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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!