Even during normal times, there are not enough doctors. We have more than enough M.D.s, however, some chose not to take care of patients, for one of many reasons. Any person who receives an M.D. has passed 3 levels of examination, but are required to complete on the job training in an internship and one of the multiple specialty residencies. It is an arduous task, using a matching program, traveling to interview while still attending medical school. It is also expensive to travel, and most graduates are poor and already in debt.
Anyone who graduates is intellectually qualified to be a doctor. However, an M.D. without postgraduate training cannot be licensed to practice medicine. The sad fact is there is a shortage of residency positions leaving many M.Ds without a suitable hospital to complete training. Some will choose to study for an M.B.A., or become a research scientist, earn a Ph.D., or become a consultant.
The process is highly competitive and there are several tiers of hospitals that train physicians, including academic medical centers, community hospitals, government hospitals, (military, VA,)
Here is a moving story of one physician:
The story is taken from the blog "NOT A DOCTOR, JUST AN M.D."
When March approached I start to build an undesirable and familiar feeling deep in my chest. The closer it gets to mid-March, known as Matchday, it grows in me like a tumor. This year, I thought I would escape that feeling by not applying to the match. Yet, the feeling crept up like an unwanted weed and grew. I saw others who were unmatched last year celebrating their success of getting into residency programs across the United States. As I read about my colleagues matching, I had to hold back the tears so as not to dampen their joy. I hoped that I could overcome it but I all my tears flow from the same source.
I received one interview last year after I had written every Family Medicine, Psychiatry, and Internal Medicine program director in the nation. I finally found a program director that had an open heart and was willing to take a chance. This was a high-stakes interview and I prepared for it every day. The day of the interview, my disabling test anxiety and exacerbated ADHD took hold of me and I was not selected. This year I did not even try to get into a residency. Sometimes I get an occasional email or message telling me about an open internship. I quickly get all my information in an email to the program, then never hear anything back. I didn't apply to the match this year. There was no point.
I want to be inspirational. I want to be positive. I have always tried so hard, yet the accumulation of persistent rejection and the mantra of: "you don't deserve to practice medicine" or "you didn't earn the right to be called the doctor" echoes in my ears and paralyzes me.
Another colleague that I work with has created a ritualistic way of dealing with his matchday rejection. He videotapes himself talking about his hopes and fears, his sadness. Others get angry and bitter. We are all cycling through the stages of grief, and it is a long road to acceptance.
I am still hearing the myth that unmatched graduates can do research or work in Information Services (IS) as a "back-up". Most people in the medical profession want to believe that a graduate physician has a chance out there in the world. There is a small percentage of people who do go into research. I have found the IS consultant job to be something. Consultancy positions are filled with unmatched graduates (mainly IMGs) who never went to residency or residents that never completed their program. Some colleagues have coined our group "The Undesirables". We train practicing physicians on Electronic Health Record (EHR) programs such as Cadence or EPIC. They often look at us curiously and wonder why we would be doing this job instead of practicing medicine. All the Is consultants have a "story" to tell. Nobody confesses the truth of being unmatched. We don't disclose that we never actually went into residency because it is taboo in this unique world of EHR "Go-Lives". Honestly, most of us are shamed by our failures.
Now those with boots on the ground will opinionate (those who accept MDs into graduate programs will say, "We get hundreds or even thousands of applicants for our residency programs. We must use some objective measures to filter our acceptances." Good, but not good enough".
This is not just the observation of a disappointed M.D. and it is not an uncommon barrier
Failure to Match Category
6% US MD 1st time
56% US MD 2nd time
21% US DO
29% Canadian MD
47% International MD (US Resident)
51% International MD (Non-US Resident)
Medical School Admissions is responsible for some of the problems.
Failures All-Around
First, she failed. Medical school isn't easy, and residency is harder. She failed Step 1. Secondly, she was a foreign medical graduate. There are some FMG schools that do rank highly for acceptance at U.S Hospitals. There are also less desirable post graduate training institutions located in less desirable regions of the United States. This was a deadly combination for this student. Every medical student is well aware of the importance of that test. The goal isn't just to pass it so you can graduate from med school, it's to rock it so you can get into a good residency program. Passing it is generally taken for granted by most medical students. She failed at the residency matching game (i.e. applying to enough programs that might really take you to match into one of them)…twice. It's not like there is one person out to get her. 200 program directors, presumably some of whom are desperate to fill their class in their new, on-probation, or failed-to-fill-last-year programs, and including her home program, took a pass on her. I suspect these issues were also reflected in her letters, essays, and interviews. There are many other things to criticize about her past decisions and writing, but that's not the point of this post so let's leave it there. The point is med school is hard, and it takes a lot of hard work, smarts, “ability to pass tests,” and the ability to communicate well and interact well with others. No matter how the system changes or how medical schools change their policies, some people are going to fail. However, many docs are surprised (I was) to learn how high these statistics are. Just looking at the US MD Match, these are the stats:
Failure to Match Category
6% US MD 1st time
56% US MD 2nd time
21% US DO
29% Canadian MD
47% International MD (US Resident)
51% International MD (Non-US Resident)
Second, her school admissions committee failed her. For some reason, the school felt she should be in that class of med students. Who knows exactly why, but they felt she was academically “good enough” (despite an MCAT of 24) and could contribute something to the class. In retrospect, they screwed up. She wasn't academically “good enough.” She couldn't pass step 1 (the first time.) She couldn't make up for it enough elsewhere to match (despite reportedly applying to 200 programs.) Now, OHSU has her money and she has debt that will, at best, be forgiven 10 years from now. Medical schools should be required to provide these sorts of statistics to their applicants. At least then they'd know what kind of a gamble they were making before they plunked down their $400K (as you can see it's a real gamble for most international schools.) The real task for a medical student isn't to get an MD, it's to get a residency spot. Neither students nor schools should ever forget that. While I suppose I expect DOs in the MD match to have a lower match rate (at least they have the DO match as a back-up), and international medical grads usually know they're gambling a bit, even 6% is way too high and 50% after hundreds of thousands in tuition is insane! When a student gets an MD but not a residency, both student and school have failed. Maybe half the tuition ought to be refunded or something aside from very prominent disclosure of these statistics. Too bad there isn't some insurance product out there that schools could purchase to at least wipe out some or all of the debt for their non-matches. They could market it as a “guaranteed match or $100K back!” If med schools are going to be “for-profit” they might as well run them like any other business.
Third, the system failed her. She is absolutely correct in her criticism of the system. 1,000 US med students a year and 2,400 US Citizen IMG med students each year don't match. They have the same debt as anyone else but don't have the income. She advocates for more residency spots to help the “doctor shortage.” Maybe that's part of the answer (probably not for her though, since there were apparently programs willing to not fill rather than take her.) Maybe it's fewer med school spots or tighter academic admissions standards. Maybe it is to allow residencies to pay the best candidates more and to allow the worst candidates to pay for the privilege of training and let market forces solve the issue. I don't know. But I do know there are 3,400 people a year coming out of med school with hundreds of thousands of dollars in debt they won't be able to pay back, and that's a problem. Each of those doctors has a personal financial catastrophe to deal with.
So next time you see your " Doctor " remember he is not just an M.D. but a "Doctor" A doctor is not just an M.D. he has been trained by other clinicians and judged accordingly. Today it is necessary to become board certified in a specially. Even the good old GP or Family Medicine Doc must pass a written and oral examination given by a specialty board in their specialty.
When I attend social events many people who I consider close friends will address me as 'Doctor Levin". I am still surprised by that, and it makes me realize who I am, not that I am 'better' than them. It makes me realize there are still people who respect me more than I do myself.
So, what is my call to action? I implore you to write your senators, write your legislators, wrote everyone who you think can make a change, and let them know that there are thousands of unemployed doctors who would love to practice medicine. We just need more residencies.
If you have comments or suggestions please leave them in the comment section.
Remember to wear your mask and distance from others.
