The Angry Doctor / Residency Shortage
On Feb. 22nd I participated in a panel discussion at the World affairs Conference held in St. Petersburg, FL. My panel covered the topic of how to make our educational systems more relevant. My topic for the panel was about the travesty occurring in medical education with the medical residency shortage. I quoted the statistic of 50,000 doctors not matching over just the last 5 years, at the rate of 10,000/year according to the NRMP (National Residency Matching Program). Afterwards, a retired doctor approached me about using that statistic of 50,000, stating that it was misleading since a large percent of those were foreign doctors. He appeared visibly angry and walked away without listening to a further explanation. At first I felt very badly, worrying that I had “lied” or used false information. I continued to ponder this scenario for the rest of the day, but awakened the next day with a new incite.
I now realized why some physicians I have encountered have dismissed the existence of a residency shortage, because they believe it is mostly affecting foreign doctors. They don’t care if a foreign doctor does not match, and probably, they prefer to keep foreign doctors from practicing in the US. My husband has told me how some foreign doctors refer patients only to doctors of their own nationality, and, probably US doctors do the same. Just like groups of any affiliation, we want to send business to our “fraternity” of peers.
My biggest revelation came when I realized that there is an “error” in the math when we are viewing these results. The angry doctor wanted me to focus only on the 13,982 US doctors who did not match over the last 5 years, even though those US doctors are “competing” on a scale of 50,000 total unmatched doctors for the residency positions. Until a preference is given to US doctors with residency programs, the benchmark of unmatched doctors has to be quoted at 50,000. To keep our math accurate, we have to subtract the number of non-citizen applicants from the ENTIRE match, if we want to look at only the results of US doctors who do not match. That is what I believe is complicating the thinking about the residency shortage. The US doctors who are feeling “territorial” about their work turf do not want to help any foreign doctors get residencies and work in the US. They are not going to get too worried when they hear about a 50,000 deficit in residency slots over the last 5 years when it includes unmatched non-citizen doctors.
Now let’s talk about the perspective of the actual residency programs. Residency programs are trying to “hire” the best candidates for their residency programs. They are looking for the highest credentials and achievements in their applicants. Some foreign doctor applicants have already been practicing Medicine in their own countries before applying to a US residency. There is no dictum for US residencies to give preference to US citizens. However, since residency programs are funded through Medicare and other governmental sources with tax dollars, US citizens should be given first priority to these residency slots. If residencies were required to select only US citizen applicants for residency slots, then I would willingly use the quote that 13,982 US doctors had not matched over a 5 year period. We cannot dismiss the 13,982 unmatched US doctors, because the other 36,018 unmatched doctors who did not match were foreign doctors.
Most importantly, the US doctors are totally dependent upon a US residency to obtain a medical license in the US (technically, 1 year of post-graduate training in a US residency is required for a license). Foreign doctors are able to practice in their native countries without a US residency. Over the last 5 years, 18,819 NON-CITIZEN doctors matched into US residency slots. (1) Had US doctors been given priority in the matches, that number would have easily taken care of the 13,982 unmatched US doctors. Then according to the angry doctor, there would be no residency shortage. To include only 13,982 unmatched US doctors as the statistic would diminish the enormity of the matching challenge that exists.
I am actually grateful to this angry doctor for making me aware of another misconception about the residency shortage. These are the misconceptions which decrease the likelihood of a timely solution to the residency crisis.
Personally, I have no ill-will toward non-citizen doctors. What I do hold “sacred” is the “social contract” which started the day any US citizen was accepted and began medical school, namely, the right to finish all requirements for licensure. Any residency slots remaining AFTER this “contract” has been fulfilled would be generously offered to non-citizen applicants.