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.