Blog Archive

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/

 

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/
 

Tuesday, September 26, 2017

Slam Dunk? / Politics / Residency








Slam Dunk?/ Politics/Residency
https://www.youtube.com/watch?v=DZt3xeV_n00&t=2s

   Too many medical students, yet not enough residency slots.  Impending doctor shortage, yet “discarding” fully educated doctor grads.  Why isn’t the solution to this dilemma a “slam dunk”?  Because nothing is ever that simple.  There are the “politics” involved that complicate the solution to this deficit. 

                                                            (Bloom's Taxonomy) 

    Is there really going to be a physician shortage, or are the VA, The Affordable Care Act, and some states planning to utilize less expensive physician assistants and nurse practitioners to administer healthcare?   Josanne Page of the Cleveland Clinic said, “P.A.s generally make about half a physician salary or less, depending on specialty (an ER doctor makes an average $270,000, an emergency-room P.A. $112,000).” (1)

 “ And several states, such as Arizona, Maine, Maryland, Nevada, Vermont, and Washington have liberalized laws to enable nurse practitioners and PAs to perform some treatment normally done by doctors.” (2)  The Affordable Care Act has allowed millions more insured patients, with a shortfall of sufficient doctors to treat them.  Compared to other countries, the US has 2.5 practicing physicians per 1,000 people vs. 3.2 physicians per 1,000 for an average of 34 other countries. (3)

 Is a PA or NP qualified to see patients as effectively as a doctor?  A PA curriculum typically requires 1 year of classroom learning and 1 year clinical work.  A NP requires a 1-3 year program post graduate after obtaining a nursing degree.  Doctor training requires a minimum of 7 years after college.  The 3 doctors in my family had 7 years, 10 years, and 11 years of post college training.  The further depths of knowledge and medical experience afford a doctor a level of synthesis not attainable with lesser years of study. 

 A dermatologist I know recommended that a patient obtain a consult regarding a skin ailment, sometimes associated with pancreatic cancer( The patient returned to thank the doctor for the early diagnosis of pancreatic cancer which might have been missed under normal circumstances.)  Would a PA have known that correlation? 

  An OB/GYN doctor told a patient to obtain further diagnostics for continued lactation after cessation of breast feeding.  There is an association with pituitary tumors with uncharacteristic lactation.  The patient did end up having a pituitary tumor.  Would this have been noticed by a PA?  Often, a doctor never enters the room when a PA is seeing a patient.

     Ironically, PAs who by “definition” are “supervised” by a doctor, are allowed to work immediately after graduation.  A doctor with 4 years of medical school cannot work at all, until obtaining a license upon completion of a residency.  They can’t even work as a PA due to the stringent PA licensure rules!
 
(1) http://www.nytimes.com/2014/08/03/education/edlife/the-physician-assistant-will-see-you.html?_r=0

(2) http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/08/11/to-address-doctor-shortages-some-states-focus-on-residencies

 
(3)http://www.epi.umn.edu/mch/wp-content/uploads/2013/09/ACA-Overview.pdf

http://nomatchmds.blogspot.com/
 

Tuesday, September 19, 2017

Doctor Shortage / Waste





Doctor Shortage/Waste
https://www.youtube.com/watch?v=DZt3xeV_n00&t=2s

Image result for people queue images free 

 

   Let’s talk about the upcoming doctor shortage.  Here are some statistics and projections:

  • 27.6% of the current physician workforce are age 60+ years old and likely to retire in the next 10 years (1)
  • 32.6% of practicing physicians are women
  • 46.1% of residents are women
  • “Historically women have worked fewer hours than men-a trend that continues today” (2)
  • 24% of current US physician workforce are IMG (International Medical Graduates)
  • 25.9% of US “ resident” workforce are IMG
  • “By year 2025 the United States will face a shortage of between 61,700-94,700 physicians”. (3)
  • “Thousands of baby boomers are turning 65….seniors are the population with the greatest healthcare needs”. (4)
  • “The Association of American Medical Colleges (AAMC) projects there will be a shortage of between 12,500-31,100 primary care physicians in the next 10 years…equally troubling is the shortage of between 28,200-63.700 specialists.”(4)
  • More than 40,000 fully qualified doctors have not matched into a residency over the last 5 years and cannot practice Medicine without residency training.
  • 8,640 doctors did not match on March 17, 2016, what are they doing now?
  • “With medical school and residency combined, it takes a minimum of seven years to train a doctor.” (4)
What are we thinking?!!!  In view of the upcoming doctor shortages over the next decade, we are simply “discarding” our fully educated doctors!  This just does not make sense!

 

(1)   page 12

(2)   page 13

(3)

(4 )page 1

(3)   page 2

Tuesday, September 12, 2017

ACGME (Accreditation Council for Graduate Medical Education)/ IMG





ACGME (Accreditation Council for Graduate Medical Education)/ IMG
https://www.youtube.com/watch?v=hL3mwmLdMZE

Image result for maze images free     The ACGME, via CEO Thomas Nasca MD, does not support the legislation enacted in Missouri.  It deals with using unmatched doctors in underserved rural areas, supervised by a licensed physician within a 50 mile radius.  The doctors could work and reapply for a residency, while performing meaningful and necessary work until the number of residencies catches up with the deficit.  Dr. Nasca bases this belief on patient safety and quality concerns.(1)  He further states that once an unmatched doctor has gone through 2 application cycles, he/she will probably never get trained.  They will remain untrained for the duration of their career.  Dr. Nasca also infers that unmatched international medical graduates are not as smart as US grads, or they would have been accepted into a US medical school.  It sounds like Dr. Nasca is not too worried about unmatched IMGs (International Medical Graduates)!

 I can certainly see the points Dr. Nasca makes about patient safety and quality.  Yet, residency also deals with training “new doctors” under a supervisory set of physicians, albeit closer in proximity.

 However, I have a different opinion about the qualifications of the IMGs.  Two of my own children have graduated from medical schools, one a US grad and one an IMG.  As an educator and mother, I would categorize the child who went to a US medical school as “system smart”, and the one who went to an IMG as “intellectually smart”.

  The US grad decided to go to medical school 2 years after graduating from college in “Broadcast Journalism”, with an “A” average.  The IMG attended the same, very competitive university (97% of incoming freshman have an academic scholarship), intending to go to medical school from the beginning, and majored in “Cell Science/Microbiology”, obtaining a “B” average.  The US grad attended a local less competitive university for pre-med classes and got an “A” average.  The IMG grad took pre-med classes, along with a competitive pre-med science major, while at the highly competitive university, getting a “B” average.

 The US grad was accepted “Early Decision” into a medical school with 1 application.  The IMG med student was only accepted into an international med school.  Two graduates, fairly comparable intellectually, one worked “smarter” in applying for medical school, while the other majored in a subject intended to “help” in Medicine.  It pays to know the system before you begin!

 Yes, this story deals with only 2 medical students. There is a whole “continuum” of ability and IQ in MDs, some are “book smart” and some are “system smart”.  Probably all applicants wished to have gone to a US medical school.  They would not have had to deal with this residency deficit, waited heavily against IMGs.  In spite of all these points, all doctors applying through NRMP have PASSED ALL THE REQUIREMENTS!  Why shouldn’t they be allowed to complete the last step of their training!

 As CEO and spokesperson for the ACGME, I believe Dr. Nasca has a responsibility to suggest a workable solution to this residency dilemma.  Not only is a solution warranted, but leadership in this role of CEO for such a vital organization in medical education is warranted!  If such leadership had taken charge of this travesty, we would not be talking about each state enacting its own legislation.  We would not be dealing with the utter waste of human time, talent, and money.  The AMA has “adopted” a similar stance, based on Dr. Nasca’s recommendation.  So 2 of the most powerful agencies dealing with healthcare in the US are leaving it up to others to fix this bureaucratic nightmare!