset.  Every institution wants to attract “the best”.  Any graduate doctor who has passed the requirements of “The Match” already is “the best”.

 I recall the tuition for medical school in South Carolina 5-10 years ago.  Tuition for in-state residents was approximately $50,000/year, and out-of-state $80,000/year.  I remember thinking that if accepted to a South Carolina medical school, a student could get their education, but South Carolina would not be underwriting any part of that cost.  South Carolina would not share in the expense of a doctor’s education, only to have the graduate leave upon graduation.

 Here are the dollars that Florida has allocated to increase the numbers of residencies in the state:

  • 2013, $80 Million for recurring State and Federal funding for Graduate Medical Education (residencies)
  • 2015, additional $100 Million appropriated by Florida Legislators for “Graduate Medical Education Startup Bonus Program”
  • Program “Gives hospitals a one-time $100,000 Bonus for every new residency slot in shortage specialties” (1)
  • The first year 66 new residency positions in seven shortage specialties qualified for the bonus” (1)
  • Florida faces a shortage of 7,000 physician specialists by 2025
As described in a prior blog, Arkansas and Kansas are garnering doctors for their own states.  Their residency solutions apply only to their citizens.  Until the residency deficit is eliminated, I believe that Florida should do the same.  Florida tax dollars are providing the monetary incentives to increase the number of residencies in Florida.  So Florida residents and its unmatched doctors should benefit.  Residency selection in Florida residencies should be skewed toward residents of Florida, not using the traditional numerical ”cutpoints”.  Florida is addressing the residency shortage by allocating tax dollars to increase the number of residencies.  The State of Florida and its doctor grads should benefit from these tax dollars.  These are the doctors who plan to live, work, and stay in Florida.

(1)http://wusfnews.wusf.usf.edu/post/florida-increases-medical-residency-slots-still-faces-doctor-shortages#stream/0

http://nomatchmds.blogspot.com/