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/
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, Iimagine
that this year will be the same….Add another 8,000+ unmatched doctors to this
story!!! http://nomatchmds.blogspot.com/
All US
citizens who have satisfied the requirements for an MD degree, and passed all
required exams (USMLE I AND II), have earned
the right to train and practice Medicine in the US.This is our “Social Contract”.Think of medical school as one big “lesson
plan”.As teachers know, each lesson
plan begins with the “Behavioral Objective” and ends with the “Criterion
Task”.If the goals and benchmarks
outlined in the Criterion Task have been met, the Behavioral Objective has been
met.US medical schools and government
legislatures have determined the criteria required to practice Medicine in the US.All medical school graduates who apply for
residency through the NRMP (National Resident Matching Program) have met these
criteria, both US medical school grads, as well as international medical school
grads. They have all passed the
CRITERION TASK!
Why aren’t we “upset”
if 25% of unmatched grads are from international medical schools,
especially since 42% of them in 2016 were US
citizens?Currently, 25% of physicians
practicing in the USare international medical school
graduates.(1) Considering the expected 90,000+ doctor shortage over the next
decade, that is quite a waste of fully educated doctors!
The ECFMG (Educational Council for Foreign Medical
Graduates) has been promoting excellence in international medical education for
60 years! (1) This organization has been evaluating the readiness of IMGs
(International Medical Graduates) to enter GME (Graduate Medical Education) programs
in the US.It has partnered with NBME (National Board of
Medical Examiners) to develop the clinical skills assessment for the USMLE (US
Medical Licensing Examination).To
become an accredited medical school with the SAME STANDARDS as a US
medical school, a foreign med school has passed rigorous standards and criteria.
“The ECFMG makes its
world-class experience with the primary-source verification of medical
education credentials available to the international medical regulatory
community.”(1)It is recognized world
wide.This is the organization
monitoring graduates of international medical schoolsThe IMGs applying through the NRMP have met
the “Criterion Task” for entry into US residencies!
I want to discuss commonly held beliefs in Medicine which I
believe help to create a laissez-faire approach to the solution of the
Residency Shortage.One belief deals
with the assumption that highly ranked medical schools/residencies can “infuse”
their graduates with a special knowledge not found elsewhere.The other belief deals with the impression
that foreign medical graduates are lesser doctors than US graduates. International Medical Graduates (IMGs) are the
group most affected by the residency shortage.In 2017 69% of unmatched graduates were IMGs. I believe that these two
assumptions promote the lackadaisical approach to a timely solution to the
Residency Shortage.If the unmatched
doctors were Harvard graduates, the US
would be in an uproar about the utter waste of human time, talent, money, and
more doctors
Consider this.Assume
that the US has
a total of 1000 medical school openings each year, but that the schools receive
a total of 5000 fully qualified applicants. 4000 applicants will be
rejected.Are we to assume that these
4000 applicants were not smart enough to gain acceptance into a US
medical school?No, there were only 1000
openings, and these positions were filled with the top candidates. The 4000 disappointed applicants were not
unqualified.There just were not enough
openings. In a similar example, the NRMP has 42,000 applicants for 32,000
residency positions each year.10,000
graduates will not match, yet they met all of the requirements set forth by the
NRMP (National Resident Matching Program).They were fully qualified, but there were just not enough residency
slots to meet the demand.
Let us talk about
highly ranked medical schools first.According to Pauline W. Chen MD, “The notion that a medical school’s
quality can be ranked and then passed on directly to their graduates has become
an integral part of American culture…But most of these popular rankings reflect
a school’s highly specialized research funding and capabilities, not the
general quality of its medical school graduates.”(1) Dr. Fitzhugh Mullan was the
lead author of a research study and paper conducted at George Washington
University School of Medicine.It
included more than 60,000 graduates of America’s
141 medical schools from 1999 to 2001.He said, “The absolute irreducible mission of medical schools is the
education and graduation of doctors to care for the country as a whole.”(1) He
continued with, ”The opportunity to learn from and be mentored by faculty
members involved with the latest research can be stimulating for medical
students, but the pressure to bring grant money into an institution can draw
even the most enthusiastic educator away from students and back to the
laboratory bench”(1)According to Dr.
Chen, “But educators like Dr. Mullan counter that traditional selection
criteria based on cognitive exams and premedical course grades do not
necessarily translate into clinical ability.”(1)Dr. Mullan concludes with, “doctors who have
done very well on everything from kindergarten to residency training in terms
of getting into prestige places are assumed to have sharp intellects, but none
of that correlates in any scientific way with their performance as
physicians.”(1)In essence, residency
programs are selecting their residents based upon the same “cognitive exams”
and highly ranked research hospital programs described by Dr. Mullan.This is due to the inordinate number of
applicants caused by the residency shortage, and the need to screen the number
of applications which have to actually be “read”.
Next let us consider the belief that IMGs are less qualified
doctors, or they would have been accepted into a US
medical school. “During the 1950s, the
need for a formal program of evaluation intensified due to explosive growth in
the demand for health care services, an increase in economic opportunities for
trained medical personnel, and a greater dependence on residents to provide
medical care, which created a large number of available positions in U.S. GME
(Graduate Medical Education) programs.” (2) The ECFMG (Educational Council for
Foreign Medical Graduates) was created to monitor IMG
credentials, and certify that IMGs have met medical education and examination
requirements. So when we as a Nation
needed additional doctors and residents to provide medical care in the 1950s,
we accepted IMGs into our residencies. But now that there is a residency
shortage, not so much… “IMGs make up roughly 25% of physicians in training and
practice in the United States.”(2)Granted, they have not attended “highly
ranked” medical schools according to “ American culture”.BUT, they have passed all the criteria and
requirements set forth by the NRMP for participation in the Match.The IMGs have passed the same criterion tasks
required of all residency programs, as their US
counterparts, and passed the scrutiny of an almost 60 year old organization,
the ECFMG.
In the US
it is our own inflated self-regard which makes us ambivalent to the plight of
the unmatched doctor.The US
is not the only producer of excellence in Medicine.Let’s put aside our national biases towards
medical education. Let’s save the fully qualified doctors who would like to
complete the final step in their quest for licensure, especially in lieu of the
projected doctor shortage over the next decade.
