Blog Archive

Tuesday, March 19, 2019

Put Up or Shut Up / Residency Shortage
A proposal to create a new medical license was made at the annual Florida Medical Association (FMA) meeting in August 2017.  In order to make a proposal at the FMA a strict procedure must be followed.  A delegate from a county medical association must obtain approval from their local medical society to bring a proposal to the state medical association.  Following strict written guidelines, the delegate is allowed 3.5 minutes to verbally present this proposal to the delegates.  The proposal presented at this year’s meeting had to do with the creation of a license called “Assistant Physician”, similar to the license passed in Missouri.  This license would allow graduate unmatched US doctors, who met all the requirements for application to the National Residency Matching Program (NRMP) for residency, to work under the supervision of a licensed physician.  This would permit meaningful work in Healthcare until the unmatched doctor could obtain a medical residency, in lieu of the current residency deficit.
This committee voted that the proposal “not be adopted”.  One of the objections discussed in a prior blog had to do with the belief that a residency shortage did not really exist.  I have since received written correspondence from the CEO of the NRMP stating that there have been 42,000 applications for 32,000 positions.  99% of the positions were filled, leaving 203 unfilled slots mostly in 1-year preliminary surgery, where “Many are dead-end positions that do not lead to further training”.  So there definitely is a residency shortage of about 10,000 slots per year.

The second objection raised against this proposal was from the medical student delegates.  They voted “no” because they felt money should be spent on Graduate Medical Education (GME) for creating more residency slots in Florida, and not money spent on creating a new license.  They felt the Assistant Physician license “would have legislative implications as the FMA’s job is to maintain that the physician stays as the leader of the health care team.  This could be a risk to the public if lesser trained providers are allowed to practice Medicine with MD/DO after their name.”(1)

The objection based upon how best to spend money to fix the residency shortage does not correlate with me.  Residency slots are subsidized by Medicare and Medicaid funding primarily.  States like Florida have created incentive money to hospitals for the creation of new residency slots.  The costs for enacting the AP license in Missouri were fairly minimal and involved primarily administrative costs, as delineated in their proposals.  Had these unmatched doctors been allowed to complete residencies, their applications would have been for traditional medical licenses, instead of the AP license.  So that expense would have occurred anyway.  The administrative costs associated with supervisory physicians would be additional, but fairly nominal in view of the benefits to the unmatched doctors and the underserved patients receiving care.  In summary, the worry about how to best spend money deals essentially with two different levels of government, the Federal level for Medicare/Medicaid, and the State level for licensure costs.  The two do not impact one another.  So money to create licenses would not reduce or impact the creation of new residency slots.

How will any of those medical student delegates feel if they happen to be some of the unfortunate doctors who do not match into a residency after graduation?  They might not be so cavalier with their objections.  What have these students and the FMA actually DONE to remediate this crisis of the residency shortage?  A doctor in my community said that the FMA was a “Go along to get along” organization.  He implied that nothing much gets done of significance.  For that matter, the AMA has not effectively dealt with this issue either, from my stand point.  So my answer is “Put up or shut up”.  If this situation had occurred to any of the FMA or AMA delegates, we would be hearing a different story!

(1)  FMA House of Delegates 2017; Consent Calendar Reference Committee III; Legislation; Aaron Sudbury, MD, Chair.

Tuesday, March 12, 2019

What Happened on Match Day 2018? / Residency Shortage

   March 16,2018 Tampa, Florida.  As described in prior blogs, a demonstration of peaceful activism took place in front of the USF Match Day celebration.  The goals were to bring the travesty of the medical residency shortage to the Nation’s attention and to gain media coverage for finding a solution to this grave injustice.  While several television stations sent camera crews to the celebration, no reporters were evident.  The camera crews did not film the demonstration, only the ceremonial events.  That was a disappointment.  However, our team of activists put forth a colorful, organized, and informative display, which was live-streamed on facebook and social media.  Hopefully, with all the “shares” on facebook many more citizens learned about the residency shortage that day.  The elimination of the residency deficit continues to be an uphill challenge.  It will only be solved when enough people become aware of it, enraged by the injustice of it, and connect the resulting doctor shortage to it.  I would encourage each of you to do your part in disseminating this important issue. 

   Our debriefing after the demonstration gave us the following things to consider for the future.  Contact the medical school in advance to ask them to join forces to address the residency shortage.  Be sure to have signs of “Congratulations” for the matched doctors.  This demonstration was not intended to detract from the great celebration that day, but to bring attention to the unlucky doctors who had not matched and were not there celebrating.  Continue to make contact with legislators, medical school deans, and persons of influence who can implement the necessary changes to eliminate the residency shortage.

Tuesday, March 5, 2019

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, February 26, 2019

Are Medical School Loans like “Predatory Loans”?
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”!

Thursday, February 21, 2019

Challenge to YOU!  / Residency Shortage

The last 2 blogs explained the process of “peaceful activism” to bring the cause of the residency shortage to the forefront of the Nation’s attention.

As I have explained in my biography of the NoMatchMDs blog, I do not personally work in the field of Medicine.  Yet, I felt that the travesty of the residency shortage warranted my activism, in lieu of the 50 years I have observed Medical Education.  I cannot solve this problem on my own.

I continue to educate the readers of the blog about the intricacies of the residency shortage dilemma.  I have delineated the politics of Medicine which are preventing a timely solution to the shortage.  I have described how a huge majority of the public and medical professionals are unaware of the current scenario.

Perhaps you are interested in this blog because you or someone you know is personally affected by the residency shortage.  I would encourage you and your supporters to become involved in this cause.  If not YOU, then WHO?  Before I became aware of this crisis, I had never even read a blog.  I had never created a logo, a website, never had a Facebook page or used Twitter, never had spoken to a Congressman, never written to an elected official, or fought for any cause.  There comes a time when we each need to speak up and DO something!  I have had to get out of my own comfort zone to learn and use these new skills.  I will be part of a panel at a World Affairs Conference in St. Petersburg, Florida in February, speaking before several thousand people.  I have never done this before either…So I am challenging each of you to step up and help with this cause.  Go back and re-listen to the two previous blogs.  Form your own “protest” group and show up at a Match Day 2018 “reveal” party.  If mine is the only “voice” talking about the residency shortage, the solution will be long in coming…

Tuesday, February 19, 2019

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

Thursday, February 14, 2019

Match Day 2018 Protest / Residency Shortage

The last blog gave an overview of the Indivisible Guide for public action.  I described how it could be utilized to bring the residency shortage to the Nation’s attention.  To many of you the idea of demonstrating or picketing might seem ludicrous.  Granted I would have felt the same way before I became aware of the residency shortage.  Yet, the direness of the circumstances of unmatched doctors calls for drastic measures.

 Normally, I am very much an optimist.  However, in this particular situation I have realized the futility of successive re-applications for residency slots.  I have “laid out” the reasons for this futility in many of my prior blogs.  The Nation is short 10,000 residency slots each year.  The demand for a residency given the current supply creates such a skewed application process.  The system will repeatedly favor the highest scoring candidates.  The result is that many fully qualified doctors graduates have to give up on a career in Medicine.

 So here are the specifics of what I plan to arrange for “peaceful activism” in Tampa on Friday, March 16, 2018, Resident Match Day.  I hope you will take these ideas and plans and use them at a Match Day celebration where you live.  You have 180 medical schools from which to choose…

  • Explore city permits for protests in my area (none needed if on public sidewalks and not obstructing traffic)
  • Contact family, friends and supporters to form a group of activists to “picket” at the USF Match Day party in Tampa, FL on March 16, 2018
  • Prepare public relation materials to hand out:  brochures and business cards (download these at my website:
  • Order 25 t-shirts with the NoMatchMD logo on them (doctors wear white coats)
  • Create protest posters to carry at the demonstration –
-“What About the Docs Who Don’t Match?”

-“Doctor Blindside”

-“Save Our Doctors!”

-“Discarded Doctors!”

-“Residency Shortage = Doctor Shortage”

-“Create More Residency Slots”

·        Reach out to media contacts, especially those who have written about the residency shortage.  Send them protest specifics and include reference links to this issue and a quote to use for a story.

I am going to make PR materials available for you to download on my website, (logo, brochure, business card, poster and sticker template).  Please use them to make your participation more probable.

I hope this will help you too, to get out of your comfort zone and help in the quest to correct the residency shortage.

Tuesday, February 12, 2019

                                      NPR Broadcast / Residency Shortage
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:

Thursday, February 7, 2019

Indivisible Guide for Action / Residency Shortage

After the last presidential election, a group of congressional staffers outlined successful strategies for making contact with members of Congress.  This information came about as a result of the outcome of the presidential election, as a way to keep congressional representatives aware of the feelings of their constituents.  This group of staffers has adopted the name, “Indivisible”, to represent this cause, and to encourage similar groups to form across the country.  It is an insider’s guide to make contact with your legislators.
I want to utilize these “insider tactics” to bring the Residency Shortage to the Nation’s attention.  I am going to suggest that those who would like to find a timely end to the residency shortage, adopt a similar strategy.  Contact your own members of Congress using the Indivisible strategies.  It is only through action that we can hope to eliminate the travesty of the residency shortage.  As I have said, there is no ONE person who has the power to correct this situation. (That is, unless there is a presidential order…) I will describe some of the key points derived from the “Indivisible Guide” to create action, and then propose a more detailed plan to implement these ideas on the upcoming Match Day, March 16, 2018.

To begin, members of Congress are concerned with “reelection, reelection, reelection. So they want their constituents to think well of them, and they want good, local press”.(1) The guide describes four local advocacy tactics:

·        town hall meetings
       ·         other local public events
       ·         district office visits
       ·         coordinated calls

 For the residency shortage, all four tactics could be utilized to make contact with legislators.  But for Match Day 2018 on March 16th, I am going to focus on “local public events”, i.e. Match Day results gatherings across the US.  In my area, that translates to the University of South Florida(USF) Match results party.  It was held last year at Ulele Restaurant in Tampa, Florida.  These events occur across the US on Match Day, when doctor graduates get the results of their residency match.  It is quite a celebration when each graduate finds out where they will be living and working for the next few years in their residency.  The idea is to utilize media attention which will be present to highlight this joyful event, but also to bring attention to the plight of the unmatched doctors.  There is no ill will or rancor involved, just an opportunity to provide another side to this story.

A small group of people to “attend” and distribute information at a Match Day results event is all it would take.  There are about 180 DO and MD medical schools in the US.  Just imagine if the residency shortage story line was generated and picked up by the Media at each one of these locations!  Email your contacts and post a message on your Facebook page to generate a grass roots group to attend the Match Day party near your local medical school.  Record everything at those events and share these clips on Social Media, as well as with local and national media.  Optimize your visibility by staying together as a group, wear similar clothing or message shirts, and carry signs.  Identify and try to speak with reporters on the scene.

One key item described in the Indivisible Guide is that Members of Congress, and probably the Media as well, WANT “concrete asks that entail a verifiable action- vote for a bill, make a public statement, etc.  Perhaps one example of a “concrete ask” could be “Create an emergency placement for unmatched doctors while increasing the number of residency slots”.  You could tailor your “concrete ask” to something pertinent to your State like, “Grant immediate Physician Assistant licensure to unmatched doctors until the residency deficit is eliminated”, or ”Add 2 additional residency slots/year to every existing residency until the deficit is eliminated”.

At the onset of the I stated that my goal was to educate the public about the residency shortage.  With this knowledge a solution to this travesty could be found.  As I have read, a good salesman is really an educator who provides information, which leads the customer to want what the salesman is selling.  Then when we know better, we do better.  This has been my continual focus, to educate the public.  That is why I am proposing “we” use every tool at our disposal to get this message out, even if it means “peaceful activism”.

 To help with this instruction I have created a website, a blog, a Facebook page, and a twitter account.  I have also created a brochure, a poster, stickers, and business cards.  I am happy to make all of these WORD documents available for your use and reproduction in your own area.  You can distribute the brochures at your Match Day event, use the poster as a sign, wear the stickers, and hand out the business cards.  All you need is a small group of supporters to join with you on March 16, Match day 2018.  Please let us all know of your plans, to give inspiration to others who are waivering.  You can write a “comment” to my blog and I can share it with other readers.  The Guide also stresses the need for a “group”, rather than 1 or 2 people.  So get your friends and colleagues to join you in this important cause.

In the next blog I will be more specific about my plans to “demonstrate” for a solution to the residency shortage on Match Day 2018, March 16th.  Please let me know of your plans, so I can encourage others to follow your example.

 I will re-publish this blog several times leading up to Match Day, hoping to enlist more “activists” to our cause.  I have already had offers from my own family members to fly to Tampa for Match day 2018, to help form a group at USF Match Day.


Tuesday, February 5, 2019

Help Create the Tsunami of Outrage / Residency Shortage

My last blog delineated the problems in bringing the Residency Shortage to the Nation’s attention.  No “one” person can solve this crisis, it involves too many variables:  ACGME accrediting, Medicare funding, and states legislation to “preserve” unmatched doctors.  My solution was to create a “Tsunami of Outrage” to bring the Residency Shortage to “the table”. 

This blog was first published on Jan. 31, 2017. To use “wave” terminology, it began with a “ripple” of readers.  In 5 months, the readership has increased to a small “wave”, reaching 232 readers during the first week of July.  Here are the statistics I am going to use to set a goal for dissemination and education about the Residency Shortage via the “NoMatchMDs” blog:


  • US Population – 321 million
  • Total Professionally Active Physicians in US – 923,308
  • US Congress – 535 Representatives and Senators
  • Combination of  (MDs +  Congressmen = 923,843) -  about 1 million
  • 200 million registered voters in US
Let’s visualize what it would take to reach a goal of 1 million readers of this blog, the total number of MDs and Legislators combined.  It is only through knowledge of the Residency Shortage that we can work toward a timely solution.  Here are my calculations.  If those 232 readers from the first week in July were to contact only 6 doctors or legislators EACH, and each of those contacts would make 6 contacts of their own, etc., etc.:

232 X 6 = 1,392

1,392 X 6 = 8,352

8,352 X 6 = 50,112

50,112 X 6 = 300,672

300,672 X 6 = 1,804,032

With only 5 cycles of contact, over 1.8 million people would have been reached with this information.  This is what it would take, 6 doctor/legislator contacts by each of 232 blog readers to theoretically contact “every” doctor and congressman in the US today…

This same story could extend to the education of the voting public.  If this process continued for 8 cycles, the total number contacted would rise to 390 million, almost twice the number of contacts than registered voters!

If you have followed this blog and find the cause of the Residency Shortage “compelling”, we cannot just let the message end with each one of us.  Knowledge without action is useless.  This “story” is too complex to explain it in “one sentence”.  The circumstances are many and varied.  Education of this travesty leading to a solution is the one and only goal of this blog.

At the end of each prior blog, I have asked the readers/listeners to contact the doctors and legislators in their local area to create action for the Residency Shortage.  Today, I am going to ask each of you to personally contact 6 doctors +/or legislators that you know.  Provide the link to this blog, “NoMatchMDs.blogspot”, and request that they in turn contact 6 more of their colleagues/legislators, etc., etc.  Tell them they can listen to this blog on their cell phones while commuting.  Just click on the YOUTUBE link with each blog.  Ask them to keep this “wave” going, with hopes that we will reach our goal of 1 million doctors + legislators.  Wouldn’t it be unbelievable if the cycle went 8 rounds and reached all 200 million registered voters??  It goes without saying that any “sharing” you may include in all your social media would be an added bonus.

So there we have it, a measurable goal.  Make 6 contacts each, ask your contacts to do the same and continue the cycle, and reach more than 1 million doctors and legislators in the US today.  Now that is a “TSUNAMI”!!

Tuesday, January 29, 2019

HCA Is at the Forefront of a Solution to the
Residency Shortage

Hospital Corporation of America is leading the charge for a timely solution to the Residency Shortage nationwide.  “Nationally, HCA is one of the largest GME providers, with more than 203 programs….Currently 2,750 residents and fellows are participating and that number is expected to grow to 5,500 by 2020”.(1)  This would mean an additional 70 residency programs.  Perhaps other hospital corporations will follow HCA’s example.  The slow moving bureaucracies of Medicare Funding, the ACGME (Accreditation Council of Graduate Medical Education), and state licensure laws have precluded a timely solution in the public sector. 

Here is what is going on in Florida, where HCA says, “The physician shortage is especially critical in Florida”.  An IHS Global study found that Florida faces a shortage of about 7,000 physician specialists by 2025.  The Teaching Hospital Council and Safety Net Hospital Alliance report said, “We are not, to put it bluntly, training enough physicians….Without more physicians, Florida will have a tough time providing quality health care to our growing, aging and increasingly diverse population.”  You may recall from a prior blog that in 2015 Florida began a “GME Start-up Bonus Program” which funded $100,000 for each new residency “slot” in shortage specialties.  I would assume that HCA is taking advantage of these bonuses to help fund their new residency slots.  In Florida, HCA says,”Currently 336 residents …are training at one of our seven teaching hospitals, with plans to expand to more than 550 residents by the 2018-2019 academic year.”

The other 49 states seem to be approaching these Residency and Doctor Shortages in many different ways.  I see the private sector approach working very nicely in Florida, and would encourage other states to offer similar incentives to the hospital corporations operating in their states.  However, I would still mention that until the Residency Shortage is solved, each state give preference to its own citizen applicants for residency, as well as those unfortunate doctors who have not matched in prior years.  Upon completion of residency, many doctors opt to practice in the state of their training.  Why should a state offer incentives for new residency slots, only to have these trained doctors leave their state when finished? 

(1) HCA West Florida 2017 Community Report

Tuesday, January 22, 2019

The Human Side of the Residency Shortage/
A Personal Story

Today I am going to share with you the “human” side of the Residency shortage.  It is the story of my husband’s personal journey to becoming a doctor.

I met my husband almost 50 years ago at the University of Illinois, Champaign.  When we first began to date my “husband” told me that he planned to go to medical school and would be studying very hard.  So I had been “warned”…He needed to get “A”s in his classes in order to get into medical school.  After we had been dating for awhile, I would sometimes try to “find” him between college classes to hang out.  I knew some of his favorite libraries to study, and I would try to seek him out.  Once he knew that I might look for him, he varied his study locations so he would not get tempted to quit studying if I found him.  He was truly the most dedicated student I had ever met!  I remember that during Spring final exams one semester, he studied so hard for his physics final that he scratched the corneas of his eyes.  His hard contact lenses did not move around enough to  get lubricated while he was studying.  So he was given a doctor’s note to skip the exam and told not to study any further.  During the summers he would work on his vocabulary in preparation for the MCAT exam.  He never stopped working toward the goal of acceptance into medical school.

 But, I really remember the day he received his acceptance into medical school.  It was his 21st birthday.  His parents had called me from Chicago saying they had received his letter from the U of I Medical School and wanted to bring it to Champaign to see him open it.  They asked me not to say anything so it would be a surprise.  I held a little party at my college apartment and his parents were hiding in the bedroom.  Once the festivities began, they came out to the living room and presented their son with the letter.  We all watched him open it, and then I saw tears streaming down his cheeks….That was a momentous day in all of our lives!  It also meant another 4 years of exceedingly hard work, aiming toward the next goal, getting into a good residency program.

I would say that in the nearly 50 years my husband and I have known each other, Medicine has been at the epicenter of our lives.  It has dictated where we have lived, when, where, and how long we take vacations, etc.  My husband has always loved the Tradition of Medicine, it has a very rigid and rich protocol.  He loved the field of Medical Education and always wanted to become the director of a Residency Program, which he did.

My husband ended up taking 2 residencies and a fellowship:  Internal Medicine, Obstetrics and Gynecology, and a Gynecologic Oncology Fellowship.  That amounted to 8 years of training added to 8 years of college and medical school.

But why did I tell you this story?  I wanted you to know how traumatizing this Residency Shortage is on people just like my husband.  Just think of the devastation a fully qualified doctor graduate is feeling the day he/she finds out they did not match into a residency!  All that hard work and dedication, leading up to the last required step toward becoming a licensed physician, would have been for naught!

If you have listened to my prior blogs, you understand there is a good chance the unmatched doctors will never match into a residency in lieu of the current situation.  The extreme number of applications in today’s “Match” will favor the “cream of the crop” which has risen to the “top” numerically.  I cannot imagine the depths of despair these unmatched doctors are feeling.  I can NOT, I CAN not, I CAN NOT!

Tuesday, January 15, 2019

Why Isn’t the Medical Community Outraged About the Residency Shortage?

Why isn’t the medical community outraged by this grave injustice, the Residency Shortage?  From what I have observed, doctors fall into 2 camps on this topic.  Physicians working in Academic Medicine at universities et al, would probably be aware of the current situation in residencies.  And those doctors in the private sector would generally not know about the shortage.  So this topic is “under the radar” for a huge percentage of practicing physicians, except for those who have completed residency in the recent past.  So why has Academic Medicine not lead the charge to correct this residency deficit, completing the last step of medical training?

There exists a tradition in Medicine that I have observed over the last 40 years.  I would compare it to a “fraternity of the Ivory Tower”.  Great reverence is shown to the leading gurus in the specialties of Medicine, the Professors.  These professors are the ones who write the textbooks used in the fields of Medicine, they are the ones conducting current research, and they are at the “cutting edge” of the most recent methods being used currently in the practice of Medicine today.  Here is how this “fraternity” operates.  The “Professor” functions in a role called, “The Attending Physician”.  Below the Attending comes the “Fellow”, a doctor specializing in the Attending’s field of Medicine.  Next, is the “Chief Resident”, followed by the third year resident (in a 4 year residency), second and first year residents, the Intern, and finally the “Medical Student”.  The lowest position in this hierarchy reports and is accountable to the person above.  During patient rounds in the hospital, questions are asked at the varying levels of difficulty and if the answer is “I don’t know”, you better find out that answer by the next day’s rounds or you will regret it!  Also, the residency schedule demands an extreme number of work hours per week.  In the last 15 years the maximum number of hours/week is 80 hours.  These hours are strictly regulated and are kept in detailed logs to prevent loss of accreditation  to a residency.  Take note, the LIMIT is 80 hours/week, twice a “normal” work week.  And unless you want disapproval from your peers who will have to take over your work load, don’t even think about taking a “sick day”!  There exists a definite work ethic and “sprit de corp” mentality that exists in this “combat like” training experience.  You better do your job or face disapproval by your peers.

Go back now to why Academic Medicine has not “lead the charge” to correct the Residency Shortage.  The traditions I described about the hierarchy of the medical education process translate into rewards and respect for excellence by your peers.  Those who excel are rewarded, and those who are lacking have to keep working.  Even though this crisis of the Residency Shortage is a result of Medicare Funding cuts by the Balanced Budget Act of 1997, the ramifications are not always clear cut.  The first instinct when a doctor does not match into a residency, is for those in Medicine to assume the doctor did not receive high scores in medical school, did not get good recommendations, or was a poor worker.  In essence, they got what they deserved.  They “just” have to re-apply next year, or have to go do some research, or work for free in an indigent care clinic to obtain some new recommendations.  This is how the “thinking” goes.  So no wonder Academic Medicine is not in an uproar!  Yet, even when they know it is a “numbers” problem, the lingering belief is that if an unmatched doctor had only been a “little bit better”, they would have matched.  It seems kind of crazy when we know there actually is a “shortage”.  But I think the traditions of Medicine’s hierarchy of learning come into play, even if only subconsciously.  So I have not observed a call to action for the Residency Shortage by the Academic Medicine community.

As CEO of ACGME (Accreditation Council for Graduate Medical Education), Thomas Nasca MD, inferred that IMGs (International Medical Graduate) were “lesser” doctor applicants.  If they were better students, they would have gotten into a US medical school.  So he does not appear to be worried about unmatched IMGs.  This feeling has influenced the stance of the AMA.  While the AMA has called for an increase in residency slots, their “position” talks mainly about US medical graduates who are less impacted by the Residency Shortage than IMGs.  In the 2017 Match, 69% of unmatched doctors were IMGs and 27.6% were US citizens.  The AMA still questions the Residency Shortage since most US grads have matched.  Perhaps, the AMA feels its responsibility is to graduates of US medical schools, although 25% of physicians practicing in the US today are IMGs.

Private practitioners I know lead exceedingly busy professional lives.  Even if they are aware of the Residency Shortage, they have little time and resources to create an outcry for a solution.  Although EVERYONE, doctor or non-doctor alike, is incredulous when they learn about the travesty of the Residency Shortage.  They view the inability to complete the last required step in training as a “blind-side”, an injustice, a travesty.

What about the unmatched doctors themselves?  They are “scattered” throughout the US.  There is no published list of unmatched applicants, to my knowledge.  Basically, the unmatched doctor is suffering their own personal devastation alone.  Other than, “someone who knows someone”, unmatched doctors are not broadcasting this news.  Ironically, they are actually still hoping they will match next time, and don’t want this “unsavory” quality disseminated.  I do not believe they realize how the deluge of applicants is affecting their chances for a subsequent match.  Not until they have re-applied 3-4 times will they start to “connect the dots”.  They are being selectively ignored by a system which cannot comfortably process the deluge of applicants, and one that does not want to select perceived “lesser candidates”.

These are the reasons I believe that have prevented the Residency Shortage from becoming a national uproar. By the time the “public” discovers this problem and the ensuing doctor shortage, it will already be too late for a timely solution.

Tuesday, January 8, 2019

Open Letter to the NRMP / #Residency Shortage

#The Match

This letter is designed to bring the plight of the unmatched US doctor graduates to the Nation’s attention. These doctors did not obtain a medical residency due to the Residency Shortage which exists in the US, and as a result cannot practice Medicine in the US today.
The NRMP, National Residency Matching Program, which manages the medical residency selection process in the US, issued a statement which appears on an opening page of the NRMP website.  The statement was signed by Maria C. Savoia, MD, Chair and Mona M. Signer, President and CEO of the NRMP.  The Statement deals with the plight of foreign medical residency applicants from the 6 travel banned countries to the US Residency Match.  I have empathy for everyone who has invested time, energy, and money toward fulfilling their goal of becoming a physician, both citizen and non-citizen doctor graduates.  The graduates should all have the right to complete the necessary requirements.  To practice Medicine in the US requires completion of 1 post-graduate year of training at an accredited US residency.  As a Nation, we have a responsibility to address FIRST the tragedy of the Residency Shortage that has existed since the Balanced Budget Act of 1997 was passed, before dealing with placement of non-citizen applicants into US residencies.  “We” have a “Social Contract” to fulfill, the right to complete the necessary requirements for US licensure. Then we should worry about training the rest of the World….

As I read the statement, I felt an overwhelming sense of sadness and frustration that the NRMP has not issued a similar statement on behalf of the more than 50,000 unmatched doctor graduates (over the last 6 years alone).  They are unable to practice Medicine because they cannot complete the last required step of training, completion of a US residency.  42% of these graduates are US citizens.  These are the doctor applicants we should be worried about!

President Trump’s Executive Order suspends “entry into the US of certain individuals” (foreign residents of 6 travel-banned countries).  Here are the concerns expressed in the NRMP’s statement:
  • “the upheaval it is causing is extensive”
Just think of the “upheaval” for a US doctor graduate who has fulfilled all requirements for residency according to the NRMP, and cannot complete the last required step to become a licensed physician in the US.
  • “the affected applicants have worked hard for many years to achieve their goal of becoming a physician”
The unmatched US doctors have done the same hard work, passed the same exams,    and fulfilled the same requirements for application via the NRMP to achieve their goal of becoming a physician.

  • “they should not be denied that opportunity because of a blanket policy”
The Balanced Budget Act of 1997, via Medicare funding, was a “blanket policy” that reduced medical residency funding, creating a deficit in residency slots compared to the number of medical school graduates.

  • US training programs should be able to select applicants based on their excellent character and qualifications without regard to nationality”
These same US programs should fulfill the “Social Contract” made with prospective US doctors when they were accepted into medical school, the opportunity to complete all requirements.  To practice Medicine in the US requires completion of a US residency.  US doctor graduates have “paid for” these residency slots via their tax dollars, which provides Medicare funding for residency slots.

  • “The Executive Order disrupts that process very considerably”
What about the disruption that has occurred to unmatched US grads whose education is “worthless to Medicine” without a residency, whose school loans are now due, and who have no one to correct this injustice?

  • “The NRMP will work with the administration and others in the graduate medical education community …being “fair” to both individuals and programs…”
I have not seen anything “fair” happen to unmatched US doctor graduates who have been “hung out to dry” on their own!  Please take a leadership role to correct this travesty in Medical Education as well.  Please issue a statement of concern to the same administration and medical educators on behalf of the unmatched doctor graduates in the US who could use a similar voice of support.  Surely, no “doctor graduate” should ever be wasted.