A Laissez-faire Attitude Toward the Residency Shortage

 

 

https://www.youtube.com/watch?v=mBok9I3J_r0

I want to discuss commonly held beliefs in Medicine which I believe help to create a laissez-faire approach to the solution of the Residency Shortage.  One belief deals with the assumption that highly ranked medical schools/residencies can “infuse” their graduates with a special knowledge not found elsewhere.  The other belief deals with the impression that foreign medical graduates are lesser doctors than US graduates.  International Medical Graduates (IMGs) are the group most affected by the residency shortage.  In 2017 69% of unmatched graduates were IMGs. I believe that these two assumptions promote the lackadaisical approach to a timely solution to the Residency Shortage.  If the unmatched doctors were Harvard graduates, the US would be in an uproar about the utter waste of human time, talent, money, and more doctors

 Consider this.  Assume that the US has a total of 1000 medical school openings each year, but that the schools receive a total of 5000 fully qualified applicants. 4000 applicants will be rejected.  Are we to assume that these 4000 applicants were not smart enough to gain acceptance into a US medical school?  No, there were only 1000 openings, and these positions were filled with the top candidates.  The 4000 disappointed applicants were not unqualified.  There just were not enough openings. In a similar example, the NRMP has 42,000 applicants for 32,000 residency positions each year.  10,000 graduates will not match, yet they met all of the requirements set forth by the NRMP (National Resident Matching Program).  They were fully qualified, but there were just not enough residency slots to meet the demand.

 Let us talk about highly ranked medical schools first.  According to Pauline W. Chen MD, “The notion that a medical school’s quality can be ranked and then passed on directly to their graduates has become an integral part of American culture…But most of these popular rankings reflect a school’s highly specialized research funding and capabilities, not the general quality of its medical school graduates.”(1) Dr. Fitzhugh Mullan was the lead author of a research study and paper conducted at George Washington University School of Medicine.  It included more than 60,000 graduates of America’s 141 medical schools from 1999 to 2001.  He said, “The absolute irreducible mission of medical schools is the education and graduation of doctors to care for the country as a whole.”(1) He continued with, ”The opportunity to learn from and be mentored by faculty members involved with the latest research can be stimulating for medical students, but the pressure to bring grant money into an institution can draw even the most enthusiastic educator away from students and back to the laboratory bench”(1)  According to Dr. Chen, “But educators like Dr. Mullan counter that traditional selection criteria based on cognitive exams and premedical course grades do not necessarily translate into clinical ability.”(1)   Dr. Mullan concludes with, “doctors who have done very well on everything from kindergarten to residency training in terms of getting into prestige places are assumed to have sharp intellects, but none of that correlates in any scientific way with their performance as physicians.”(1)  In essence, residency programs are selecting their residents based upon the same “cognitive exams” and highly ranked research hospital programs described by Dr. Mullan.  This is due to the inordinate number of applicants caused by the residency shortage, and the need to screen the number of applications which have to actually be “read”. 

Next let us consider the belief that IMGs are less qualified doctors, or they would have been accepted into a US medical school.  “During the 1950s, the need for a formal program of evaluation intensified due to explosive growth in the demand for health care services, an increase in economic opportunities for trained medical personnel, and a greater dependence on residents to provide medical care, which created a large number of available positions in U.S. GME (Graduate Medical Education) programs.” (2) The ECFMG (Educational Council for Foreign Medical Graduates) was created to monitor IMG credentials, and certify that IMGs have met medical education and examination requirements.  So when we as a Nation needed additional doctors and residents to provide medical care in the 1950s, we accepted IMGs into our residencies. But now that there is a residency shortage, not so much… “IMGs make up roughly 25% of physicians in training and practice in the United States.”(2)  Granted, they have not attended “highly ranked” medical schools according to “ American culture”.  BUT, they have passed all the criteria and requirements set forth by the NRMP for participation in the Match.  The IMGs have passed the same criterion tasks required of all residency programs, as their US counterparts, and passed the scrutiny of an almost 60 year old organization, the ECFMG.

In the US it is our own inflated self-regard which makes us ambivalent to the plight of the unmatched doctor.  The US is not the only producer of excellence in Medicine.  Let’s put aside our national biases towards medical education. Let’s save the fully qualified doctors who would like to complete the final step in their quest for licensure, especially in lieu of the projected doctor shortage over the next decade.

(1)   https://mobile.nytimes.com/2010/06/17/health/17chen.html
 (2)   www.ecfmg.org/about/history.html

www.NoMatchMDs.blogspot.com

About The Residency Shortage

ABOUT

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

Imagine there is a projected teacher shortage of 90,000 teachers over the next decade.  Pretend that you wanted to be a teacher and attended a teacher’s college.  You have only 1 requirement left to fulfill, STUDENT TEACHING.  Assume that in spite of the projected teacher shortage, the Education Budget is cut nationally, which results in a limited supply of student teaching positions.  Without student teaching you can’t get your teaching credential.  Imagine that over the last 5 years alone, there were more than 40,000 students unable to find a student teaching assignment. They would have had to give up on a teaching career, find another job, and begin paying their student loans.  How could such a bureaucratic slip-up occur in view of the projected upcoming teacher shortage???

Well, this is exactly what is currently happening in Medical Education!  There is a projected shortage of 90,000 doctors over the next decade.  Over 40,000 doctors in the last 5 years ALONE have been UNABLE to match into a required residency.  They cannot complete the last step required for a Medical License!  They have to leave Medicine. After being accepted into Med School, 4 years of hard work, passing board exams, and graduating with an MD Degree, they now have to look for other work and begin repaying an average of $183,000 in student loans. 

 It is a classic case of bureaucracy, where the right hand does not know what the left hand is doing.  In 1997 the Federal Government’s “Balanced Budget Act” put a freeze on Medicare reimbursement for medical residency training slots.  Yet, with a projected doctor shortage of up to 90,000 physicians in the next decade, the number of medical schools was INCREASED.  What a surprise!  The number of medical schools increased at the same time as the number of required post-graduate training slots was REDUCED!  This catastrophe has left more than 40,000 graduate doctors, over the last 5 years alone, with no where to go!!

 This blog is designed to educate the public about this travesty.  It is a call to action to those who can help rectify this ongoing catastrophe.  The voices who can help include:  State and US Legislators, State and National Medical Societies, US and Foreign medical school deans, Residency Directors, Medical students, Physicians, Public Health Departments, and finally the MEDIA
http://nomatchmds.blogspot.com/

 

Video - Second-Half Summary/ Residency Shortage

Video - Snail Mail Worked! / Doc Shortage

Biography

 

 

BIO

 

I thought I was “retired”.  I turned 66 years old, the kids were raised, and the mortgage paid.  I was planning to “coast” for the twilight years of my life.  But then something inconceivable came to my attention.  Something that would cause me to undergo one of the steepest learning curves of my life!  Suddenly, “coasting” was no longer an option.

 My credentials are NOT in the Medical Field.  I have a Masters in Education, taught in Special Education, and have tutored all ages to adulthood for the last 35 years.  I particularly enjoy analysis of learning gaps and how to remediate them, the differences in learning modalities and how to utilize them to assist in learning, etc. 

 So how did I become interested in this topic of Medical Education?  I have been on the sidelines of Medical Education for nearly 50 years.  3 members of my immediate family are doctors.  I have watched the process of their educations from beginning to end.  I have listened to the stories about medical residencies for at least 40 years.  My husband is currently and has been either faculty or Program Director for OB/GYN residencies for over 25 years.

I have heard the intricacies of resident applicants, their extra credentials and life experiences, and how the candidates were ranked in the National Resident Matching Program.  I would await the results of the “Match” and hear how far down the rank list the program had to go for their matches.   And then there were the “unfilled” slots which were filled by a “Scramble” (before S.O.A.P.), and many phone calls to fill the remaining slots.  So this topic is very familiar to me.

 When I became aware of the huge deficit in residency slots I was incredulous!  How could this be happening?  After all it takes to gain acceptance into medical school and complete all the necessary steps to becoming a doctor, how could the “SYSTEM” allow the breaking of our “SOCIAL CONTRACT”?

In the course of my research, I have come to realize there are a lot of misconceptions about the residency shortage.  Many doctors who are aware of the residency shortage just say, “Let them re-apply next year…” or “They must not have been a strong candidate…”

 If you asked me whether my “passion” was Medical Education, I would have to answer “no”.  My passion is in recognizing a series of events which have resulted in a grave injustice, and telling the Nation what is happening!  Most people have not observed the process of Medical Education over a nearly 50 year period.  Most people would not be in a position to “connect the dots” to discover where the breakdowns in the process are occurring.  Most people might not have heard about the devastation and incredulity experienced by unmatched doctors like I have.  Someone needed to pull this whole situation together and get the real story “out there”!  I am that person.  I could not let this travesty go on without a fight!

 

ABOUT

ABOUT

 

 

It is a classic case of bureaucracy where the right hand does not know what the left hand is doing.  In 1997 the Federal Government’s “Balanced Budget Act” put a freeze on Medicare reimbursement for medical residency training slots.  Yet, with a projected doctor shortage of up to 90,000 physicians in the next decade, the number of medical schools was INCREASED.  What a surprise!  The number of medical schools increased at the same time as the number of required post-graduate training slots was REDUCED!  This catastrophe has left more than 40,000 graduate doctors, over the last 5 years alone, with no where to go!!

 

These unmatched graduate doctors fall into a “limbo” where they cannot complete their training.  They cannot obtain a medical license without a residency.  They can’t even work as Physician Assistants!  Their school loans are due, an average of $180,000, with no viable means of employment.  They are in a real “Catch 22”.

 

And we, the American public, are in for a real surprise as we age with the impending doctor shortage!

 

This blog is designed to educate the public about this travesty.  It is a call to action to those who can help rectify this ongoing catastrophe.  The voices who can help include:  State and US Legislators, State and National Medical Societies, US and Foreign medical school deans, Residency Directors, Medical students, Physicians, Public Health Departments, and finally the MEDIA.