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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.