Summary
Medical Residency Shortage = Doctor
Shortage
https://www.youtube.com/watch?v=ff-3EGBabSY&t=2s
Pretend there is a projected teacher
shortage of 105,000 teachers over the next decade. Pretend that you wanted to be a teacher and
attended a teacher’s college. You have
only 1 requirement left to fulfill, student teaching. Assume that in spite of the projected teacher
shortage, the Education Budget is cut nationally, which results in a limited
supply of student teaching positions.
Without student teaching you can’t get your teaching credential. Imagine that over the last 5 years alone,
there were more than 50,000 students unable to find a student teaching
assignment. They would have had to give up on a teaching career, find another
job, and begin paying their student loans.
How could such a bureaucratic slip-up occur in view of the projected
upcoming teacher shortage???
Well,
this is exactly what is currently happening in Medical Education! There is a projected shortage of 105,000
doctors over the next decade. Over 50,000
doctors in the last 5 years alone have been unable to match into a required
residency. They cannot complete the last
step required for a medical license in the US
Here’s
what happened. In 1997 the Balanced
Budget Act capped the amounts paid in reimbursement for residency slots to
hospitals with residency programs. However,
with the projected doctor shortage the number of medical schools was increased. The number of residency “slots” went down,
while the number of graduated doctors went up.
As a result, the number of residency applicants soared. For fear of being a “loser”, each doctor
graduate applies to an average of 47 residencies each. Some programs have received 1,400
applications for 12 residency positions, 1,000 applications for 15 positions,
etc. In order for residency programs to
reduce the number of applications for closer scrutiny, a computer screening tends
to favor top-scoring applicants, year after year, selectively “ignoring” other
fully credentialed candidates. Many of
these doctor grads have earned extra degrees or done research to enhance their
credentials and re-applied in subsequent years, only compounding the already
dire circumstances. Many have had to
give up and been forced to look for other jobs and begin re-paying huge student
loans. Some doctors have re-applied for
residency for 4 years in a row with no success.
The screening process keeps “skimming the cream off the top” of
applicants, selectively ignoring the same candidates repeatedly. They do this because they can. The demand greatly exceeds the supply of
residencies.
If
the solution to increase the number of residencies is so obvious, why has this
deficit in residencies not been corrected?
Misconceptions about the residency shortage, as well as political agendas
about reducing future healthcare costs, have precluded a unified front on this
issue.
At the recent Florida Medical Association
meeting in August, a proposal was made to create a new license. It would allow
unmatched doctors to work in a capacity similar to a physician assistant until
the number of residency slots increased.
This proposal was voted down by the delegates for several reasons. Politically, some healthcare professionals
want to use nurse practitioners and physician assistants in roles currently
performed only by doctors. Hence, they
do not believe there will be a doctor shortage in the next decade, and are not
worried about the unmatched doctors.
Some
delegates do not believe that a residency shortage really exists, and that the
applicants were too picky in their specialty choices or locations. According to the CEO of the National Resident
Matching Program (NRMP), Mona Signer, there have been 42,000 applicants for
32,000 positions. She said that 99% of
the positions were filled with only 203 unfilled slots, mostly in Preliminary
Surgery. Ms. Signer said of the unfilled slots “many were dead- end positions
that do not lead to further training”. So
there is annual deficit of 10,000 residency slots.
In 2017 69% of unmatched doctors were
graduates of foreign medical schools, even though 27.6% of the unmatched grads
are US citizens. The impression has been
that if these foreign graduates had been smarter, they would have been admitted
to US medical schools. However all residency applicants through the NRMP must
pass the same exams and fulfill the same requirements for participation. As an educator, that means they all passed
the same “criterion task”.
None
of these political agendas or misconceptions really matter. These doctors have a right to complete the
last step of their training. They have
fulfilled their side of the contract.
How
can we fix the residency shortage for the long term? I see it as three-fold. Medicare should
expand the increase in residency slots. Legislation
was proposed to the US Congress at least 11 times since 2009 to increase the
number of residency slots by 15,000 over a 5 year period. None have yet to
pass. At the rate of 10,000 unmatched
graduates per year, we would still “lose” 35,000 doctors over the next 5 years,
even if the Residency Shortage Reduction Bill were to pass in 2018. Secondly, the credentialing process needs to
accelerate. It now takes 2-3 years to
accredit a new residency program. Finally, each State should pass legislation
for a new license to “carry” these doctors in relevant jobs until they match
into a residency. Our Nation has broken its “Social Contract”
with these unmatched doctors who are here now.
We need to fix it before they are forced economically to leave Medicine
permanently.
What
do we need to do in the short term?
US citizens should be given first priority to
US residencies until the deficit is eliminated.
Doctors who are non-citizens are not required to complete training in
the US US US
To
prevent a permanent loss to healthcare, the unmatched doctors should be moved
to the top of the list for residencies.
We need to be “fair” to the doctors who have been waiting for years to
complete their training, and not just “fair” to the highest scoring
applicants. Any elimination of doctors
should have occurred before they went to medical school, and not blind-sided
after graduation.
Other
measures which could be taken include emergency licensing to allow unmatched
doctors to work, just like physician assistants can work right after
graduation. Also, each medical school
could create “Transitional Residency Slots” to place their unmatched doctors
until more residency slots become available, as with one medical school
already. Another suggestion has been to
allow the unmatched doctors to work at VA facilities which are sorely in need
of more healthcare providers. They could
work under the supervision of current VA doctors, much like residency.
Most importantly,
we as a Nation need to apologize with “action” to correct this deficit! Unmatched doctors have suffered a
humiliation, frustration, and economic loss through no fault of their own. We need to fulfill our “Social Contract”.
www.NoMatchMDs.blogspot.com
keep it up
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