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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Summary So Far/ Residency Shortage

Summary So Far/Residency Shortage

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

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

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

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Creative Solutions, State by State

Creative Solutions, State by State

https://www.youtube.com/watch?v=1m6LwTpJZnQ

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

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

• More than 8,640 unmatched doctors on March 18, 2016
• More than 40,000 unmatched doctors over the last 5 years

Unmatched doctor grads ESTIMATE by State for 2016 ?

• California:  1,037 unmatched doctors (based on % of National Population)
• Florida:  536                 “             “
• New York:  527          “            “
• Texas:  734                 “             “

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

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

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

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Snail Mail Worked! / Doctor Shortage

Snail Mail Worked! / Doctor Shortage

 https://www.youtube.com/watch?v=sUyvlc3UOBI

There was a great revelation that occurred during the frustrating process of trying to contact my legislators.  After no responses to my countless emails and phone calls, I realized that doctors who are members of the State medical association have MEDICAL PRACTICES!  I googled the names and addresses of members of both the State and National Legislative Councils for the Florida Medical Association.  My husband and I sent letters by US mail to each of these council members.  Within days my husband received phone calls from a number of these doctors.  They were very interested in the issue of “Residency Shortage”, and quite appalled by the current travesty.

 It turns out, most physicians and healthcare professionals, do not really know the enormity of this situation.  The ramifications for unmatched graduate doctors unable to complete their training are appalling.  The natural consequence of “discarding” thousands of graduated and fully qualified doctors at a time when there is an impending doctor shortage (up to 90,000 doctors over the next decade) is complete insanity!

 This is all going on ”under the radar”. These unmatched doctors are so mortified and despondent, they’re not broadcasting this dire situation to friends and family.  It is very humbling, because 20 years ago and before the Balanced Budget Act of 1997, all doctor graduates matched into a residency.  The impression is that somehow they have failed, when it is the system which has failed them.  They are not stupid, there is a SHORTAGE!

 Why hasn’t the AMA solved this crisis?
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OH! So We Just Need a New Law? / Doc Shortage

OH!  So We Just Need a New Law?/ Doc Shortage

 https://www.youtube.com/watch?v=B7W2GXxEbUo&t=3s

Have you ever wondered about the procedure to create a new State law?  If you’re like me I thought, “Go to my local legislators”.  That’s exactly what I tried to do.  With all the hype of running for political offices, I thought they would be ready and waiting for a meeting with one of their constituents.  Was I wrong!  I have contacted no fewer than 30 public officials and received exactly 2 responses (written by assistants).  You probably won’t get an in person meeting with your legislator, but you might get to speak with an assistant.  And, you won’t get any audience at all if you are not part of the legislator’s electoral district.

 When I finally obtained an appointment with my State Representative, I proceeded to tell the story of the medical residency crisis.  It turns out that Medical Education has its own traditions, and you can’t just go “apply for another job elsewhere”.  So my representative had no clue as to the components of medical training and the process of communicating this dilemma was an uphill challenge.  After countless letters, emails, and phone calls to legislators, members of the State Board of Medicine, the State Executive Director of Medicine, the State Surgeon General, and yes, even the Governor of the State, I was nowhere on my quest to create a new State law for physician licensure!

 My next step was to contact the Florida Medical Association (FMA) where the advice was ambiguous.  It turns out that in the end, the real process begins with your county branch of the State medical association.  However, after numerous phone messages and emails to the Executive Director of our county’s medical association, I could not believe I was getting no answer!  When I finally decided to go in person to the address of record, my GPS lead me to a PO Box at the post office!  What is with this world?!  No one answers anyone!  It turns out, you will only get a “response” if you are a member of the medical association.  My husband had to make the call….

 So after 4 futile months of trying to get a starting point for the creation of a new State law, here is the ANSWER:

• Contact a Delegate from your county medical association
• Convince the Delegate of the merits of a new law
• If they agree, begin the drafting of a proposal to take to the annual meeting of the State medical association.
• Present the proposal to the State association and make amendments. If the association agrees…
• The State association sends the proposal via their legislative delegates to the Health Committee of the State Legislature for drafting into a Bill
• Continue the legislative process with the Bill to pass a new law

So, you think you have the answer now?  Not so fast!  You won’t believe the politics that get involved.  Politics?  Yes, politics.  Life is really a “turf”war!

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The Solution/ Residency Match

The Solution/ Residency Match

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

The solution to the National residency shortage is not an easy one.  It involves a combination of 3 separate factors: 

•  Medicare funding for increased residency slots (National issue)
•  reduce time required to accredit a new residency program (2-3 years)-ACGME
•  new State legislation necessary to “license” these new doctor grads until the deficit in residencies is eliminated ( State  level).

The good news is that the first factor is already being addressed. Senator Bill Nelson, FL, has resubmitted House Bill HR 2124 which, if passed by Congress, would increase the number of residency slots by 15,000 over a 5 year period. However, the bill remains yet to be passed, and it would take 5 years to fully implement.

 We have right now more than 40,000 unmatched doctors over the last 5 years alone.  What will “carry” these doctors until the supply meets up with the demand? 

 The licensing dilemma of retaining these “untrained” doctors is what remains. These licenses are written at the State level (The State of Florida is projected to be 7000 doctors short by the year 2025).  If legislation in each of the 50 states were enacted to “carry” these doctors until the number of residencies has increased, it would prevent the devastating loss of more than 8000 fully educated doctors in the US this year alone.   

 There currently exists in Florida the “House Physician” license, Fl. Statutes 458.345, which allows an unlicensed physician to be hired directly by a hospital and work under the supervision of a licensed physician. Since the advent of Physicians Assistants, this license has rarely been used. This idea could be expanded to work under an individual doctor, much like the new Missouri statute-House Bill 1842, under what is called the “Assistant Physician” license. In Missouri these doctors will work under the supervision of another licensed physician and then re-apply for residencies in subsequent years. 

 Most important is to “preserve” these unmatched doctors, until the supply equals the demand for residencies.  Medicare changes and ACGME credentialing are slow moving bureaucracies.  The States will have to move swiftly to enact legislation to enable these unmatched doctors to obtain meaningful work, and also, to prevent their loss to the Nation when we are going to need these doctors more than ever. 

 How to eat an elephant?  One bite at a time!

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"Breaking the Social Contract" / The Match

“Breaking the Social Contract”/ The Match

https://www.youtube.com/watch?v=v689rYZVN_E

I have heard some pretty sad stories from unmatched doctors.  One doctor wrote that he had applied 4 years in a row to the Match with no success.  He was planning to give up, but somehow my website caught his interest.

 Another med student was driving my son in an UBER car in Chicago, and was expressing fear of not matching.  My son warned him, “All I know is you better get a good score on your Step 2 Exam!”

 One unmatched doctor is working in an indigent care clinic in Jupiter, FL and desperate to complete his training with a residency.  Finally, another unmatched doctor is working as a research coordinator, even after completing an unpaid year in a research fellowship after medical school.

 Some doctors who are forced to start repayment of their school loans have no choice but to obtain some kind of work.  But for what else do they qualify?  (I guess they qualify to be an UBER driver)

 Just imagine the desperation these graduate doctors are experiencing, and the sense of betrayal in a system that has broken its “promise”.   Dr. Keith Frederick, a legislator from Missouri, has        coined the term “Social Contract” to describe what has happened in the US.  When a society establishes criteria to obtain a professional license, the candidate can assume that when the requirements are met, the license will be forthcoming.  Our “society” has prevented the completion of the criteria, and thus has broken the “Social Contract”. 

 Once a student has been accepted into medical school, the time for elimination/screening is over.

 The medical graduate should be allowed to complete all the necessary steps to licensure.  What if our country educated thousands of new teachers but failed to provide enough opportunities to complete the final requirement of student teaching?  It just would not make sense!

 What can be done to correct this dire situation?
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