Blog Archive

Tuesday, August 28, 2018

Summary So Far/ Residency Shortage

Summary So Far/Residency Shortage

Here is a summary of the “Story” so far:

  • The goal of this blog is to tell the compounding story of the Medical Residency Shortage-how it began and what has resulted
  • In 1997 the Balanced Budget  Act effectively cut the number of residency slots available by reducing the reimbursement allocated to hospitals involved with resident education for patient care
  • The fear of not matching into a residency and being considered “a loser”, has caused the average number of applicants/medical school graduate to increase to 47 applications each
  • The deluge of applications has triggered the use of “quantitative” screening for resident applicants to reduce the number of applications needing “detailed review”
  • Unmatched applicants are in “limbo”.  They can’t complete the last requirement of their training.  They cannot practice Medicine and they can’t demonstrate qualifications due to lack of malpractice coverage
  • Application process repeats yearly, compounding the problem, more time and more money wasted with each application cycle, and some doctors have to give up and quit Medicine
  • Some very sad stories of repeated failure to match.  The time for “weeding out” should have occurred before beginning medical school
  • The solution to this travesty is very complex:  Federal, state, and ACGME
  • We need to “preserve” unmatched doctors until they match

Creative Solutions, State by State

Creative Solutions, State by State

            State by State licensing to retain these “untrained” doctors is quite a challenge.  It requires the interest and enthusiasm of state medical societies to bring proposed legislation to their state legislatures. They have to proceed through the lengthy legislative process to enact changes to their existing licensing statutes. Imagine this process for each of the 50 states!

 What are the numbers we are talking about for unmatched doctor grads? (LINK)

  • More than 8,640 unmatched doctors on March 18, 2016
  • More than 40,000 unmatched doctors over the last 5 years
Unmatched doctor grads ESTIMATE by State for 2016 ?

  • California:  1,037 unmatched doctors (based on % of National Population)
  • Florida:  536                             
  • New York:  527                     
  • Texas:  734                             
These unmatched doctor graduates are fully qualified and have met all the requirements set by the National Resident Matching Program (NRMP) to participate in the national “Match”.  They have obtained their MD degrees and passed all required exams, such as USMLE parts Step I and Step II.  There are just not enough residency slots available to meet the increased demand. In order to “preserve” these unmatched doctors until the supply of residency slots increases, each State would have to pass new legislation.  Medical licensure is legislated state by state.  This legislation would allow these grads to work “under supervision” in “qualified settings” (Essentially, residency allows work “under supervision” in a qualified program).  If given the opportunity for meaningful work (and service to the community!), these unmatched grads could re-apply for residency as the numbers of residency slots increase.  The result:  preservation of fully qualified doctors while addressing the impending doctor shortage in the next decade.

 Three states have passed this legislation so far, Arkansas, Kansas, and Missouri.  “Arkansas Graduate Registered Physician Act” applies to an “individual who is a resident of Arkansas…”  Kansas passed a special license which applies to graduates of the University of Kansas School of Medicine.  Missouri passed legislation for “Assistant Physician” which is open to US residents.  State by state legislation could generate its own set of problems while trying to ameliorate this crisis situation.  Arkansas and Kansas have “prevented” a huge influx of desperate unmatched doctors flocking into their states by gearing legislation for their own state residents/graduates.  Missouri could be the “recipient” of this influx.  Just think of all the time, effort, and money which this state by state legislation would entail!

 Why haven’t the AMA and ACGME (Accreditation Council for Graduate Medical Education) acted to correct this travesty on a National level??