Residency Policy Punishes Good US Doctors — And The Rest Of Us
By Dr. Doug Medina
For years, the Association of American Medical Colleges has predicted the United States will face a large physician shortage, and the coronavirus pandemic may further exacerbate this shortage.
However, there are thousands of qualified U.S. doctors who are unable to practice. Every year, about 1,000 U.S. citizens graduate medical schools in the U.S., but don’t move onto residency at a teaching hospital because they don’t “match” via the National Resident Matching Program (NRMP), the organization that controls this process. Without matching into residency, doctors cannot practice medicine.
I’m one of those doctors ready to help during this current pandemic but can’t. Even though I graduated Georgetown University School of Medicine (GUSOM) in good standing, earning Honors in five clinical rotations, I have not matched into residency.
My path to a top-tier medical school in our nation’s capital started at the University of Colorado where I earned a degree in biochemistry. After college, I received a grant to work at the Ferroelectric Liquid Crystal Materials Research Center in Colorado. My hard work and study ethic helped me score in the 90th percentile on the Medical College Admissions Test (MCAT). I was accepted to GUSOM, which receives about 10,000 applications per year and only selects about 200 candidates.
Since graduating Georgetown in 2011, I passed the United States Medical Licensing Exam (USMLE), Steps 1, 2 and 3. To become a licensed physician, a doctor must pass the USMLE. While I am a nationally licensed physician in the U.S., I cannot practice because I do not have a license number since I don’t have a residency position.
This is happening every year to too many U.S. doctors.
Since 2011, I worked with Floating Doctors, an international nonprofit organization in Central America. In 2014, I published research from the Research Institute on Addictions. After 2014, I received grants to work as an extern under supervising psychiatrists at St. Elizabeth’s Hospital, the first federally operated mental health hospital, and the Veteran’s Administration Mental Health Clinic in Washington, D.C. I’ve worked jobs in electronic medical records and as an intake clinician admitting patients at a mental health hospital. I’ve had nine supervisors give me high marks and provide letters of recommendation.
To obtain my medical degree, I incurred debt of $50,000+ per year in federal student loans to pay tuition at Georgetown. With an interest rate of 6.7 percent, my student loans accrue interest of more than $25,000 annually and have ballooned to more than $460,000. Even with my job as an intake clinician earning $30 an hour, and paying my student loans via an Income Driven Repayment (IDR) plan, I’m not even able to afford to pay the accruing monthly interest on my student loans.
Last month, more than 1,200 U.S. medical seniors did not match into residency through the NRMP. In addition, an untold number of prior medical graduates didn’t match. In fact, each year, upwards of 2,000 current-year grads and prior-year graduates don’t match.
Yet just this year, through the NRMP, 4,222 non-U.S. citizen international medical graduates (non-U.S. IMGs) from medical schools outside the U.S. were provided medical residencies, which are largely funded by U.S. taxpayers (via Medicare funding). In fact, each year since 2011, the year I graduated, the number of non-U.S. IMGs receiving U.S. residencies has increased – from 2,721 in 2011 to more than 4,200 in 2020, a total of more than 36,000 foreign doctors in a ten-year period.
To ensure fairness to American citizens, a simple solution is to prioritize U.S. graduates. This may mean a lower number of foreign doctors receiving residency positions, but in this current pandemic, doctors are needed in their home countries. For instance, currently, India has a shortage of 600,000 doctors.
Institutions that should do more to help American doctors achieve their goals work against them. That includes the powerful, influential American Medical Association, which has been lobbying to issue more employment-based visas like the H-1B and the J-1.
U.S. medical students go through a highly rigorous process to get one of the coveted first-year slots. We have a reasonable expectation that when we graduate medical school, we’ll practice our chosen profession. To be shut out while foreign nationals are hired violates America’s social contract with its citizens.
There are reasonable solutions to address this serious problem that is ruining thousands of American lives per year. The governing medical organizations, universities and our elected officials must right this wrong.
Dr. Doug Medina is a graduate of Georgetown University School of Medicine and advocate for ensuring U.S. doctors in good standing receive residency status in order to practice medicine. Contact Medina at firstname.lastname@example.org.