Put Up or Shut Up / Residency Shortage

https://www.youtube.com/edit?o=U&video_id=oEpkEa6GEpk

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.

www.NoMatchMDs.blogspot.com

Indivisible Guide for Action / Residency Shortage

https://www.youtube.com/results?search_query=indivisible+Guide+for+Action+%2F+residency+shortage

After the last presidential election, a group of congressional staffers outlined successful strategies for making contact with members of Congress.  This information came about as a result of the outcome of the presidential election, as a way to keep congressional representatives aware of the feelings of their constituents.  This group of staffers has adopted the name, “Indivisible”, to represent this cause, and to encourage similar groups to form across the country.  It is an insider’s guide to make contact with your legislators.

I want to utilize these “insider tactics” to bring the Residency Shortage to the Nation’s attention.  I am going to suggest that those who would like to find a timely end to the residency shortage, adopt a similar strategy.  Contact your own members of Congress using the Indivisible strategies.  It is only through action that we can hope to eliminate the travesty of the residency shortage.  As I have said, there is no ONE person who has the power to correct this situation. (That is, unless there is a presidential order…) I will describe some of the key points derived from the “Indivisible Guide” to create action, and then propose a more detailed plan to implement these ideas on the upcoming Match Day, March 16, 2018.

To begin, members of Congress are concerned with “reelection, reelection, reelection. So they want their constituents to think well of them, and they want good, local press”.(1) The guide describes four local advocacy tactics:

·        town hall meetings

       ·         other local public events
       ·         district office visits
       ·         coordinated calls

 For the residency shortage, all four tactics could be utilized to make contact with legislators.  But for Match Day 2018 on March 16^th, I am going to focus on “local public events”, i.e. Match Day results gatherings across the US.  In my area, that translates to the University of South Florida(USF) Match results party.  It was held last year at Ulele Restaurant in Tampa, Florida.  These events occur across the US on Match Day, when doctor graduates get the results of their residency match.  It is quite a celebration when each graduate finds out where they will be living and working for the next few years in their residency.  The idea is to utilize media attention which will be present to highlight this joyful event, but also to bring attention to the plight of the unmatched doctors.  There is no ill will or rancor involved, just an opportunity to provide another side to this story.

A small group of people to “attend” and distribute information at a Match Day results event is all it would take.  There are about 180 DO and MD medical schools in the US.  Just imagine if the residency shortage story line was generated and picked up by the Media at each one of these locations!  Email your contacts and post a message on your Facebook page to generate a grass roots group to attend the Match Day party near your local medical school.  Record everything at those events and share these clips on Social Media, as well as with local and national media.  Optimize your visibility by staying together as a group, wear similar clothing or message shirts, and carry signs.  Identify and try to speak with reporters on the scene.

One key item described in the Indivisible Guide is that Members of Congress, and probably the Media as well, WANT “concrete asks that entail a verifiable action- vote for a bill, make a public statement, etc.  Perhaps one example of a “concrete ask” could be “Create an emergency placement for unmatched doctors while increasing the number of residency slots”.  You could tailor your “concrete ask” to something pertinent to your State like, “Grant immediate Physician Assistant licensure to unmatched doctors until the residency deficit is eliminated”, or ”Add 2 additional residency slots/year to every existing residency until the deficit is eliminated”.

At the onset of the NoMatchMDs.blog I stated that my goal was to educate the public about the residency shortage.  With this knowledge a solution to this travesty could be found.  As I have read, a good salesman is really an educator who provides information, which leads the customer to want what the salesman is selling.  Then when we know better, we do better.  This has been my continual focus, to educate the public.  That is why I am proposing “we” use every tool at our disposal to get this message out, even if it means “peaceful activism”.

 To help with this instruction I have created a website, a blog, a Facebook page, and a twitter account.  I have also created a brochure, a poster, stickers, and business cards.  I am happy to make all of these WORD documents available for your use and reproduction in your own area.  You can distribute the brochures at your Match Day event, use the poster as a sign, wear the stickers, and hand out the business cards.  All you need is a small group of supporters to join with you on March 16, Match day 2018.  Please let us all know of your plans, to give inspiration to others who are waivering.  You can write a “comment” to my blog and I can share it with other readers.  The Guide also stresses the need for a “group”, rather than 1 or 2 people.  So get your friends and colleagues to join you in this important cause.

In the next blog I will be more specific about my plans to “demonstrate” for a solution to the residency shortage on Match Day 2018, March 16^th.  Please let me know of your plans, so I can encourage others to follow your example.

 I will re-publish this blog several times leading up to Match Day, hoping to enlist more “activists” to our cause.  I have already had offers from my own family members to fly to Tampa for Match day 2018, to help form a group at USF Match Day.

(1) https://www.indivisible.org/guide/

www.NoMatchMDs.blogspot.com

Help Create the Tsunami of Outrage / Residency Shortage

https://www.youtube.com/watch?v=BOK9A7WdZvA

My last blog delineated the problems in bringing the Residency Shortage to the Nation’s attention.  No “one” person can solve this crisis, it involves too many variables:  ACGME accrediting, Medicare funding, and states legislation to “preserve” unmatched doctors.  My solution was to create a “Tsunami of Outrage” to bring the Residency Shortage to “the table”. 

This blog was first published on Jan. 31, 2017. To use “wave” terminology, it began with a “ripple” of readers.  In 5 months, the readership has increased to a small “wave”, reaching 232 readers during the first week of July.  Here are the statistics I am going to use to set a goal for dissemination and education about the Residency Shortage via the “NoMatchMDs” blog:

2017

• US Population – 321 million
• Total Professionally Active Physicians in US – 923,308
• US Congress – 535 Representatives and Senators
• Combination of  (MDs +  Congressmen = 923,843) -  about 1 million
• 200 million registered voters in US

Let’s visualize what it would take to reach a goal of 1 million readers of this blog, the total number of MDs and Legislators combined.  It is only through knowledge of the Residency Shortage that we can work toward a timely solution.  Here are my calculations.  If those 232 readers from the first week in July were to contact only 6 doctors or legislators EACH, and each of those contacts would make 6 contacts of their own, etc., etc.:

232 X 6 = 1,392

1,392 X 6 = 8,352

8,352 X 6 = 50,112

50,112 X 6 = 300,672

300,672 X 6 = 1,804,032

With only 5 cycles of contact, over 1.8 million people would have been reached with this information.  This is what it would take, 6 doctor/legislator contacts by each of 232 blog readers to theoretically contact “every” doctor and congressman in the US today…

This same story could extend to the education of the voting public.  If this process continued for 8 cycles, the total number contacted would rise to 390 million, almost twice the number of contacts than registered voters!

If you have followed this blog and find the cause of the Residency Shortage “compelling”, we cannot just let the message end with each one of us.  Knowledge without action is useless.  This “story” is too complex to explain it in “one sentence”.  The circumstances are many and varied.  Education of this travesty leading to a solution is the one and only goal of this blog.

At the end of each prior blog, I have asked the readers/listeners to contact the doctors and legislators in their local area to create action for the Residency Shortage.  Today, I am going to ask each of you to personally contact 6 doctors +/or legislators that you know.  Provide the link to this blog, “NoMatchMDs.blogspot”, and request that they in turn contact 6 more of their colleagues/legislators, etc., etc.  Tell them they can listen to this blog on their cell phones while commuting.  Just click on the YOUTUBE link with each blog.  Ask them to keep this “wave” going, with hopes that we will reach our goal of 1 million doctors + legislators.  Wouldn’t it be unbelievable if the cycle went 8 rounds and reached all 200 million registered voters??  It goes without saying that any “sharing” you may include in all your social media would be an added bonus.

So there we have it, a measurable goal.  Make 6 contacts each, ask your contacts to do the same and continue the cycle, and reach more than 1 million doctors and legislators in the US today.  Now that is a “TSUNAMI”!!

www.NoMatchMDs.blogspot.com

Why Isn’t the Medical Community Outraged About the Residency Shortage?

https://www.youtube.com/watch?v=_4uEAtnTJsw

Why isn’t the medical community outraged by this grave injustice, the Residency Shortage?  From what I have observed, doctors fall into 2 camps on this topic.  Physicians working in Academic Medicine at universities et al, would probably be aware of the current situation in residencies.  And those doctors in the private sector would generally not know about the shortage.  So this topic is “under the radar” for a huge percentage of practicing physicians, except for those who have completed residency in the recent past.  So why has Academic Medicine not lead the charge to correct this residency deficit, completing the last step of medical training?

There exists a tradition in Medicine that I have observed over the last 40 years.  I would compare it to a “fraternity of the Ivory Tower”.  Great reverence is shown to the leading gurus in the specialties of Medicine, the Professors.  These professors are the ones who write the textbooks used in the fields of Medicine, they are the ones conducting current research, and they are at the “cutting edge” of the most recent methods being used currently in the practice of Medicine today.  Here is how this “fraternity” operates.  The “Professor” functions in a role called, “The Attending Physician”.  Below the Attending comes the “Fellow”, a doctor specializing in the Attending’s field of Medicine.  Next, is the “Chief Resident”, followed by the third year resident (in a 4 year residency), second and first year residents, the Intern, and finally the “Medical Student”.  The lowest position in this hierarchy reports and is accountable to the person above.  During patient rounds in the hospital, questions are asked at the varying levels of difficulty and if the answer is “I don’t know”, you better find out that answer by the next day’s rounds or you will regret it!  Also, the residency schedule demands an extreme number of work hours per week.  In the last 15 years the maximum number of hours/week is 80 hours.  These hours are strictly regulated and are kept in detailed logs to prevent loss of accreditation  to a residency.  Take note, the LIMIT is 80 hours/week, twice a “normal” work week.  And unless you want disapproval from your peers who will have to take over your work load, don’t even think about taking a “sick day”!  There exists a definite work ethic and “sprit de corp” mentality that exists in this “combat like” training experience.  You better do your job or face disapproval by your peers.

Go back now to why Academic Medicine has not “lead the charge” to correct the Residency Shortage.  The traditions I described about the hierarchy of the medical education process translate into rewards and respect for excellence by your peers.  Those who excel are rewarded, and those who are lacking have to keep working.  Even though this crisis of the Residency Shortage is a result of Medicare Funding cuts by the Balanced Budget Act of 1997, the ramifications are not always clear cut.  The first instinct when a doctor does not match into a residency, is for those in Medicine to assume the doctor did not receive high scores in medical school, did not get good recommendations, or was a poor worker.  In essence, they got what they deserved.  They “just” have to re-apply next year, or have to go do some research, or work for free in an indigent care clinic to obtain some new recommendations.  This is how the “thinking” goes.  So no wonder Academic Medicine is not in an uproar!  Yet, even when they know it is a “numbers” problem, the lingering belief is that if an unmatched doctor had only been a “little bit better”, they would have matched.  It seems kind of crazy when we know there actually is a “shortage”.  But I think the traditions of Medicine’s hierarchy of learning come into play, even if only subconsciously.  So I have not observed a call to action for the Residency Shortage by the Academic Medicine community.

As CEO of ACGME (Accreditation Council for Graduate Medical Education), Thomas Nasca MD, inferred that IMGs (International Medical Graduate) were “lesser” doctor applicants.  If they were better students, they would have gotten into a US medical school.  So he does not appear to be worried about unmatched IMGs.  This feeling has influenced the stance of the AMA.  While the AMA has called for an increase in residency slots, their “position” talks mainly about US medical graduates who are less impacted by the Residency Shortage than IMGs.  In the 2017 Match, 69% of unmatched doctors were IMGs and 27.6% were US citizens.  The AMA still questions the Residency Shortage since most US grads have matched.  Perhaps, the AMA feels its responsibility is to graduates of US medical schools, although 25% of physicians practicing in the US today are IMGs.

Private practitioners I know lead exceedingly busy professional lives.  Even if they are aware of the Residency Shortage, they have little time and resources to create an outcry for a solution.  Although EVERYONE, doctor or non-doctor alike, is incredulous when they learn about the travesty of the Residency Shortage.  They view the inability to complete the last required step in training as a “blind-side”, an injustice, a travesty.

What about the unmatched doctors themselves?  They are “scattered” throughout the US.  There is no published list of unmatched applicants, to my knowledge.  Basically, the unmatched doctor is suffering their own personal devastation alone.  Other than, “someone who knows someone”, unmatched doctors are not broadcasting this news.  Ironically, they are actually still hoping they will match next time, and don’t want this “unsavory” quality disseminated.  I do not believe they realize how the deluge of applicants is affecting their chances for a subsequent match.  Not until they have re-applied 3-4 times will they start to “connect the dots”.  They are being selectively ignored by a system which cannot comfortably process the deluge of applicants, and one that does not want to select perceived “lesser candidates”.

These are the reasons I believe that have prevented the Residency Shortage from becoming a national uproar. By the time the “public” discovers this problem and the ensuing doctor shortage, it will already be too late for a timely solution.

http://ecfmg.org/about/history.html

http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Results-and-Data-2017.pdf

www.NoMatchMDs.blogspot.com

Second-Half Summary/ Residency Shortage

Second- half Summary/Residency Shortage

https://www.youtube.com/watch?v=LT2xcjL-eNo

Here is the second half of the “story”:

• What is the AMA doing?
• The Nation has broken the “Social Contract”
• 25% international medical graduates do not match, yet ECFMG has been monitoring and making recommendations to them for 60 years!
• We want to think US Medical Schools are “better”, yet individual learning and passing of the “Criterion Task” have leveled the field.  Only fully qualified applicants are eligible to participate in the NRMP in the first place!
• ACGME is not in favor of Missouri’s plan for Assistant Physician License, yet has not taken the lead in finding a solution
• AMA and ACGME, two of the most influential agencies in Medical Education, are not leading in timely fashion to prevent an utter waste of human talent
• The impending doctor shortage will be more than 90,000 doctors short in the next decade
• Some question the legitimacy of the “Doc Shortage”.  Either the demographics are correct, or they are not!  Baby Boomers are ageing and will require even more medical care.  Is this really politics trying to use lesser trained medical professionals to provide patient care at lower costs, using physician assistants and nurse practitioners?
• Are P.A.s and N.P.s as qualified as MDs?
• A number of states are approaching this problem but tend to favor their own residents
• Need a “tsunami” of outrage to solve this
• Need action by each person concerned about this solution

http://nomatchmds.blogspot.com/

A Tsunami of Outrage/ Residency Shortage

A Tsunami of Outrage/ Residency Shortage
https://www.youtube.com/watch?v=wvXBq9P_hjw

 

   Do you remember the outrage that ensued after the 2-3 hour wait times and missed flights that occurred at O’Hare Airport the weekend of May 14, 2016?  Frustrated passengers began tweeting #IHateThe Wait.  US Senator Mark Kirk, IL, called for TSA Administrator, Peter Neffenger, to fix this problem by Memorial Day or step down.  Even the White House weighed in on this travesty. (1)  By May 25^th Mr. Neffenger told members of House Homeland Security Committee that the agency was taking measures to resolve this issue.  By May 24^th an airline official said that O’Hare’s waits were down to 15 minutes.  That took 10 days to “fix”!

 This outrage is what has to happen to solve the current travesty of the residency shortage.  There are no “normal channels” to solve this crisis.  The Federal government is moving in typical fashion, slowly.  The first legislation introduced was “Resident Physician Shortage Reduction Act of 2011.  It was proposed again in 2013, and again by Senator Bill Nelson, FL, in 2015 (S1148) and by Representative Joseph Crowley (HR 2124) in the House.  Nothing has been passed or implemented at this point.

 This bill would increase the number of residency slots by 15,000 over a 5 year period.  We already have more that 40,000 unmatched graduates right now over the last 5 years alone!  The AMA and the ACGME have not proposed any solutions.  Only a few states have created legislation (generally applicable only to their own citizens). 

 The only glimmer of hope has been the budgetary allocations some states have made.  They have offered financial incentives to hospitals to increase residency slots or add new residencies.  This has had some success.

 Why are we not as outraged as the passengers at O”Hare Airport?  These unmatched doctors have spent more that 4 years of their lives and countless dollars trying to complete their medical training.  But they are deadlocked.  If I were they, I would gladly accept a 3 HOUR security delay in view of their own situations.

 We have to get the “word out”.  We have to tweet, blog, share on facebook, contact healthcare professionals and societies, contact legislators, and yes, even the White House!

(1)http://www.zerohedge.com/news/2016-05-18

http://nomatchmds.blogspot.com/

Slam Dunk? / Politics / Residency

Slam Dunk?/ Politics/Residency
https://www.youtube.com/watch?v=DZt3xeV_n00&t=2s

   Too many medical students, yet not enough residency slots.  Impending doctor shortage, yet “discarding” fully educated doctor grads.  Why isn’t the solution to this dilemma a “slam dunk”?  Because nothing is ever that simple.  There are the “politics” involved that complicate the solution to this deficit. 

                                                            (Bloom's Taxonomy) 

    Is there really going to be a physician shortage, or are the VA, The Affordable Care Act, and some states planning to utilize less expensive physician assistants and nurse practitioners to administer healthcare?   Josanne Page of the Cleveland Clinic said, “P.A.s generally make about half a physician salary or less, depending on specialty (an ER doctor makes an average $270,000, an emergency-room P.A. $112,000).” (1)

 “ And several states, such as Arizona, Maine, Maryland, Nevada, Vermont, and Washington have liberalized laws to enable nurse practitioners and PAs to perform some treatment normally done by doctors.” (2)  The Affordable Care Act has allowed millions more insured patients, with a shortfall of sufficient doctors to treat them.  Compared to other countries, the US has 2.5 practicing physicians per 1,000 people vs. 3.2 physicians per 1,000 for an average of 34 other countries. (3)

 Is a PA or NP qualified to see patients as effectively as a doctor?  A PA curriculum typically requires 1 year of classroom learning and 1 year clinical work.  A NP requires a 1-3 year program post graduate after obtaining a nursing degree.  Doctor training requires a minimum of 7 years after college.  The 3 doctors in my family had 7 years, 10 years, and 11 years of post college training.  The further depths of knowledge and medical experience afford a doctor a level of synthesis not attainable with lesser years of study. 

 A dermatologist I know recommended that a patient obtain a consult regarding a skin ailment, sometimes associated with pancreatic cancer( The patient returned to thank the doctor for the early diagnosis of pancreatic cancer which might have been missed under normal circumstances.)  Would a PA have known that correlation? 

  An OB/GYN doctor told a patient to obtain further diagnostics for continued lactation after cessation of breast feeding.  There is an association with pituitary tumors with uncharacteristic lactation.  The patient did end up having a pituitary tumor.  Would this have been noticed by a PA?  Often, a doctor never enters the room when a PA is seeing a patient.

     Ironically, PAs who by “definition” are “supervised” by a doctor, are allowed to work immediately after graduation.  A doctor with 4 years of medical school cannot work at all, until obtaining a license upon completion of a residency.  They can’t even work as a PA due to the stringent PA licensure rules!

(1) http://www.nytimes.com/2014/08/03/education/edlife/the-physician-assistant-will-see-you.html?_r=0

(2) http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/08/11/to-address-doctor-shortages-some-states-focus-on-residencies

(3)http://www.epi.umn.edu/mch/wp-content/uploads/2013/09/ACA-Overview.pdf

http://nomatchmds.blogspot.com/

Doctor Shortage / Waste

Doctor Shortage/Waste

https://www.youtube.com/watch?v=DZt3xeV_n00&t=2s

 

   Let’s talk about the upcoming doctor shortage.  Here are some statistics and projections:

• 27.6% of the current physician workforce are age 60+ years old and likely to retire in the next 10 years (1)
• 32.6% of practicing physicians are women
• 46.1% of residents are women
• “Historically women have worked fewer hours than men-a trend that continues today” (2)
• 24% of current US physician workforce are IMG (International Medical Graduates)
• 25.9% of US “ resident” workforce are IMG
• “By year 2025 the United States will face a shortage of between 61,700-94,700 physicians”. (3)
• “Thousands of baby boomers are turning 65….seniors are the population with the greatest healthcare needs”. (4)
• “The Association of American Medical Colleges (AAMC) projects there will be a shortage of between 12,500-31,100 primary care physicians in the next 10 years…equally troubling is the shortage of between 28,200-63.700 specialists.”(4)
• More than 40,000 fully qualified doctors have not matched into a residency over the last 5 years and cannot practice Medicine without residency training.
• 8,640 doctors did not match on March 17, 2016, what are they doing now?
• “With medical school and residency combined, it takes a minimum of seven years to train a doctor.” (4)

What are we thinking?!!!  In view of the upcoming doctor shortages over the next decade, we are simply “discarding” our fully educated doctors!  This just does not make sense!

(1)   page 12

https://www.aamc.org/download/452922/data/thenationsphysicianworkforceandfuturechallenges.pdf

(2)   page 13

https://www.aamc.org/download/452922/data/thenationsphysicianworkforceandfuturechallenges.pdf

(3)

https://news.aamc.org/for-the-media/article/gme-funding-doctor-shortage/

(4 )page 1

https://www.aamc.org/download/386378/data/07252014.pdf

(3)   page 2

https://www.aamc.org/download/386378/data/07252014.pdf

http://nomatchmds.blogspot.com/

ACGME (Accreditation Council for Graduate Medical Education)/ IMG

ACGME (Accreditation Council for Graduate Medical Education)/ IMG

https://www.youtube.com/watch?v=hL3mwmLdMZE

     The ACGME, via CEO Thomas Nasca MD, does not support the legislation enacted in Missouri.  It deals with using unmatched doctors in underserved rural areas, supervised by a licensed physician within a 50 mile radius.  The doctors could work and reapply for a residency, while performing meaningful and necessary work until the number of residencies catches up with the deficit.  Dr. Nasca bases this belief on patient safety and quality concerns.(1)  He further states that once an unmatched doctor has gone through 2 application cycles, he/she will probably never get trained.  They will remain untrained for the duration of their career.  Dr. Nasca also infers that unmatched international medical graduates are not as smart as US grads, or they would have been accepted into a US medical school.  It sounds like Dr. Nasca is not too worried about unmatched IMGs (International Medical Graduates)!

 I can certainly see the points Dr. Nasca makes about patient safety and quality.  Yet, residency also deals with training “new doctors” under a supervisory set of physicians, albeit closer in proximity.

 However, I have a different opinion about the qualifications of the IMGs.  Two of my own children have graduated from medical schools, one a US grad and one an IMG.  As an educator and mother, I would categorize the child who went to a US medical school as “system smart”, and the one who went to an IMG as “intellectually smart”.

  The US grad decided to go to medical school 2 years after graduating from college in “Broadcast Journalism”, with an “A” average.  The IMG attended the same, very competitive university (97% of incoming freshman have an academic scholarship), intending to go to medical school from the beginning, and majored in “Cell Science/Microbiology”, obtaining a “B” average.  The US grad attended a local less competitive university for pre-med classes and got an “A” average.  The IMG grad took pre-med classes, along with a competitive pre-med science major, while at the highly competitive university, getting a “B” average.

 The US grad was accepted “Early Decision” into a medical school with 1 application.  The IMG med student was only accepted into an international med school.  Two graduates, fairly comparable intellectually, one worked “smarter” in applying for medical school, while the other majored in a subject intended to “help” in Medicine.  It pays to know the system before you begin!

 Yes, this story deals with only 2 medical students. There is a whole “continuum” of ability and IQ in MDs, some are “book smart” and some are “system smart”.  Probably all applicants wished to have gone to a US medical school.  They would not have had to deal with this residency deficit, waited heavily against IMGs.  In spite of all these points, all doctors applying through NRMP have PASSED ALL THE REQUIREMENTS!  Why shouldn’t they be allowed to complete the last step of their training!

 As CEO and spokesperson for the ACGME, I believe Dr. Nasca has a responsibility to suggest a workable solution to this residency dilemma.  Not only is a solution warranted, but leadership in this role of CEO for such a vital organization in medical education is warranted!  If such leadership had taken charge of this travesty, we would not be talking about each state enacting its own legislation.  We would not be dealing with the utter waste of human time, talent, and money.  The AMA has “adopted” a similar stance, based on Dr. Nasca’s recommendation.  So 2 of the most powerful agencies dealing with healthcare in the US are leaving it up to others to fix this bureaucratic nightmare!

(1) http://www.healthleadersmedia.com/quality/acgme-chief-sees-huge-risk-error-proposed-assistant-physician-licensure?page=0%2C2   

http://nomatchmds.blogspot.com/

Our "Social Contract" / NRMP

Our “Social Contract”/ NRMP

https://www.youtube.com/watch?v=0TigWx26pCc

 

All US citizens who have satisfied the requirements for an MD degree, and passed all required exams (USMLE I AND II), have earned the right to train and practice Medicine in the US.  This is our “Social Contract”.  Think of medical school as one big “lesson plan”.  As teachers know, each lesson plan begins with the “Behavioral Objective” and ends with the “Criterion Task”.  If the goals and benchmarks outlined in the Criterion Task have been met, the Behavioral Objective has been met.  US medical schools and government legislatures have determined the criteria required to practice Medicine in the US.  All medical school graduates who apply for residency through the NRMP (National Resident Matching Program) have met these criteria, both US medical school grads, as well as international medical school grads.  They have all passed the CRITERION TASK!

 Why aren’t we “upset” if 25% of unmatched grads are from international medical schools, especially since 42% of them in 2016 were US citizens?  Currently, 25% of physicians practicing in the US are international medical school graduates.(1) Considering the expected 90,000+ doctor shortage over the next decade, that is quite a waste of fully educated doctors!

 The ECFMG (Educational Council for Foreign Medical Graduates) has been promoting excellence in international medical education for 60 years! (1) This organization has been evaluating the readiness of IMGs (International Medical Graduates) to enter GME (Graduate Medical Education) programs in the US.  It has partnered with NBME (National Board of Medical Examiners) to develop the clinical skills assessment for the USMLE (US Medical Licensing Examination).  To become an accredited medical school with the SAME STANDARDS as a US medical school, a foreign med school has passed rigorous standards and criteria.

 “The ECFMG makes its world-class experience with the primary-source verification of medical education credentials available to the international medical regulatory community.”(1)  It is recognized world wide.  This is the organization monitoring graduates of international medical schools  The IMGs applying through the NRMP have met the “Criterion Task” for entry into US residencies!

(1)http://ecfmg.org/about/history.html). 
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What is the American Medical Association Doing? AMA

What is the American Medical Association doing?

https://www.youtube.com/watch?v=06jOdVolNF0 

            According to CME Report 3-A-16, from the Council on Medical Education, the AMA recognizes the funding and distribution of residency positions for GME (Graduate Medical Education) are “in crisis in the US and that meaningful and comprehensive reforms are urgently needed”.  This report focused only on US medical school seniors, and does not include International Medical Graduates (IMG).  Currently, 25% of practicing physicians in the US are graduates of international medical schools.(1)  Many of these are US citizens who attended international medical schools.(2)  Here are some of the points made in this report and Resolution 308 (A-16):

• “There is a predicted physician shortage of between 46,100 and 90,400 physicians by 2025” (AAMC, March 2015)
• The overall match rate for US and IMG medical students was 75.2%
• The majority of the 25% not matching are International Medical Graduates(IMG)
• There has been continuous growth of US medical schools and increased enrollment
• There has been limited growth in Graduate Medical Education (residency positions) due to caps in federal funding (The Affordable Care Act)
• The AMA “will strenuously advocate for legislation” along with the AAMC (Association of American Medical Colleges) to increase federal funding of GME
• Medical school seniors’ “fear of being a loser” have caused residency applicants to apply to an average of 47 programs to avoid not matching into a residency (up 20% in the last 5 years)
• This has forced program directors to use USMLE scores and quantitative criteria as a numeric “cutpoint” rather than perform an in-depth review of every application
• USMLE  scores alone are NOT predictors of success in residencies
• The AMA is opposed to state legislation for licensing “untrained” doctors on the basis of patient safety and quality concerns

If the AMA says the number of GME positions is in “crisis”, yet does not support state legislation for licensing unmatched doctors, how can this catastrophic deficit in residency slots be rectified before these fully educated and qualified doctors are forced to leave Medicine?  More than 40,000 doctors have not matched already in the last 5 years.

 Why isn’t the plight of unmatched international medical graduates as crucial as that of graduates of US medical schools, since 42% of IMG in 2016 were also US citizens?

 Are US medical schools better than IMGs?  Are US graduates smarter than IMG graduates?

 (1)   http://ecfmg.org/about/history.htmlhttp://ecfmg.org/about/history.html

 (2)   Report of the Council on Medical Education, CME Report 3-A-16

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