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

What Happened on Match Day 2018? / Residency Shortage

https://www.youtube.com/edit?video_referrer=watch&video_id=NXlx3isiUM4

   March 16,2018 Tampa, Florida.  As described in prior blogs, a demonstration of peaceful activism took place in front of the USF Match Day celebration.  The goals were to bring the travesty of the medical residency shortage to the Nation’s attention and to gain media coverage for finding a solution to this grave injustice.  While several television stations sent camera crews to the celebration, no reporters were evident.  The camera crews did not film the demonstration, only the ceremonial events.  That was a disappointment.  However, our team of activists put forth a colorful, organized, and informative display, which was live-streamed on facebook and social media.  Hopefully, with all the “shares” on facebook many more citizens learned about the residency shortage that day.  The elimination of the residency deficit continues to be an uphill challenge.  It will only be solved when enough people become aware of it, enraged by the injustice of it, and connect the resulting doctor shortage to it.  I would encourage each of you to do your part in disseminating this important issue. 

   Our debriefing after the demonstration gave us the following things to consider for the future.  Contact the medical school in advance to ask them to join forces to address the residency shortage.  Be sure to have signs of “Congratulations” for the matched doctors.  This demonstration was not intended to detract from the great celebration that day, but to bring attention to the unlucky doctors who had not matched and were not there celebrating.  Continue to make contact with legislators, medical school deans, and persons of influence who can implement the necessary changes to eliminate the residency shortage.

www.NoMatchMDs.blogspot.com

Answers from the NRMP / Does a Residency Shortage Really Exist?

 https://www.youtube.com/watch?v=jgVZDIF7zXU

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!

http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf

www.noMatchMDs.blogspot.com

Challenge to YOU!  / Residency Shortage

https://www.youtube.com/watch?v=Oajp9YP8k8Y

The last 2 blogs explained the process of “peaceful activism” to bring the cause of the residency shortage to the forefront of the Nation’s attention.

As I have explained in my biography of the NoMatchMDs blog, I do not personally work in the field of Medicine.  Yet, I felt that the travesty of the residency shortage warranted my activism, in lieu of the 50 years I have observed Medical Education.  I cannot solve this problem on my own.

I continue to educate the readers of the blog about the intricacies of the residency shortage dilemma.  I have delineated the politics of Medicine which are preventing a timely solution to the shortage.  I have described how a huge majority of the public and medical professionals are unaware of the current scenario.

Perhaps you are interested in this blog because you or someone you know is personally affected by the residency shortage.  I would encourage you and your supporters to become involved in this cause.  If not YOU, then WHO?  Before I became aware of this crisis, I had never even read a blog.  I had never created a logo, a website, never had a Facebook page or used Twitter, never had spoken to a Congressman, never written to an elected official, or fought for any cause.  There comes a time when we each need to speak up and DO something!  I have had to get out of my own comfort zone to learn and use these new skills.  I will be part of a panel at a World Affairs Conference in St. Petersburg, Florida in February, speaking before several thousand people.  I have never done this before either…So I am challenging each of you to step up and help with this cause.  Go back and re-listen to the two previous blogs.  Form your own “protest” group and show up at a Match Day 2018 “reveal” party.  If mine is the only “voice” talking about the residency shortage, the solution will be long in coming…

www.NoMatchMDs.blogspot.com

Dirty Little Secret / Residency Match

https://www.youtube.com/watch?v=qCFIM1jnLxg

Assuming that over the last 5 years alone over 50,000 doctors have not matched into a residency, why are we not hearing more about the Residency Shortage?  Why are we not outraged?  Surely, the 50,000 unmatched doctors should be incredulous about their futures, despondent, mortified, frustrated, and ultimately furious with a system which has betrayed them! Why are we not hearing from them or about them?  My answers include:  the unmatched doctor is embarrassed by “their own” failure to match- a “dirty little secret”, the lack of a support group or committee to join, the isolation each unmatched doctor experiences while their peers are rejoicing in a “match”, and the other unmatched doctors are “scattered” across the US. There is a sense of futility unmatched doctors have when they try to figure out a plan, a solution, or “someone” to contact to correct this injustice.  Think about it.  Who would you contact under the circumstances:  your legislator, your dean, the Federal Government?  There is no “one person” who can right this wrong.

Recently, my son met a new doctor graduate at a happy hour he was hosting in his Chicago condo.  The doctor had failed to match into a residency this past March and was very sad and reluctant to discuss it.  My son told her about my blog and website, and encouraged her to look at them.  The topic was so painful that she just wanted to drop the subject.  My heart cringed ONCE AGAIN when I heard this sad story.  My first thought was, if only she would listen to my blogs she would realize the fault for not matching was not hers, but a system which had failed her.  That also, the sheer numbers of applicants and the use of computerized screening had probably eliminated her application from consideration, that any redeeming parts of her application had probably gone UN-READ, and that unfortunately that scenario was bound to repeat itself in subsequent match attempts.  I hoped that with this knowledge her sadness and embarrassment would change to one of anger and determination to let her voice be heard on this travesty.

Leading up to the next residency Match Day 2018 I am going to be focusing on getting those 50,000 unmatched doctors to unify and speak out.  No one will care about the solution to the Residency Shortage as much or as fervently as those affected by it.  Ironically, in the next decade we will all be affected by it to some degree with the impending doctor shortage.  Yet, until the unsuspecting public is directly impacted by this shortage, there will be little public outcry.  That is why the unmatched doctors, their friends, family and colleagues need to get over their “uncomfortable” dirty little secrets, and convert their embarrassment to action!  Let’s get the word out there regarding the residency shortage and our Nation’s failure to uphold its side of our “Social Contract

www.NoMatchMDs.blogspot.com

Match Day 2018 Protest / Residency Shortage

https://www.youtube.com/watch?v=t1flvOiHMMs

The last blog gave an overview of the Indivisible Guide for public action.  I described how it could be utilized to bring the residency shortage to the Nation’s attention.  To many of you the idea of demonstrating or picketing might seem ludicrous.  Granted I would have felt the same way before I became aware of the residency shortage.  Yet, the direness of the circumstances of unmatched doctors calls for drastic measures.

 Normally, I am very much an optimist.  However, in this particular situation I have realized the futility of successive re-applications for residency slots.  I have “laid out” the reasons for this futility in many of my prior blogs.  The Nation is short 10,000 residency slots each year.  The demand for a residency given the current supply creates such a skewed application process.  The system will repeatedly favor the highest scoring candidates.  The result is that many fully qualified doctors graduates have to give up on a career in Medicine.

 So here are the specifics of what I plan to arrange for “peaceful activism” in Tampa on Friday, March 16, 2018, Resident Match Day.  I hope you will take these ideas and plans and use them at a Match Day celebration where you live.  You have 180 medical schools from which to choose…

• Explore city permits for protests in my area (none needed if on public sidewalks and not obstructing traffic)
• Contact family, friends and supporters to form a group of activists to “picket” at the USF Match Day party in Tampa, FL on March 16, 2018
• Prepare public relation materials to hand out:  brochures and business cards (download these at my website:  www.NoMatchMD.com)
• Order 25 t-shirts with the NoMatchMD logo on them (doctors wear white coats)
• Create protest posters to carry at the demonstration –

-“What About the Docs Who Don’t Match?”

-“Doctor Blindside”

-“Save Our Doctors!”

-“Discarded Doctors!”

-“Residency Shortage = Doctor Shortage”

-“Create More Residency Slots”

·        Reach out to media contacts, especially those who have written about the residency shortage.  Send them protest specifics and include reference links to this issue and a quote to use for a story.

I am going to make PR materials available for you to download on my website, www.NoMatchMD.com (logo, brochure, business card, poster and sticker template).  Please use them to make your participation more probable.

I hope this will help you too, to get out of your comfort zone and help in the quest to correct the residency shortage.

www.NoMatchMDs.blogspot.com

                                      NPR Broadcast / Residency Shortage

https://www.youtube.com/watch?v=B7u4oUAAOyg

August 3, 2017, someone was listening….Julio Ochoa, editor for Health News Florida, broadcast a story about the residency shortage in Florida on NPR Radio, WUSF.  He started the story by talking with Dr. Michael Smith, a 2014 graduate from a Caribbean medical school, who has applied 3 years in a row for a residency in Medicine.  Each year Dr. Smith applied to hundreds of residencies at a cost of $5,000 per year with no luck.  He will re-apply for a 4^th time in 2018.  Dr. Smith has accrued a medical school debt of about $350,000 to date, with the inability to work as a licensed physician to begin repayment.  To work in the US as a licensed physician requires a minimum 1 year post graduate training in a US residency.  In reality, the “real minimum” number of residency years is 3 years, for the ability to become board certified.  Doctors are really considered “employable” when they are board certified.

Mr. Ochoa broadcast this story one day before the beginning of the Florida Medical Association annual meeting.  The timing could not have been better!  Apparently, most of the meeting’s attendees did not hear this story.  A proposal to create the new license described in Mr. Ochoa’s story to preserve the unmatched doctors, failed to gain support from the membership.  They voted “no” on the proposal.  The objections raised dealt with the belief that a residency shortage does not really exist, that the doctor graduates were too selective in their choice for residency specialties and that is why they did not match, and that emphasis should be placed on increasing medical education (number of residency slots) and not on creating “short-term” licensing.  Each of these objections provides fodder for upcoming blogs.  The current situation of the residency shortage continues to wallow in the doldrums due to these very misconceptions.

By the way, that “someone” who was listening to Mr. Ochoa’s broadcast, offered Dr. Smith an immediate spot in a “Transitional Residency Program”.  Hopefully, this is “the foot in the door” that Dr. Smith has long awaited!  Congratulations Dr. Smith on your willingness to speak out about this travesty of the residency shortage.  It was never YOUR fault.  It was our Nation that broke its “Social Contract”!

Please listen to Mr. Ochoa’s story for yourself.  Here is the link where you will find it:

http://wusfnews.wusf.usf.edu/post/lack-residency-slots-florida-leaves-some-doctors-without-licenses#stream/0

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

Why Are We Not Upset? / DOC SHORTAGE

https://www.youtube.com/watch?v=LoiM4aHIr1o

Initially upon learning about the “why’s” of the residency shortage, I thought the lack of action to correct this travesty was due to the lack of knowledge about its existence.  The doctors I contacted had heard a little about the residency shortage but just assumed the unmatched doctor grads were “weaker candidates” and would just have to reapply again next year.  As discussed in prior blogs, the residency shortage has NOTHING to do with applicant qualifications (since all have met the requirements for applying in the NRMP), and everything to do with the shortage and the compounding effects of re-applications.  Now we know the story.  Why are we not enraged??!!

Perhaps a feeling of powerlessness causes most of us to shrug our shoulders and feel grateful it does not affect us personally.  But what if this circumstance involved one of your children or a relative?  Knowing all the years of study, sacrifice, and money they had endured, only to be denied the right to complete the last requirement for practicing Medicine, might get your interest and action!

Just think of all the rural and underserved areas of our country which would be overjoyed to have one of these fully educated doctors work in their areas.  The healthcare professionals who serve for a week in a third world country know first hand the “preciousness” of a doctor.  Some friends of mine travel annually to Guatemala to perform orthopedic and gynecologic surgeries for the masses.  One team makes an initial visit prior to the team trip just to triage the patients on which they will operate.  That way, there will be no time wasted when they return during the actual team visit, and as many surgeries as possible will be performed.  How can we just “discard” our unmatched doctors with no regard for the “human condition”?  What would Guatemala not do for one of our “cast offs”??!!

Some might say, “Look at all of the lawyers who do not get jobs”.  Although this comparison is quite a “stretch”, at least the lawyers were allowed to complete all their requirements to practice Law.  They probably were aware before Law School that getting a job might be difficult.  I do not think most students beginning Medical School worry about not being able to “complete” the requirements to practice Medicine.  Usually, the hard part is getting “into” medical school.  If there was a “glut” of doctors in the US today, prospective students would enter medical school at their “own risk”, and not be “blindsided” in the end.

I believe the Medical community and all Healthcare Professional should actively promote a solution to this residency shortage.  The “Public” is clueless as to the traditions and requirements of Medicine.  Only those who have taken this path can fully appreciate the devastation that is occurring with the discard of thousands of fully educated doctors.  Yes, I know, you are all “very busy”, and do not have time to take on this cause.  But, you DO have your voices, your email contacts, your “followers”, your legislators, your colleagues, your Medical Societies, and ”theoretically” the AMA, to help promote this agenda FOR YOU.  So talk to them about it and demand a solution!

http://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

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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

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Solve DOC Schortage State by State

Solve DOC Shortage State by State

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

Until the residency deficit has been resolved, I suggest that each state “preserve” its own doctors.  Currently, the “best numerical candidates” prevail in the residency match (see previous blogs).  That would have to change. 

The tradition of Medical Education is to “reward” the “best” students.  The students with the best GPA, the best test scores, get into the most competitive schools and residencies.  It’s hard to change that mindset.  Every institution wants to attract “the best”.  Any graduate doctor who has passed the requirements of “The Match” already is “the best”.

 I recall the tuition for medical school in South Carolina 5-10 years ago.  Tuition for in-state residents was approximately $50,000/year, and out-of-state $80,000/year.  I remember thinking that if accepted to a South Carolina medical school, a student could get their education, but South Carolina would not be underwriting any part of that cost.  South Carolina would not share in the expense of a doctor’s education, only to have the graduate leave upon graduation.

 Here are the dollars that Florida has allocated to increase the numbers of residencies in the state:

• 2013, $80 Million for recurring State and Federal funding for Graduate Medical Education (residencies)
• 2015, additional $100 Million appropriated by Florida Legislators for “Graduate Medical Education Startup Bonus Program”
• Program “Gives hospitals a one-time $100,000 Bonus for every new residency slot in shortage specialties” (1)
• The first year 66 new residency positions in seven shortage specialties qualified for the bonus” (1)
• Florida faces a shortage of 7,000 physician specialists by 2025

As described in a prior blog, Arkansas and Kansas are garnering doctors for their own states.  Their residency solutions apply only to their citizens.  Until the residency deficit is eliminated, I believe that Florida should do the same.  Florida tax dollars are providing the monetary incentives to increase the number of residencies in Florida.  So Florida residents and its unmatched doctors should benefit.  Residency selection in Florida residencies should be skewed toward residents of Florida, not using the traditional numerical ”cutpoints”.  Florida is addressing the residency shortage by allocating tax dollars to increase the number of residencies.  The State of Florida and its doctor grads should benefit from these tax dollars.  These are the doctors who plan to live, work, and stay in Florida.

(1)http://wusfnews.wusf.usf.edu/post/florida-increases-medical-residency-slots-still-faces-doctor-shortages#stream/0

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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

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