Blog Archive

Tuesday, June 20, 2017

Creative Solutions, State by State






Creative Solutions, State by State

https://www.youtube.com/watch?v=1m6LwTpJZnQ
 

 

            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??

http://nomatchmds.blogspot.com/

 

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!

http://nomatchmds.blogspot.com/

Tuesday, June 6, 2017

The Solution/ Residency Match






 
 

The Solution/ Residency Match

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

 

 

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!

http://nomatchmds.blogspot.com/

Tuesday, May 30, 2017

"Breaking the Social Contract" / The Match






“Breaking the Social Contract”/ The Match

https://www.youtube.com/watch?v=v689rYZVN_E

 

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?
http://nomatchmds.blogspot.com/
 

Tuesday, May 23, 2017

Residency Match: A Case of Supply/Demand



 
 
Residency Match:  A Case of Supply/Demand

https://www.youtube.com/watch?v=j0rtf4YQYds

 

 
 

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, http://www.nrmp.org/match-data/main-residency-match-data/http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

 

What happens to unmatched doctor grads?

http://nomatchmds.blogspot.com/

 

Tuesday, May 16, 2017

Quantitative vs. Qualitative Residency Match / NRMP


Quantitative vs. Qualitative Residency Match/NRMP
 
https://www.youtube.com/watch?v=WUynulWye3E&t=33s

 

 

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


ABOUT
https://www.youtube.com/watch?v=-SGuWAgYNIs

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
http://nomatchmds.blogspot.com/

 

Tuesday, May 2, 2017


 
video
 
Is There “Really” A Doc Shortage?


Are we really going to have a doctor shortage over the next decade?  Or, could we provide more cost effective care through the utilization of NPs and PAs?  In that case, there might not really be a doctor shortage, as some believe.

I agree that greater use of NPs and PAs for follow-up and routine care would be more cost effective healthcare.  However, some patients only seek medical care on an as needed basis.  A new health problem might be their rare visit to see a doctor.  This might be a one-time chance to discover other untreated conditions, which might go “unexplored” by a PA or NP.  When I go to a doctor, I want to pay for that doctor’s “blink”, but I will discuss that idea a little later.
First, I want to discuss a theory from my teacher education days. The theory was called “Bloom’s Taxonomy” and dealt with the incremental levels of learning a student experiences with new subject matter.  To illustrate, remember when you were in high school and your teacher announced an upcoming test?  All the students would plead for a True/False exam.  I now know why.  True/False tests are at the lowest rung of learning.  The student has only to recognize the simplest level of knowledge about the material, whether the question was “True” or “False”.  The next levels up were “matching”, followed by “ fill in the blank”, and writing a complete sentence for the answers.  The highest levels on the learning curve were concept formation, synthesis, and prediction.  How does this idea relate to the projected shortage??
The amount of training required for a PA and a NP are 1-3 years post college graduation (the NP requiring a nursing degree).  The amount of education and training a doctor pursues is generally 7+ years after a college degree.  As I mentioned before, my 3 family members have trained for 7, 10, and 11 years post college. I would suggest that there is a significant difference in the knowledge level acquired in the training years between PAs/NPs and MDs.  The additional years spent in learning by an MD would allow for significant exposure to the learning levels of concept formation, synthesis, and prediction.  How can we equate 1-3 years of training with 7-10+ years of training?
Now back to the idea that when I go to the doctor I want to “pay” for that doctor’s “blink”.  In Malcolm Gladwell’s book, Blink, he defines his use of the word “blink” as “the power of thinking without thinking”(1 ).  When the years of study, experience, and familiarity come together an intuition exists much like the “adaptive unconscious”.  Mr. Gladwell describes this, “The adaptive unconscious is thought of, instead, as a kind of giant computer that quickly and quietly processes a lot of data…” (1) When I go to a doctor appointment, I want my doctor’s “computer brain” to bring forth the sum total of knowledge and experience acquired to date.
To answer the original question about whether there will be a doctor shortage in the next decade, I will say “Yes”.  NPs and PAs provide excellent, but DIFFERENT, levels of care than a doctor provides.  One degree does not replace the other.  I want MY doctors to have reached the upper echelons of “Bloom’s Taxonomy” in learning.  I want them to have had multiple exposures to a myriad of medical conditions, years of experience, and an “eye for the unseen”.
(1) http://www.course-notes.org/files/uploads/english/blink.pdf
http://nomatchmds.blogspot.com/
 

Tuesday, April 25, 2017





video

Ramifications of a Doctor Shortage
https://www.youtube.com/watch?v=zi2qSDB4t4o

Although some people question the legitimacy of an upcoming doctor shortage, the AAMC (American Association of Medical Colleges) does not.  The AAMC predicts a shortage of up to 105,000 doctors over the next decade.  Those who do not believe there will be a shortage propose that with more efficient healthcare management, the projected shortage would be alleviated.  I will discuss that issue in my next blog.  For today, assume there will be a doctor shortage.  What would the ramifications of that be like?

In the AAMC study of projected doctor shortages over the next decade, there is a predicted shortage of primary care doctors of up to 31,000 doctors.(1)  Ironically, because of the push for more primary care doctors, the surgical and specialty care areas of Medicine will suffer even more.  Specialty care would include Neurology, Gerontology, Urology, Psychiatry, Opthamology, and medical subspecialties.  These are all specialties well utilized by seniors. By 2030, the number of people in the US greater than 65 years old will be growing by 41%, while those less than 18 years old will be growing by 5%. (1)  When seniors will be receiving 2-3 times more healthcare, they will need the specialty areas of Medicine more than ever!  These are the specialties facing some of the greatest shortages. (1)  It takes 5-10 years to train a doctor.  If we are not proactive about our future healthcare needs today, we will all “be dead” by the time the shortfall of doctors can be replaced to meet the deficit.

The AAMC projection graphs show multiple scenarios about the potential numbers of doctors practicing over the next decade.  The graphs show how the numbers will differ depending upon current doctors retiring at age 65, plus or minus 2 years.  Here is what I am seeing in my corner of the US.  Doctors are retiring before age 65.  The requirement for electronic medical records, coupled with the advent of managed care, is causing some doctors to just quit early.  About 6 years ago, a number of doctors sold their practices to hospitals or managed care companies.  After the initial “sweetheart” income deals evaporated and the new projected lower salaries were announced, the doctors just quit practicing Medicine. They had non-compete clauses and had lost control over their own practice of Medicine.  1/3 of the currently practicing physicians in the US will be greater than 65 years old over the next decade.  So this story could repeat itself quite a bit over the next decade.

Due to the thoughtless discard of unmatched fully qualified doctors, we are “shooting ourselves in the foot”.  Our population is ageing and their healthcare needs are escalating.  Just when seniors need medical specialties the most, there will be a shortage.  What are we thinking?  I guess we are not thinking, or the Residency Shortage would have been solved yesterday!

Tuesday, April 18, 2017

 
video

 
 
 
 
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, April 11, 2017


video

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, April 4, 2017


video

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…