Tuesday, December 25, 2018
Ramifications of a Doctor Shortagehttps://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
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. US
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
. 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. US
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, December 18, 2018
Move Unmatched Dr. Grads to the “Top of the List” /
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
incentive money with state funds to private hospital corporations to add
residencies, as in
with Florida HCAHospitals
- Create positions at VA Hospitals for unmatched doctors to work under supervision of current VA staff doctors
a “House Physician” license (as in
) for unmatched doctors to work under supervision of hospital staff physicians Florida
- 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
the CRITERIA necessary to apply through the NRMP. They deserve a Match!
Tuesday, December 11, 2018
A Win-Win for Doctors and Vets / #Save GMEhttps://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
, 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. US
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
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. Missouri
Tuesday, December 4, 2018
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: firstname.lastname@example.org
Tuesday, November 27, 2018
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
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. US
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
require the completion of a US RESIDENCY.
So first we owe the right to complete their training to our OWN
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. US
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
(1). It turns out more than 1,000
doctors from these 7 countries ALONE were applying through the NRMP for the
residency match on US 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
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, November 20, 2018
Why Are We Not Upset? /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
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”??!! Guatemala
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
that getting a job might be difficult. I
do not think most students beginning Law 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 Medical
today, prospective students would enter medical school at their “own risk”, and
not be “blindsided” in the end. US
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!
Tuesday, November 13, 2018
Blog Plan / Residency Shortagehttps://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!!!
Tuesday, November 6, 2018
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
’s plan for Assistant Physician License, yet has not taken the lead in finding a solution Missouri
- 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 30, 2018
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!
Tuesday, October 23, 2018
A Tsunami of Outrage/ Residency Shortage
Do you remember the outrage that ensued after the 2-3 hour wait times and missed flights that occurred at O’Hare Airport the weekend of
May 14, 2016?
Frustrated passengers began tweeting #IHateThe Wait. US Senator Mark Kirk, IL, called for TSA
Administrator, Peter Neffenger, to fix this problem by Memorial Day or step
down. Even the White House weighed in on
this travesty. (1) By May 25th
Mr. Neffenger told members of House Homeland Security Committee that the agency
was taking measures to resolve this issue.
By May 24th an airline official said that O’Hare’s waits were
down to 15 minutes. That took 10 days to
This outrage is what has to happen to solve the current travesty of the residency shortage. There are no “normal channels” to solve this crisis. The Federal government is moving in typical fashion, slowly. The first legislation introduced was “Resident Physician Shortage Reduction Act of 2011. It was proposed again in 2013, and again by Senator Bill Nelson, FL, in 2015 (S1148) and by Representative Joseph Crowley (HR 2124) in the House. Nothing has been passed or implemented at this point.
This bill would increase the number of residency slots by 15,000 over a 5 year period. We already have more that 40,000 unmatched graduates right now over the last 5 years alone! The AMA and the ACGME have not proposed any solutions. Only a few states have created legislation (generally applicable only to their own citizens).
The only glimmer of hope has been the budgetary allocations some states have made. They have offered financial incentives to hospitals to increase residency slots or add new residencies. This has had some success.
Why are we not as outraged as the passengers at O”
We have to get the “word out”. We have to tweet, blog, share on facebook, contact healthcare professionals and societies, contact legislators, and yes, even the White House!
Tuesday, October 16, 2018
by State DOC Shortage State
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
Here are the dollars that
- 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)
faces a shortage of 7,000 physician specialists by 2025 Florida
Tuesday, October 9, 2018
Slam Dunk?/ Politics/Residency
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.
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
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!
Tuesday, October 2, 2018
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
physician workforce are US IMG(International Medical Graduates)
“ resident” workforce are US IMG
- “By year
will face a shortage of between 61,700-94,700 physicians”. (3) United States
- “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.
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)
(1) page 12
(2) page 13
(4 )page 1
(3) page 2
Tuesday, September 25, 2018
ACGME (Accreditation Council for Graduate Medical Education)/https://www.youtube.com/watch?v=hL3mwmLdMZE
The ACGME, via CEO Thomas Nasca MD, does not support the legislation enacted in
. 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 Missouri
medical school. It sounds like Dr. Nasca
is not too worried about unmatched IMGs (International Medical Graduates)! US
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
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
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
Tuesday, September 18, 2018
A Tale of 3 Medical Studentshttps://www.youtube.com/watch?v=6s1_3ZTanUg
Here’s how medical school works…The first 2 years of medical school cover the acquisition of medical knowledge. This occurs through lectures, reading, study, and testing. The acquisition of this knowledge occurs through individual interaction and involvement with the subject matter. The last 2 years of medical school include monthly clinical rotations at hospitals and clinics in the subspecialty areas of Medicine. The student treats patients under the supervision of residents, faculty, and attending physicians. Supervised clinical practice uses the knowledge acquired from the first 2 years of school on real patients for the last 2 years. Here are examples of how 3 real medical students approached their learning.
“John” attended the University of Illinois Medical School in the early 1970s, earning the honorary designation of “James Scholar”. This honor entitled him to the exclusive use of a study carrel at the medical school, and the privilege of designing his own course of study, as long as he passed all requirements and exams. John’s method of study involved reading each medical text book cover to cover, not attending class, and graduating in 3 years.
“Mary” attended a
“Joe” attended An international medical school. He attended class lectures, read, studied, and took exams. His clinical rotations took place in the
These 3 students each had a different approach to the didactic portion of their medical knowledge. The clinical rotations were a fairly uniform experience, all taken in the